临床路径病案的质量分析

目的探讨临床路径病案质量控制的内容和方法。方法根据临床路径标准住院流程和治疗表单制定病案质控内容,对我院121例急性ST段抬高心肌梗死的病案进行临床路径质量分析。结果所查121份病案中,住院时间不符合路径标准最多,缺陷率为14.1%,入院诊断、诊断依据、检查项目、手术治疗时间、出院评估及变异因素缺陷率在4.1%～12.4%结论临床路径病案质控与临床路径规范实施密切相关,建立规范的临床路径病案质控体系及临床路径病案质控实施办法,将有助于临床路径工作开展。     

智能化质量控制模式下住院病案首页填写缺陷分析

目的 应用住院病案首页质控系统智能化质量控制模式,分析住院病案首页填写缺陷,提高住院病案首页填写质量,也为住院病案首页填写的准确性和完整性提供可靠的数据依据。方法 选取使用住院病案首页质控系统前5个月的7068份住院病案首页做对照组,使用住院病案首页质控系统后5个月的6376份住院病案首页做观察组,对两组的缺陷率进行统计分析。结果 对照组缺陷率为36.23%,观察组缺陷率为26.22%,与对照组相比下降10.01%,两组缺陷率相比差异有统计学意义(P<0.05)。前20项的缺陷项目中有9项缺陷的缺陷率下降有显著性差异,分别为缺签名、漏填手术与操作、填错输血反应、填错输血三项检查、填错实施临床路径、漏填出院日期、填错护理天数、填错药敏、漏填出院情况。结论 应用住院病案首页质控系统智能化质量控制模式进行住院病案首页的精准管理和有针对性的培训,同时强化智能化管理后,可以有力辅助临床医师更加完整地、准确地填写住院病案首页诊疗部分的各项信息,大大减少了人工漏填、错填的情况,并保证了住院病案首页诊疗信息的完整性、准确性和合理性,提高了住院病案首页诊疗信息的质量。     

某院2012年与2013年病案质量对比分析

目的 通过对比实施多环节质控前后终末病案的质控结果,探究提高终末病案质量的有效途径.方法 分别抽取2012年度、2013年度环节质控前后终末病案进行缺陷分析,并利用SPSS11.0统计软件进行统计学比较.结果 多环节质控病案后,终末病案总缺陷率由25％下降至12％,各缺陷项目所占比例明显下降,且手术科室病案缺陷率下降,均有统计学差异,医疗纠纷亦有所减少.结论 严格落实实施多环节质控病案较传统单一模式的终末病案质控有着显著优势,使终末病案缺陷率明显下降,尤其是手术科室的病案缺陷率明显下降,使得病历书写质量显著提高,某种程度上降低了医疗纠纷事件的发生,故加强多环节病案质控对提高病案质量有重要意义.     

1140份病案质控前后对比分析

目的了解临床各科影响病历书写质量的主要因素及质量控制在病历书写过程中的重要作用。方法按照江西省《住院病历质量评价标准（试行）》对归档病案评价、统计、分析。结果质控后平均每份病案缺陷数及病案缺陷率较质控前显著提高。结论提高病案质量要充分发挥各级质控组织的职能作用,同时临床医师要增强工作责任心。     

银离子生物敷料封闭网状植皮创面临床观察: 前瞻性病例对照研究

目的 通过与传统网眼油纱封闭网状植皮创面法进行比较,分析银离子生物敷料封闭网状植皮创面方法应用于烧伤、创伤等各种开放创面植皮手术的临床效果.方法 符合入选标准的18例患者按手术方法分为两组,试验组(6例)为银离子生物敷料覆盖网状植皮创面,对照组(12例)为传统网眼油纱封闭网状植皮创面.记录入选患者的人口统计学特征、创面情况、植皮后创面感染情况、术后第一次更换最内层敷料时间、术后第一次换药疼痛评分、住院时间,并计算植皮成活率、术后植皮创面感染率和住院总费用.结果 试验组术后植皮创面感染率低于对照组(0 vs 50.0％,P＜0.05);试验组术后第一次更换内层敷料疼痛评分小于对照组(2.50±1.05 vs 5.42±2.02,P＜0.01);试验组第一次更换内层敷料时间晚于对照组[(7.50±1.05)d vs (4.08±1.31)d,P＜0.01];试验组住院时间短于对照组[(14.33±1.50)d vs(16.42±1.93)d,P＜0.05];试验组术后植皮成活率高于对照组[(97.50±1.87)％vs(91.42±4.48)％,P＜0.01].结论 银离子生物敷料封闭网状植皮创面的方法可以提高植皮存活率、缩短创面愈合时间、减少患者痛苦,疗效满意.     

