多学科综合治疗在中国胸痛中心认证中的作用

正急性胸痛是一类以胸痛为主要表现的临床急诊,包括急性冠状动脉综合征(Acute Coronary Syndrome,ACS)、主动脉夹层、肺动脉栓塞等,常常可危及患者生命。及时、准确地诊断各种胸痛相关性疾病,对患者的救治和预后有着重要意义,也是临床工作的重点和难点。为破解这一难题,在上世纪80年代,国际上逐渐提出了胸痛中心的概念。胸痛中心最初是为降低急性心肌梗死(acute     

肺癌多学科综合治疗的临床思维

肺癌多学科综合治疗的临床思维涉及制定治疗方案，实施治疗方案和考核治疗方案三个方面。制定治疗方案时应依据肿瘤的生物学特性，病人的全身和局部情况以及各种治疗措施的特点。实施治疗方案时应处理好局部治疗和全身治疗的关系，疗效和副作用的关系以及抗癌治疗和辅助治疗的关系。考核治疗方案应凭借影像学改变，生存时间和生活质量。     

多学科综合治疗晚期血吸虫病效果观察

目的 探讨多学科综合治疗晚期血吸虫病的疗效。 方法 选择2010年1月至2011年12月接受多学科综合治疗的173例晚期血吸虫病患者（其中巨脾型患者75例,腹水型患者98例）和2007年1月至2009年12月接受单学科治疗的晚期血吸虫病患者193例（其中巨脾型84例,腹水型109例）为研究对象,比较不同治疗模式的临床疗效。 结果 与单学科治疗相比,多学科综合治疗巨脾型晚期血吸虫病的术前准备时间、住院时间缩短（P < 0.01）,手术时间短、术后并发症减少、住院费用降低（P < 0.05）,病人投诉下降（P > 0.05）;治疗腹水型晚期血吸虫病的治疗前时间、腹水消失时间缩短（P <0.01）,住院时间缩短、治疗后并发症减少、住院费用降低、病人投诉下降（P < 0.05）。 结论 多学科综合治疗晚期血吸虫病能提高疗效,减少并发症,并改善患者的生活质量。     

中国胰腺癌多学科综合治疗模式专家共识(2020版)

胰腺癌的病因尚未完全明确,预防便尤为困难。辅助检测手段的灵敏度和特异度低,早诊是世界性难题,现有的治疗手段疗效不满意,且短期内难以突破,总的5年生存率仅7.2%。面对胰腺癌的现状,要加强基础研究、探究其病因和发病机制,去除病因、切断发生发展路径。研发高灵敏度、高特异度的外周血和尿液等检测技术以及影像诊断技术以提高早期诊断率和疗效,然而基础和早期诊断技术的研究时间长、费用高,短期内难以见效。因此,急需解决的问题是通过规范的MDT、优化组合现有的诊疗方法,制订个性化的治疗方案,达到改善疗效的目的。本共识是在第1版的基础上,基于胰腺癌的诊治现状且短期内难以突破的窘境,参照国际、国内成功的诊治经验、结合中国国情、由国内业界众多知名专家参与,经反复推敲、讨论、几易其稿成文。本共识就MDT的意义和宗旨、主要任务、开展的必要客观条件、工作流程、注意事项、相关临床和基础研究、多中心MDT模式探索、eMDT模式探索等方面进行了详细论述,希望能为推动我国胰腺癌MDT的规范化开展、改善胰腺癌的疗效、总结成功经验、促进国际交流、加强人才培养和梯队建设有所脾益;为国家制订相关政策、推动全国MDT的开展有所帮助。本共识是中国制定的MDT模式的专家共识,不仅仅适用于胰腺癌,也可供其他肿瘤借鉴。     

基层医院多发性创伤的急诊救治体会

目的探讨基层医院多发性创伤的临床特点及救治措施,提高急诊救治多发伤的成功率。方法回顾性分析2010-02~2014-09宾阳县人民医院收治的66例多发性创伤患者的临床资料。结果本组抢救成功56例,成功率为84.85%,死亡10例,病死率为15.15%。3种不同ISS评分者病死率比较差异有统计学意义(P0.01)。合并有颅脑损伤者病死率为23.33%,高于未合并颅脑损伤者的8.33%,但比较差异无统计学意义(P0.05)。结论多发性创伤致病因素多种多样,创伤程度ISS评分对多发性创伤患者预后评估具有一定指导价值,临床上对合并颅脑损伤的多发性创伤患者应加以重视。     

