医院后勤服务社会化实践中的几点思考

就医院后勤服务社会化的实际操作中的几个问题进行了论述,指出实行后勤社会化服务,必须有相应的外部环境;后勤部门实行企业化管理,必须有相配套的政策作保障;实施商品化服务,必须有对等的经济意识;加大后勤服务化的力度,必须有果敢超前的决策意识。     

溶栓及经皮冠脉腔内成形术治疗急性心肌梗死的疗效分析

目的　对比直接冠状动脉腔内成形术 (PTCA)及静脉尿激酶 (UK)溶栓对急性心肌梗死 (AMI)治疗的临床疗效。方法　采用观察性队列研究的方法 ,对 97例AMI患者采用UK溶栓 ,60例AMI患者采用直接PTCA治疗 ,比较两组住院期及随访期的超声心动图 (UCG)和临床结果。结果　住院期间UCG检查室壁运动正常者在PTCA组为 (4 6.0 0 % ) ,高于UK组 (2 4.73 % ) (p =0 .0 2 1) ,矛盾运动发生率PTCA组为 0 ,而UK组为 11.83 %。LVEF在PTCA组为 5 6.88± 10 .47,高于UK组 (5 1.5 8± 10 .97) (p =0 .0 41)。住院期心衰发生率UK组为 3 2 .5 9% ,高于PTCA组 (18.3 3 % ) (p =0 .0 2 9)。随访 13 .3 2± 6.86个月累计心衰发生率UK组为 16.2 8% ,也高于PTCA组 (5 .19% ) (p =0 .0 0 1)。住院期间的病死率UK组为 10 .3 1% ,PTCA组为 5 .0 0 % (p =0 .10 0 )。累计病死率UK组为 15 .5 6% ,明显高于PTCA组 (5 .0 0 % ) (p =0 .0 2 1)。 60岁以上年龄组累计的病死率仍然是UK组 (2 8.99% )高于PTCA组 (10 .3 4% ) (p =0 .0 49)。在随访 3、6、12及 2 4个月时PTCA组的生活质量计分各自为 :5 9.90± 14 .67、74.40± 12 .86、73 .86± 9.70、82 .47± 10 .47均高于同时期UK组的计分 (分别是 5 2 .0 8± 14 .49、65 .0 0± 14 .72、67.0 2     

Contractile properties of in situ perfused skeletal muscles from rats with congestive heart failure

We hypothesized that in congestive heart failure (CHF) slow-twitch but not fast-twitch muscles exhibit decreased fatigue resistance in the sense of accelerated reduction of muscle force during activity. Experiments were carried out on anaesthetized rats 6 weeks after induction of myocardial infarction or a sham operation (Sham). Animals with left ventricular end-diastolic pressure (LVEDP) > 15 mmHg under anaesthesia were selected for the CHF group. There was no muscle atrophy in CHF. Force generation by in situ perfused soleus (Sol) or extensor digitorum longus (EDL) muscles was recorded during stimulation (trains at 5 Hz for 6 s (Sol) or 10 Hz for 1.5 s (EDL) at 10 or 2.5 s intervals, respectively) for 1 h in Sol and 10 min in EDL at 37 °C. Initial force was almost the same in Sol from CHF and Sham rats, but relaxation was slower in CHF. Relaxation times (95–5 % of peak force) were 177 ± 55 and 131 ± 44 ms in CHF and Sham, respectively, following the first stimulation train. After 2 min of stimulation the muscles transiently became slower and maximum relaxation times were 264 ± 71 and 220 ± 45 ms in CHF and Sham, respectively (   P < 0.05  ). After 60 min they recovered to 204 ± 60 and 122 ± 55 ms in CHF and Sham, respectively (   P < 0.05  ). In CHF but not in Sham rats the force of contraction of Sol declined from the second to the sixtieth minute to 70 % of peak force. The EDL of both CHF and Sham fatigued to 24–28 % of initial force, but no differences in contractility pattern were detected. Thus, slow-twitch muscle is severely affected in CHF by slower than normal relaxation and significantly reduced fatigue resistance, which may explain the sensation of both muscle stiffness and fatigue in CHF patients.     

驼背二种截骨术远期效果对比

作者对６３２例强直性脊柱炎并驼背畸形施行二种脊柱截骨矫治术，对其中１３５例病人进行了６～１０年观察，结果表明：７１例椎弓椎体联合截骨效果较好，驼背复发平均３．２°。而６４例椎板截骨效果略差，驼背平均复发１３．５°。经统计学处理，两者对比有显著的统计学意义（ｐ＜０．０１）。作者认为病变未完全静止，截骨术式的选择，术中身体重心前移未彻底纠正，以及外固定时间过短等是影响远期效果的因素。     

Tissue characterization of symptomatic and asymptomatic disc herniations by quantitative magnetic resonance imaging

The purpose of this investigation was to determine differences in tissue composition of symptomatic and asymptomatic disc herniations as reflected in T₁ and T₂ relaxation times (quantitative magnetic resonance investigation of the lumber spine. The longitudinal and transverse magnetic rlaxation times (T₁ and T₂, respectively) were calculated from a set of 20 images obtained with five single-slice/multi-echo sequences at different repetition time values on a commercial whole-body system (1.5 T). Twenty-two symptomatic and asymptomatic disc herniations could be matched according to age, gender, disc level, and the extent of herniation (protrusion or extrusion) and were compared with regard to T₁ and T₂ relaxation times. Symptomatic disc herniations exhibited significantly (p_T1 < 0.04 and p_T2 < 0.003) shorter T₁(ΔT₁:–182.1 milliseconds, ?15%) and T₂(ΔT₂: ?11.0 milliseconds, ?21%) relaxation times than matched asymptomatic herniations. Symptomatic disc herniations also exhibited more advanced disc degeneration as graded by Pearce's criteria (p < 0.01). These results suggest that symptomatic and morphologically matched asymptomatic disc herniations differ with regard to disc matrix composition.     

病案质量整体管理的做法

病案质量是衡量临床工作质量的重要标志。目前，因重效益轻质量、重科研轻临床现象突出，致病案质量有所下降。因此，应加强病案质量整体管理，建立医院、科室、个人三级病案质量控制体系；以病案内涵质量为核心内容，制定完善科学的病案质量评价标准；加强岗前培训，抓人员素质的提高；强化病案过程质量管理和终末质量管理，重视病案质量信息反馈作用。     

医院融资经营提高资本利用质量

着重从资本运作中最主要的手段——融资,去剖析医院以融资方式实现医疗规模迅速扩张的全过程。介绍了经营租赁与融资租赁及其优缺点,并附案例加以说明。     

干部门诊就诊质量的影响因素与对策

对900例干部门诊中的就诊患者进行问卷调查分析,探讨干部门诊就诊质量的各种影响因素,提出干预措施,在提高患者就诊质量的前提下节省卫生资源.     

静脉肾盂造影病人肠道准备中的整体护理

目的观察静脉肾盂造影术（IVP）前行肠道准备病人实施整体护理和常规健康指导的临床效果。方法对96例IVP术前行肠道准备病人进行随机分组，观察组（48例）实施整体护理，对照组（48例）进行常规健康指导。结果两组肠道准备效果比较，差异有显著性（P〈0．05）；观察组病人满意度（93．8％）与对照组（72．9％）比较，差异有显著性（P〈0．05）。结论开展“以病人为中心”的整体护理，可以明显提高护理质量，增加病人满意度。