关于主诉定义和书写要点的讨论

文章提出了在医院医疗服务范围和项目不断拓宽的情况下,现行病历书写规章制度中有关“主诉”的定义和书写要求也应进一步修改和拓宽。作者根据多年做临床质量控制工作和住院病历检查的经验,结合国内医学文献中部分专家的意见,对主诉的书写要点和常见问题进行了分析、总结。     

从病案管理看规范书写护理病案的重要性

护理记录作为病案的一部分,社会应用日益广泛,越来越被人们所重视。因此,护理人员必须适应时代发展的需求规范书写护理记录,增强法律意识,防范医疗纠纷。     

799例住院患者死亡病例回顾性分析

目的了解住院患者死因及威胁人类生命的主要原因,降低病死率,提高医疗质量。方法收集我院2003年～2005年住院病例799例,对其死因、性别、年龄、职业、发病时间、入院时间、抢救措施等进行回顾性分析。结果死亡病例中,以老年人为主,男性多于女性,恶性肿瘤成为住院患者死亡的首位原因,寒冷季节是死亡高峰期,多数患者来院时发病已超过1周,一半患者在入院一周内死亡,抢救过程中气管插管和电除颤是重要措施。结论重视各种因素对死亡病例的影响,加强新理论、新知识的提高,对提高医疗质量有重要作用。     

对高职生诊断教学的几点思考

诊断学是论述诊断疾病的基本理论、基本技能和临床思雏方法的一门学科。现存的高职诊断学教学中存在培养目标不明确、课程设王不舍理、教学模式陈旧单一、实习基地建设不足、考试评估体系不完善等问题。为此，我们可以采取明确培养目标；调整课程设置，增加实践教学；采用多种教学模式；加强实习基地的建设；改进测评手段。强化技能训练等措施加以改进。     

Experimental study on inhibitory effect of bridgy duct of hepatic artery on apoptosis of liver and bile duct cells

Objective： To investigate whether the method of bridgy duct established between the recipient＇s spleen artery and the donor＇s gastroduodenal artery could inhibit the apoptosis of liver and bile duct cells caused by hepatic artery ischemia. Methods： Twenty-four mongrel dogs from Xi＇an area were used to establish simplified models of dog orthotopic liver transplantation and divided into three groups randomly： HAI group （hepatic artery ischemia group）,BBB group（bypassing the blood by a bridgy duct） and control group. After cold perfusion, The samples were collected from liver and bile duct in each group at different time and fixed in glutaraldehyde and 4% polyformaldehyde respectively. At last, the apoptosis of liver and bile duct cells were observed and the apoptotic indexes were calculated. Results： Two hours after cold perfusion, apoptotic phenomenon was common in HAI group, rare in BBB group, while no apoptotic phenomenon was observed in control group. TUNEL staining showed that there was no significant difference in apoptotic index among the three groups immediately after cold perfusion. However, with time going, the apoptotic cells were increased in three groups, and the difference in apoptotic index was significant among three groups （P 〈 0.01 ）. Conclusions： Bridgy duct of hepatic artery can inhibit the apoptosis of liver and bile duct cells caused by HAI significantly.     

The expression of TRPA1 mRNA in the rat brain

Objective： To investigate the distribution of TRPA1 （one kind of the TRP-like ion channel family） channel in the hippocampus and cerebral cortex of rat. Methods： RT-PCR was used to amplify the fragment of TRPA1 in the DRG （dorsal root ganglion）, hippocampus and cerebral cortex of adult SD rat. In situ hybridization staining was used to show the distribution of TRPA1 mRNA in the hippocampus and cerebral cortex of adult rat brain. Results： Both RT-PCR and in situ hybridization staining showed that TRPA1 mRNA was expressed in hippocampus and cerebral cortex of the adult rat brain. Conclusion： Our results suggest that there is expression of TRPA1 mRNA both in the hippocampus and cerebral cortex of the adult rat brain.     

