新型冠状病毒肺炎疫情下心血管内科疫情防控管理研究

目的探讨新型冠状病毒肺炎疫情下心血管内科疫情防控管理措施,为心血管内科的传染病疫情防控工作提供参考。方法针对新型冠状病毒肺炎突发事件,成立心血管内科疫情防控专项工作管理小组,制订疫情防控标准工作流程,加强心血管内科/监护病房人员管理,开展专项培训,严格消毒管理,加强防控督导等。结果共排查发热患者47例,各级人员100%落实疫情防控标准工作流程,护士理论和技能考核成绩优秀,医护人员及患者零感染。结论制订心血管内科疫情防控工作管理流程实施统筹管理、动态调配、防控兼顾、专项培训,有效提高和保证了新型冠状病毒肺炎疫情下心血管内科工作的高效运转。     

新型冠状病毒肺炎流行期间综合医院发热门诊管理实践

发热门诊是防控急性传染病期间专门用于排查疑似传染病患者、治疗发热患者所启动的预防预警机制。为了积极配合做好新型冠状病毒肺炎疫情防控工作,本院迅速完善发热门诊管理,规范医务人员个人防护,严格患者筛查管理,避免交叉感染,确保医患安全,遏制新型冠状病毒在院内传播。本文从发热门诊的布局、医务人员管理及工作制度和工作流程管理等方面阐述了新型冠状病毒肺炎流行期间发热门诊的管理现状。     

发热门诊新型冠状病毒感染预检分诊与疫情防控策略

目的探讨发热门诊新型冠状病毒感染预检分诊和疫情防控策略,进一步做好新型冠状病毒肺炎定点医院疫情防控和救治工作。方法以2020年1月20日—2月24日在我院发热门诊接受就诊患者和实施诊疗医务人员作为研究对象,构建基于应对新型冠状病毒感染疫情的一站式发热门诊,实施标准化预检分诊流程和疫情防控策略,回顾性分析和评价疫情期间发热门诊诊疗情况和管理效果。结果预检分诊台接受就诊患者共22 382例,其中经发热门诊就诊患者共1 314例,有湖北地区相关接触史患者共94例,接受进一步住院隔离治疗患者共52例,经发热门诊筛查后最终在感染科确诊新型冠状病毒肺炎病例共3例,期间预检分诊和发热门诊在岗医务人员共48名。所有患者均得到妥善诊治,未发生患者漏诊、患者和医务人员发生交叉感染现象及候诊、分诊和转诊期间医疗护理不良事件。进行感控督查共432人次,每周感控总体正确率由最初的93.60%提高到99.20%。结论科学构建应对新型冠状病毒感染的一站式发热门诊,实施标准化预检分诊流程和疫情防控策略,有利于尽早筛查出疑似病例和感染病例,做好早发现、早报告、早隔离、早治疗,避免交叉感染,有助于推动疫情防控和救治工作的顺利开展。     

新型冠状病毒肺炎疫情期间基层医院发热门诊护理管理实践

本文主要介绍了新型冠状病毒肺炎疫情防控期间基层医院发热门诊的建设和管理,包括就诊流程、人员调配、防控措施、人文关怀、人员培训等,以期为进一步完善新型冠状病毒肺炎疫情期间基层医院发热门诊的工作流程提供参考。     

新型冠状病毒肺炎疫情期间发热门诊护理管理体会

本文总结新型冠状病毒肺炎疫情期间发热门诊的护理管理体会。疫情防控期间发热门诊应做到:合理布局发热门诊;完善发热门诊工作和感控的制度及流程;加强人力资源管理;严格落实护理及相关人员培训;加强发热门诊的信息化管理;提供强有力的后勤保障。科学有效的护理管理能有效控制新型冠状病毒肺炎在医院内的传播,同时提高护理人员对新型冠状病毒肺炎疫情的应对能力,保障护理安全。     

应对新冠肺炎疫情中发热门诊设计的感染防控思路

正发热门诊是当前应对新型冠状病毒肺炎(新冠肺炎)疫情中实现"早发现、早报告、早隔离、早治疗"的基础条件和哨点,国家各级卫生行政管理部门都陆续发布了发热门诊相应的管理要求和建设标准。为帮助基层医疗机构落实发热门诊建设和管理的具体要求,本文梳理了2003年"非典"疫情以来,以及新冠肺炎疫情期间我国发布的发热门诊相关规范性文件和标准,提出发热门诊设计中的具体实施建议和方法。     

非定点收治新型冠状病毒肺炎医院建立发热门诊与隔离病房的应对策略

[目的]探讨非定点收治新型冠状病毒肺炎医院建立发热门诊与隔离病房的应对策略。[方法]医院应对新型冠状病毒肺炎暴发期间总体部署感染防控,通过对防控部门进行选址、布局,组建护理人力资源应急储备库与应急梯队,对护理人员采用多维度防控知识培训及考核,完善全院的疫情防控管理,加强后勤保障工作等一系列严密的防控措施健全医院防控体系。[结果]经过一系列有效的临床防控实施,在疫情防控工作方面取得了一定的成效,有效地控制了传染源、切断传播途径,防止疫情扩散蔓延,确保了医护人员和病人的安全。截至目前实现了医院内零感染,无医护人员与病人发生感染,防止了社区疫情扩散。[结论]医院在防治新型冠状病毒肺炎的特殊时期,医院领导精准施策、统一部署,通过早规划、早布置、早防控,实行全员培训,确保整个防控体系科学有序高效地进行,在传染病疫情暴发期间防止医院内感染效果明显。     

血液科新型冠状病毒肺炎疫情应急防控实践

本文主要介绍了新型冠状病毒肺炎疫情防控期间血液科在预防新型冠状病毒肺感染的应急防控策略,包括成立负责疫情期病区管理及人员调配的应急管理小组,加强病房消毒管理,建立特殊时期应急管理程序及患者分流方案等,以期通过合理有效的防控策略,提高病区对新型冠状病毒肺炎疫情的防控能力,从而保证患者的治疗工作得到有序开展。     

应对新冠肺炎疫情中发热门诊设计的感控思路

正发热门诊是当前应对新型冠状病毒肺炎(以下简称"新冠肺炎")疫情中实现"早发现、早报告、早隔离、早治疗"的基础条件和哨点,国家、省市管理部门和相关专业机构都陆续发布了发热门诊相应的管理要求和建设标准。为帮助基层医疗机构落实发热门诊建设和管理的具体要求,本文梳理了2003年"非典"疫情以来、新冠肺炎疫情期间我国发布的发热门诊相关规范性文件和标准,提出发热门诊设计中的具体实施建议和方法。     

精神病专科医院应对新型冠状病毒肺炎的防控策略

本文总结了精神病专科医院应对新型冠状病毒肺炎的防控策略,包括门诊防控、发热患者的检查、病房防控、人员培训、清洁消毒工作、病区宣传教育、物资管理等方面,为医院应对突发疫情的组织管理提供参考。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.