院长是官,还是职业经理人？

“现在很多院长的首要目标是做官。一个成天想着当官的院长，能当好院长吗？在国外也有很多公立医院做得很好，所以最重要的不是产权改革，而是机制。”     

构建医院安全管理新体系

医院安全管理不仅包括消防、人身安全、财产安全以及突发性事件的处理,还涉及医院空间动线规划、设备仪器保养、耗材物资补充以及信息系统安全等因素,贯穿诊疗过程、手术安全、感染管理、血液安全、用药安全、膳食供应等多个环节.安全管理已逐渐成为医院管理的核心内容,其中预防和减少病人及医护人员在诊疗过程中的不良事件是关键.     

流动对兔动脉缩窄区域内皮细胞形态的影响

目的：在体考察不同流场环境中血管内皮细胞形态学和完整性的改变，及其与流场的空间相关性。方法：将10只大耳白兔分成动脉缩窄组和对照组，建立兔颈总动脉环缩狭窄，使用脉冲多普勒超声系统考察缩窄下游的湍流流场及对侧血管的层流流场；用扫描电子显微镜探测内皮细胞（ECs)计数、形状指数和定向角等形态学指标。结果：缩窄下游的湍流流场中ECs大量脱落，细胞下基质和胶原组织暴露，ECs变形，无明显定向性。越远离缩窄，ECs的残留率越高，细胞也逐渐重新建立了定向性。结论：缩窄血管下游的湍流流动是导致血管ECs形态结构异常和损伤的重要原因。     

人颈动脉分叉模型流场分布的数值模拟

目的实现不同流速下人颈动脉分叉模型中流场分布的数值模拟。方法依据实验应用的人颈动脉分叉模型，采用Gambit软件建立了数值模拟应用的颈动脉分叉几何模型。应用FLUENT6．0软件分别计算不同流速下颈动脉分叉模型内血管壁面切应力分布。结果在人颈动脉分叉模型内的颈总动脉区域，无论流速如何改变，其切应力分布大致均匀。颈内动脉窦（internal carotid artery sinus，ICAS）的外侧壁存在明显的低切应力区域，并且随着流速的增加，低切应力区域的范围明显减小。结论低血管壁面剪切应力是动脉粥样硬化发生的危险性血流动力学因素。     

职业化院长的领导力路径

领导力,是医院院长职业化发展中安身立命的根本。作为倡导和培养医院院长卓越领导力的《中国医院院长》杂志,"领导力"自然是其主办的2007中国医院院长年会上一个不可或缺的关键词。来自海内外的知名医院管理专家以及来自医院管理一线的实战精英们与全国300多位院长共聚一堂,分享他们的管理理念与实战经验。作为医院院长职业化浪潮中的弄潮儿,他们在实践中,预见性地发现医院未来的需求,并创造性地满足这种需求,他们更像是权力的驾驭者而非奴役者,他们正以独特的创新精神和卓越的领导魅力为中国医院的改革推波助澜。让我们回到2007中国医院院长年会的现场,再重温一下他们不断摸索并形成自己独特领导力的成长路径吧!     

三尖瓣置换术的临床应用

目的总结三尖瓣置换术（tricuspid valve replacement，TVR）治疗三尖瓣病变的经验，探讨手术指征、方法，以提高临床治疗效果。方法回顾性分析2003年1月至2007年4月期间24例接受TVR患者的临床资料，其中风湿性心脏病15例，Ebstein畸形5例，先天性三尖瓣发育不良2例，感染性心内膜炎1例，外伤1例；再次手术患者4例。结果院内死亡2例，死亡率8．3％（2／24）。术后发生并发症2例，其中一过性Ⅲ°房室传导阻滞1例，安置心内临时起搏器20d后恢复；病态窦房结综合征1例，经使用临时心外膜起搏器15d后，恢复自主心律。经门诊随访19例（86．4％），心功能恢复至Ⅰ级12例，Ⅱ级7例。结论严格把握手术指征，加强围术期处理，行TVR安全、可靠、疗效满意。     

含氧血心脏停搏液持续灌注后血清钾的变化

目的　观察含氧血心脏停搏液持续灌注后血清钾的变化 ,对造成高钾血症的原因及预防措施进行了探讨。　方法　根据灌注不同的心脏停搏液 ,将 6 8例心瓣膜直视术患者随机分为两组 ,组 :用冷晶体心脏停搏液 (St.Thomas液 )灌注 ;组 :用含氧血心脏停搏液灌注。对两组血清钾水平进行了连续监测及比较分析。　结果　含氧血心脏停搏液持续灌注者术后能使血清钾维持在较好的水平 ,但有可能造成术中高钾血症。　结论　使用含氧血心脏停搏液持续灌注技术适当 ,可避免高钾血症。     

Prognosis model of trauma outcome for Chinese victims：a revision on ASCOT parameters and weight coefficients from native trauma database