肺癌多学科综合治疗面临的挑战和机遇

经过近50多年的努力，目前肺癌的治疗已具有规范化和循证化的特点，建立在循证医学证据基础上的肺癌诊断治疗指南是其重要的标志，如中国抗癌协会肺癌专业委员会制定的《中国肺癌诊断治疗指引》和美国的《国家癌症综合网络（NCCN）肺癌指引中国版》，这两个指南的最大特点是以临床分期为基础的肺癌多学科综合治疗，也就是肺癌的规范化分期治疗模式。     

晚期血吸虫病多学科综合治疗模式的探讨与规范化实施

晚期血吸虫病是血吸虫病中最严重的临床类型,其诊疗涉及消化内科、普通外科、神经内科、内分泌科、中医科、血液净化、内镜、介入、影像科、ICU等诸多专科,因此采用多学科综合治疗(MDT)模式非常必要。然而,这种模式尚无一致的方案和规范,成立MDT专家工作小组,制定工作制度,规范工作流程等对晚期血吸虫病开展MDT有十分重要的临床价值。MDT的规范化实施将为晚期血吸虫病的临床决策提供重要保障。     

晚期血吸虫病多学科综合治疗的价值与评价

晚期血吸虫病病情复杂,并发症多,严重威胁患者生命健康。本综述通过对晚期血吸虫病临床分型、辅助检查与治疗的主要手段(包括手术类型等)进行综合分析与评价,认为根据患者具体情况制定的个体化多学科综合治疗方案是晚期血吸虫病最合理的治疗模式。建议今后要设立多学科协作的诊疗制度,定期组织多学科病例讨论,形成稳定的治疗团队,以提高晚期血吸虫病的诊疗水平,减少误诊,提高疗效。     

多学科综合治疗BPH所致膀胱逼尿肌收缩力弱患者的疗效

目的探讨多学科综合治疗方式对良性前列腺增生(BPH)所致的膀胱逼尿肌收缩力弱患者的临床疗效。方法回顾性分析2010年1月至2013年10月本院泌尿外科收治的200例确诊为膀胱逼尿肌收缩力弱的BPH患者的临床诊治资料;按治疗方式不同分为对照组(单纯手术治疗,90例)和试验组(多学科综合治疗,110例),分别比较治疗前、后及两组患者的膀胱逼尿肌功能及国际前列腺症状评分(IPSS)等。结果与治疗前比较,试验组在治疗1、2、3个月后最大尿流率(Qmax)、最大逼尿肌压力(Pdet)、剩余尿量(PVR)、IPSS及泌尿症状困扰(BS)评分均有不同程度改善(均P<0.05),而最大膀胱容量未见明显改善(P>0.05);对照组在治疗2个月以后逐渐出现不同程度的显著改善(P<0.05);两组各项观察指标在治疗后比较均有统计学差异(均P<0.05)。结论对于BPH所致的膀胱逼尿肌收缩乏力患者,多学科综合治疗方式较单纯手术有更好的临床疗效,且可改善患者症状和生存质量,但未发现具有明显优势疗效的手术时机。     

Building a trauma center and system in Tuscany, Italy

BACKGROUND: Growing evidence supports the premise that adult trauma centers lower the risk of death for severely injured patients. The same principles have been applied to the pediatric population and mounting research suggests that, as in the adult population, gravely injured children have better outcomes at pediatric trauma centers where personnel trained and experienced in the specific needs and unique physiology of injured children provide care. As in the United States, acute traumatic injury represents an important public healthcare concern to the Tuscan regional government whose goal is to maximize clinical outcomes within available resources. In order to address this problem, the Tuscan regional government has created a new and innovative collaboration between the Meyer Pediatric Hospital/University of Florence School of Medicine and the Children's Hospital Boston/Harvard Medical School to build a pediatric trauma center and regional pediatric trauma referral system. GOALS AND OBJECTIVES: This long-term international initiative will seek to develop a demonstration model for pediatric trauma care that may later be replicated elsewhere. The initial goals of the project will focus on expanding the role of the pediatricians working in the emergency department to include the acute care of medical, surgical, orthopedic and multiple trauma patients. This new configuration will closely resemble the single provider model of emergency medical care commonly utilized in the United States. During this transition period to a more broadly trained emergency physician, a multi-disciplinary trauma team will be created and pediatric trauma clinical practice guidelines will be introduced into the emergency department and inpatient care units. Systems measurements will be achieved through a comprehensive quality improvement and risk management program. Ultimately, all Tuscan regional pediatric major trauma will be consolidated at the Meyer Pediatric Hospital in Florence.     

重型颅脑外伤合并多发伤救治及预后分析研究

目的：重型颅脑外伤患者合并多发伤救治及预后的分析研究.方法：回顾性分析重型颅脑外伤患者299例合并多发伤救治及预后的影响因素.结果：脑干功能衰竭、严重休克、多器官功能衰竭、严重肺部感染是致死原因.结论：高度重视多发伤的诊治,早期诊断,避免漏诊是抢救成功的基础.迅速、果断、正确处理致命伤是抢救成功的关键.多器官功能衰竭及并发症的防治是降低死亡率的重要环节.     

