基于医院全局管理的临床研究型MDT模式实施与体会

多学科诊疗(Multi-disciplinary team,MDT)模式适应当前医学发展和医学模式转变的需要,已成为国内各级公立医院重点关注并积极探索践行的医疗服务模式。介绍了上海交通大学医学院附属第九人民医院临床研究型MDT的组织和实施过程,对其实施成果进行总结分析,并从医院全局管理角度对如何有效落实和发展MDT进行思考,为今后国内其他公立医院有效推进多学科协作诊疗模式的规范化和常态化提供参考。     

脊柱原发性肿瘤的X线分析(附18例报告)

发生于脊柱的肿瘤少见.转移癌占半数以上.现将我院近期收治的18例发生于脊柱的原发性肿瘤分析报导如下:     

热应激对内毒素血症小鼠的影响

目的 探讨热应激和内毒素（ET）对小鼠的影响。方法 从体内和体外试验观察了热应激和内毒素联合作用下小鼠直肠温度、死亡率、诸脏器组织硫代巴比妥酸反应物（TBARs)及血管壁通透性的变化。结果 热应激使ET血症小鼠肛温升高，促进小鼠死亡，并使诸脏器组织的TBARs及血管壁的通透性升高，光镜观察其损伤加重。正常小鼠肝匀浆在高温条件下培养，其TBARs亦显著增加。结论 热应激能加重ET血症小鼠的损伤。     

石蜡油治疗粘连性肠梗阻52例临床观察

目的探讨石蜡油治疗粘连性肠梗阻的疗效方法观察52例粘连性肠梗阻患者应用石蜡油治疗后效果结果治愈37例占71.15%,显效6例占11.54%,好转4例占7.69%,无效5例占9.62%结论石蜡油降低粘连性肠梗阻患者再手术率,提高非手术疗法的治愈率。     

染铅小鼠海马不饱和脂肪酸含量研究

Objective To study possible impairment mechanisms of learning and memory abilities from unsaturated fatty acids in hippocampus of mice exposed to lead.Methods Forty-eight healthy mice were divided into 4 groups:low dose(0.625 g/L),middle dose(1.250 g/L) and high dose(2.500 g/L) of lead solution in diet and control group (distilled water).The mice in treatment groups were fed with lead solution every day while the mice in control group were fed with distilled water for 50 days.After learning and memory abilities were measured,the mice were killed and contents of oleic acid (C 18:1),linoleic acid (C 18:2),linolenic acid (C18:3),arachidonic acid (AA,C20:4),eicosapentaenoic acid (EPA,C20:5) and docosabexaenoie acid (DHA,C22:6) in hippocampus of mice were determined by high performance liquid chromatography (HPLC).Results (1) In the four training days,the mice treated with lead in the middle dose group and high dose group significantly increased the escape latencies compared with the mice treated with distilled water (P＜0.05) ,and on the 4th day,the low dosage mice' s escape latencies were delayed (P＜O.05).The escape latencies of the I st,2nd,3rd and 4th day had significantly positive linear relation with lead dose.Their relative coefficient in turn is r=0.973,0.985,0.929 and 0.936,indicating that lead harmed spatial memory of mice in Morris water maze (MWM).(2)The contents of C18:2 and AA were obviously enhanced in hippocampus of middle and high dosage (P＜0.05);while there was evident decrease in the contents of C 18:3,EPA and DHA (P＜0.05);the content of C 18:1 was decreased significantly in high dosage group (P＜0.01).The mice's escape latencies had significantly negative linear relation with contents of C 18:1,C 18:3,EPA and DHA,while there was positive linear relation significantly with contents of C18:2 and AA.Their relative coefficient in turn was r=-0.901,-0.914,-0.893,-0.855,0.936,0.727.Conclusion Lead interferes with the metabolism of hippocampus fatty acids and affects membrane function in hippocampus of mice,which might contribute to change of the synthesis,metabolism and release of central neurotransmitter and decrease of the learning and memory abilities.     

