深化医院改革 提高医疗效率——鼓楼医院缩短平均住院日初探

平均住院日是衡量医院医疗质量与管理水平的综合指标。目的：通过分析鼓楼医院2003～2007年平均住院日等资料,探索医院缩短平均住院日的影响因素和有效途径。结论：我院平均住院日呈下降趋势,术前平均住院日需要进一步缩短;影响平均住院日的因素是多方面的,加强医院管理、发展医疗新技术、改造医疗服务流程是缩短平均住院日的有效措施。     

上海市区与郊区平均住院日差异分析

目的：比较上海中心城区与郊区的平均住院日,分析其差异。方法：收集我院位于市区和郊区两家医院2007年平均住院日的数据,用t检验进行分析。结果：我院市区及郊区两医院间平均住院日有明显差异,市区平均住院日大于郊区（P〈0．001）。结论：城郊两地在平均住院日上有差异,形成这种差异的主要原因是医疗费用的报销,两地居民年龄结构不同和两地居民就医便利性的不同。     

解放军总医院骨科病种质量费用分析

目的：分析解放军总医院骨科病种质量与费用管理效果。方法：按ICD-9六位数类目编码的疾病分类法提取病例，采用单病种医疗质量综合评价系统计算机软件，对单病种医疗质量进行综合评价。结果：计算和统计出骨科病例各型平均住院日和平均费用情况；收容数顺位在前10位疾病的平均住院日、平均药品费用、平均医疗费用情况等。结论：病种病例分型质量费用管理适合于医院当前质量管理的要求，骨科单病种医疗质量处于优良水平。     

4460例初产妇阴道分娩住院日的统计分析

平均住院日是医院质量管理的一个指标 ,影响平均住院日的因素很多。为了了解不同年龄的初产妇阴道分娩对住院日的影响以及分娩过程中阴道切开、裂伤与住院日的关系 ,笔者就我院 1989～ 1998年 10年间 446 0例初产妇分娩住院日进行统计分析。为探索适宜二、三级医院产妇分娩平均住院日标准和开展全面质量管理提供参考依据。1　资料来源与方法1.1　从我院 1989～ 1998年住院阴道分娩的病案中找出初产阴道分娩共 446 0份病案为依据 ,多胎、死胎、早产除外。1.2　把初产妇按年龄分为三个年龄段 ( 2 1岁～、2 6岁～、31～40岁 )。计算平均住院日 …     

从手术室工作看以局部促全局

根据北京市卫生局2007年的统计数据，我院平均住院日为9．8天，而同期三级医院的平均住院日约为15．9天，三级甲等综合医院约为13．9天，在北京地区，目前我院的平均住院日是最低的，这是对我院近年来为合理缩短平均住院日，全院员工辛勤工作的一个总结。     

157例输卵管妊娠患者基于临床路径的护理分析

目的：探讨输卵管妊娠临床路径的护理应用效果。方法：回顾性分析我院试行实施单病种临床路径以来，157例输卵管妊娠患者实施基于临床路径的优质护理，以去年同期214例输卵管妊娠患者作为对照，比较两组健康知识掌握情况，患者满意度、出院后遵嘱随访情况、平均住院日及平均医疗费用。结果：临床路径护理组掌握健康知识情况、患者满意度、出院后遵嘱随访情况、平均住院日及住院费用均与对照组比较有显著性差异（P〈0．05）。结论：临床路径在护理中的应用提高了护理质量。     

加强学科建设 合理缩短平均住院日

目的：平均住院日长是我国医院发展中的重要课题。如何科学合理的缩短平均住院日，已成为民众关注的热点，也是医院管理中的难点。方法：通过分析影响综合医院平均住院日的诸多因素，制定以加强学科建设为手段，量化绩效考核指标，优化临床路径，减少延长住院天数的因素。结果：通过三年的干预措施，首都医科大学宣武医院平均住院天数由2005年的14．56天降至2007年的12．18天。结论：通过提升学科建设的绩效管理水平，可以实现缩短平均住院日的管理目标，同时也可以提高医疗质量，减少医源性并发症的发生，降低患者医疗费用。     

影响结节性甲状腺肿手术患者平均住院日因素初探

目的：通过对可能影响结节性甲状腺肿手术患者平均住院日的因素进行筛选,针对筛选得到的关键因素分析、讨论和总结,为进一步缩短平均住院日工作提供思路和管理办法,从而促进医疗工作的持续改进。方法：采用系统抽样方法抽取我院结节性甲状腺肿手术患者718例,应用单因素分析、多元线性回归分析对影响结节性甲状腺肿手术患者平均住院日的相关因素进行统计分析。结果：结节性甲状腺肿手术患者平均住院日与性别、职业、手术操作类型无关,与年龄、住所地、伴发疾病、确诊天数、待手术天数、术后住院天数和新技术的采用等因素有关,其中,待手术天数对平均住院日的影响最大,其次为术后住院天数。结论：缩短结节性甲状腺肿手术患者平均住院日从缩短待手术天数、术后住院天数着手将会收到较好的效果。     

住院日超长住院病人的现状分析

平均住院日是评价医院工作效率和效益、医疗护理工作质量和技术水平的综合指标,合理缩短平均住院日在一定程度上反映了医院医疗水平的提高。本文主要对2010年1月-2011年5月我院住院日数超长住院病人构成进行分析,探讨其对平均住院日的影响及合理降低平均住院日的相应措施,从而为提高医院的社会效益和整体经济效益提供借鉴。     

318例冠状动脉搭桥手术治疗分析

目的：要文探讨318例冠状动脉搭桥手术的效果及危险因素统计分析。方法：分析518例冠状动脉搭桥长的平均费用与平均住院日相互关系，治愈效果分析以及手术患者搭多少支桥、手水患者年龄与手术死亡率相关因素。结果：本组3l8例搭桥术患者平均住院日影响平均费用的变化，且平均住院日与平均费用呈下降趋势，平均住院日下降，而手术技术大是的提高；高龄患者、搭三支桥以上及术前并发多种疾病患者，手术死亡率高，女性患者比等性患者手术死亡率高。结论：冠状动脉搭桥术的成功率逐年上升，与手术相关的危险因素有年龄、性别及病变程度，减少并点症，从而缩短平均住院日，减少平均费用，早期预防冠心病。     

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.     

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.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.