全科医师医院感染相关知识及技能培养模式的探讨

目的探讨全科医师医院感染相关知识及技能培养模式的改革与创新,以期降低社区感染率。方法选取医院实习的全科医师作为研究对象,以2010年7月-2011年1月实习的189名全科医师为对照组,以2011年7月-2012年1月实习的195名全科医师作为观察组;对照组采取传统方式进行带教与培训,观察组采取自行设计符合卫生部全科医师培训要求的培养模式进行社区带教管理;对比两组考核结果,评估培养新模式的优劣并提出改进方法。结果对照组189名医师的综合实习成绩评定合格162名,合格率为80.4%,观察组195名医师合格183名,合格率为93.8%,组间比较差异有统计学意义(P<0.05);观察组全科医师实习后医院感染相关知识和技能得分分别为(92.1±7.5)分和(90.3±9.4)分,对照组分别为(84.4±9.3)分和(81.1±11.9)分;两组比较差异均有统计学意义(P<0.05);观察组全科医师对各项满意度调查其满意度均明显高于对照组(P<0.05)。结论采取自行设计符合卫生部全科医师培训要求的培养模式进行社区带教管理,全科医师考核成绩明显得到提高。     

153钐-乙二胺四甲基膦酸联合治疗肺癌骨转移骨痛的疗效观察

目的 探讨153钐-乙二胺四甲基膦酸(153 Sm-EDTMP)核素加伊班膦酸钠(艾本)治疗肺癌骨转移骨痛的疗效.方法 100例肺癌骨转移患者随机分为153Sm-EDTMP加伊班膦酸钠静脉滴注52例(治疗组)、单用153Sm-EDTMP核素治疗组48例(对照组),比较两组止痛效果、活动能力、生活质量改善、溶骨病灶的修复及毒副作用.结果 治疗组疼痛总缓解率为94.2％,明显高于对照组的64.5％(x2=4.78,P＜0.05);治疗组活动能力改善状况的总有效率为82.6％,明显高于对照组的64.5％(x2=4.13,P＜0.05);治疗组生活质量改善状况的总有效率为84.6％,明显高于对照的62.5％(x2 =4.58,P＜0.05);两组毒副作用差异无统计学意义(x2=0.345,P＞0.05).结论 153Sm-EDTMP联合治疗肺癌骨转移,具有止痛、改善活动能力、提高生治质量的疗效.     

~(131)I不同剂量法治疗甲亢疗效对比

Objective To compare clinical efficacy of ~(131)I treatment for hyperthyroidism between fixed dose and calculated dose methods.Methods One hundred and forty eight patients with hyperthyroidism were randomly allocated fixed dose and calculated dose groups.Follow up was done 6months post therapy,serum free triiodothyronine(FT_3),free thyroxin(FT_4)and thyroid stimulating hormone(TSH)were measured and following clinical outcome was monitored.Results The occurrence of hypothyroidism 6 months after ~(131)I treatment in fixed dose and calcuhted dose groups was 31.1% and 28.4%respectively.There was no distinct difference between them(χ~2=0.742,P=0.528).The cure rate was 93.3%and 85.2% respectively.There was no distinct difference between them(χ~2=0.958,P=0.403).A good correlation was between clinical efficacy and thyroid mass(F=13.639,P=0.000).There was no distinct difference between the two groups of ages and 24h radioactive iodine uptake(F=1.374,P=0.241;F=2.534,P=0.137).Conclusion The use of a fixed dose metllod simplifies the approach to treatment with potential cost savings.     

全自动远程核素分药仪的研制和应用

本工作组研制了一种全自动远程分药仪,该仪器主要由机械系统、控制系统、监视系统、过流系统、气动系统、防辐射装置、病案管理软件、配药计算软件等组成。应用结果表明:其放射防护率达99.99%,发药误差<2%,所配制药液的放射性活度均匀,无污染,是一种新型的专门的核医学设备。     

131Ⅰ治疗分化型甲状腺癌并远处转移疗效分析

目的 探讨分化型甲状腺癌（DTC）并远处转移患者接受131Ⅰ治疗的临床效果.方法 50例DTC术后患者,根据DTC转移部位给予一次和分次治疗,总去除剂量为（370～740）×10^7Bq,间隔时间为4个月.结果 50例DTC术后患者中,35例首次清除剩余甲状腺组织成功（70.0%）;转移癌18例中,治愈6例（33.3%）,有效8例（44.4%）,无效4例（22.2%）;甲状腺转移患者治疗前甲状腺球蛋白水平明显高于无甲状腺转移（t=2.715,P〈0.01）,治疗后明显下降（t=2.844,均P〈0.01）;治疗组治疗后CD4＋、DD8＋、CD4＋/CD8＋含量[（26.5±4.7）%、（39.4±5.7）%、（0.6±0.4）%]均低于治疗前[（38.3±5.6）%、（29.8±6.9）%、（1.4 ±0.5）%]（t=2.345,t=2.244,t=2.451,均P〈0.05）.结论 DTC术后131Ⅰ治疗可以有效清除剩余甲状腺组织,治疗转移灶.     

