三甲医院妇产科门诊科学护理管理体会

文章根据三甲医院妇产科门诊特点,强调护理安全管理,树立以病人为中心服务理念,合理规范就诊流程,采取科学护理管理措施,制定质量控制标准,实行科学人性化护理管理,塑造良好的门诊护理服务形象.     

风湿性心脏瓣膜病换瓣手术患者住院死因分析

目的 探讨风湿性心脏瓣膜病换瓣手术患者住院病死率及其主要死因.方法 回顾性分析2006年1月至2009年11月明确诊断为风湿性心脏瓣膜病患者130例(所有患者均准备行瓣膜置换术).按其住院是否发生死亡分成死亡组10例和存活组120例.收集其内外科术前临床资料以及合并症和并发症等情况,用Logistic,回归方法分析其住院病死率及其死因.结果 死亡组总胆红素和间接胆红素分别为(30.31±19.10)、(22.38±17.34)μmol/L,均明显高于存活组的(19.47±8.61)、(12.92 ± 7.30)μmol/L,两组比较差异有统计学意义(P＜0.01).死亡组术后并发症、脑梗死病史和心肺合并症发生率明显高于存活组(P＜0.01).多因素Logistic回归分析显示术后并发症为住院死亡的独立危险因素(P=0.002).结论 风湿性心脏瓣膜病换瓣手术患者合并术后并发症是其住院死亡的独立预测因素,加强住院期间治疗及护理尤为重要.

Abstract：

Objective To investigate the hospital mortality of rheumatic heart disease (RHD)and major cause of death. Methods One hundred and thirty patients with RHD prepared to take valve replacement from January 2006 to November 2009 were involved in this study. They were divided into two groups according to all clinical data: death group (10 cases ) and survival group (120 cases ). The clinical data and complications were collected, and the hospital mortality and their causes were analyzed with Logistic regression analysis. Results Univariate analysis: total bilirubin and indirect bilirubin levels in death group [(30.31 ± 19.10), (22.38 ± 17.34) μmol/L] were significantly higher than those in survival group [(19.47 ± 8.61),(12.92 ± 7.30) μmol/L] (P ＜ 0.01). The incidence of postoperative complications,history of cerebral infarction and cardiovascular complications in death group were significantly higher than those in survival group (P ＜0.01). The Logistic regression analysis showed that the postoperative complications was an independent risk factor for hospital mortality (P =0.002). Conclusions RHD with postoperative complications is identified as an independent predictor of hospital mortality. It is very important to enhance the treatment and care during hospitalization.     

风湿性心瓣膜病合并冠心病危险因素分析

[目的]对风湿性心瓣膜病患者资料及冠脉造影结果进行回顾性分析,探讨其合并冠心病的危险因素。[方法]收集分析本院2006—2009年风湿性心瓣膜病,且符合换瓣手术指征、年龄50岁的患者130例资料。[结果]130例风湿性心瓣膜病患者中合并冠心病18例(13.9%)。合并冠心病组年龄较非冠心病组大。冠心病组合并糖尿病和高血压者较多。[结论]高龄风湿性心瓣膜病患者,合并糖尿病和(或)高血压是合并冠心病的主要危险因素。     

两种检测急性冠脉综合征患者CKMB及CTNI方法一致性分析

目的:评价急性冠脉综合征患者中,化验室心肌酶及标志物分析法检测心肌肌酸激酶同工酶(CKMB)和心肌肌钙蛋白I(CTNI)结果与心梗三联床旁检测法是否一致及其一致性程度.方法:对78例临床诊断急性冠脉综合征的患者同时采集两份标本,分别应用化验室心肌酶及标志物分析法和心梗三联床旁检测法进行CKMB及CTNI测定.采用配对卡方检验(McNemar Test)和一致性检验(Kappa检验)方法进行统计学分析.结果:两种方法测得CKMB和CTNI值比较差异无统计学意义(t=1.123,P=0.265;t=-0.326,P=0.747),且一致性较好(Kappa=0.579,P＜0.05;Kappa=0.546,P＜0.05).采用配对卡方检验结果显示,两种方法测得CKMB和CTNI值升高程度差异均无统计学意义(P＞0.05).结论:化验室心肌酶及标志物分析法与心梗三联床旁检测法检测CKMB及CTNI值结果一致性较好.