Objective:ASCOT(a severity characterization of trauma)is available for prognosis of trauma patients because its combination of parameters as physiology, anatomy,traumas types and age,These parameters are appareled with regressive reight coefficients that developed from TOS(the major trauma outcome study)reflecting North America patients.To improve the accuracy of ASCOT for Chinces trauma cases a serial of new weight coefficients is revised based on Chinese trauma database.Methods:Eleven thousand two hundred and fiftyeight cases from West China Trauma Database were analyzed with multi-variation regression to estimate the new weight coefficients of ASCOT for Chinese injured victims.Ps(probability of survival)of Chinese trauma victims were calculated with ACOOT,applying the weight coefficients of MTOS as well as the Chinese new ones,to predict their clincal outcome.The difference of the predicated and the actual outcomes was analyzed ,and the advantages of new coefficients in prognosis outcome of Chinese trauma were compared with that of MTOS coefficients.Results:The new coefficients emphasized weights of age,GCS,penetrating cerebral and blunt abdominal injury,Indexes of the new weight coefficients increased in accuracy,disparity,sensitivity and specificity,and the misclassification was reduced,when compared with the indexes of MTOS‘s weight coefficients.Conclusions:The new weight coefficients of ASCOT are in enhanced performance to prognosis outcome of Chinese trauma victims.It suggests that the new weight coefficients of ASCOT be used in the Chinese trauma cases as the sample size and the goodness-to -fit of resource database of the native trauma patients.     

肺、食管手术中的细菌调查

目的　了解肺、食管手术中可能受到的各种内源性、外源性细菌污染 ,以利更好地控制手术后感染。方法　对 44 9例肺、食管择期手术患者的食管腔或支气管腔以及手术室空气、手术人员手作细菌学检查。　结果　肺、食管手术后感染发病率为 7.8% ,术后感染是肺、食管手术重要的并发症。食管手术患者食管腔内含有大量细菌 ,如甲型链球菌、肠道杆菌、绿脓杆菌等 ,而支气管腔内细菌较少 ,以甲型链球菌为主。手术室空气中主要致病菌为金黄色葡萄球菌 ,手术人员洗手后手上主要细菌为表皮葡萄球菌。　结论　与支气管腔相比 ,食管腔中所含的大量细菌可能严重污染手术野 ,成为食管手术后感染重要的内源性细菌。     

模拟缺血再灌注后心肌细胞胰岛素抵抗机制的初步研究

Objective Recent.studies have found a strong association of insulin resistance, which might occur during ischemia reperfusion in vitro in the experimental dogs, with disturbed function of cardiomyocytes. Obvious acute insulin resistance, along with glucose dysmetabolism in the reperfused cardiomyocytes, was furher observed in the study performed with ischemia-reperfused ventric- ular myocytes of rats. We tried to investigate preliminarily the molecular mechanisms of insulin resistance in the cardiomyocytes after ischemia reperfusion. Methods An experimental model of insulin-stimulated ischemia reperfusion (SI/R) was created by isolating cardiomyocytes from adult rats. Glucose uptake of the cardiomyoctyes was evaluated with isotope-labeling technique. Glucose trans- porter 4 (GLUT4) translocation induced by insulin was investigated with Western blot analysis, and the intracellular level of free Ca2+ ([Ca2+]I) was measured quantitatively with Ca2+ indicator Fura-2. Results Insulin can stimulated glucose uptake by cardiomyo- cytes, indicating that these cells were insulin-sensitive. Cardiomyocytes were demonstrated notable acute insulin resistmce during reperfusion. Insulin-stimulated GLUT4 translocation in the cardiomyocytes 15 minutes after reperfusion was 72.2% of that in the con- trol group(P<0.05), in which the GLUT4 content in plasma membrane remained unchanged. The finding suggested that a disturbed GLUT4 translocation might happen in the cardiomyocytes during insulin-stimulated ischemia-reperfusion. Calcium overload was identi- fied in the cardiomyocytes with ischemia reperfusion. At 15 minutes of reperfusion, [Ca2+]I was significantly higher in the reperfused cardiomyocytes than that in the control cardiomyocytes[(318.66±23.06)vs(130.70±0.82) nmol/L, P<0.05], and kept at a higher level [(177.79±17.46) nmol/L] at 60 minutes of reperfusion (P<0.05, vs control). Partial correlation analysis revealed a negative correlation of[Ca2+]I with insulin-induced ghcose uptake in the cardiomyoctyes (r = -0.557,P=0.006). Conclusion Disturbed GLUT4 translocation and decreased intrinsic activity may be important molecular mechanisms for the development of insulin resistance in the cardiomyocytes of rat during insulin-simulated ischemia reperfusion,. [Ca2+]I overload may account for the de- creased intrinsic activity d GLUT4.