基层医院胃肠手术围手术期预防性应用抗菌药物的调查研究

目的调查我院胃肠外科手术患者围手术期抗菌药物预防使用现状,进一步推动围手术期预防用药合理化。方法对210例Ⅰ类与Ⅱ类手术切口患者围手术期抗菌药物预防性使用情况进行回顾性调查。蛄果208例患者使用了抗菌药物,术前50min、术前2h及术后预防使用抗茵药物者分别占6．75％,15．94％,79．55％。喹诺酮类药物使用率最高,其次是三代头孢菌素类、青霉素类;术后单用、二联、三联应用抗茵药物的比例分别为66．85％,25．48％,7．8g％。I类切口平均用药时间为5．56d,≤5d者59例（29．52％）;Ⅱ类切口平均用药时间为7．15d,≤5d者19例（25．55％）。结论基层医院胃肠外科普遍采用抗菌药物预防手术感染,但严格按围手术期预防用药原则应用者少,必须加强抗菌药物围手术期应用的管理。     

中西医结合治疗活动期类风湿关节炎39例

目的 观察大活络丸辅助治疗活动期类风湿性关节炎的临床疗效. 方法 将49例患者随机分2组,治疗组39例,服用大活络丸联合甲氨喋呤、来氟米特片;对照组10例,用甲氨喋呤、来氟米特片,疗程均为2个月. 结果 2组临床疗效比较治疗组优于对照组(P＜0.01). 结论 大活络丸能有效缓解活动期类风湿关节炎症状,改善患者的关节功能,减少西药副作用.     

新时期如何加强乡镇卫生院管理

目的：探讨新时期乡镇卫生院的的特点,管理方式,发展模式,作为管理者应具有的素质。方法：通过分析当前内部和外部环境因素对卫生院发展的影响,找出适合的发展道路。结果：新时期乡镇卫生院如果发展,作为一院之长,应具有一定的思想素质和管理素质。结论：院长应把握公益性办院的方向,协调好医院内部和医患两个关系,提高思想、管理和专业素质,完善社会卫生、医疗质量、医疗安全和财务管理,培养艰苦创业等五种精神。     

围术期体温保护对肝癌患者行肝叶切除术中出血量的影响

目的探讨肝叶切除术中固术期保温对肝癌患者出血量的影响。方法择期肝癌手术患者60例,随机分为观察组和对照组各30例。对照组术中不采用任何升温装置,观察纽患者术中采用输液加温器及充气保温毯加温。所有患者用鼻咽温度探头监测其术前、术中、术后体温变化、凝血功能指标及术中出血量,并进行比较。结果观察组体温高于对照组体温（P〈0．05）,使用保温毯加温后30min体温明显高于入室后体温（P〈0．05）,使用保温毯加温30min以后不同时间点体温比较差异无统计学意义（P〉0．05）。观察组出血量与对照组比较明显减少,差异具有统计学意义（P〈0．01）。结论对肝癌患者行肝叶切除手术过程中使用输液加温器和保温毯,可有效维持患者正常体温,减少术中出血量。     

非小细胞肺癌患者术后化疗过程中外周血CK19 mRNA表达水平的变化及其临床意义

目的 探讨定量检测外周血CK19 mRNA表达水平在判定术后辅助治疗疗效及早期预测肿瘤复发中的价值.方法 接受以根治为目的的手术治疗的非小细胞肺癌(NSCLC)患者共26例,分别于术后化疗开始前、第1、2、3周期化疗结束后第3周各采集外周血标本.对照组为健康体检者(n=20).运用实时荧光定量逆转录-聚合酶链反应法(fqRT-PCR)检测各时点外周血中CK19 mRNA水平.结果 化疗前患者外周血CK19 mRNA表达水平显著高于第1、2、3周期化疗后.阳性率从化疗前的84.6%分别下降至46.2%、38.5%及46.2% (P=0.004 6).术后有临床转移/复发患者外周血CK19 mRNA表达水平显著高于无临床转移/复发者(P=0.019).结论 术后定期监测外周血CK19 mRNA表达水平可作为判定术后辅助治疗疗效的重要标准.术后动态监测有助于预测NSCLC复发或转移.化疗难以完全消灭外周循环癌细胞,需寻找新的治疗方法或靶点.     

Inter-hemispheric asymmetry of motor corticospinal excitability in major depression studied by transcranial magnetic stimulation

BACKGROUND: Imaging and electroencephalographic studies have reported inter-hemispheric asymmetries in frontal cortical regions associated with depression. This study aimed at comparing motor corticospinal excitability assessed by methods of transcranial magnetic stimulation (TMS) between the right and left hemispheres in patients with major depression and healthy controls. METHOD: Patients with major depression (n=35) and healthy controls (n=35) underwent a bilateral study of various motor corticospinal excitability parameters, including rest motor threshold (RMT), corticospinal silent period (CSP) duration and intra-cortical inhibition (ICI) and facilitation (ICF). Indexes of asymmetry were calculated, and the relationships between excitability parameters and clinical scores of depression were statistically analyzed. RESULTS: Depressed patients showed a reduced excitability of both excitatory (RMT, ICF) and inhibitory (CSP, ICI) processes in the left hemisphere, compared to the right hemisphere and to healthy controls. CONCLUSION: The present results confirmed the existence of inter-hemispheric asymmetries in frontal cortex activities of depressed patients in favor of a left-sided reduced excitability. This neurophysiological approach may help to guide repetitive TMS procedures in the treatment of depressive disorders.     

