量化考核中标准动态管理存在问题及对策

我们病区自2000年至今针对病区护理质量管理制订了量化考核标准，在实施过程中针对存在问题及时评价标准的合理性、可行性、科学性，及时修订标准，对量化考核标准进行了动态管理。     

浅谈检验科的管理

检验科管理是一项复杂的系统工作,科室管理者只有带领科室成员不断提高业务知识和基本技能、重视检验质量、了解检验学发展趋势才能满足检验事业和医学事业的发展要求,这就需求科室管理者重点关注三方面问题即质量管理、学科发展和人员管理.     

碘过量和多聚肌苷酸-聚胞苷酸及甲状腺球蛋白诱发小鼠甲状腺炎对Toll样受体3表达的影响

Objective To observe the effect of iodine excess(HI),polyinosinic-polycytidylic acid[Poly(I:C),Poly]and thyroglobulin(TG)on the thyroid of mice by the expression of Toll-like receptor 3(TLR3)to reveal the functional role of TLR3 in autoimmune thyroiditis.Methods Forty-two non-obese diabetic mice,body weight (20±3)g,were divided into six groups:control group,HI group,Poly group,TG group,HI+TG group,HI+Poly group. Fed with deionized water and injected intraperitoneally with physiological saline 0.1 ml each day for a week, the mice in control group were injected with physiological saline every other day at the same dose for 1 week before they were sacrificed; HI group drank 0.05% NaI water and were injected intraperitoneally with physiological saline same as control group; Poly group drank deionized water and were injected intraperitoneally with poly 0.1 ml (1 g/L)each day of the week, then the mice were injected with Poly every other day at the same dose for 1 week before they were sacrificed; TG group drank deionized water and were injected intraperitoneally with physiological saline same as control group, immunized with 0.1 mg TG by subcutaneously injecting and the immunization was enhanced after they were fed half dose for 4 and 8 weeks separately. In HI + Poly group, the treatment was the same as HI group and Poly group; HI + TG group: the treatment was the same as HI group and TG group. Eight weeks later, mice were sacrificed and thyroids were taken to make frozen sections, Hematoxylin-Eosin (HE) staining was employed to observe the morphological change of the thyroids. The expression of TLR3 of thyroids was observed under fluorescence microscope after Immumofluorescence using TLR3 antibody and TR3-positive cells were analyzed in the thyroid density. Results HE staining showed thyroids of Poly group had no inflammation under microscope.There were different degrees of inflammatory cell infiltration in HI group and TG group. The inflammatory cell infiltration and the damage of follicular thyroid of HI + TG group and HI + Poly group were serious, and the degrees of inflammation were higher over "++". Thyroid follicular epithelial cell with TLR3 expression could be seen in Poly group and HI group, meanwhile, there were TLR3 strong positive inflammatory cells in HI group under fluorescent microscope. Using stereological analysis of TLR3-positive cell density in the thyroid, the difference between groups was statistically significant(F=7.870, P<0.01 ). TLR3-positive cell density in the thyroid of HI + Poly group was higher[ (9.287 ± 0.522)mm2] than control group[ (0.062 ± 0.025)mm2, P < 0.01] significantly, meanwhile, the density in HI + Poly group was higher than HI group [ (2.574 ± 0.257 )mm2] and Poly group[ (1.361 ± 0.148 )mm2, all P < 0.01]. The density in HI + TG group[ (4.843±0.405)mm2] was higher than HI group and TG group[(1.601 ±0.268)mm2, all P < 0.01 )]. Conclusions Excessive iodine and thyroglobulin can induce thyroiditis, and stimulate the expression of TLR3 in the thyroid follicular epithelial, Poly aggravated thyroiditis induced by iodine excess in NOD mice; TLR3 positive inflammatory cells also appeared in inflammatory region, suggesting that TLR3 is involved in the pathogenesis of autoimmune thyroiditis     

人型支原体合并解脲脲原体感染的检出率和耐药性分析

目的了解泌尿生殖道人型支原体（Mycoplasma hominis,Mh）单纯及合并解脲脲原体（Ureaplasma urealyticum,Uu）的感染和耐药情况。方法用选择性固体培养基-液体培养基一步法检测7486例生殖泌尿道标本中Mh的检出率和耐药情况。结果Mh单纯检出率为2．8％,合并Uu检出率为11．3％,女性检出率高于男性（P〈0．05）。Mh和Mh合并Uu对多西环素和米诺环素的敏感率最高,均〉90．0％,对红霉素、罗红霉素、阿奇霉素和克拉霉素耐药率最高,耐药率均大于90,0％。两者对这6种抗生素的敏感率和耐药率差异无统计学意义（P〉0．05）。Mh对交沙霉素的敏感率（87．6％）高于混合感染者（75．4％）,差异有统计学意义（P〈0．05）。结论Mh单纯感染或混合感染检出率较低,且以女性感染为主,两者的耐药谱基本一致,对半合成四环素的敏感率最高,对大环内酯类抗生素耐药率最高。     

