新生儿窒息复苏后早期凝血功能的变化及临床意义

目的探讨新生儿窒息复苏后早期凝血功能的变化及其临床意义。方法检测58例窒息复苏后的新生儿血浆D-二聚体(DD)、蛋白C(PC)水平以及凝血酶原时间(PT)、凝血酶时间(TT)和部分活化凝血活酶时间(APTT),并与20例正常新生儿比较。结果重度窒息组血浆DD值增高,PC值降低,与正常对照组或轻度窒息组比较差异具有显著性意义(P<0.01)。轻度窒息组血浆DD值亦增高,与正常对照组比较差异具有显著性意义(P<0.01),而PC值与正常对照组比较差异无显著性意义(P>0.05)。轻度窒息组和重度窒息组血浆PT、TT、及APTT均较对照组延长,比较差异具显著性意义(P<0.05和P<0.01);重度窒息组PT、TT及APTT与轻度窒息组比较,差异亦具显著性意义(P<0.01)。结论新生儿窒息复苏后早期多数存在凝血功能紊乱,主要表现高凝状态,且凝血功能紊乱程度与窒息程度相关。对窒息新生儿复苏后早期进行凝血功能监测具有重要的临床意义。     

清远地区孕妇及其新生儿血铅含量分析

目的了解清远市孕妇及其新生儿血铅水平的现状与相关因素。方法选取1364对孕妇及其新生儿静脉血采用BH2100型原子吸收光谱法进行血铅含量的测定并对铅中毒的相关因素的调查。结果孕妇血铅中毒率26％，中位教76.8μg／L，新生儿中毒率27．5％，中位数80．6μg／L，孕妇血铅与新生儿铅含量正相关性(P＜0．05)调查表66.7％的铅中毒孕妇有相关因素。结论孕妇血铅含量高低与其新生的血铅值呈正相关且由于胎儿期生长发育需求，铅高于母亲。     

防范医疗纠纷 提高病案基础质量

防范医疗纠纷 ,必须提高病案基础质量和医疗工作者意识 ,认清病案基础质量存在的主要问题 ;对存在问题进行改进 ;保证病案基础质量 ,维护自己和医院合法权益。     

影响农村产妇住院分娩因素的调查与分析

目的 :摸清农村产妇住院分娩的影响因素。方法 :对 1380人农村产妇采用统一自制调查表入户调查。结果 :居住平原者与居住山区或丘陵者比较 ,前者住院分娩率明显高于后两者 (P<0 .0 1) ;家庭经济收入≥ 4 0 0元者与≤ 4 0 0元者比较 ,前者住院分娩率明显高于后者 (P<0 .0 1) ;文化程度初中及以上者与小学文化程度者比较 ,前者住院分娩率明显高于后者 (P<0 .0 1) ;孕期接受健康教育者与未接受教育者比较 ,前者住院分娩率明显高于后者 (P<0 .0 1) ;产前检查≥ 5次者与产前检查 <5次或未产前检查者比较 ,前者住院分娩率明显高于后者 (P<0 .0 1)。结论 :影响农村产妇住院分娩首要原因是地处山区导致的交通不便 ,其次是经济收入和分娩费用制约 ;旧的生育观 ,孕产妇的健康教育和孕期系统管理也是不可忽视的影响因素     

Outcome of myocardial infarction in patients treated with aspirin is enhanced by pre-hospital administration

OBJECTIVE: Reducing time to reperfusion therapy is one of the goals in the management of acute myocardial infarction (AMI). We assessed the association between timing of aspirin administration and outcome of patients with AMI. PATIENTS: We studied 922 consecutive AMI patients with ST-segment elevation in Killip class I-III on admission. Patients were divided into two groups based upon the timing of emergency aspirin administration: before (early aspirin users) or after (late aspirin users) hospital admission. RESULTS: Early aspirin users (n = 338; 37%) were younger, less likely to be women, and more likely to smoke (p < 0.006) than late users (n = 584; 63%). Other baseline and clinical characteristics were similar. Early aspirin users were more likely to be treated with thrombolysis or primary percutaneous transluminal coronary angioplasty. Compared with late users, early aspirin users had significantly lower in-hospital complications and lower mortality rates at 7 (2.4 vs. 7.3%, p = 0.002) and 30 days (4.9 vs. 11.1%, p = 0.001). By multivariate adjustment, pre-hospital aspirin was an independent determinant of survival at 7 (odds ratio 0.43; 95% confidence interval 0.18-0.92) and at 30 days (odds ratio, 0.60; 95% confidence interval 0.32-1.08). Survival benefit associated with aspirin persisted for subgroups treated or not with reperfusion therapy. CONCLUSIONS: Outcome of AMI patients treated with aspirin is improved by pre-hospital administration. Our findings suggest that emergency pre-hospital aspirin might facilitate early reperfusion.     

