替莫唑胺联合放疗治疗脑转移瘤的疗效及安全性的Meta分析

目的评价替莫唑胺(Temozolomide;TMZ)联合放疗(radiotherapy)治疗与单纯放疗相比,治疗脑转移瘤(Brain Metastasis)的有效性及安全性。方法计算机检索PubMed(2004年1月~2014年1月)、万方数据库(2004年1月~2014年1月)、中国知网数据库CKI(2004年1月~2014年1月)、维普医学数据库(2004年1月~2014年1月)参考文献。纳入替莫唑胺联合放疗治疗新诊断的脑转移瘤的临床随机对照试验(randomized control ed trial,RCT),纳入文献的方法学质量分析依据Cochrane评价手册5.0.0[3]随机对照试验质量评价标准。采用RevMan5.0软件进行Meta分析。结果共纳入10个RCT,共包括528例患者。Meta分析结果显示,替莫唑胺联合放疗组与单纯放疗组比较,其总有效率[RR=4.27,95%CI(2.64,6.92)]差异有统计学意义。替莫唑胺联合放疗治疗引发的副反应,如院白细胞减少与单纯放疗相比,差异有统计学意义,而胃肠道反应与单纯放疗相比,差异无统计学意义。结论目前国内的有限证据表明,与单纯放疗相比,替莫唑胺联合放疗能提高脑转移瘤的总有效率,但由于纳入研究样本量小且质量较低,上述结论尚需要高质量、大样本的随机双盲对照试验加以证实。     

急性心血管事件院前急救的应急策略及流程探讨

Objective To study the strategy and process of out-hospital emergency care of acute cardiovascular events. Methods One hundred and eighty-three patients in the Second Affiliated Hospital of Baotou Medical College were prospectively studied. The patients were divided into two groups according to the different ways of out-hospital care, one group consisted of patients who received first-aid care after calling " 120" (94 cases), another was self-aid group consisting of patients sent to hospital by relatives (89 cases). The proportion of persons with higher than high school education and better knowledge for emergency care of patients with heart disease in first-aid group was higher than self-aid group (50. 0% vs. 29. 2%, 83.0% vs. 60. 7%, both P<0. 05). When the patients were brought to the emergency room, they were all treated according to our standard procedure and then registered. All patients were followed up at the end of first and third month after illness. Results Cardiovascular events were mainly myocardial infarction (61.7%) among 183 patients. There were statistically significant differences between two groups in self-aid response time, first disposal time and out-hospital rescuing time [(32.3 ± 5.6) minutes vs. (89.6±8.4) minutes, (47.3±7.3) minutes vs. (149.8±13.5) minutes, (61.7±8.3) minutes vs. [(149.8±13.5) minutes, all P<0. 01], but no difference was found in in-hospital rescuing time [(29. 9±5.3) minutes vs. (31.1±4.5) minutes, P>0. 05]. Morbidity rate was lower in first-aid group than self-aid group in 1st and 3rd month, respectively (2.1% vs. 9. 0%, 4. 2% vs. 12.4%, both P<0. 05). Conclusion Excellent emergency system and procedure can shorten initial disposal time and out-hospital rescuing time, thus improve patients' prognosis. The education level and health knowledge of patients and their raletives directly affect their mode of arriving hospital and prognosis.     