Effect of 131Ⅰ therapy On differentiated thyroid carcinoma metastases

Objective To investigate the effect of iodine-131(131Ⅰ) therapy on patients with differentiated thyroid carcinoma concurrent metastases.Methods 50 cases with differentiated thyroid carcinoma after operation ac-cording to metastaticsites were given one of fractionated treatment,a total removal of dose(370～740)×107Bq,inter-val of 4 months.Results 35 of 50 patients(70.O%) had successful ablation of residual thyroid tissue after the first administration of radioiodine.Metastatic carcinoma in 18 cases,6 cases(33.3%) were cured,effective treatment was shown in 8 cases(44.4%)and treatment failure in 4 cases(22.2%);Thyroid metastasis before treatment were signifi-cantly higher than non-HTG thyroid metastasis(t=2.715,P<0.01),decreased significantly after treatment(t=2.844,all P<0.01);The contents of CD4+、CD8+、CD4+/CD8++ in treatment group after treatment[(26.5±4.7)%、(39.4±5.7)%、(0.6±0.4)%] were lower than before treatment[(38.3±5.6)%、(29.8±6.9)%、(1.4±0.5)%](t=2.345,t=2.244,t=2.451,all P<0.05).Conclusion Treatment with multiple hlsh doses of 131Ⅰ was safe and effective with little adverse side-effect.     

Effect of 131Ⅰ therapy On differentiated thyroid carcinoma metastases

Objective To investigate the effect of iodine-131(131Ⅰ) therapy on patients with differentiated thyroid carcinoma concurrent metastases.Methods 50 cases with differentiated thyroid carcinoma after operation ac-cording to metastaticsites were given one of fractionated treatment,a total removal of dose(370～740)×107Bq,inter-val of 4 months.Results 35 of 50 patients(70.O%) had successful ablation of residual thyroid tissue after the first administration of radioiodine.Metastatic carcinoma in 18 cases,6 cases(33.3%) were cured,effective treatment was shown in 8 cases(44.4%)and treatment failure in 4 cases(22.2%);Thyroid metastasis before treatment were signifi-cantly higher than non-HTG thyroid metastasis(t=2.715,P<0.01),decreased significantly after treatment(t=2.844,all P<0.01);The contents of CD4+、CD8+、CD4+/CD8++ in treatment group after treatment[(26.5±4.7)%、(39.4±5.7)%、(0.6±0.4)%] were lower than before treatment[(38.3±5.6)%、(29.8±6.9)%、(1.4±0.5)%](t=2.345,t=2.244,t=2.451,all P<0.05).Conclusion Treatment with multiple hlsh doses of 131Ⅰ was safe and effective with little adverse side-effect.     

年龄结构与护士核心能力相关性调查及对策研究

目的:量化分析年龄结构与护士核心能力的相关性,掌握其现状。方法:采用《注册护士核心能力量表》对368名取得护士执业资格的护士进行问卷调查。结果:注册护士专业核心能力得分均值为(171.04±2.39)分,用方差分析比较不同年龄组护士的核心能力测评总分及各维度(除专业发展外)得分之间的差异,差异有统计学意义。结论:根据不同年龄段护士核心能力的差异性,制定有效的干预措施,以提高护理队伍的核心能力,提高护理质量,更好地促进护理事业发展。     

~(131)I不同剂量法治疗甲亢疗效对比

目的 比较131I固定剂量法和计算剂量法治疗甲亢的近期疗效。方法 148例甲亢患者随机分配为固定剂量组和计算剂量组,131I治疗后6个月随访,检测患者血清促甲状腺激素(TSH)、游离三碘甲腺原氨酸(FT₃)和游离甲状腺素(FT₄)水平,评价131I治疗效果。结果 131I治疗后6个月固定剂量组、计算剂量组甲减发生率分别为31.1%、28.4%,统计学差异无意义(χ2=0.742,P=0.528),总治愈率分别为93.3%、85.2%,统计学差异无意义(χ2=0.958,P=0.403)。不同治疗结果(甲亢、甲状腺功能正常和甲减)之间甲状腺质量的统计学差异有意义(F=13.639,P=0.000),患者年龄、24h甲状腺吸碘率(RAIU)统计学差异无意义(F=1.374,P=0.241;F=2.534,P=0.137)。结论 131I固定剂量法简化治疗步骤,节约治疗费用,是值得提倡的治疗方法。