Beckman化学发光检测系统促甲状腺素性能评价

目的评价Beckman Access全自动化学发光免疫分析仪测定促甲状腺激素(TSH)的分析性能。方法用Beckman Access全自动化学发光免疫分析仪测定相应要求标本的TSH含量,分别计算批内精密度、批间精密度、偏差和可报告范围以及分析灵敏度。结果TSH的批内精密度为3.50%,批间精密度4.80%;偏差3.4%;可报告范围0.01～150.0mIU/L;检测低限为0.006mIU/L,生物检测限为0.024mIU/L,功能灵敏度为0.024mIU/L。结论Beckman Access化学发光检测系统测定TSH具有重复性好、可报告范围宽、灵敏度高等优点,适合于临床应用。     

Beyond community-based diabetes management and the COAG coordinated care trial

Objective: This article describes the patient management processes developed during the Council of Australian Governments (COAG) coordinated care trial and use of health outcome measures to monitor changes in utilisation patterns and patient well‐being over time for a subgroup of 398 patients with type 2 diabetes. Design: The Eyre component of the South Australian (SA) HealthPlus coordinated care trial was a matched geographically controlled study in which the outcomes for the intervention group of 1350 patients were compared with those of a similar control group of 500 patients in another rural health region in SA. Setting: The trial was carried out on Eyre Peninsula in SA across populations in rural communities and in the main centres of Whyalla, Port Lincoln and Ceduna. Care planning was organised through general practitioner practices and services negotiated with allied health services and hospitals to meet patient needs. Subjects: The SA HealthPlus trial included 1350 patients with chronic and complex illness. A subset of this group comprising 398 patients with type 2 diabetes is described in this report. Patients recruited into the three‐year trial were care planned using a patient centred care planning model through which patient goals were generated along with medical management goals developed by clinicians and primary health care professionals. Relevant health services were scheduled in line with best practice and care plans were reviewed each year. Patient service utilisation, progress towards achieving health related goals and patient health outcomes were recorded and assessed to determine improvements in health and well‐being along with the cost and profile of the services provided. Results: Significant numbers of patients experienced improved health outcomes as a consequence of their involvement in the trial, and utilisation data showed reductions in hospital and medical expenditure for some patients. These results suggest that methods applied in the SA HealthPlus coordinated care trial have led to improvements in health outcomes for patients with diabetes and other chronic illnesses. In addition, the processes associated with the COAG trial motivated significant organisational change in the Regional Health Service as well as providing an opportunity to study the health and well‐being outcomes resulting from a major community health intervention. Conclusions: The importance of the SA HealthPlus trial has been the demonstrated link between a formal research trial and significant developments in the larger health system with the trial not only leading to improvements in clinical outcomes for patients, but also acting as a catalyst for organisational reform. We now need to look beyond the illness focus of health outcome research to develop population based health approaches to improving overall community well‐being. What is already known: Much work has been completed in recent years tracing the clinical impact of more effective management of patients with chronic illness. Evidence suggests that more structured management of patient care and better access resources and support can improve patient well‐being and reduce demand on acute care services. What is needed, however, are mechanisms for managing patients to access relevant care and to comply with best practice protocols. Lowered HbA1c readings correlate with reduced crises for diabetic patients, but how can we encourage patients to engage in practices that actually lower these levels? What this study adds: The current study, based on work carried out during the COAG coordinated care trials, suggests that a structured patient centred care planning process can improve patient knowledge of their condition and increase motivation for sustainable behaviour change in the way they manage their illness. These processes of patient engagement and symptom monitoring have led to better long‐term health and well‐being for patients with diabetes. The wider application of such processes of care management will be an important next step in improving the management of health and well‐being at larger population levels.     

小婴儿病理性黄疸77例分析

目的：为探讨引起小婴儿的病理性黄疸发病相关因素,以指导治疗和诊断,避免误诊。方法：小婴儿的黄疸77例进行分析。结果：其中母乳性黄疸61例（占79.2%）,巨细胞病毒感染5例（占6.4%）,婴儿肝炎综合症者3例（占3.8%）。先天性甲状腺功能低下1例（占1.2%）,乙型肝炎1例（1.2%）,其他疾病6例（占7.8%）。结论：认为新生儿后期的黄疸,虽然主要是母乳性黄疸,但其他一些疾病也可引起黄疸,要注意鉴别,避免误诊和漏诊。