Financial analysis of an inner city trauma center: charges vs collections

The changes in the economy and in tax rules have caused hospitals to assess the financial viability of different areas within their institutions. While emergency departments generally have become recognized as a cost-effective portal of entry for patients, trauma centers, particularly those located in the inner city, usually are seen as areas of large investment and small financial return. This study looks at a large, inner-city trauma service and the charges, collections, and demographics of the trauma population it serves. For patients admitted to the trauma service, total collections were 77% of charges. There was no difference in collections between those patients with blunt injuries and those with penetrating injuries; violent vs nonviolent injuries; patients transferred in vs primary receivals; or patients transferred out after stabilization vs those retained at the trauma center.     

Outcome analysis of management of liver trauma: A 10-year experience at a trauma center

AIM: To review the outcomes of liver trauma in patients with hepatic injuries only and in patients with associated injuries outside the liver.METHODS: Data of liver trauma patients presented to our center from January 2003 to October 2013 were reviewed. The patients were divided into two groups. Group 1 consisted of patients who had hepatic injuries only. Group 2 consisted of patients who also had associated injuries outside the liver.RESULTS: Seven (30.4%) patients in group 1 and 10 (28.6%) patients in group 2 received non-operative management; the rest underwent operation. Blunt trauma occurred in 82.8% (48/58) of the patients and penetrative trauma in 17.2% (10/58). A higher injury severity score (ISS) was observed in group 2 (median 45 vs 25, P < 0.0001). More patients in group 1 were hemodynamically stable (65.2% vs 37.1%, P = 0.036). Other parameters were comparable between groups. Group 1 had better 30-d survival (91.3% vs 71.4%, P = 0.045). On multivariate analysis using the logistic regression model, ISS was found to be associated with mortality (P = 0.004, hazard ratio = 1.035, 95%CI: 1.011-1.060).CONCLUSION: Liver trauma patients with multiple injuries are relatively unstable on presentation. Despite a higher ISS in group 2, non-operative management was possible for selected patients. Associated injuries outside the liver usually account for morbidity and mortality.     

糖尿病药物治疗的现状

近年来,随着对糖尿病（DM）发病机制的深入研究,众多新型降糖药物获得研发,为DM患者的治疗提供了更多选择。临床医师合理选择降糖药物,能有效控制血糖,减少药物不良反应,降低DM患者并发症的发生。本文系统地综述了DM治疗药物进展,详细介绍了胰岛素分泌促进剂、胰岛素增敏剂、α-葡萄糖苷酶抑制剂、肠促胰岛素及二肽基肽酶Ⅳ抑制剂,以及胰岛素各类药物和新药情况,同时介绍了正在研发的其他降糖药物和治疗糖尿病并发症的药物。     

肝细胞癌介入治疗的现状与展望

肝细胞癌（HCC）是全球最难治疗的恶性肿瘤之一,全球每年约有65万患者死于HCC。虽然其治疗手段繁多,但疗效仍不令人满意。目前,以经导管肝动脉化疗栓塞术（TACE）为代表的介入治疗已成为中晚期肝癌患者的主要治疗手段。介绍了经皮无水酒精注射、射频消融术、局部氩氦冷冻治疗、放射性粒子植入术等局部介入治疗的发展,以及与生物、基因治疗的联合应用,使综合介入治疗成为HCC最主要的非手术治疗模式。指出随着个体化、规范化的综合介入治疗手段的应用和推广,HCC的整体疗效将得到进一步提高。     

Should the emergency IVP be used more selectively in blunt renal trauma?

A retrospective study was performed to determine if the emergency intravenous pyelogram (IVP) is being overused in the evaluation of blunt renal trauma. Medical records of 105 blunt renal trauma patients undergoing IVPs for suspected blunt renal trauma were analyzed. Eighty-eight patients (83.8%) had normal IVPs, and 17 patients (16.2%) had abnormal IVPs. Three of the 105 patients (2.9%) required urologic surgical intervention. The medical records of these patients were examined in detail because it was believed that this patient population needed to be identified by emergency IVP. All three patients requiring urologic surgery had gross hematuria. All three patients had one or more associated injuries. Two of the three patients had flank tenderness and/or flank mass. The third patient was obtunded. From this study and information from the literature an algorithm has been constructed as a guideline for a prospective study. Following this guideline no patients in the study requiring urologic surgical intervention would have been missed. Of patients requiring an emergency IVP, 7.3% would have required urologic surgery. This would have resulted in a savings of $10,432 at our institution.