中医药治疗颈椎病心得

<正>颈椎病是颈椎及其周围软组织的退行性改变,致使神经、血管、脊髓等受损所产生的一系列临床症候群,属中医痹证、眩晕、颈筋急等病证范畴,是一种床常见病、多发病,好发于中老年人。近年来本     

天津市医德量化考核的研究与实施

天津市卫生局对医德考核量化办法进行了研究,制定了考核标准,建立了考核组织,确定了考核时间与方法,并制定了道德奖惩规定。此项考核办法已付诸实施。     

粘液退行性变所致的主动脉瓣病变──附5例报告

本文对５例经病理学检查证实为粘液退行性变所致的主动脉瓣病变病人，进行瓣膜形态学及临床分析发现：（１）肉眼见瓣膜多变薄、脱垂，也可有增厚与钙化，同时可引起主动脉窦病变。（２）粘液退行性主动脉瓣病变应与风湿性主动脉瓣病变进行鉴别，而单纯主动脉瓣关闭不全病变，应想到粘液退行性变之可能。（３）对粘液变性所致的主动脉瓣返流，外科治疗应替换主动脉瓣，以防止退行性瓣膜病变的进一步发展。     

软组织恶性纤维组织细胞瘤的治疗(附12例报告)

发生于软组织的恶性纤维组织细胞瘤１２例，平均年龄６１．９岁，平均随访２９个月。本病与发生在骨组织的恶性纤维组织细胞瘤不同，病理学还可分为席纹样－多形性型、粘液样型、巨细胞型、黄色肉芽肿型。本病局部广泛切除可以得到较好的治疗，综合治疗特别放疗及化疗药物的应用，对减少复发，治疗转移有一定的疗效。     

论质控管理在紧急医疗救援中的作用

随着社会经济的快速发展,人民物质及文化水平的提高,人们对紧急医疗救援和日常急救医疗服务质量的需求就越高.急救中心如何满足百姓的需求,如何质控考核职工为院前急救病人提供文明、优质、快捷、满意的医疗服务是本文研究探讨的课题.院前急救是集通讯、医疗、转送为一体,以维持病人生命、减轻病人痛苦、防止病人病情加重,为院内急救创造条件为目的的医疗急救服务体系.建立和完善运转有效的紧急医疗救援质控管理考核机制,对提高院前急救医疗服务质量,避免医疗不良事件的发生至关重要.笔者从工作实践中对紧急医疗救援全程医疗服务质量进行了质控考核的探讨已取得了初步成效.     

我国八个大中城市院前急救流行病学调查分析

Objective To investigate the epidemiological information of patients in pre-hospital medical care for our large and medium-sized cities and probe the patients' characteristic. Method The data in 2008 were exported from the computer databases of 8 large and medium-sized cities' emergency medical centers in our country.The thorough records of data were conducted to statistical analysis. Results ( 1 ) The scheduling time, running time, rescue time, returning time, total time and service radius in the pre-hospital medical care group were 2.16± 1.10(min), 14.01 ±6.82(min), 12.12±5.96(min), 14.08± 6.85(min), 42.34± 20.21(min)and 8.50±4.18(km), and the above parameter in the non-death group were 2.19 ± 1.13(min), 14.15 ± 7.14(min),11.60±6.72(min), 14.92 ±6.89(min), 41.86± 19.53(minutes) and 8.63±4.31(Km), and the above parameter in the death group were 2.10± 1.08(min), 13.68 ± 7.14(min), 25.25 ± 12.34(min), 13.75±6.48(min), 54.74 ± 25.47(min) and 7.86± 3.91(Km), and the above parameter in the non-sudden cardiac death group were2.09± 1.03(min), 13.58±6.78(min), 25.53± 12.34(min), 13.60± 6.54(min), 53.79±23.77(min) and 7.67 ± 3.86(Km), and the above parameter in the sudden cardiac death group were 2.12 ±1.02(min), 14.10±7.05(min), 24.79± 12.08(min), 13.79±6.61(min), 54. 80 ± 25. 36( min) and 7.90±3.92(Km) respectively. The scheduling time, running time, returning time and service radius in the death group were less than those of the non-death group, but the rescue time and total time of the former were more than those of the latter respectively ( P ＜ 0.05 or P ＜ 0. 001 ). The scheduling time and returning time didn' t have significant difference between the sudden cardiac death group and the non-sudden cardiac death group respectively ( P ＞ 0.05), but the running time, total time and service radius of the sudden cardiac death group were more than those of the non-sudden cardiac death group, and the rescue time of the former was less than that of the latter respectively ( P ＜ 0.05 or P ＜ 0.001 ). (2)The patients' amount in pre-hospital medical care group, the non-death group, the death group, the non-sudden cardiac death group and the sudden cardiac death group were at most in first quarter, and the least time slice of patients' amount were 4:00～ 6:00, 4:00～6:00, 4:00～ 6:00, 22:00～ 24:00, 2:00～4:00 respectively, and the most time slice of patients' amount were 20:00～ 22:00, 20:00～22:00, 8:00～ 10:00, 2:00 ～ 4:00, 8:00 ～ 10:00 respectively. (3)In 241 876 cases of pre-hospital medical care group, the patients' amount of trauma was at most, whose age grades was by far among21 ～50, and the others in sequence were nervous system, circulatory system, other group, digestive system, respiratory system and poisoning group respectively, whose age grades in nervous system, circulatory system and respiratory system was by far above 51, especially above 70. The patients' age grades in other group and digestive system had two climax age groups, which the one was 21 ～ 30, and the other was above 70. The patients' age grades in poisoning group was by far among 21 ～ 50, which the patients' amount of acute alcoholism was at the most. (4) In 12 568 cases of death group, the death amount of circulatory system, other group, respiratory system, nervous system and digestive system ranked at the lst,2nd,4th,5th 8th respectively, whose age grades was by far above 51, especially above 70,and the patients' amount of sudden cardiac death was at the most in the death amount of circulatory system. The death amount of trauma and poisoning group ranked at the 3rd, 6th respectively, whose age grades was by far among 21 ～ 50. (5)The total amount, the death amount and the sudden cardiac death amount of male patients were more than those of female patients. (6)The percentage of the death group to the pre-hospital medical care group was 5.20%, and the percentage of the sudden cardiac death group to the pre-hospital medical care group was 1.29%,and the percentage of the sudden cardiac death group to the death group was 24.87 %, and the percentage of the sudden cardiac death group to the circulatory system group was 67.33 %. Conclusions ( 1 )The trauma and the sudden cardiac death are the overriding reason of disease and the overriding reason of death in our large and medium-sized cities respectively. (2) It is very important to cut the death rate of the middle-old age patients by strengthening prevention and cure of cardiovascular and cerebrovascular diseases, discerning the critical illness early and improving the level of pre-hospital medical care. (3)It is a strong method to decrease the total amount and the death amount of the trauma, especially in traffic accident, by strengthening safety in production, observing traffic regulation and enhancing the legal awareness.     

