中山市农村社区慢性病患者综合管理效果的初步分析

目的探索农村社区慢性病(主要指糖尿病、高血压)患者综合管理的有效模式。方法选择已经确诊的糖尿病、高血压患者40例,进行强化综合管理,包括个体化的健康教育,量化饮食治疗,量化运动治疗,指导合理用药等。观察连续综合管理3个月后病情控制情况。结果强化管理后和管理前比较舒张压平均下降了7 mm Hg,空腹血糖平均为下降了1.28 mmol/L。结论以糖尿病、高血压病为代表的慢性病患者综合管理效果显著。     

多金属氧酸盐抗艾滋病病毒活性研究进展

本文主要总结了近些年来多金属氧酸盐在抗艾滋病病毒（HIV）方面的研究情况；比较分析了不同多金属氧酸盐的结构及其抗病毒效果的差异；简要介绍了抗HIV的作用机制及预测未来的发展方向。     

自体外周血干细胞移植治疗老年人慢性下肢缺血临床研究

目的:评价外周血干细胞移植治疗老年人慢性下肢缺血的临床疗效。方法:应用自体外周血干细胞移植治疗慢性下肢缺血10例,其中下肢动脉硬化闭塞症4例,糖尿病足3例,血管闭塞性脉管炎3例。患肢12条中左5条,右7条。均予G-CSF 300μg/d皮下注射,连用4～6天行外周血干细胞动员,当外周血白细胞计数>30×109/L时,用血细胞分离机单采干细胞,配成干细胞悬液。部分干细胞悬液直接注射至患肢肌肉内,其余干细胞悬液经球囊导管技术灌注至患肢末梢动脉内。结果:患肢疼痛和冷感觉改善率为100%。间歇性跛行3例行走距离明显增加。移植后1个月,5例7条下肢数字减影血管造影结果示均有新生侧支血管形成。结论:外周血干细胞移植治疗慢性下肢缺血安全、简单、有效。     

Is there a place for otorhinolaryngology in primary care? Analysis of different areas

Otolaryngological disorders do have a high incidence, and prevalence and require specific physical examinations amongst general population. As a result, it is believed that it would be efficient to have otorhinolaryngologists within the primary care system. The main aim of this study was to assess the differences in hospital referrals comparing primary care units with and without ENT specialists. The study was carried out in Osona County (Catalonia, Spain). We studied the referrals to the hospital from two different primary care units, one with otorhinolaryngology services and the other without them. We analysed the morbidity, follow up and demographic variables of first visits in the hospital ENT department referred by these two primary care units. The primary care organisation without ENT specialist tends to refer more patients (3.96 first visits more per 1000 inhabitants a year, CI 95% 2.84-5.09) with ENT problems than the primary care one with ENT specialist. The difference is mainly due to an higher number of referrals that do not require hospital treatment (i.e. acute otitis, patients without an ENT clear diagnosis). In the area with ENT specialist, GP's also tend to refer patients directly to the hospital, hampering the organisation efficiency. The referrral pattern of GPs from the two organisations is quite similar, and they refer a high percentage of patients that do not need ENT hospital care. The study shows that ENT specialists in primary care units refer less patients with ENT disorders that can be successfully diagnosed and treated outside the hospital.     

Is troponin I useful for predicting in-hospital risk for unstable angina patients in a community hospital? Results of a prospective study

INTRODUCTION AND OBJECTIVES: Before including troponin I detection in the daily practice of our hospital we performed a prospective study to determine its real usefulness and to establish the best cut-off point. METHODS: We studied 82 consecutive patients admitted with unstable angina to a community hospital. Troponin I was determined (> 10 h after chest pain). Patients were referred to a tertiary hospital for catheterization/revascularization if clinical events developed. RESULTS: Twenty-five patients (31%) suffered events during admission: recurrent angina in 23 cases (28%); heart failure in 5 (6%); exitus in 3 (4%); myocardial infarction in 1 (1%). The cut-off point for troponin I that best predicted events was 0.1 ng/ml. Patients with troponin I > 0.1 (34 patients, 42%) experienced more events [47 vs. 19%; OR = 3.8 (1.4-10.4); p = 0.01] and had higher rates of recurrent angina (42 vs. 19%), heart failure (12 vs. 2%) and exitus (9 vs 0%). Patients with ECG changes and troponin I > 0.1 showed a significantly higher percentage of events (63%) than those with ECG changes alone (23%) or troponin I > 0.1 alone (15%) or those without ECG changes and troponin I < 0.1 (17%) (p < 0.0001). CONCLUSIONS: Troponin I elevation is useful for predicting in-hospital risk for unstable angina patients admitted to a community hospital. A low cut-off value (0.1 ng/ml) predicts events. The association of ECG changes and high troponin I identifies a population at very high risk; however, the absence of both variables in patients with a diagnosis of unstable angina does not preclude the development of events.     