急性心血管事件院前急救的应急策略及流程探讨

Objective To study the strategy and process of out-hospital emergency care of acute cardiovascular events. Methods One hundred and eighty-three patients in the Second Affiliated Hospital of Baotou Medical College were prospectively studied. The patients were divided into two groups according to the different ways of out-hospital care, one group consisted of patients who received first-aid care after calling " 120" (94 cases), another was self-aid group consisting of patients sent to hospital by relatives (89 cases). The proportion of persons with higher than high school education and better knowledge for emergency care of patients with heart disease in first-aid group was higher than self-aid group (50. 0% vs. 29. 2%, 83.0% vs. 60. 7%, both P<0. 05). When the patients were brought to the emergency room, they were all treated according to our standard procedure and then registered. All patients were followed up at the end of first and third month after illness. Results Cardiovascular events were mainly myocardial infarction (61.7%) among 183 patients. There were statistically significant differences between two groups in self-aid response time, first disposal time and out-hospital rescuing time [(32.3 ± 5.6) minutes vs. (89.6±8.4) minutes, (47.3±7.3) minutes vs. (149.8±13.5) minutes, (61.7±8.3) minutes vs. [(149.8±13.5) minutes, all P<0. 01], but no difference was found in in-hospital rescuing time [(29. 9±5.3) minutes vs. (31.1±4.5) minutes, P>0. 05]. Morbidity rate was lower in first-aid group than self-aid group in 1st and 3rd month, respectively (2.1% vs. 9. 0%, 4. 2% vs. 12.4%, both P<0. 05). Conclusion Excellent emergency system and procedure can shorten initial disposal time and out-hospital rescuing time, thus improve patients' prognosis. The education level and health knowledge of patients and their raletives directly affect their mode of arriving hospital and prognosis.     

PICU患儿的睡眠障碍

睡眠障碍在PICU患儿中普遍存在,多种因素可使重症患儿出现睡眠障碍,对疾病恢复、远期预后均可能产生影响。目前对危重患儿睡眠障碍尚缺乏系统的研究,PICU中可用的睡眠评估工具有限,多元化促进睡眠管理方案可能对改善睡眠有效。     

急性心血管事件院前急救的应急策略及流程探讨

Objective To study the strategy and process of out-hospital emergency care of acute cardiovascular events. Methods One hundred and eighty-three patients in the Second Affiliated Hospital of Baotou Medical College were prospectively studied. The patients were divided into two groups according to the different ways of out-hospital care, one group consisted of patients who received first-aid care after calling " 120" (94 cases), another was self-aid group consisting of patients sent to hospital by relatives (89 cases). The proportion of persons with higher than high school education and better knowledge for emergency care of patients with heart disease in first-aid group was higher than self-aid group (50. 0% vs. 29. 2%, 83.0% vs. 60. 7%, both P<0. 05). When the patients were brought to the emergency room, they were all treated according to our standard procedure and then registered. All patients were followed up at the end of first and third month after illness. Results Cardiovascular events were mainly myocardial infarction (61.7%) among 183 patients. There were statistically significant differences between two groups in self-aid response time, first disposal time and out-hospital rescuing time [(32.3 ± 5.6) minutes vs. (89.6±8.4) minutes, (47.3±7.3) minutes vs. (149.8±13.5) minutes, (61.7±8.3) minutes vs. [(149.8±13.5) minutes, all P<0. 01], but no difference was found in in-hospital rescuing time [(29. 9±5.3) minutes vs. (31.1±4.5) minutes, P>0. 05]. Morbidity rate was lower in first-aid group than self-aid group in 1st and 3rd month, respectively (2.1% vs. 9. 0%, 4. 2% vs. 12.4%, both P<0. 05). Conclusion Excellent emergency system and procedure can shorten initial disposal time and out-hospital rescuing time, thus improve patients' prognosis. The education level and health knowledge of patients and their raletives directly affect their mode of arriving hospital and prognosis.     

连续55例输液反应调查分析

近年来,我院输液反应仅偶然发生。去年4月我院突然连续出现的输液反应,人数多,时间集中,地点局限在一个科室。我们对这一情况的全面调查报告如下。我院门诊补液室,从4月1日下午6时至4月7日下午5时,共出现输液反应55例。反应均在液体输完(120ml一瓶)后半小时内,病人出现寒战、百色苍白、四肢冰冷、高热(39℃～41℃);近一半病人出现唇周、指、趾端发绀,皮肤出现大理石纹。即停止补液、吸氧、肌注非那根、安痛定等药后症状逐渐缓解。 4月1日晚(出现5例)我们立即将所有输液环节物一一送检,对治疗室的空气取样培养检查,重新更换所有消毒用品,并对环境彻底改善,严格消毒隔离等规章制度,严格进行无菌操作,将急需补液病人疏散到其它科室病房进行,并换用病房的药品器械;停用本院制备的液体,改用外购液体。然而,输液反应仍继续发生。4月8日收到各种送检药物检测报告,提出××药厂生产,批号为910820的地塞米松磷酸钠注射液鲎试剂热源检测为阳性。全     

