护士长竞争上岗--护理工作的催化剂

我院是一家三级甲等综合医院 ,设有病床 86 5张 ,30个护理单元 ,4 32名护理人员。 2 0 0 1年医院人事制度改革 ,全院所有的护理管理岗位全部实行竞争上岗。经过近 2a的试行 ,护理工作呈良性运转 ,护理人员持积极支持态度。1　增强了护士长的危机感和责任感我院竞聘护士长实行任期目标责任制管理 ,任期为 3a,1a试用期。同时 ,本着自愿报名的原则 ,竞岗者普遍表现出对所竞岗位的热爱 ,变革了沿袭已久的“要我干”为“我要干” ,从而充分调动了护士长工作的积极性 ,使其责任感增加。 2 0 0 2年 ,我院争创三级甲等综合医院的过程中 ,她们爱岗敬…     

终末期肝病模型评分在原发性肝癌合并肝硬化脾功能亢进外科治疗中的作用

目的 探讨终末期肝病模型(MELD)评分评估肝储备功能在原发性肝癌合并肝硬化脾功能亢进中确定手术适应证的应用价值.方法 对2001年1月至2007年1月间行肝癌切除联合脾切除(联合术)治疗的40例原发性肝癌合并肝硬化脾功能亢进患者的临床资料进行回顾性分析.通过MELD评分与Child-Pugh分级比较,结合临床资料及术后并发症分析,确定这一方法在评估肝储备功能中的作用.结果 同一Child-Pugh分级的患者MELD评分结果并不一致,在各级别间有交错现象.术后发生肝功能衰竭组(6例)的MELD评分均值为(24.6±6.6).未发生肝功能衰竭组(34例)的MELD评分均值为(16.3±8.5),差异有统计学意义(P<0.05).根据MELD评分分为A组16例(MELD评分<10),B组17例(MELD评分10-20),C组7例(MELD评分>20).A组术后肝功能衰竭发生率为0,B组为11.8%(2/17),C组为57.1%(4/7),差异有统计学意义(P<0.05).根据Child-Pugh分级分为Ⅰ级26例,Ⅱ级14例.Ⅰ级术后肝功能衰竭发生率为15.4%(4/26),Ⅱ级为14.3%(2/14),差异无统计学意义(P>0.05).结论 MELD评分能够较为客观地反映肝储备功能,对外科术式的选择、手术时机的确定有一定的参考作用.     

体外不同比例再生肝细胞与结肠癌细胞的共培养

Objective To investigate the proliferation potential of colon cancer cells co-cultured with different proportions regenerating hepatocytes and role of the cell growth factors related to liver regeneration in vitro.Methods Active regenerating hepatocytes were obtained by collagenase perfusion in situ of rats models underwent 70% liver resection after 24 hours.Co-cultures with different proportions of hepatocytes to human colon cell line SW480 were performed respectively.The proportion of hepatocytes to human colon cell line SW480 Was 10:1 in group A,1:1 in group B.There was only human colon cell line SW480 in group C(control group).Proliferation capacity was assessed with the percentage by 3H-thy incorporation.Concentration of epidermal growth factor(EGF),insulin-like growth factor-1(IGF-1)and hepatocyte growth factor(HGF)was analyzed by ELISA.Results There was no significant difference among the 3 groups in 3H-thy incorporation percentage,and concentration of EGF,IGF-land HGF after 24 hours' culture(P>0.05).3H-thy incorporation percentage(15.9±1.4,13.2±1.5),and concerntration of EGF [(722.9±55.4)ng/L,(498.2+41.5)ng/L]and IGF-1[(755.2±35.7)ng/L,(538.1±37.5)ng/L]in Group A and B were higher than that in group C after 72 hours(P<0.05).Especially the indexes above in group A were higher than that in group B(P<0.05).there was no significant difference in concerntration of HGF among the 3 groups after 72 hours(P>O.05).Conclusions These results imply that the regenerating hepatocytes contribute to the hyperproliferative state of co-culturing colon cancer cells.The mechanism maybe have relationship with EGF and IGF-1 high expression in colon cancer cells caused by growth signals coming from hepatocytes.     

体外不同比例再生肝细胞与结肠癌细胞的共培养

Objective To investigate the proliferation potential of colon cancer cells co-cultured with different proportions regenerating hepatocytes and role of the cell growth factors related to liver regeneration in vitro.Methods Active regenerating hepatocytes were obtained by collagenase perfusion in situ of rats models underwent 70% liver resection after 24 hours.Co-cultures with different proportions of hepatocytes to human colon cell line SW480 were performed respectively.The proportion of hepatocytes to human colon cell line SW480 Was 10:1 in group A,1:1 in group B.There was only human colon cell line SW480 in group C(control group).Proliferation capacity was assessed with the percentage by 3H-thy incorporation.Concentration of epidermal growth factor(EGF),insulin-like growth factor-1(IGF-1)and hepatocyte growth factor(HGF)was analyzed by ELISA.Results There was no significant difference among the 3 groups in 3H-thy incorporation percentage,and concentration of EGF,IGF-land HGF after 24 hours' culture(P>0.05).3H-thy incorporation percentage(15.9±1.4,13.2±1.5),and concerntration of EGF [(722.9±55.4)ng/L,(498.2+41.5)ng/L]and IGF-1[(755.2±35.7)ng/L,(538.1±37.5)ng/L]in Group A and B were higher than that in group C after 72 hours(P<0.05).Especially the indexes above in group A were higher than that in group B(P<0.05).there was no significant difference in concerntration of HGF among the 3 groups after 72 hours(P>O.05).Conclusions These results imply that the regenerating hepatocytes contribute to the hyperproliferative state of co-culturing colon cancer cells.The mechanism maybe have relationship with EGF and IGF-1 high expression in colon cancer cells caused by growth signals coming from hepatocytes.     