Range of motion during the perioperative period in total knee arthroplasty

INTRODUCTION: This study focused on the change in the range of motion (ROM) during the perioperative period, i.e., the preoperative and intraoperative ROM, and that on discharge, and compared the difference between posterior cruciate ligament-retaining (PCLR) and -sacrificing (PCLS) prostheses. MATERIALS AND METHODS: In this prospectively randomized study, we compared the changes in the ROM in PCLR (n = 50) and PCLS (n = 50) total knee arthroplasties. RESULTS: The mean flexion in PCLR prostheses was 130.0 degrees preoperatively, 120.0 degrees intraoperatively, and 105.0 degrees at discharge, and 125.0 degrees , 120.0 degrees , and 100.0 degrees , respectively, in PCLS. The designs did not differ statistically in each period (P > 0.05). Both designs showed significant correlations between the preoperative and intraoperative ROM, and between the preoperative and discharge ROM. Only the PCLS showed a significant correlation between the intraoperative and discharge ROM, and a significant difference was observed in correlation of rank coefficient between the two prostheses (P < 0.001). CONCLUSIONS: The PCLS design has an advantage in rehabilitation planning because of the predictable changes in the ROM during the perioperative period, although the acquired average ROM at discharge did not differ statistically.     

Patient's satisfaction with perioperative care: development, validation, and application of a questionnaire

Background: Measuring patient satisfaction after anaesthesia care is complex.The existing patient satisfaction questionnaires are limitedand omit aspects of patient satisfaction, such as professionalcompetence, information provision, service, and staff–patientrelationship. The aim of our study was to develop a valid andreliable self-reported multidimensional questionnaire assessingpatient satisfaction that included these issues. Methods: The development of the Leiden Perioperative care Patient Satisfactionquestionnaire (LPPSq) was as follows: expert consultation, constructionof the pilot questionnaire, pilot study, statistical analysisof the results of the pilot study (validity, reliability, andfactor analysis), compilation of the definitive questionnaire,main study, and repeated statistical analysis (validity, reliability,and factor analysis). The overall patient satisfaction is expressedby the mean satisfaction score. Results: Three hundred and eighty-two patients consented to participatein the study; 80.4% of the patients (n=307) completed the questionnaire.The LPPSq isolated three dimensions: information (Cronbach’s=0.82), fear and concern (Cronbach’s =0.69), and staff–patientrelationship (Cronbach’s =0.94). Patient satisfactionwith perioperative care was not directly dependent on the outcomesof anaesthesia but how patients were approached and the amountof information they received. Age (P=0.001), gender (P=0.001),work situation (P=0.003), and specialty (P=0.017) were the characteristicsmost influencing patient satisfaction. Conclusions: We developed the LPPSq questionnaire to measure patient satisfactionwith perioperative care, of which anaesthesia care is an importantelement. In this study, information provision and the relationshipbetween staff and patient were the major determinants of patientsatisfaction.     

Setting priorities for improving the preoperative assessment clinic: the patients' and the professionals' perspective

BACKGROUND: The quality of the preoperative assessment clinic (PAC) is determined by many factors. Patients' experiences are important indicators, but often overlooked. We prepare to set priorities to improve the PAC by obtaining detailed patients' feedback on the quality of the PAC, and establishing the value patients and professionals attach to different care aspects, using the Patient Experiences with the Preoperative Assessment Clinic questionnaire. METHODS: The PAC's standard of service was determined for five care aspects (dimensions), using patients' feedback. The importance of a dimension to patients was determined by calculating the effects of the dimensions on patients' overall appraisal. In addition, professionals were asked to rate the importance of the different care aspects. RESULTS: Patients had the most positive experiences with the nurse, and the least positive experiences with waiting. However, waiting was least important to patients. When combining the PAC's standard of service with the value given to the dimensions by patients and professionals separately, we found in both instances that waiting was in greatest need of improvement. This was followed by reception, the anaesthetist, remaining experiences, and finally the nurse. CONCLUSIONS: Quality improvement of the PAC can be achieved by obtaining patients' feedback on the quality, determine a PAC's standard of service, recognize service areas that require improvement, and identify actions appropriate to bring about improvement. The value patients and professionals attach to different aspects of care can then be used to prioritize improvements.     

Perioperative tobacco use interventions in Japan: a survey of thoracic surgeons and anaesthesiologists

BACKGROUND: Tobacco use interventions in surgical patients who smoke could benefit both their short-term outcome and long-term health. Anaesthesiologists and surgeons can play key roles in delivering these interventions. This study determined the practices, attitudes, and beliefs of these physicians regarding tobacco use interventions in Japan. METHODS: Questionnaires were mailed to a national random sampling of Japanese anaesthesiologists and thoracic surgeons (1000 in each group). RESULTS: The survey response rate was 62%. More than 80% of respondents agreed or strongly agreed with the statements affirming the benefits of abstinence to surgical patients. However, only 26% of surgeons and 6% of anaesthesiologists reported almost always providing help to their patients to quit smoking. Compared with anaesthesiologists, surgeons were more likely to perform the elements of current recommendations for brief intervention, and to have attitudes favourable to tobacco use interventions. The most significant barrier to intervention identified by both groups was a lack of time to perform counselling. Compared with non-smokers, physicians who smoked were less likely to perform each of the recommended tobacco interventions CONCLUSIONS: Although current rates of intervention provided by anaesthesiologists and surgeons are low, there is considerable interest among these physicians in learning more about interventions. Given the relatively high prevalence of smoking in Japan and the potential for surgery to serve as a 'teachable moment' to promote abstinence from smoking, leadership by these specialists in the area of tobacco control could have a major impact on public health in Japan.