我国大中城市院前心脏性猝死流行病学调查分析

目的调查我国大中城市院前心脏性猝死患者流行病学情况,探讨院前心脏性猝死病例特点。方法从我国8个大中城市急救中心系统数据库中导出2008年度全部死亡数据,就其有完整记录的资料进行统计分析。结果①院前心脏性猝死的调度时间、到达时间、现场时间、返回时间、总时间、急救半径分别为（2．12±1．02）min、（14．10±7．05）min、（24．79±12．08）min、（13．79±6．61）min、（54．80±25．36）min、7．90±3．92（km）;②院前心脏性猝死的病例数以第一季度为最多,且最多时间段是8：00～10：00,最少时间段是2：00～4：00;③男性院前心脏性猝死明显多于女性,但年龄明显小于女性;④院前心脏性猝死目击者CPR为4．48％,医护人员现场CPR成功率2．26％。结论①心脏性猝死已成为我国大中城市最常见的院前死亡原因;②加强心血管病防治,提高中老年患者的常见急危重症早期识别与院前急救水平以及普及公众CPR对降低死亡有重要意义。     

突发120急救通讯线路中断5小时14分紧急处置后的启示

天津市急救中心承担天津市1100万人口的院外急救、突发公共事件现场抢救及安全转运的任务。天津市急救中心120通讯是院外急救,突发公共卫生事件医疗救援的生命中枢。突发120通讯线路中断,后果难以预测。本文总结天津急救中心罕见的通讯中枢长时间不能发布120指令的恶性事件的经验教训,警示次生。现报告如下。     

抑肽酶抑制体外循环及心肌缺血再灌注过程中炎性因子ET-1、IL-8的释放

 目的 研究抑肽酶在体外循环及心肌缺血再灌注过程中对炎性因子冠状窦血清中内皮素-1(ET-1)、白介素-8(IL-8)释放的抑制作用。方法 健康幼牛12头,随机分成对照组及抑肽酶组,模拟临床低温体外循环手术,冷晶体灌注心脏停跳,采用放免法测定两组周围动脉及ET-1、IL-8浓度,并进行对比。结果 开放后抑肽酶组ET-1及IL-8浓度显著低于对照组(P＜0.05)。开放60min时抑肽酶组ET-1浓度与开放30 min相比已开始下降(P＜0.05),而对照组无明显下降(P＞0.05)。开放60min时抑肽酶组IL-8浓度与开放30min相比无继续升高的趋势(P＞0.05),而对照组仍继续升高(P＜0.05)。结论抑肽酶可以显著抑制体外循环及心肌缺血再灌注过程中炎性因子ET-1、IL-8的释放。     

三金排石汤治疗泌尿系结石36例

<正>2005年开始,笔者自拟三金排石汤加减治疗泌尿系结石36例,取得满意疗效,现报道如下:1一般资料36例均为本院门诊患者,男性20例,女性16例;年龄17～70岁,平均(41±3.4)岁;肾结石11例,输尿管结石15例,肾、输尿管均有