医改背景下某三甲医院合理使用医用耗材效果研究

目的:通过研究医改背景下某三甲医院合理使用医用耗材的管理成效,探索科学的医用耗材控费路径。方法:深圳市某三甲医院实施耗材使用管控方案,对该医院管控方案实施前后耗材使用数据进行统计分析。结果:2016-2018年,全院百元医疗收入(不含药品收入)中卫生材料费用呈现下降趋势,对于百元医疗收入(不含药品收入)中耗材费用,骨关节外科、骨脊柱外科、心内科连续2年降低,耗材管控方案实施后,骨关节外科、骨脊柱外科、心内科的单台手术耗材费下降,胸外科、胃肠外科有所上升。结论:耗材合理使用管理措施取得成效;为进一步提高耗材管理效率,可采取单病种管理、优化耗材遴选准入机制、实施耗材供应链精益管理等措施。     

黄色肉芽肿性胆囊炎

黄色肉芽肿性胆囊炎是一种以胆囊的慢性炎症为基础、伴有以泡沫状组织细胞为特征的黄色肉芽肿形成和重度增生性纤维化的特殊类型的胆囊炎性病变。临床表现无特异性,B超、CT对诊断有一定帮助,甚至术中都难以辨别,往往依靠冰冻切片确诊。最终诊断应依据病理学检查。该病为良性病变,预后良好。     

先天性二叶主动脉瓣畸形27例临床分析

27例住院治疗的先天性二叶主动脉瓣(CBAV)临床分析,结果显示:合并心功能不全21例(78%),合并感染性心内膜炎(IE)12例(44%),与其它心血管畸形并存7例(26%).IE为CBAV的主要死亡原因.本文认为,并发IE或存在明显血流动力学障碍时外科换瓣术为CBAV治疗的根本措施,结果还提示,CBAV一旦心功能失代偿发展迅速,准确掌握外科治疗指征及尽早手术至关重要.     

L4椎体上终板陈旧性骨折误诊误治分析

椎体的终板在维持椎间盘的结构与功能中具有重要作用,腰椎上终板骨折在临床上少见,在X线检查中不能显示或不能完全显示,容易误诊。本院于2014-01收治L4椎体上终板陈旧性骨折1例,之前在外院误诊为腰椎结核,报道如下。1病例资料患者,男,19岁,因腰痛伴盗汗、纳差9个多月,双下肢疲乏无力20 d余就诊。患者自述于9个月前上呼吸道感染后出现腰背部疼痛不适,     

主动脉瓣二叶畸形并心尖肥厚型心肌病1例

患者男,41岁,反复胸闷、心前区疼痛3年,发作时呈隐痛伴压迫感,无放散,持续数分钟至数小时不等,与劳累及情绪激动无关。含服硝酸甘油症状不能缓解。因发病时心电图有“心肌缺血”改变,曾在当地医院诊为“冠心病、心绞痛”。既往无高血压及风湿热史,近2个月发作频繁,症状加重来诊。入院查体:BP18/11kPa,无紫绀,卧位无颈静脉怒张,两肺呼吸音清,无罗音,心界无扩大,心率76次/分,律齐,心尖部及胸骨左缘三、四肋间闻及Ⅱ级收缩期杂音,柔和无传导,A_2>P_2。ECG示:R I、Ⅱ、avL1.2～1.5mV,Rv4～v62.4～3.0mV,S—T I、Ⅱ、avl下移0.5～1.0mV,S—Tv4～v6下移2.0～3.0mV,TI、Ⅱ、avL倒置,Tv4～v6呈巨型倒T,波幅1.0～1.5mV。X线胸片:心肺影正常。超声心动图:左室心尖部增厚达1.7cm,余室壁厚度及室腔大小正常范围。主动脉瓣呈二叶纵裂式,开放无受限。彩色多普勒测及主动脉瓣轻度返流。冠脉造影未发现异常。同位素心肌显象见心尖肥厚部放射性分布稀疏。肝肾功能及电解质检查均正常。确诊为先天性二叶主动脉瓣,心尖肥厚型心肌病。经休息及钙离子拮抗剂、小剂量β受体阻滞剂治疗,症状缓解后出院。     

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.     

高血压患者的血压昼夜节律变化与靶器官损害

目的研究原发性高血压（ＥＨ）患者血压昼夜节律改变与高血压病期及严重程度的关系。方法应用无创动态血压监测系统记录２４ｈ血压并分析正常人组（５２例）、高血压Ⅰ期（４８例）、Ⅱ期（８５例）、Ⅲ期（３２例）患者白昼与夜间的血压变化。结果Ｉ～Ⅲ期患者夜间收缩压（ＳＢＰ），舒张压（ＤＢＰ）下降率分别为１８％，１５％；８％，７％；１％，２％；昼夜节律紊乱Ⅰ期６％，Ⅱ期３６％，Ⅲ期８４％。Ⅰ期夜间ＳＢＰ下降率高于正常人组（Ｐ＜０．０５）。结论夜间血压下降率可以做为临床上高血压程度及靶器官受损评估的一项指标。     

候诊成功率与候诊时间的非线性回归模型

目的 研究候诊成功率与候诊时间的函数关系,揭示两者的内在联系.方法 从HIS系统数据库收集了某医院一个月候诊时间在7小时之内的全部门诊病人(共36697人)的候诊时间资料,利用SPSS统计分析软件建立候诊成功率与候诊时间非线性回归模型.结果 候诊成功率与候诊时间函数关系模型为p=eα+βx/1+eα+βx×100％,决定系数为0.974,预测值与实际值相近,预测logistic回归模型曲线与实际值曲线也基本拟合,回归方程拟合良好、有效.结论 候诊成功率与候诊时间之间符合logistic回归模型,候诊成功率与候诊时间函数模型的建立可反映候诊时间在候诊人群的分布,有利于完善门诊候诊管理.