妇产科超声危急值报告与临床医疗安全相关性研究

目的 探讨妇产科超声危急值报告与临床医疗安全的相关性.方法 回顾分析我院2009 年1 月至2010 年12月建立妇产科超声危急值报告制度后妇产科临床医疗安全的相关情况;对建立危急值报告制度前后两年间危急患者医疗干预开始时间、孕产妇/妇科患者及围生儿危急重症发生率、母儿预后情况等进行比较.结果 超声危急值报告率与孕产妇/ 妇科患者及围生儿急救发生率呈负相关(r=-1.0,P＜0.01);妇产科超声危急值报告制度建立后对危急患者医疗干预开始时间明显缩短,孕产妇/ 妇科患者及围生儿危急重症、母儿不良结局发生率明显降低(均P＜0.05).结论 妇产科临床超声危急值报告制度的建立与应用,可有效降低涉及"妇产科超声危急值"方面的医疗安全隐患.     

妇产科超声危急值报告与临床医疗安全相关性分析

目的探讨妇产科超声危急值报告与临床医疗安全的关系。方法回顾分析我院2010年5月-2012年10月实行妇产科超声危急值报告制度后,妇产科临床医疗安全的情况观察总结;对实行危急值报告制度前3年,危急患者医疗干预时间、产科、妇科患者及围生儿危急重症急救率、急救成功率及医患纠纷率等进行比较。结果超声危急值报告率与孕产妇及围生儿急救发生率呈负相关,妇产科超声危急值报告制度建立后对危急患者医疗干预开始时间明显缩短,孕产妇科及围生儿危急重症的急救成功率明显提高,医患纠纷发生明显降低。结论临床妇产科超声危急值报告制度的建立与应用,可有效提高孕产妇及围生儿的生命安全,提高了医疗安全性,减少医患纠纷的发生     

检验结果危急值报告管理在产科急救中的应用

目的探讨检验结果危急值报告管理在产科急救中的应用价值。方法随机选取检验结果危急值报告管理实施前5012例孕产妇作为对照组、实施后5525例孕产妇作为实验组,用平均医疗干预时间、母婴发生急救率、急救成功率、母婴不良事件发生率、医患纠纷发生率五个指标进行综合分析评价。结果实验组在医疗干预时间、母婴发生急救率、急救成功率、母婴不良事件发生率、医患纠纷发生率与对照组结果比较差异显著（P〈0．01）。结论检验人员必须认真执行检验项目危急值报告制度和过程管理。以便产科医生快速、准确、及时获得急、危、重病人的结果信息,使孕产妇的病理症状得到有效控制,为安全分娩创造时机,切实保障母婴生命健康。     

检验结果危急值报告制度的建立与临床应用

检验结果危急值报告制度是中国医院协会在“患者安全目标”中提出来的。该制度的建立与应用既是检验科实施《医疗机构临床实验室管理办法》的目标之一,也是保障患者医疗质量和医疗安全的需要^[1]。我院自2007年建立和应用检验结果危急值报告制度以来,有效地防止和减少了不良事件、医疗纠纷和事故的发生。     

产科超声危急值报告与临床医疗安全相关性的分析

目的:研究并分析产科超声危急值报告与临床医疗安全相关性。方法:将构建妇科超声危急值报告制度以后的孕产妇当作观察组,将未构建妇科超声危急值报告制度前的孕产妇当作对照组,每组60例,对比分析两组产妇与围生儿医疗安全的相关情况。结果:观察组医疗干预时间相对于对照组而言更短,且产妇与幼儿结局也比对照好,两者差异有统计学意义(P<0.05)。结论:从本次研究的结果来看,产科超声危急值报告与临床医疗安全之间所存关系非常密切,通过产科超声危急值报告制度的构建,可使临床医疗安全性得到显著的提高。     

危急重症患者院内转运中护理干预的应用效果

目的：观察分析危急重症患者院内转运中护理干预的应用效果。方法：将该院2013年2月至2015年11月间收治的危急重症患者100例为本次研究对象,采用随机技术偶数法将其分为观察组50例与对照组50例。观察组患者行综合护理干预方法进行院内转运,对照组患者行常规护理进行院内转运,观察对比2组患者意外事故发生率和转运成功率以及接受科室的满意度。结果：观察组患者转运中意外事件发生率、转运成功率、护理纠纷率明显低于对照组（P＜0．05）。观察组接受科室满意率率明显低高于对照组（P＜0．05）。结论：对危急重症患者进行院内转运时采用综合护理干预方法进行院内转运,能有效的降低医患纠纷,提高患者院内转运的安全性。     

检验科危急值报告制度的建立和临床应用

<正>检验结果危急值报告制度是在中国医院协会2007年"患者安全目标"中正式提出来的。这种"危急值"制度的建立是《医疗事故处理条例》举例中的重要部分,也是临床实验室认可的重要条件之一[1]。建立临床实验室危急值报告制度,使检验人员能及时识别危急值,及时通知医护人员,对抢救危重患者保护医疗质量和医疗安全起着重要作用。因此,临床实验室有必要结合临床建立本实验室检验项目的"危急值",并建立实验室"危急值"报告制度。我科根据医院的实际情况,     

医院检验危急值个性化管理平台的探索和实践

目的:分析利用人工智能技术和智能手机应用进行危急值管理流程优化的实践效果.方法:依托信息化平台建设契机,对现有危急值管理流程进行优化,构建医院危急值个性化管理平台.结果:医院危急值个性化管理平台应用后,危急值患者的开始干预时间显著缩短,及时干预率和干预成功率明显提高.结论:将人工智能和智能手机技术与医院现有危急值管理流...     

临床药师对临床不合理用药的药学干预

目的：分析药学干预纠正临床用药不合理现象的突出效果。方法：选取该院2015年1月至2016年1月门诊药房所记录的各科室用药情况,对比临床药师行药学干预前后的干预效果。结果：从临床用药情况可看出采用药学干预后处方不合格率、抗菌药使用率及不良反应发生率均较之干预前出现明显降低（P ＜0.05）;从临床基本情况可看出采用药学干预后患者的平均住院时间明显缩短（P ＜0.05）;药品费用以及抗菌药费用明显减少（P ＜0.05）;延迟干预的接受率（90.0％）高于及时干预（70.0％,P ＜0.05）。结论：鉴于临床用药具有诸多不合理性,临床药师应实施延迟药学干预,规范用药操作,增强药师用药安全意识,改善不良结局。     

床旁快速检测危急值在急诊科的应用分析

目的 探讨床旁快速检测(POCT)危急值在急诊科的应用价值.方法 选取2013年1月-2013年12月在该院急诊科行POCT危急值检验的患者90例为研究组,2012年1月-2012年12月在该院实验室行POCT危急值检验的患者90例为对照组.比较两组危急值检验周转期(TAT)、复检准确率、报告临床处置时间及抢救成功率.结果 ①研究组TAT[(15.20±7.66)min]明显少于对照组[(59.71±49.96)min],差异有统计学意义(t=8.35,P＜0.01);②研究组复检准确率为69.57％,对照组为73.68％,差异无统计学意义(P＞0.05);③研究组危急值报告临床处置时间[(9.34±4.99)min]少于对照组[(11.58±6.59)min],差异有统计学意义(t=2.56,P ＜0.05);④研究组抢救成功率(93.33％)较对照组(83.33％)高,差异有统计学意义(x 2=4.37,P＜0.05).结论 急诊科POCT危急值快捷可靠,在缩短危急值TAT和报告临床处置时间方面有较大优势,值得在急诊科推广.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.