MRI用于立体定向放射治疗定位的精确性分析

目的：研究MRI用于立体定向放射治疗（SRT）定位时误差的大小，明确MRI能否单独用于SRT定位。方法：模拟对病人的扫描方法，对特制体模进行固定和MRI扫描。在治疗计划系统上，测量x、y、z3个方向靶点距离，并将结果与实际距离做比较，差别的绝对值即为该定位系统的误差。结果：相邻点x方向，误差0.2～1.4mm，平均0．9mm；y方向误差0.5～1.5mm，平均0．9mm。相对点x方向，误差0.3～1．7mm，平均0.9mm；y方向，误差0.4～1．8mm，平均0．9mm。各标记层面之间误差无显著性差别（P〉0．05）。z方向误差0．3～1.9mm，平均1．0mm。结论：本研究采用的立体定向定位系统和MRI扫描方法，用MRI进行影像采集制定SRT计划，对多数颅内和头颈部肿瘤的定位精度符合临床要求，但在将MRI进行SRT定位扫描时，必须作全面的检查和验证。     

厂矿企业实施职工健康促进的现状研究——关于企业职工健康促进干预方案的建议

目的对在昆明市厂矿企业实施职业健康促进提出针对性建议。方法综合分析昆明市20个厂矿企业的1432名职工进行健康促进现况调查的结果。结果开展职业健康促进,提高职工整体健康水平必须采取综合干预措施,包括(1)加强领导,加强社区行动;(2)制定健康的公共政策,强化考核;(3)采取多种形式,提高职工自我保健技能;(4)创造支持性环境,维护职工身体健康。结论完善的企业健康促进方案有利于提高职工的健康水平,并可以为今后健康教育的实施、监测和效果评价奠定基础。     

综合性医院患者常见心理障碍的诊断与治疗

心理障碍（Psychologicdisorder），一般指非精神病性心理障碍。疾病所致心理反应国外资料估计21％-26％的内科门诊病人患有精神障碍，慢性躯体疾病患伴发精神障碍患病率为25％；国内资料显示综合医院住院病人中精神疾病发生率为20-70％。其中抑郁性障碍、器官性脑病综合征和焦虑性障碍占其中的70％-80％。慢性躯体疾病患的终生患病率达到42％（多为物质滥用，情感或焦虑性疾病），无慢性躯体疾病患为33．4％，33％-60％的短程普通外科机构的病人有明显的心理社会因素和精神障碍。但大多数医务人员在学校和继续教育中都没有机会接受精神卫生知识和技能的培训，对心理行为问题的识别和处理能力较低，甚至延误诊治，而造成医疗资源的浪费。     

A retrospective study of fluid therapy for 100 patients of liver transplantation

Objective: To review the evolution of fluid therapy (IOFT) during liver transplantation (LTX) based on clinical experience in our institute over 7 years. Methods: All patient records (n = 130) of LTX from 1996 to 2003 were examined. After excluding patients with co-morbidities 100 cases were found suitable for IOFT analysis. All patients had undergone LTX and follow-up under the same surgical team. Based on IOFT records we tried to identify distinct patterns of practice evolving over 7 years. Intraoperalive hemodynamics (IOHD) and long-term outcome records were examined. Results: Retrospectively, 3 types of IOFT were found. Group A (n= 18, period 1996-1997) received high amounts of crystalloids; group B (n= 24, period 1998-2000) received high amounts of plasma and albumin; and group C (n = 58, period 2001-2003) received lower amounts of albumin and plasma and recommended amounts of 6% hy-droxyethyl starch 200/0. 5 (HES) and high amounts of vasoprcssors. Intraoperatively, group A exhibited the highest levels of central venous and pulmonary artery pressures in the neo-hepatic stage (P<0. 05). Postoperatively, the patients in group C had the shortest time to extubation; the values for group A,B,C were (15.8±11), (17. 3±10. 2) and (7. 98±3. 2) h respectively( P<0. 05). At the end of one-year follow-up, the patients in group C had the lowest mortality (group A, B, C were 27. 78%, 29. 17% and 6. 25% respectively; P<0. 05). Conclusion: In our institute over the years the use of crystalloids, albumin and plasma during IOFT of LTX is gradually replaced to a large extent by HES. The improvements in IOHD and long term outcomes are likely to be related to improved surgical experience of our team. Nevertheless, the shift in IOFT practices might be associated with an beneficial effect on IOHD or long term outcome. Treatment with proper amount of liquid and vasoactive drugs may be a better method of fluid therapy.     

医学激光设备的应用及选购

激光在医学中的应用非常广泛,根据医用激光仪的特点,介绍了在采购医用激光设备时应考虑的几个问题.     

生物安全三级实验室负压控制系统探究

生物安全三级实验室负压控制必须解决气流组织问题、实验室内各房间的压力梯度问题以及压力稳定性问题.本文从问题入手,提出科学合理的解决方法,为生物安全三级实验室负压控制的设计提供了理论依据;从节能的角度,建议在生物安全实验室内使用全热交换器来更好的节能.     

探讨医疗设备引资(合资)风险管理体系建设

从现代风险管理角度，结合医院医疗设备引资（合资）管理实际，发现存在4类风险。探讨了建立医疗设备引资（合资）风险管理体系。包括风险管理流程、风险管理机制、风险规避措施和风险分析方法等方面，以便度时识别、降低和化解存在的风险。