甲状腺手术方式和喉返神经损伤的关系

目的探讨甲状腺手术方式和喉返神经损伤（RLN）的关系。方法回顾性分析2009年1月至2012年6月期间于笔者所在医院科室接受开放性甲状腺手术的985例患者的临床资料,探讨甲状腺手术方式和RLN损伤的关系。结果本组患者术后发生RLN损伤26例（2.6%）,未发生RLN损伤959例（97.4%）。logistic回归分析结果显示,年龄、性别、超声刀应用、麻醉方式及肿块良恶性与RLN损伤均无关（P〉0.05）,而手术范围（OR=3.726,P=0.007）和显露RLN（OR=0.302,P=0.006）则是RLN损伤的影响因素,行扩大性手术及未显露RLN者的RLN损伤率较高。结论在开放性甲状腺手术中,手术范围以及显露RLN是RLN损伤的独立影响因素,术中显露并注意保护RLN,对避免RLN损伤具有重要意义。     

美托洛尔缓释片、螺内酯片及盐酸贝那普利片联合治疗慢性心力衰竭的临床研究

目的探究美托洛尔缓释片、螺内酯片及盐酸贝那普利片联合治疗慢性心力衰竭的效果。方法采用临床对照研究设计,研究期限为2017年4月至2019年7月,研究对象源自我院心血管内科62例慢性心力衰竭患者。根据治疗方法不同分为观察组(30例)和对照组(32例),对照组采用常规治疗,观察组加用美托洛尔缓释片、螺内酯片及盐酸贝那普利片联合.治疗。治疗6个月,观.察两组临床疗效、心.功能(LVMI、CI、SV、LVEF、CO)、炎性指标(BNP、CRP)、不良反应。结果治疗6个月,观察组总有.效率(9333%)高于对照组(6875%),差异显著(P<005)。.心功能指标中,观察组LVMI低于对照组,但CI、.SV、LVEF、CO则高于对照组,差异显著(P<005)。炎性指标中,观察组BNP、CRP水平低于对照组(P<005)。两组并发症总发生率比较无显著差异(P>005)。结论美托洛尔缓释片、螺内酯片及盐酸贝那普利片联合治疗慢性心力衰竭患者疗效较好,可有效改善心功能,降低炎性反应,且未新增不良反应。     

血清TSH浓度与结节性甲状腺肿合并甲状腺癌关系的研究

目的探讨术前血清促甲状腺素(TSH)浓度与结节性甲状腺肿合并甲状腺癌的相关性。方法回顾性分析632例结节性甲状腺肿患者的TSH浓度与合并甲状腺癌间的关系。根据TSH值不同,将患者分成5组进行统计分析。结果结节性甲状腺肿合并甲状腺癌患者血清TSH浓度为(2.10±1.38)mU/L,较未合并者的(1.51±0.98)mU/L高(P<0.000 1);随着血清TSH浓度的升高,合并甲状腺癌比率升高(P=0.023 5),TSH0.3～0.9 mU/L组为9.91%、0.9～1.7 mU/L组为12.37%、1.7～4.8 mU/L组为20.09%、>4.8 mU/L组为27.27%。肿瘤直径<2 cm组、2～4 cm组和>4 cm组比较,直径较大的TSH浓度更高(P=0.018 6)。TNM分期T3～T4期患者TSH浓度高于T1～T2期患者(P=0.030 6)。结论术前血清TSH浓度可能是预测结节性甲状腺肿合并甲状腺癌风险的一个指标。     

普林格尔仪联合手法按摩治疗产后乳汁淤积疗效观察

[目的]观察普林格尔仪联合手法按摩乳房对产妇乳汁淤积的治疗效果.[方法]将148例乳汁淤积产妇随机分为两组,观察组采用普林格尔仪联合手法按摩乳房后人工挤奶;对照组按传统的局部热敷按摩后行人工挤奶.观察并比较两组病人乳腺管疏通情况.[结果]观察组疗效明显优于对照组,差异有统计学意义(P＜0.01).[结论]用普林格尔仪联合手法按摩治疗产后乳汁淤积效果优于传统的局部热敷按摩.