辅助生殖技术后发生宫内外同时妊娠的相关因素分析

目的探讨辅助生殖技术后发生宫内外同时妊娠的高危因素、诊断、治疗及预后。方法对2005年1月～2008年10在广州医学院第三附属医院生殖科进行辅助生殖治疗后发生的7例宫内外同时妊娠病例进行回顾性分析。结果宫内外妊娠的发生率为0.6%,5例为输卵管因素不孕,其中1例有既往异位妊娠史。6例经B超确诊,1例经手术确诊。1例行阴道B超引导下异位孕囊穿刺抽吸胚芽术,1例行输卵管切开取胚术,5例行输卵管切除术,其中3例在异位病灶去除后继续宫内妊娠并分娩活婴。结论既往输卵管盆腔疾病或手术、异位妊娠史是辅助生殖技术后发生宫内外同时妊娠的高危因素。对有高危因素的患者早期加强B超检测有助于早期诊断、早期治疗,将对宫内妊娠的影响减到最小。     

1例舞蹈病——棘红细胞增多症患者的护理

舞蹈病——棘红细胞增多症临床上主要表现为进行性舞蹈样不自主运动、抽搐、呐吃、癫痫发作、自残性唇舌咬破与进食性肌张力障碍，以及多见于腿部的不等程度的失神经性肌萎缩、感觉减退、腱反射降低或消失等。该病罕见，自我院建院以来共收治3例。现将我科于2004年7月收治的1例舞蹈病一棘红细胞增多症患者的护理报告如下。     

亚急性联合变性病的病因护理6例

亚急性联合变性病(subacutecombineddegeneration,SCD)是维生素B12缺乏所引起的脊髓变性疾病。临床上以脊髓后索和侧索联合损害为特发性改变,表现为肢体深感觉障碍,感觉性共济失调,痉挛性截瘫及伴发周围神经病,巨幼红细胞贫血。在我国此病非常少见,近年有上升趋势。我院2003年7月～2004年9月共收治SCD病人6例,针对其发病原因,在护理过程中我们结合治疗对病人进行饮食、用药及心理护理,取得良好的效果,现将护理报告如下。临床资料1.一般资料。男4例,女2例,年龄21～71岁,平均年龄51岁。6例中素食者1例;家住偏远山区、经济条件差、饮食差2例…     

体外受精—胚胎移植术后宫内妊娠合并宫颈妊娠2例

目的:探讨宫内妊娠合并宫颈妊娠的选择性减胎术的治疗效果。方法:报道我院生殖中心行体外受精-胚胎移植术后发生宫内妊娠合并宫颈妊娠的患者2例,经阴道超声指导下实施宫颈处妊娠胚胎抽吸减胎术,同时进行文献复习。结果:成功实施了选择性减胎术,宫颈处妊娠被终止,宫内妊娠继续,并顺利分娩,无并发症发生。结论:阴道超声引导下选择性宫颈妊娠减胎术对需要保留宫腔妊娠的患者是侵入性小且比较安全的治疗方法。     

小鼠阴道黏膜干细胞的分离、富集和鉴定

目的研究小鼠阴道黏膜干细胞的分离、富集和鉴定方法,为干细胞替代疗法或构建人工阴道黏膜治疗先天性无阴道提供依据。方法取7~8周龄小鼠的阴道黏膜上皮,用酶消化培养法原代培养阴道黏膜干细胞(VMSC)。用Ⅳ型胶原黏附法并连续传代分离和富集VMSC。显微镜下动态观察细胞生长特性;苏木精-伊红(HE)染色;透射电镜观察细胞超微结构;荧光显微镜下观察标记滞留细胞(LRC)。免疫组化SP法检测细胞表面标记物(β1整合素、细胞角蛋白19)进行鉴定。结果用酶消化培养法得到原代VMSC,用Ⅳ型胶原黏附法分离到较纯的VMSC,经连续传代,富集到大量VMSC。动态观察发现细胞呈克隆性生长的干细胞特性。HE染色细胞呈椭圆形或梭形、核质比例大等幼稚细胞特征。透射电镜发现细胞呈未成熟细胞特征。荧光显微镜下LRC的核呈亮黄色,标记滞留时间长。免疫组化SP法检测β1整合素和细胞角蛋白19呈阳性表达。结论用酶消化培养法可原代培养VMSC。用Ⅳ型胶原黏附法并连续传代可分离、富集VMSC。免疫组化SP法检测细胞表面标记物可鉴定VMSC。