医院的医疗服务质量是医院硬件设施、医疗技术水平和管理水平综合体现的结果.随着人们医疗服务需求的不断提高,大型医用设备在临床应用越来越广泛.大型医疗设备作为医院资产的重要组成部分,其筹建工作是一项涉及规划选型、基建施工、设备购置、安装验收的系统工程.该研究分析了目前大型医疗设备筹建管理现状及存在的问题,以西安市中医医院新院区CT和MR筹建为例,阐述了设备管理部门在项目筹建过程中的作用,为其职能扩展、转变提供思路.

Objective:To explore the factors affecting the management of medical devices in the COVID-19 pandemic, and to provide guidance for the management of medical devices in public health emergencies.Methods:A total of 184 hospitals caring COVID-19 patients in Jiangsu, Zhejiang, Shanghai, Anhui and Shandong were selected, and clinical engineers were randomly sampled. A self-compiled questionnaire was used to conduct an online survey on factors affecting medical device management during the COVID-19 pandemic from August to December 2021.The index system of influencing factors of medical device management during the COVID-19 pandemic was determined through an exploratory factor analysis, and then the structural equation model was used to verify the rationality and scientificity of the index system, while the relative weight method was used to calculate the weight of the index system.Results:277 valid questionnaires were recovered. Through the exploratory factor analysis, an index system of influencing factors of medical device management was established, which consisted of such level-indexes as the human factor, device factor, material factor, method factor, and environment factor, as well as 17 level-2 indexes. The fitness-indexes of the second-order structural equation model were finally fitted as follows: the chi-square to freedom ratio was 2.606, the approximate root mean square error was 0.076, and the value of value-added adaptation index, non-standard adaptation index and comparative adaptation index were 0.921, 0.903 and 0.920, respectively. The weights of the method factor, human factor, device factor, material factor and environment factor of the level-1 indexes were 0.216, 0.191, 0.175, 0.274 and 0.144, respectively. Such factors as manpower, regulations and institutional processes, and information technology ranked top three among the 17 level-2 indexes, which were 0.090, 0.082 and 0.080 respectively.Conclusions:The influencing factor model of medical device management during the COVID-19 pandemic in this study is ideal; human factors and method factors are the influencing factors deserving high priority in medical device management during the COVID-19 pandemic. Ensuring sufficient human resources, improving laws, regulations and processes, as well as enhancing information management level are breakthroughs expected in medical device management.

医用耗材是临床诊疗中必不可少的物资组成部分,是推动医院诊疗技术提升的重要因素,但由于其种类多、品规杂、命名不规范、技术难度高等问题,导致医用耗材的合理使用监管成为医院运营的重点和难点.如果医用耗材从采购到使用的整个过程存在监管不到位的现象,不仅会导致耗材"跑冒滴漏"现象严重,还会加重患者的经济负担,甚至危及患者生命.该研究通过分析医疗机构医用耗材管理存在的问题,探索解决方案,为医用耗材管理工作提供参考.

Objective:To investigate the dosimetric difference between dose volume optimization (DVO) algorithm and photon optimization (PO) algorithm with the Eclipse 13.6 system for intensity modulated radiation therapy (IMRT) after radical mastectomy for left breast cancer.Methods:For 20 patients undergoing radiotherapy after radical mastectomy of left breast cancer, the target area and organs at risk (OAR) were contoured by a designated physician. With a constant setting of prescription dose, field settings, and optimization parameters, PO and DVO algorithms were used to optimize the IMRT plan, and the final doses were calculated by anisotropic analytical algorithm (AAA) . The two optimization algorithms were compared for the differences in target dose, conformity index (CI) , homogeneity index (HI) , OAR dose and monitor unit.Results:In general, the two optimization algorithms fulfilled the clinical requirements. There was no statistically significant difference in the mean cardiac dose (D mean) between the two optimization algorithms ( P>0.05) . The target area D 95, maximum dose (D max) , HI, CI, monitor unit, cardiac V 30, V 40 and spinal cord D max were more favorable with PO algorithm than with DVO algorithm, while V 5, V 20 and D mean of the ipsilateral lung were less favorable with PO algorithm than with DVO algorithm (all P<0.05) . Conclusion:For IMRT planning after radical mastectomy for left breast cancer, PO algorithm can improve the conformity of the target area, reduce the heart dose, and expedite implementation of the plan without loss of the target dose volume.

高低压氧舱是现代科学技术发展的成果,其可以模拟飞行环境对飞行人员进行高空生理训练,使飞行人员在飞行任务中能及时发现身体异常状态并作出调整,以提高飞行人员的战斗力.文章阐述了高低压氧舱的基本作用及安全管理内容,结合两个国家标准GB/T 12130-2005《医用空气加压氧舱》和GB/T27513-2011《载人低压舱》及实际情况,为满足训练要求,对山东烟台宏远GY3200D-A型高低压氧舱多方面进行升级改造.改造内容基本满足训练需求,为高低压氧舱的安全管理与建设提供一定的借鉴经验.