The V264M polymorphism of tissue factor pathway inhibitor gene in patients with acute coronary syndrome

Objective： To investigate V264M polymorphism of tissue factor pathway inhibitor （TFPI） in patients with acute coronary syndrome （ACS） in Chinese. Methods ： The genotypes of V264M were detected by polymerase chain reaction （PCR） and restriction fragment length polymorphism （PCR-RFLP） in 136 patients with ACS and 106 healthy controls with their plasmal f-TFPI tested by enzyme linked immunosorbent assay （ELISA）. Results： Two genotypes were found in V264M： GG and GA. The distribution frequencies of alleles and genotypes were in accordance with those predicted by Hardy Weinberg equilibrium in the present study （χ2 = 0.437, P 〉 0.05）. Plasma f-TFPI level was lower in A allele bearer than that in non-A allele carriers and higher in ACS than control subjects （P〈0.05）. No relationship was found between ACS and V264M polymorphism （P〉0.05）. Conclusion： The V264M polymorphism may have an impact on the plasma level of free TFPI（f-TFPI）, but it has no relationship with ACS.     

Hyperglycemia, hyperlipemia, and periodic paralysis: a case report of new side effects of clozapine

1. 1. This case report of a Chinese male schizophrenic patient describes new side effects that have not been documented previously for patients treated with clozapine. At certain doses of clozapine, the patient showed direct adverse reactions, which include a combination of hyperglycemia, hyperlipemia, and periodic paralysis.

2. 2. In a four-year study of this patient who had no previous episodes of diabetes in his or his family history, the authors found that these symptoms disappeared upon withdrawal of clozapine and relapsed with re-treatment of the drug.

3. 3. This study indicates that hyperglycemia, hyperlipemia, and periodic paralysis may need to be monitored on patients treated with clozapine.

     

The value of pulse wave velocity in the diagnosis of coronary heart disease

Objective: Using receiver operating characteristics (ROC) curve to evaluate the value of pulse wave velocity (PWV) in the diagnosis of coronary heart disease (CHD). Methods: By using coronary angiography as golden diagnostic standard of CHD, 218 patients were divided into both CHD group (n=121) and non-CHD group (n = 97). All these patients received PWV test. The efficacy of PWV of each artery segments in the diagnosis of CHD was evaluated by ROC curve. The sensitivity and specificity were calculated with the golden diagnostic standard of CHD. Results:The PWV of right carotid to femoral artery (Rc-f), left carotid to femoral artery (Lc-f), right radial to carotid artery (Rc-r), left radial to carotid artery (Lc-r) in CHD group were significantly higher than that of non-CHD group (9. 31±1. 75 vs 7.60±1.59, P<0. 01; 9. 02±1.71 vs 7. 52±1.50, P<0. 01; 8. 69±1. 37 vs 8. 00±1. 27, P<0. 01; 8.52±1. 03 vs 8. 03±1. 2, P<0. 01 respectively). However, the PWV of both right and left femoral to ankle artery (Rf-a and Lf-a) had no significant differences between the two groups. We then compared the area under curve (AUC) of each ROC(AUCROC) of PWV of Rc-f, Lc-f Rc-r and Lc-r to evaluate their diagnostic efficacy for CHD. We found that AUCROC of Rc-f PWV was the biggest (AUCROC = 0. 818), at the peak point of its ROC curve, the PWV was 8. 32 m/s. PWV>8. 32 m/s of Rc-f could predict the presence of CHD with a sensitivity of 79% and specificity of 77%. Conclusion: The PWV of Rc-f, Lc-f, Rc-r, Lc-r are significantly higher in CHD group than that in non-CHD group, and PWV of Rc-f is the most accurate in the detection of CHD. The PWV>8. 32 m/s of RC-F is a valuable predictor of CHD.     

微量肝素对重度窒息并发SIRS新生儿的干预作用

目的探讨微小剂量肝素降低新生儿重度窒息并发全身炎症反应综合征(SIRS)的作用和机制,并观察其副作用。方法对我科2001年1月～2005年10月间94例重度窒息新生儿(不含新生早产儿窒息病例)作回顾性分析。治疗组48例,常规综合治疗基础上加用低分子肝素钠5U/(kg·次),皮下注射,每12h1次,连用3d。对照组46例,采用综合治疗。就组间1周内SIRS的发生率作对照分析。结果治疗组1周内SIRS发生率和对照组间存在比较显著差异(P<0.05〉,而新生儿颅内出血、上消化道出血、和皮下出血的发生情况比较无显著差异性(P均>0.05)。结论早期应用微小剂量肝素可有效降低重度窒息新生儿SIRS的发生率而不致增加继发器官出血的机会。