不同分级肝硬化患者血清甲状腺素水平的意义

目的探讨肝硬化患者血清中甲状腺素水平的变化与肝硬化病变程度及其临床实验室检查之间的相关性。方法用放免法测定肝硬化患者血清FT3、FT4、PC-Ⅲ、Ⅳ-C、LN及HA，并按Child—Pugh方法将肝功能分为A、B、C三级。结果随着肝硬化病变程度的加重，血清肝纤维化指标逐渐增高，甲状腺素呈下降趋势，同时血清甲状腺素水平与肝硬化的低蛋白血症、腹水及凝血酶原时间密切相关。结论肝硬化患者体内存在不同程度的甲状腺素水平紊乱，紊乱程度与肝功能受损程度有明显相关性，联合检测血清FT3、FT4、PC-Ⅲ、Ⅳ—C、LN及HA对估计肝硬化病变程度及判断预后有十分重要的临床价值。     

脑电双频指数指导老年病人异丙酚麻醉诱导用量

[目的]通过监测老年病人麻醉诱导时脑电双频指数(BIS)的变化,探讨既能维持足够麻醉深度又能避免严重低血压的异丙酚诱导用量。[方法]40例ASA II～I级的老年病人(65～85岁),随机分成两组。A组静脉注射异丙酚1.6 mg/kg;B组静脉注射异丙酚,其用量是使BIS下降到40～50时的用量。两组均复合维库溴铵0.1 mg/kg和瑞芬太尼1ug/kg诱导后行气管插管分别记录基础值、插管前、插管后1 min、5 min和10 min时的收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、心率(HR),同时记录诱导异丙酚用药量和BIS的变化。[结果]A组异丙酚诱导用药量(99.7±18.05)mg,平均(1.64±0.7)mg/kg,B组(82.9±12.5)mg,平均(1.35±0.5)mg/kg,差异有统计学意义(P﹤0.05)。A组血压(BP)和BIS比B组明显降低。[结论]老年病人异丙酚麻醉诱导的合适用量为(1.35±0.5)mg/kg;既能维持老年人足够的麻醉深度又能避免严重低血压的发生。     

血液分析仪红细胞指数质控方法的探讨

目的 探讨血液分析仪红细胞指数的质控方法。方法 利用L-J质控空图和某全血质控物提供的有关数据,推理论证红细胞指数[MCV、MCH、MCHC]在控时对其有关测定参数值的新的质控要求。结果 红细胞指数有关测定参数值的质控范围应分别为HGB:(?)±1.7 s,HCT:(?)±1.06 s,RBC:(?)±1.06s。超出此范围判定为失控。结论 执行该质控判定标准可以实现对红细胞指数实施质控的目的。     

踝肱指数异常增高的糖尿病患者心血管病危险因素研究

目的 分析踝肱指数（ABI）增高的糖尿病患者的心血管病危险因素。方法采用多普勒血流探测仪测定解放军第306医院2003--2005年门诊及病房收治的493例2型糖尿病患者的ABI，以ABI〈0．90为低ABI组（n=39），0．90≤ABI≤1．40为正常组（n=353），ABI〉1．40为高ABI组（n=101）；同时对心血管病危险因素进行分析。结果高ABI与正常ABI组比较，腰围、腰臀比、C反应蛋白、尿酸显著增高，吸烟率及高血压合并症发生率显著增加。结论ABI〉1．40的糖尿病患者有更多的动脉硬化危险因素，需要将这些患者与ABI〈0．90的患者同样重视。     

体表面积、体质量指数对老年骨质疏松的影响

目的探讨体表面积（BS）、体质量、体质量指数（BMI）对老年人骨密度（BMD）的影响。方法用双能X线骨密度仪测定1794例老年人腰椎、髋关节的BMD值，并对其与BS等指标进行相关回归分析。结果BS大的老年人其BMD大于BS小者，有显著性差异。在各种指标与BMD的相关性比较中，BS与BMD的相关性最好，其后依次为：体质量、身高、OSTA得分（亚洲人自我骨质疏松筛查工具）、BMI。结论BS比BMI等指标更能反映出人体体型对老年人BMD的影响。     