24例胃大部切除术中损伤邻近器官的原因及对策

目的：分析胃大部切除术中邻近器官损伤的原因,提出防范措施和处理方法。方法：回顾分析24例胃大部切除术中邻近器官损伤的病例。结果：发现损伤的发生与溃疡病变严重、局部变形粘连解剖关系改变以及术操作不够规范、细致有关。结论：应重视胃大部切除术的基本要求和基本操作训练,熟悉解剖,从而避免或减少胃大部切除术中医源性损伤的发生。     

全膝关节置换术后持续被动运动的临床应用研究

目的　评价全膝关节置换术后持续被动运动（ＣＰＭ）的临床应用价值。方法将１９例患者共２４个全膝置换关节随 机分成两组。ＣＰＭ治疗组１４个膝关节于术后第３天开始治疗。非ＣＰＭ治疗组１０个膝关节作为对照。结果两周后 ＣＰＭ治疗组膝关节主动屈曲度平均达到９４．６２度,比对照组大２３．３７度。结论　全膝关节置换术后ＣＰＭ治疗,可使膝关 节屈伸功能明显提高。     

论知识经济时代的预防医学信息服务

知识经济的兴起与发展对预防医学信息服务已产生巨大影响,因此预防医学信息服务工作者应更新观念,根据预防医学信息的内在特征,完善预防医学信息服务体系,做好规范化、标准化工作.预防医学信息服务主要通过活动中各类信息的收集、处理,使之成为有效信息,并应用于预防医学科研和管理.     

FRAX评估类风湿关节炎患者骨折风险及相关临床危险因素的研究

目的运用FRAX探究中国RA患者骨折风险及相关临床危险因素。方法纳入52例RA、47例p SS以及41例体检健康者分别为RA组、p SS组、对照组,RA组患者检测ACPA、RF、ESR、CRP并计算DAS28-ESR、HAQ-DI,所有纳入者以双能X线吸收测定法测定骨密度并通过FRAX官方网站预估10年骨折风险。所有统计分析采用SPSS统计软件。结果 FRAX相关骨折危险因素包括身高、吸烟、饮酒、既往骨折、父母骨折,在3组间差异未见统计学意义。RA组糖皮质激素累积服用天数高于p SS组(P0.05)。通过FRAX无论是否结合骨密度评估,RA组主要骨质疏松性骨折风险及髋关节骨折风险均较对照组高(P0.01),主要骨质疏松性骨折风险亦较p SS组高(P0.05或P0.01)。通过FRAX结合骨密度评估,从年龄、糖皮质激素、绝经方面分析,RA组主要骨质疏松性骨折及髋关节骨折风险均较对照组高(P0.05或P0.01)。通过FRAX结合BMD评估RA组10年主要骨质疏松性骨折风险发生率分为低危、中危、高危组,ACPA、RF、ESR、CRP、DAS28-ESR、HAQ-DI在三组中均值呈上升趋势,差异均有统计学意义(P0.01)。结论 RA患者骨折风险评估可结合FRAX与骨密度;长期、大量服用糖皮质激素以及高龄、绝经后女性RA患者更应重视骨折风险评估;有效控制RA疾病活动度、改善关节功能情况有助于骨质疏松性骨折的预防。     

膝关节的粘弹特性

对6例人体膝关节标本进行研究以了解其两种不同的粘弹特性:蠕变和应力松弛现象。 首先,施加恒定的瞬时载荷于有或无半月板的膝关节,整个测试过程膝关节保持完全伸直。结果发现,在压缩载荷作用下,蠕变逐渐增加,但无论有否半月板,两者之间无显著差异。测试5分钟的蠕变与通过Maxwell体VoiRt体模型推导出的值完全一致。 其次,在上述测试基础上,保持瞬时蠕变10分钟。虽然膝关节的蠕变保持恒定,但由于软骨的应力松弛现象,股骨髁与胫骨平台之间的力随时间推移而下降,力下降的程度取决于施加的载荷和持续时间。在2牛顿和100牛顿时,力的下降分别为46％和58％。这些值显著大于蠕变测试,结果的估计值。同时,在施加载荷后和实验结束时以压力传感器测定胫股间接触压力。接触压下降区与区之间各不相同,特别是无半月板的膝关节,结果表明,无论有无半月板,膝关节均有良好的蠕变顺应性,而且,应力松弛的局部差异很大。     

胃肠道功能紊乱与胃动素关系的实验研究

目的 探讨胃动素（MTL）与胃肠道功能紊乱发生的关系。方法 用放射免疫分析方法（RIA）检测胃肠道功能紊乱模型大鼠体液及组织中MTL的含量,并用四君子汤反证。结果 与正常对照组相比,胃肠道功能紊乱模型大鼠在制摸过程的早期（第6d),血浆、肠液、空肠及下丘脑组织中MTL含量增加（P＜0．05）,而晚期（第14d)MTL含量下降（P＜0．05）。经四君子汤预防和治疗的胃肠道功能紊乱模型大鼠,MTL水平得到明显改善,明显优于自然恢复大鼠（P＜0．05）。结论 体液及组织中MTL含量异常是胃肠道功能紊乱发生的重要因素之一。