分级诊疗背景下基层医疗卫生机构基本医疗服务绩效考核指标体系探讨

目的 在分级诊疗的背景下,尝试建立一套客观、合理的基层医疗卫生机构基本医疗服务绩效考核指标体系,为政府的监管考核提供参考。方法 在查阅相关卫生政策和大量文献的基础上,采用两轮德尔菲专家咨询法、界值法确定绩效考核指标,利用专家打分法和乘积法确定指标权重,形成基层医疗卫生机构基本医疗服务绩效考核指标体系。结果 构建了一套基层医疗卫生机构基本医疗服务绩效考核指标体系。一级指标3个,分别为医疗服务数量与效率、医疗服务质量与安全、医疗费用,其权重为0.328 1、0.344 3、0.327 7,二级指标21个。结论 客观、合理的绩效考核指标体系有利于激发基层医疗卫生机构医务人员的积极性,提升医疗服务能力,切实推进分级诊疗,最终达到提高人民健康水平的目的。     

处理眼轮匝肌后脂肪对上睑臃肿重睑术的效果

目的探讨眼轮匝肌后脂肪(ROOF)的处理在上睑臃肿重睑术的作用。方法 2018年1月至2020年1月, 解放军联勤保障部队第940医院烧伤整形科对76例(年龄18～58岁, 平均26岁)上睑臃肿单睑女性患者进行PARK法重睑术, 术中先由外向内、内窄外宽呈椭圆形剪除部分ROOF脂肪, 再适度去除部分外侧的眶隔内脂肪;若有肥厚的眼轮匝肌与睑板前脂肪影响重睑形成时, 可适当去除。结果术后随访7 d至24个月, 5例泪腺脱垂者泪腺复位较好无复发, 4例上睑下垂矫正后角膜暴露率正常, 外形自然;除2例重睑变浅外, 74例患者上睑臃肿均明显改善, 恢复期均较短, 重睑外形美观、弧度流畅, 瘢痕轻微, 手术效果满意。结论根据上睑臃肿患者导致上睑臃肿的原因综合处理, 依次适度去除各处眶脂肪与肥厚的眼轮匝肌, 才能取得较好的效果。     

TLC-SERS技术体系构建及应用研究

目的 构建薄层色谱与表面增强拉曼光谱联用(TLC-SERS)技术支持及应用体系,实现技术优化升级和转化推广,应用于非法添加实践工作.方法 将薄曼联用仪升级为薄曼一体机,升级μtrait系统非法添加模块,建设拉曼光谱云计算数据中心.结果 建成拉曼光谱云计算数据中心,完成μtrait系统非法添加模块优化,完成薄曼一体机实验...     

褥疮的临床分型与整形外科治疗

目的：探讨褥疮的临床分型与治疗。方法：分析总结１９９０－０１～１９９９－１２间收治的４６例６３处褥疮患者的临床资料。结果：根据创面特点将褥疮分为窦道型和溃疡型,前者采用局部皮瓣,后者采用带血管蒂（肌）皮瓣移位修复,效果满意。结论：褥疮的临床分型有利于治疗方式的选择。     

双Endobutton钢板解剖重建喙锁韧带治疗Neer Ⅱ型锁骨远端骨折

目的:探讨双Endobuaon钢板解剖重建喙锁韧带治疗Neer Ⅱ型锁骨远端骨折的手术方法,并评价其疗效.方法:采用双Endobutton钢板解剖重建斜方韧带及锥形韧带、缝线环扎或拉力螺钉固定骨折端治疗Neer Ⅱ型锁骨远端骨折12例,观察骨折愈合时间,并应用ASES评分和Constant-Murley评分评估肩关节功...     

中医基础理论教学中几个概念的完善与修正

中医理论教学的水平高低,对学生以后是否能真正学成中医,成为一名合格的中医医生起着关键的作用。纵观近十数年中医院校培养的中医学生,其中能真正继承发扬中医学的,可谓寥若星辰。究其原因,根源之一在中医基础理论教学上。目前在教学中存在的两大问题:一是教学中忽视引导学生理解古代语言的表述与现代语言表述的差异;二是教材编写中,对几个中医学入门的关键名词上存在着概念模糊和逻辑混乱。对“整体观念”、“阴阳”、“精”、“气”、“神”、“病”、“证”等概念提出自己的修改意见。     

不同人群载脂蛋白E基因频率分布特征

目的 :研究江苏地区汉族人群载脂蛋白E(ApoE)基因型及等位基因频率 ,并与国内外不同人群比较分布特征。方法 :聚合酶链反应 -限制性片段长度多态性 (PCR -RFLP)方法检测 16 8例江苏地区无血缘关系汉族人群ApoE基因型。计算各基因型及等位基因频率。结果 :江苏地区汉族人群载脂蛋白E各基因型频率分别为 :ε2 / 2 =0 .6 0 % ;ε2 / 3 =11.90 % ;ε2 / 4 =1.2 0 % ;ε3 / 4 =10 .70 % ;ε3 / 3 =75 .0 0 % ;ε4 / 4 =0 .6 0 % ;各等位基因频率分别为 :ε2 =7.14% ;ε3 =86 .31% ;ε4 =6 .5 5 %。频率分布在不同年龄、性别无显著差异。与其他地区中国人群频率分布相似。中国人群ε3 等位基因频率明显高于欧美人群 ,而ε4等位基因频率明显低于欧美人群。结论 :江苏地区汉族人群载脂蛋白E等位基因频率分布与其他地区中国人群频率分布相似 ,但与欧美人群有显著差异。     