全国社区卫生服务现状调查——影响社区居民选择就诊机构的因素分析

目的了解居民选择医疗服务机构的影响因素。方法对社区卫生服务机构及医院的就诊者进行问卷调查。结果社区就诊疾病多为常见病、慢性病的长期治疗,医院就诊疾病除急、重病外,常见病、多发病也占有较大比例;居民选择社区就诊的主要原因是离家近、看病方便和服务态度好,选择医院的主要原因是技术好;多次就诊者主要选择社区卫生服务机构;医院就诊者的首选就诊机构多为大中型医院,他们中有30%不知道社区卫生服务。结论影响居民选择机构的主要原因是技术水平。社区卫生服务的基本功能得到一定程度的发挥,但“小病进社区,大病进医院”的模式尚未形成,应加强宣传教育,扩大社区卫生服务群体,努力构建社区与医院相结合的城市医疗卫生服务体系。     

医院抗菌药物应用的管理与控制

为防止抗菌药物的滥用,本院建立健全了合理应用抗菌药物的管理组织和管理制度;加强了对医务人员合理使用抗菌药物的知识培训;制定了抗菌药物的使用原则;严把购药关,有计划地更新换代药物品种;对全院抗菌药物的使用认真督察,把督查结果以多种形式向全院各科室反馈,并对滥用抗菌药物的科室和个人进行经济处罚,使抗菌药物的滥用得到有效控制。本文对本院采取的管理与控制措施进行介绍。     

纤维蛋白原对肝移植术后患者凝血功能的影响

目的观察纤维蛋白原对肝移植术后患者凝血功能的影响。方法将26例肝移植患者分成治疗组与对照组,治疗组术中、术后间断应用纤维蛋白原,而对照组只在术中使用;分别于新肝灌注0.5h,术后24.0h及72.0h采静脉血检测两组患者凝血酶原时间(PT),纤维蛋白原(Fib)和激活的部分凝血活酶时间(APTT)。结果行肝移植术后伴有低纤维蛋白原血症且PT、APTT延长的患者,应用纤维蛋白原能够使PT、APTT时间缩短,与对照组间差别有显著性意义(P<0.05)。结论肝移植患者术后在补充血浆、血小板、凝血酶的同时,补充纤维蛋白原有利于改善肝移植术后凝血功能的异常。     

晚期非小细胞肺癌的化放疗序贯治疗

目的探讨吉西他滨联合顺铂治疗晚期非小细胞肺癌3周方案并序贯化放疗的疗效和不良反应。方法经病理和细胞学证实的晚期非小细胞肺癌患者，既往未进行化疗和放疗，临床上有可测量病灶（根据WHO标准），美国东部肿瘤协作组（ECOG）评分为0—2分，肝、肾功能基本正常。均给予吉西他滨和顺铂的联合化疗并序贯化放疗方案治疗。按照WHO的标准评价疗效和不良反应，并随访生存期。结果共入组43例患者，其中39例可评价疗效：19例（48．72％）部分缓解、13例（33．33％）病情稳定和7例（17．95％）疾病进展。生存期为3．7—21．4个月，中位生存期为10．1个月。主要的不良反应为血液毒性，表现为白细胞、中性粒细胞、血小板和血红蛋白下降；其次为消化道症状。结论吉西他滨联合顺铂治疗晚期非小细胞肺癌3周方案并序贯化放疗是晚期非小细胞肺癌的标准一线化疗方案之一，患者可较好耐受。