急性心血管事件院前急救的应急策略及流程探讨

目的 探讨急性心血管事件院前急救的应急策略及流程.方法 采用前瞻性研究方法 ,连续登记本院急诊科收治的新发心血管疾病患者183例.按不同就诊模式分为拨打"120"就诊的救护组(94例)和由家人护送来院就诊的自救组(89例).救护组高中以上文化程度者及了解心血管急救知识的比例均较自救组高(50.0%比29.2%,83.0%比60.7%,P均<0.05),救护组院外给予各种应急治疗,自救组院外未进行正规治疗;到院后两组均按绿色通道救治方案及流程处理.1、3个月末对所有患者进行盲法随访.结果 183例患者中心血管事件构成以心肌梗死为主(占61.7%).救护组自救反应时间、第一处置时间、院外救治时间均较自救组短[(32.34±5.6)min比(89.6±8.4)min,(47.3±7.3)min比(149.8±13.5)min,(61.7±8.3)min比(149.8±13.5)min,P均<0.01];而两组院内急救时间比较差异无统计学意义C(29.9±5.3)min比(31.1±4.5)min,P>0.05].救护组1、3个月病死率较自救组低(2.1%比9.0%,4.2%比12.4%,P均<0.05).结论 完善的急救体系及路径能明显缩短患者第一处置时间和院外急救时间,改善患者预后;患者及家属的文化程度及健康知识直接影响就诊模式和预后.     

急性心脑血管事件院前急救模式与预后的关系

我国是心脑血管疾病高发国家.心脑血管疾病的主要风险集中在发病早期,而发病后能否得到及时救治是决定死亡、残疾的关键[1-3].因此,建立完善的急诊救治体系已势在必行.本研究采用前瞻性队列研究,评价不同就诊模式对心脑血管事件预后的影响.     

急性心血管事件院前急救的应急策略及流程探讨

Objective To study the strategy and process of out-hospital emergency care of acute cardiovascular events. Methods One hundred and eighty-three patients in the Second Affiliated Hospital of Baotou Medical College were prospectively studied. The patients were divided into two groups according to the different ways of out-hospital care, one group consisted of patients who received first-aid care after calling " 120" (94 cases), another was self-aid group consisting of patients sent to hospital by relatives (89 cases). The proportion of persons with higher than high school education and better knowledge for emergency care of patients with heart disease in first-aid group was higher than self-aid group (50. 0% vs. 29. 2%, 83.0% vs. 60. 7%, both P<0. 05). When the patients were brought to the emergency room, they were all treated according to our standard procedure and then registered. All patients were followed up at the end of first and third month after illness. Results Cardiovascular events were mainly myocardial infarction (61.7%) among 183 patients. There were statistically significant differences between two groups in self-aid response time, first disposal time and out-hospital rescuing time [(32.3 ± 5.6) minutes vs. (89.6±8.4) minutes, (47.3±7.3) minutes vs. (149.8±13.5) minutes, (61.7±8.3) minutes vs. [(149.8±13.5) minutes, all P<0. 01], but no difference was found in in-hospital rescuing time [(29. 9±5.3) minutes vs. (31.1±4.5) minutes, P>0. 05]. Morbidity rate was lower in first-aid group than self-aid group in 1st and 3rd month, respectively (2.1% vs. 9. 0%, 4. 2% vs. 12.4%, both P<0. 05). Conclusion Excellent emergency system and procedure can shorten initial disposal time and out-hospital rescuing time, thus improve patients' prognosis. The education level and health knowledge of patients and their raletives directly affect their mode of arriving hospital and prognosis.     

浅析医德教育与医院管理医院建设的关系

浅析医德教育与医院管理医院建设的关系广州市儿童医院（５１０１２０）李倩影医院开展医德教育是促使职工切实履行医务工作者崇高职责的需要，是提高医疗护理质量的需要，是加强医院管理、推动医学科学发展的需要，是培养人才建立一支又红又专的卫生专业队伍的需要。近年...