军队医院等级评审中医学装备管理部门的作用探讨

分析了医学装备管理现状以及等级评审对设备管理部门的作用要求,指出了如何发挥医院装备管理的作用,从院部领导高度重视、迎评工作组织严密、强化标准学习、修订各项规章制度等方面重点阐述了等级医院评审中的实践经验与体会,以期为医学装备管理部门提供参考.     

Should sleep laboratories have their own predictive formulas for continuous positive airway pressure for patients with obstructive sleep apnea syndrome?

BackgroundSeveral formulas predicting optimal continuous positive airway pressure (CPAP) for obstructive sleep apnea treatment have been developed and diverse parameters selected as predictive factors in different sleep laboratories using different ethnic groups. This study aimed to validate a constructed predictive formula for the study laboratory and to test the hypothesis that sleep laboratories should have their own predictive formulas.MethodsFifty-seven adult subjects with obstructive sleep apnea syndrome (OSAS) were enrolled in the model-building set and underwent two polysomnography (PSG) studies to diagnose OSAS and titrate for optimal CPAP. A predictive formula, derived from anthropometric and polysomnographic variables, was validated together with two other predictive formulas in 30 subjects by comparing the mean predictive CPAP values, rates of successful prediction, and agreements.ResultsRegression analysis showed that apnea–hypopnea index (AHI), SaO_2nadir (nadir of arterial oxyhemoglobin saturation by pulse oximetry), and body mass index (BMI) strongly correlated with optimal CPAP. The derived predictive formula for the study laboratory was: CPAPpred (predictive CPAP) = 6.380 + 0.033 × AHI – 0.068 × SaO_2nadir + 0.171 × BMI (R² = 0.335, adjusted R² = 0.298). In Taiwan, different predictive formulas used by different sleep laboratories with different independent predictors led to similar mean predictive CPAP values to the mean observed optimal CPAP values, rates of successful prediction, and agreements with the observed optimal CPAP. There were significant differences between the mean predictive CPAP values and mean observed optimal CPAP values, lower rates of successful prediction, and negatively skewed 95% confidence interval (CI) when using a predictive formula derived from different ethnic populations.ConclusionA sleep laboratory may not need to have its own predictive formula for determining the optimal effective CPAP but should adopt the one derived from the same ethnicity of OSAS patients as the reference formula.     

肺表面活性物质联合鼻塞式持续气道正压通气治疗新生儿呼吸窘迫综合征的护理

目的探讨肺表面活性物质(固尔苏)联合鼻塞式持续气道正压通气(NCPAP)对新生儿呼吸窘迫综合征(NRDS)的疗效及其相关护理策略。方法选取本院2012年1月至2013年12月收治的58例NRDS患儿并随机分为两组各29例,对照组行机械通气+固尔苏治疗,观察组行NCPAP+固尔苏治疗,两组患儿治疗期间均给予新生儿儿科常规性护理,观察两组患儿的病情转归及预后情况。结果观察组患儿抢救成功率为89.66%、死亡率为10.34%,对照组分别为75.86%、24.14%,两组比较P<0.05。观察组患儿机械通气时间、住院时间、家属满意度评分显著优于对照组(P<0.05)。结论固尔苏与NCPAP治疗NRDS效果显著,在治疗期间给予患儿科学、全面的护理可提高患儿预后,缩短患儿住院时间,提高患儿家属满意度。     

PiCCO监测指标与脓毒性休克患者预后的相关性分析

目的分析脉搏指示连续心排出量(pulse-indicated continuous cardiac output,PiCCO)监测指标与脓毒性休克患者预后之间的相关性。方法回顾性分析我院2017年1月～2018年1月收治的50例脓毒性休克患者临床资料,依据其预后分为存活组30例及死亡组20例,比较两组患者PiCCO监测指标并分析其与患者预后的相关性。结果死亡组心脏指数低于存活组,血管外肺水指数、肺毛细血管通透性指数高于存活组,差异有统计学意义(P0.05);两组胸腔内血容积指数、体循环阻力指数差异无统计学意义(P0.05);Pearson相关分析结果提示,心脏指数与脓毒性休克患者预后呈正相关,血管外肺水指数、肺毛细血管通透性指数则呈负相关(r=0.381、-0.062、-0.084,P0.05)。结论 PiCCO监测指标中心脏指数、血管外肺水指数、肺毛细血管通透性指数与脓毒性休克患者预后存在着密切的关联性,对上述指标进行监测有助于评估临床疗效及患者预后。     

连续性血液净化对急性呼吸窘迫综合征单核细胞分泌功能和抗原呈递功能的影响

目的:研究连续性血液净化(CBP)对急性呼吸窘迫综合征(ARDS)患者单核细胞分泌功能和抗原呈递功能的影响.方法:动态检测36例接受CBP的ARDS患者单核细胞功能,并与健康人群进行比较.结果:ARDS患者单核细胞分泌细胞因子功能高于健康人群,而抗原呈递功能与健康人群相比无显著性差异.CBP治疗48h后,单核细胞细胞分泌功能恢复至正常水平,CBP治疗对单核细胞抗原呈递功能无显著性影响.结论:CBP治疗可降低ARDS单核细胞的细胞因子分泌功能,但对其抗原呈递功能无明显影响.