补肾活血饮对帕金森病模型小鼠脑组织一氧化氮及α-肿瘤坏死因子、γ-干扰素的影响

目的探讨补肾活血饮对帕金森病模型小鼠脑组织中NO及细胞因子α-肿瘤坏死因子(TNF-α)、γ-干扰素(IFN-γ)的影响。方法 45只C57BL/6小鼠随机分为生理盐水正常组、1-甲基-4-苯基-1,2,3,6四氢吡啶(MPTP)模型组和补肾活血饮中药组,用分光光度法和ELISA法分别检测各组小鼠脑组织NO及细胞因子TNF-α、IFN-γ含量。结果模型组NO含量为(5.93±0.79)μmol/g protein,高于正常组(P<0.01)和中药组(P<0.01)。模型组TNF-α、IFN-γ含量分别为(0.36±0.11)ng/L和(0.83±0.25)ng/L,高于正常组(P<0.001)和中药组(P<0.01)。中药组和正常组NO及TNF-α、IFN-γ含量比较均无显著性差异(P>0.05)。结论补肾活血饮治疗帕金森病的疗效机制可能与其能降低NO及TNF-α、IFN-γ含量有关。     

双歧杆菌四联活菌片治疗肝硬化自发性细菌性腹膜炎的临床疗效

目的:探讨使用微生态调节剂双歧杆菌四联活菌片治疗肝硬化自发性细菌性腹膜炎的效果。方法:将我院2009年8月～2011年10月收治的肝硬化自发性细菌性腹膜炎患者70例随机分为两组,对照组患者35例给予一般治疗,实验组患者35例给予双歧杆菌四联活菌片治疗,比较两组患者的治疗效果。结果:实验组患者菌球数明显降低,C反应蛋白降低,血浆内毒素和降钙素原也低于对照组患者,各指标比较差异明显,P<0.05。结论:使用微生态调节剂双歧杆菌四联活菌片治疗肝硬化自发性细菌性腹膜炎的效果较好,可以更快地改善患者的炎性症状。     

联合应用缺血后处理、远隔缺血后处理和纳洛酮后处理对大鼠脑缺血-再灌注损伤的影响

Objective To assess the effects of ischemic postconditioning, remote ischemic postconditioning and naloxone postconditioning on focal cerebral ischemia-reperfusion injury in rats.Methods A total of 110 adult SD rats were randomly divided into 5 groups (n =22 each). The focal cerebral ischemia-reperfusion injury was induced by a 90-minute occlusion of right middle cerebral artery (MCA) and a 24-hour reperfusion sequentially. Group 1 was of ischemia-reperfusion control; Group 2 ischemic postconditioning induced by three 30-second cycles of MCA occlusion followed by a 30-second reperfusion; Group 3 remote ischemic postconditioning performed via a transient occlusion of right femoralartery at 5 min before the initiatlon of reperfusion:Group 4 naloxone posteonditioning with naloxone 10 mg/kg intraperitoneaUy injected at the initiation of reperfusion;Group 5 combined ischemic,remote ischernic & naloxone postconditioning performed simultaneously in accordance with the methods used in Groups 2,3 & 4.The neumlogie deftcit scores(NDS)were obtained at 2 h & 24 h post-reperfusion.At 24 h post-reperfusion.the anesthetized rat was sacrificed by decapitation and the brain rapidly extracted to asseSS the size ofcerebral infaret(n=10),detect the cerebral expression of microtubule-associated protein2(MAP2)(n=6),measure the plasma volume of cerebral tissues and quantify the diameter and segment artery at 5 min before the initiation of reperfusion; Group 4 naloxone postconditioning with naloxone 10 mg/kg intraperitoneally injected at the initiation of reperfusion; Group 5 combined ischemic, remote ischemic & naloxone postconditioning performed simultaneously in accordance with the methods used in Groups 2, 3 & 4. The neurologic deficit scores ( NDS) were obtained at 2 h & 24 h post-reperfusion. At 24 h post-reperfusion, the anesthetized rat was sacrificed by decapitation and the brain rapidly extracted to assess the size of cerebral infarct (n = 10), detect the cerebral expression of microtubule-associated protein2 ( MAP2) (n =6) , measure the plasma volume of cerebral tissues and quantify the diameter and segment length of cerebral microvessel (n = 6 ). Results There were no significant differences in the heart rate (HR) and mean arterial pressure (MAP) among the above five groups at all observed time points (P ＞ 0. 05). At 24 h post-reperfusion, the percentage of ischemic cerebral infarct size was 43% ±6% , 31% ±4% , 32% ±5% , 28% ±6% & 21% ±7% in ipsilateral hemisphere area (i. e. , cerebral infarct severity)in Groups 1-5 respectively. Compared with Group 1, the levels of NDS and cerebral infarct severity significantly decreased at ischemic side in Groups 2-5 ( P ＜ 0. 05 ). And the cerebral expression of MAP2,plasma volume of cerebral tissues, diameter and segment length of cerebral microvessel significantly increased at the ischemic side (all P＜0. 05). However, there were no significant differences in the abovementioned parameters at ischemic side among Groups 2, 3 and 4 (all P ＞0. 05). The parameters of NDS,cerebral infarct severity, cerebral expression of MAP2 and plasma volume of cerebral tissues in the ischemic side significantly increased in Group 5 compared with Groups 1,2,3 and 4 (all P ＜ 0. 05). The diameter and segment length of cerebral microvessel at ischemic side were not different among Groups 2,3,4 and 5 (all P＞0. 05). Conclusion In focal cerebral ischemia-reperfusion rats, ischemic, remote ischemic and naloxone postconditioning may produce significant neuroprotective effects of reduced cerebral infarct severity and improved neurologic dysfunctions. A combination of three postconditioning approaches enhances the above neuroprotective effects.