临床健康教育路径在腹腔镜子宫肌瘤手术患者中的应用

目的 探讨临床健康教育路径在腹腔镜子宫肌瘤手术患者中的临床应用价值.方法 选择需行腹腔镜子宫肌瘤切除术的患者230例,按入院先后顺序随机分为观察组和对照组,每组115例.观察组给予临床健康教育路径模式进行管理,针对患者住院不同时段制定标准的健康教育内容,按健康教育路径实施健康教育;对照组给予传统的健康教育形式进行管理.比较两组患者对康教育知识的知晓率、遵医行为率、工作的满意度及平均住院时间.结果 观察组患者的住院时间为（9.0±3.2）天,对照组为（12.9±6.0）天,组间差异具有统计学意义（P＜0.05）;观察组对健康教育知识的知晓率、遵医行为率及对护理工作的满意度分别为99.1％、95.7％、97.4％均高于对照组的87.0％、77.4％、81.7％,组间差异具有统计学意义（P＜0.05）.结论 临床健康教育路径作为一种科学的健康教育模式,应用于腹腔镜子宫肌瘤手术中,可以缩短住院时间,提高患者对康教育知识的知晓率、遵医行为率及患者的满意度,具有重要临床应用价值.     

实施声带息肉摘除术临床护理路径的应用分析

目的分析声带息肉临床护理路径实施的应用效果。方法利用医院信息系统提供的声带息肉病案、收费的数据资料及患者满意度测评结果,将择期住院在全麻支撑喉镜下行声带息肉摘除术患者分为两组,根据临床护理路径标准住院流程实施临床护理路径,将实施临床护理路径前声带息肉摘除术患者261例设为对照组,将实施临床护理路径后声带息肉摘除术患者249例设为观察组,回顾性分析对比两组患者的平均住院天数、住院费用和患者满意度测评。结果实施临床护理路径的观察组平均住院天数[（4.00±1.00）d]显著短于对照组[（5.50±2.00）d],住院费用[（3 200.00±289.30）元]显著少于对照组[（4 000.00±256.80）元],患者满意度[（96.00±2.50）分]显著高于对照组[（93.00±1.96）分],差异均有统计学意义（均P〈0.01）。结论在声带息肉手术患者中应用临床护理路径,可有效降低住院天数和住院费用,提高患者满意度,推动优质护理服务示范工程的进程,减少护理差错事故的发生,提高医院的护理质量     

某市公立医院与民营医院住院病案首页质量分析

目的 通过分析某市公立医院和民营医院住院病案首页数据质量,对比其缺陷率差异并找出差异主要原因,为提高某市住院病案首页填写质量提供参考。方法 以全市40家公立医院和民营医院2019年1月1日-12月31日出院患者的住院病案首页为研究对象,随机抽取700份住院病案,按照住院病案质量有关标准对其首页进行质控,使用SPSS22.0软件分别对两类医院住院病案首页中四大信息的缺陷率进行统计学分析,并将具有统计学意义部分的主要缺陷项目进行对比。结果 该市住院病案首页缺陷率最高的是费用信息(38.86%),最低的是基本信息(2.60%)。民营医院的总体缺陷率高于公立医院(χ²=9.105,P<0.01),住院信息缺陷率低于公立医院(χ²=7.930,P<0.01),诊疗信息缺陷率(11.40%)高于公立医院(8.24%)(χ²=40.793,P=0.000),基本信息与费用信息方面缺陷率差异无统计学意义。手术操作和疾病诊断名称及编码、费用信息、签字类信息等项目的填写缺陷是该市住院病案首页缺陷的主要原因。结论 该市民营医院和公...     

术前麻醉科普和心理干预对手术患者的影响

目的 探究术前麻醉科普和心理干预对手术患者心理状态、痛阈、满意度和术后康复速度的影响.方法 选择择期手术患者160例,随机分为对照组和试验组,每组80例.对照组术前常规访视患者,试验组选用通俗易懂的麻醉科普语言、漫画和微信小视频的方式对患者宣教,并进行心理干预.比较2组干预前后痛阈值、焦虑评分(HAMA)、满意度评分和术后住院时间.结果 与访视前比较,访视后对照组痛阈值降低了20.6％,HAMA评分增加了22.4％,试验组痛阈值增加了25.7％,HAMA评分降低了30.9％;与对照组比较,访视后试验组痛阈值、满意度评分分别为(0.44±0.08)、(3.6±0.4),明显高于对照组(0.27±0.05)、(2.7±0.6),HAMA评分和术后住院时间分别为(10.3±4.1)、(4.1±1.8)d,明显低于对照组(18.6±5.7)、(6.7±2.1)d,2组相比差异有统计学意义(P＜0.05).结论 术前麻醉科普干预和心理干预,可增强医患沟通效果,降低患者的焦虑情绪,减轻应激反应,提高患者的痛阈和满意度,缩短术后住院时间.     

某三甲医院住院病案首页质控效果分析

目的 评价某院住院病案首页质控体系改进后实施效果,提出改进措施,提高住院病案首页质量.方法 改进质控体系,调取2019年10月1日-12月31日住院病案首页质控数据和2020年10月1日-12月31日住院病案首页质控数据各1410份,统计住院病案首页缺陷数和缺陷率,采用χ2检验进行分析,评价改进后效果.结果 改进质控体...     

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.     

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.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.