浅谈如何提高医疗质量

为提高医疗质量，论述以下三点：①强调“以病人为中心”，坚持服务方向、整合优化流程、收集反馈信息；②加强医务人员思想道道修养，在加大教育、监督、管理力度三个方面下功夫；③强化引导管理模式，采取开展质量分析、狠抓环节质控、进行法律法规引导等方法收到较好效果。     

吸入一氧化氮对心瓣膜置换术后肺动脉高压患者血流动力学的影响

目的：观察吸入一氧化氮（ＮＯ）对心瓣膜置换术后肺动脉高压患者血流动力学的影响。方法：选择９例心瓣膜置换术后伴肺动脉高压的病人，吸入ＮＯ０．００３％，观察三个时象点：吸入ＮＯ前；开始吸入ＮＯ后１５分钟；停止吸入ＮＯ后１５分钟。结果：吸入ＮＯ能显著降低肺动脉压和肺循环阻力指数（Ｐ＜０．０１），停止吸入ＮＯ１５分钟后，肺动脉压和肺循环阻力指数恢复到原有水平。在整个观察过程中，心率、平均动脉压、中心静脉压、肺动脉楔压、体循环阻力指数和心脏指数均无显著变化（Ｐ＞０．０５）。结论：吸入ＮＯ具有选择性肺血管扩张作用，是治疗心瓣膜置换术后肺动脉高压的较理想药物。     

脑肿瘤伴发精神障碍─—附36例分析

９８例颅内肿瘤经手术和病理检查证实，其中３６例脑瘤伴精神障碍，最常见的精神症状是情感淡漠，情感不稳，遗忘，意识模糊，嗜睡、痴呆。为最常见的部位为额顶部和颞叶部。     

Pharmacokinetics of intravenously administered sodium dichloroacetate in rabbits

ＰｈａｒｍａｃｏｋｉｎｅｔｉｃｓｏｆｉｎｔｒａｖｅｎｏｕｓｌｙａｄｍｉｎｉｓｔｅｒｅｄｓｏｄｉｕｍｄｉｃｈｌｏｒｏａｃｅｔａｔｅｉｎｒａｂｂｉｔｓＧｕＢｉｎ（顾斌）；ＳｏｎｇＬｉｎｇ（宋岭）；ＪｉａｎｇＹｏｎｇｐｅｉ（蒋永培）；ＷｅｎＡｉｄｏｎｇ（文...     

Influence of lecithin on mitochondrial DNA and age-related hearing loss.

OBJECTIVES: Lecithin is a polyunsaturated phosphatidylcholine (PPC), which are high energy functional and structural elements of all biologic membranes. PPC play a rate-limiting role in the activation of numerous membrane-located enzymes, including superoxide dismutase and glutathione, which are important antioxidants protecting cell membranes from damage by reactive oxygen species (ROS). ROS-induced damage to mitochondrial DNA may lead to reduced mitochondrial function in the cochlea and resultant hearing loss. STUDY DESIGN AND SETTING: The effects of lecithin on aging and age-associated hearing loss were studied in rats by measuring hearing sensitivities using auditory brainstem responses (ABR). In addition, mitochondrial function as a measure of aging was assessed by determining mitochondrial membrane potentials using flow cytometry and by amplifying mitochondrial DNA deletions associated with aging. Harlan-Fischer rats aged 18 to 20 months (n = 14) were divided into 2 groups. The experimental group was supplemented orally for 6 months with lecithin, a purified extract of soybean phospholipid (Nutritional Therapeutics, Allendale, NJ). RESULTS: The data obtained were compared with the control group. ABRs were recorded at 2-month intervals and showed significant preservation of hearing sensitivities in the treated subjects. Flow cytometry revealed significantly higher mitochondrial membrane potentials in the treated subjects, suggesting preserved mitochondrial function. Finally, the common aging mitochondrial DNA deletion (mtDNA(4834)) were amplified from brain and cochlear tissue including stria vascularis and auditory nerve. This specific deletion was found significantly less frequent in all tissues in the treated group compared with the controls. CONCLUSION: These experiments support our hypothesis and provide evidence that lecithin may preserve cochlear mitochondrial function and protect hearing loss associated with aging.     

无心肌梗死冠心病患者心功能变化与室性心律失常的关系

目的：探讨冠心病心力衰竭对各种室性心律失常的影响。方法：选择381例冠心病住院患者，根据心功能分级标准（NYHA）分为4组，检测24h动态心电图（Holter），分析室性心律失常类型及发生率，进行统计分析。结果：各级心功能组其室性心律失常发生率经x^2检验示，室性心律失常的发生率除联律和持续性或非持续性室性心动过速外各组间差异无显著性（P＞0．05）。结论：非心肌梗死冠心病患者室性心律失常发作频率与心力衰竭的程度无关，但联律和持续或非持续性室性心动过速在重度心力衰竭患者发生率增加。     

经阴道超声诊断子宫内膜癌

目的 探讨应用经阴道超声（TVS）诊断绝经前后出血妇女子宫内膜癌的价值。方法 采用彩色多普勒超声诊断仪检测74例阴道异常出血的妇女，其中绝经前28例，绝经后46例，所有患者均取子宫内膜组织行病理对照。结果 TVS检测子宫内膜癌的敏感性、特异性、假阳性率、假阴性率、阳性预测值和阴性预测值，绝经前妇女依次为61．5％，50．0％，14．3％，23．8％，94．1％和54．5％，绝经后妇女依次为97．3％，55．6％，44．4％，2．7％，90．0％和83．0％。结论 TVS检测可作为子宫内膜癌首选的筛查方法，尤其对于绝经后妇女价值更大。     

先天性胆脂瘤的MRI诊断

目的：探讨MRI对先天性胆脂瘤的诊断价值。方珐：回顾性分析7例经手术病理证实的先天性胆脂瘤的MRI表现，7例均为脑外型，其中6例胆脂瘤位于桥小脑角区，l例胆脂瘤位于脊髓内．结果：先天性胆脂瘤的绝大多数MRI表现为T1WI呈低信号,T2WI呈高信号，信号欠均匀，且病灶具有“见缝就钻”的特点。增强扫描，病灶无强化，但如合并感染可有轻度强化。结论：MRI的表现及特殊序列FLAIR、SPIR像的相互补充应用对先天性胆脂瘤的诊断及鉴别诊断具有重要意义。     

推行ISO质量管理体系完善病案管理

探索ISO-9000在医院质量管理中的应用研究,已经形成一大热点.新的<医疗事故处理条例>的出台与实施,对医疗机构的病案管理也提出了更高更严的要求,推行ISO量管理体系,有利于病案管理的规范和完善,减少医疗纠纷的发生.