目的:探讨9S管理法在重症监护室(ICU)仪器设备管理中的应用价值.方法:按照9S管理法中的整理(Seiri)、整顿(Seiton)、清扫(Seiso)、清洁(Seiketsu)、节约(Saving)、安全(Safety)、服务(Service)、满意(Satisfaction)和素养(Shitsuke)9个方面对医院ICU医疗仪器设备实施9S管理.选取2020年7月医院ICU临床在用的346台仪器设备,实施9S管理,对比9S管理实施前后的管理效果.结果:实施9S管理后,仪器设备放置不规范率、使用记录不完整率和相关不良事件发生率均比实施前显著下降,差异有统计学意义(x2=170.961,x2=56.171,x2=5.917;P<0.05);床单位终末消毒整理耗时和仪器设备取用耗时均有所下降,仪器设备消毒保养耗时显著增加,差异有统计学意义(t=4.895,t=2.532,t=-6.869;P<0.05);医护人员仪器设备相关理论知识考核、操作技能考核和维护能力考核成绩均显著提升,差异有统计学意义(t=-6.957,t=-8.477,t=-24.428;P<0.05).结论:对ICU仪器设备实施9S管理能够提升科室对医疗仪器设备的管理效能,提高临床服务质量和效率.

介绍了PLX7000B型高频移动式C型臂X射线机的结构组成,详细分析了该设备出现的机架不能动作、图像质量出现问题、手动和自动模块功能按键失控3例故障产生的原因并提出了具体的排除方法,为同行排除类似故障提供了参考.最后指出了采用逐步排除和仔细观察相结合的维修方法对于提高维修效率具有重要意义.

本院从2015年开始医疗器械不良事件监测工作(MDR),经过四年的探索学习,不断改进,最终在上报数量和合格率上均有所提高,对本院的医疗器械质量控制环节起到良好的指导作用.

Objective:To independently develop a power control system of ultrasonic scalpel so as to reduce the energy consumption and maintain the normal temperature of ultrasonic scalpel.Methods:In this paper, the model of equivalent circuit of ultrasonic transducer nearby syntony was built up, and the hardware control system of ultrasonic scalpel based on digital signal processing (DSP) was designed.Results:Through testing the circuit and work performance of power control system, the series of parameters such as effective value and so on which were produced by this system could adjust frequency of power source in time and attain anticipative functional indicator, and it took the ultrasonic scalpel to work in syntonic situation.Conclusion:The tested indicators of power control system of ultrasonic scalpel based on the kernel design of DSP can attain anticipative requirement, and can take this system to work in syntonic situation.

Objective:To solve the problems that medical equipment couldn't be used during clinical applying process because its parts was damaged, through applying three-dimensional (3D) printing technique.Methods: The repair of key on the multiparameter monitor was taken as an example, and it showed the manufacture process of 3D modeling and printing for damaged parts.Results:The parts made from the 3D printing technique could supersede original parts, and its strength and performance could meet the demand of clinical practice. This results has been recognized by specialist of quality control.Conclusion:3D printing technique can solve the problems caused by losing or damaging of parts, and it has vast application space in clinical engineering field.

Objective： Body-surface electrogastrogram signals can be adopted in studies of gastrodynamic characteristics and diagnoses of functional gastric diseases. Collecting signals directly from the human body contains interference signal components can not be directly applied to clinical diagnosis characteristics of wavelet transform be decomposed into multi-scale and Methods： As a tool in matlab, using multi-resolution the signal containing the noise of the stomach would get a different band sub-band signals. We selected the number of sub-band for signal reconstruction, and these sub-band signals associated with the stomach. Results： We have obtained a more satisfactory EGG. Conclusion： Wavelet analysis is an easier and effective way to do EGG analysis in clinical diagnosis.

本文采用HHT(Hilbert-Huang Transformation,HHT)时间序列分析方法,处理从人体采集到的胃电信号,通过经验模态分解(EMD)技术将一非线性、非稳态过程的原始胃电序列分解为一组内在模态函数(IMF),然后对每一个IMF进行Hilbert变换,这样得到信号的瞬时频率,然后选择与胃电成分相关的频率成分,即2~4 cpm之间的IMF进行重构提取胃电信号,这是一种更具自适应性的、新型的、基于模态分解的时间序列数据处理方法,可以有效去掉叠加在胃电信号中的呼吸和血流等干扰信号,使胃电图(EGG)在临床诊断中更具有实际意义.