运用市场手段实现医药自然分开的理论探讨

回顾了韩国、我国台湾和大陆实行医药分开改革的过程,认为我国以往的相关改革陷入了“管制”的思维误区。认为通过制度设计,创造医疗机构门诊处方自由流动的环境,依靠市场竞争形成处方流向结构多元化,可以实现医药自然分开状态。提出了“医药自然分开”、“处方流向结构”和“处方分散度”等新概念。     

Intentional mis-reporting of food consumption and its relationship with body mass index and psychological scores in women

BACKGROUND: The reasons for mis-reporting food consumption warrant investigation. OBJECTIVE: To document intention to mis-report food consumption and its associations with psychological measures in women. DESIGN: A total of 184 female volunteers aged 18-65 years, comprising 50 seeking help in primary care to lose weight with a body mass index (BMI) >/=30 kg m(-2) (obese-clinical group) and 134 nurses (nonclinical groups) (BMI <25 kg m(-2), n = 52; BMI 25-29.9 kg m(-2), n = 45; BMI >/=30 kg m(-2), n = 37) were studied. A questionnaire was administered containing three psychological tests (self-esteem, psychological well-being and Stunkard's three-factor eating questionnaire) and new items to address food intake mis-reporting. RESULTS: Overall, 68% of participants declared an inclination to mis-report (64% nonclinical, 78% clinical). Inclination to under-report was 29, 33 and 51% in the three nonclinical groups; and 46% among the obese clinical patients. Among the same groups, inclination to over-report were 39, 29, 11 and 32%. After adjusting for social deprivation and BMI, women inclined to mis-report had higher hunger (P = 0.008) and disinhibition (P = 0.005) scores than those intending to report accurately. These variables were associated with current dieting, frequency of dieting, self-reported bingeing and dissatisfaction with body weight. CONCLUSIONS: These findings indicate that intentional under-reporting and over-reporting of food consumption are common in women of all BMI categories and are associated with eating behaviour. Current dieting, frequency of dieting in the past, self-reported bingeing and dissatisfaction with body weight seem to mediate this relationship.     

胶片剂量测量和验证方法的研究

目的设计和实现基于通用激光扫描仪的胶片剂量测量和验证系统。方法采用胶片饱和冲洗、非线性光学校正、多分辨率阈值滤波、离散傅里叶逆变换图像复原等方法,消除了普通扫描仪用于胶片剂量学定量处理中的各种伪影、噪声和畸变;采用过响应系数校正方法消除测量胶片对低能散射光子的过响应,改善了胶片剂量测量的准确性;采用γ结合NAT指标的方法对放疗计划进行二维定量验证,给出可视化图形表达和具有定量数据的验证结果。结果和三维水箱系统、VeriSoft胶片测量系统相比较,研制系统对放疗剂量的测量结果在±2%内符合一致,对IMRT放疗计划的定量验证结果在±3%内符合一致。结论该系统能够实现对放疗剂量的高精度测量和对适形调强放疗计划剂量的可靠验证。     

Effect of a Low-Cost Intervention on Recording Body Mass Index in Patients'' Records

PURPOSE: Evaluate the effectiveness of body mass index (BMI) tables placed in exam rooms as an intervention to encourage providers to calculate and record BMI scores in patients' medical records. DESIGN: In a prospective cohort design, medical record data for 276 adult patients at a federally funded community health center in New England were examined from August 2000 to August 2002 following the intervention. METHODS: Prominent, multicolored, laminated BMI tables were posted in the exam rooms of one of the study site's three primary health care teams. Medical record data collected included documentation of BMI calculation in medical records, documentation of an obesity diagnosis, and inclusion of heights and current weights. Frequency distributions were calculated; chi-square tests were used to identify associations. FINDINGS: In contrast to the comparison teams, patients on the intervention team were more likely to have BMI recorded in the medical record. A statistically significant increase in the diagnosis of obesity was observed throughout the health center after the intervention. CONCLUSIONS: Posting BMI tables in exam rooms contributed to increased BMI documentation in patients' medical records.