分析急诊分诊安全管理模式对急诊护理的影响

目的：分析急诊分诊安全管理模式对急诊护理的影响。方法：分别应用传统管理模式与急诊分诊安全管理模式对急诊护理工作进行管理，对比分析两种管理模式下的护理质量评分、护患纠纷发生率以及护理满意度。结果：传统管理模式下的护理质量评分、护患纠纷发生率以及护理满意度分别为（80．3±5．6）分、9．0％、88．0％，急诊分诊安全管理模式下的护理质量评分、护患纠纷发生率、护理满意度分别为（95．9±4．2）分、2．0％、97．0％，对比各组差异显著（P ＜0．05）。结论：急诊分诊安全管理模式在急诊护理中具有较高的应用价值，可提升急诊护理质量与护理满意度，降低护患纠纷发生率，值得推广。     

心理护理管理在夜查房中的应用

目的探讨心理护理的管理在夜查房中的作用及效果。方法将心理护理的管理应用于2007年夜查房中，以2006年夜查房作对照，对夜查房的缺陷发生率、患者满意率等进行对照分析。结果夜查房缺陷发生率由2006年的33．45％T降至2007年的7．64％，p〈0．01（u=12．415），患者及家属的满意率由90．2％提高至98．69％，护士对夜查房制度的赞成比由68．36％提高至95．78％，p〈0．01（u=3．704）。结论心理护理管理有利于提高患者满意率以及晚夜班的工作效率和质量。     

“输液安全登记单”在急诊输液流程管理中的应用

目的通过改进和加强急诊输液过程管理的方法,确保输液安全。方法针对急诊输液过程中的风险因素,设计制作“输液安全登记单”,并应用于急诊输液整个过程的监管,从规章制度上完善安全措施。结果应用该表1年。输液缺陷发生率从4．32‰降至0．88‰（P〈0．01）,病人输液满意度从92．2％提高到98．8％（P〈0．01）,急诊输液质量差异有统计学意义。结论“输液安全登记单”的应用,使操作流程更加合理,并强化了急诊输液的全程监管,大大降低了护理差错的发生率,有力促进了急诊护理质量的提升。     

抓护理风险管理 促进护理安全

目的：为了提供安全有序的优质服务，提高护士的安全防范意识，降低护理风险的发生率。方法：健全护理风险管理制度，严格执行护理操作规程，强化安全防范意识和服务理念，提高护士专业理论知识和操作技能水平。结果：住院病人满意率保持在98％以上，护理差错发生率由0．21％下降至0．04％。结论：实施有效的护理风险管理，对预防护理安全隐患的发生，减少护理纠纷起到重要的作用。     

手术室中风险因素的评估和手术室护理安全管理

目的通过对手术室风险因素的评估,加强手术室护理安全管理,从而控制及减少手术室风险的发生。方法通过对照2009年间（2009组）实行风险管理前完成各类手术3020例及2010年间（2010组）实行风险管理后完成手术3024例,比较两组手术的投诉纠纷率、差错发生率和患者满意度。结果通过对手术室护理安全管理后,2010组患者投诉纠纷率1起／年、差错发生率2起／年均显著低于2009组7起／年、6起／年（P〈0．05）,2010组患者满意度98．5％显著高于2009组88．0％（P〈0．05）。结论通过充分的风险因素评估,加强护理安全管理,可以有效地减少差错事故的发生,提高护理服务质量。     

护理安全事项分析报告单的设计与应用

目的：设计并探讨护理安全事项分析报告单的应用效果。方法：运用预见性风险管理原理和非惩罚性不良事件报告制,科学设计护理安全事项分析报告单并应用。护理质量管理委员会每月对本月的安全隐患和不良事件按回顾性管理模式根本原因分析进行分析,总结经验,提出整改意见。结果：护理部能及时掌握全院护理工作质量,及时发现安全隐患。护理安全事件上报率由0．98％提高到2％;不良事件上报率由0．22％提高到0．47％;护士对护理管理工作的满意度由73．8％上升至90．9％,比较差异均具有统计学意义（P〈O．05）。结论：护理安全事项分析报告单的应用保障患者安全和提高护理质量,提高护士对管理工作的满意度。     

风险管理在产科护理管理中的应用

目的探讨产科护理风险管理模式及其临床应用价值。方法对风险管理前与执行风险管理后的护理质量比较,评估护理工作加强风险管理的价值。结果护理综合评分由95．2％上升至97．8％,病人满意度由91．0％上升至97．0％,一般差错由5起降至2起。无护理投诉发生。结论在产科实施风险管理,能有效预防和减少护理风险的发生,为病人提供更加安全、有序、优质的护理服务。     

护理纠纷的风险因素分析及其规避措施的探讨

目的探讨护理纠纷的风险因素及其规避措施。方法对2005-2006年全院各科的护理安全月报表的数据进行统计，并对45081例（21509例和23572例）住院患者中发生的护理纠纷55例（0．12％）进行调查核实，详细分析原因，采取有效护理对策。结果护理纠纷发生率由2005年的0．16％下降到2006年的0．08％，p〈0．01（u=243．066），差异有高度显著性意义；护士不同护理工作年限引发的护理纠纷发生率亦有高度显著差异p〈0．01。结论认真分析引发护理纠纷的风险因素，制定相应的护理风险应急预案，健全护理风险管理组织，切实落实好护理风险管理制度与措施，规范护理行为，监督制度落实，对减少医疗护理纠纷的发生、保障护理安全、提高护理质量有所裨益。     

风险管理在急诊护理管理中的应用

目的:为强化急诊护理风险管理,降低护理风险的发生率,为患者提供优质、安全的护理。方法:健全、完善护理风险管理制度,强化安全和护士素质教育,提高护理安全认识,加强业务素质培训,提高护理工作质量,规范仪器设施的应用和管理。结果:护理缺陷发生率、护理投诉下降,患者及家属满意率、急救物品完好率及护理质量在风险管理前后比较差别均有统计学意义(P<0.05)。结论:实施急诊护理风险管理,对预防护理安全隐患,提高护理质量起到重要作用。     

无痛人流安全管理与护理风险的探讨

目的：探讨无痛人流的安全管理与护理风险。方法：抽选加强护理管理前、后无痛人流手术患者各50例，对无痛人流患者护理过程出现的问题进行统计、总结并分析，并对护理服务工作进行加强管理，对加强管理前后两组患者的护理满意度、护理纠纷发生率及术后并发症发生率进行对比。结果：加强护理服务管理后，患者对护理服务工作满意度由加强前的72．0％提升至96．0％，护理纠纷发生率由加强前的14．0％降低至2．0％，术后并发症发生率由加强前的18．0％降低至6．0％，加强管理前后各项数据比较（ P＜0．05）。结论：加强安全管理，了解护理风险出现原因并针对性应对，能有效提高护理质量，减少护理风险的发生。     

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.