医疗设备档案是医院仪器、设备在申请、购置、验收、调试运行、质控、计量、维修、改造、报废等全部活动过程中直接形成的、具有保存利用价值的文字、图表、声像载体以及随机材料.青岛大学附属医院是一所集医疗、教学、科研、预防、保健、康复、业务技术指导为一体的省属大型综合性三级甲等医院.医院拥有国际一流的万元以上医学设备5800余台(件),医学设备总价值达13亿元,拥有美国1.5T、3.0T核磁共振、宝石能谱CT、ECT、DSA、瓦里安直线加速器、彩色多普勒B型超声诊断仪、眼科准分子激光治疗仪、全自动生化分析仪、达芬奇机器人等国际一流的高、精、尖设备,为临床诊断、治疗的高效、准确提供了有力保证.医疗设备管理在医院管理工作中的重要性越来越突出,加强医疗设备档案管理也变得越来越重要.

公立医院招标采购工作是一项政策性、专业性、技术性很强的工作，在招标项目论证、招标文件编制与审核、现场招标活动的有效组织、评标专家的素质提升、供应商资格预审、招标合同的签署与执行等环节都存在漏洞或缺陷，本文结合工作实际就如何改进医院招标采购工作提出对策。

Objective To study the cause, characteristics and new trends of medical disputes, Provide the advice to im-prove the medical quality and management. Methods A total of 55 cases of medical disputes in one hospital from 2010 to 2012 were retrospectively analyzed. Results Patients had no obviously difference in sex and age but area, The age range concentrate in 36~65 years, The urban population take the higher Proportion (69.09%); The educational back-ground of most doctors is Master and Doctor, The post of most doctors is senior positional title and subsidiary-senior positional title;the surgery departments make more medical disputes(61.82%); The insignificance of medical technology is the major factor of medical malpractice(52.72%).Conclusion Standardizing medical practices, improving comprehen-sive quality of medical staffs and enhancing skills of physician-patient communication are important measures to pre-vent medical disputes.

随着我国医疗卫生事业的不断发展和人们法律意识的不断提高,医疗纠纷的数量每年以10％-20％的速度增加,这已经成为社会关注的热点问题之一.医疗纠纷给医患双方都带来伤害,已经严重影响了医院的日常医疗和管理工作,甚至成为影响社会稳定的重要因素.

<正>病人,女,35岁。因腹痛4d入院。既往无高血压史,入院4d前出现左下腹部疼痛,为阵发性隐痛,持续10 min。入院时测血压20/12kPa,心率70min-1,体质量65kg;CT检查提示左下腹部占位性病变,直径约6cm,左肾囊肿。拟全身麻醉下行腹膜后囊肿切除术。麻醉经过:麻醉前30 min给予苯巴比妥钠0.1g,东莨菪碱0.3mg;入室血压17/10kPa,心率70min-1,给予舒芬太尼15μg,顺式苯阿曲库铵12mg,丙泊酚100mg行麻醉诱导,气管内插管,呼吸

To discuss the effective measures of improving medical records management and it's performance.Monitor the distribution of medical record number by computer program to ensure the correct medical record number.At the same time the warehouse management process has been optimized.There is an important significance of improving management skills.

目的比较不同镇痛方法对肝癌切除术患者围手术期T淋巴细胞亚群及NK细胞的影响。方法选择36例ASAⅡ~Ⅲ级肝癌切除术患者,根据术中及术后不同镇痛方法随机分为3组,每组12例。Ⅰ组患者术中间断静注芬太尼镇痛,术后根据患者需要间断肌注哌替啶50 mg/次镇痛;Ⅱ组患者术中镇痛方式与Ⅰ组相同,术毕即刻行静脉自控镇痛(PCIA),镇痛药液为曲马多(10 mg/ml,2 ml/h);Ⅲ组患者,术中硬膜外腔间断注入0.25%布比卡因5~8 ml,术毕即刻行硬膜外自控镇痛(PCEA),镇痛药液为0.15%布比卡因+0.004%芬太尼(2 ml/h);3组患者均以咪唑安定0.1~0.2 mg/kg、芬太尼2~4μg/kg、维库溴铵0.08~0.1 mg/kg、异丙酚1~2 mg/kg诱导行气管内插管,吸入异氟醚和静注维库溴铵维持麻醉。记录手术后6,18,24和48 h患者的VAS评分,并测定麻醉前、术后1,3,5 d T淋巴细胞亚群及NK细胞的水平。结果与Ⅰ组相比Ⅱ组患者术后6 h和18 hVAS评分明显降低(P<0.01),Ⅲ组患者术后各时点VAS评分明显低于Ⅰ组和Ⅱ组(P<0.05);3组患者手术后第1天CD3+,CD4+,CD8+及NK细胞均明显下降(P<0.01),Ⅲ组患者T细胞和NK细胞分别于第3天和第5天恢复至术前水平(P>0.05),而Ⅰ,Ⅱ组患者于术后第5天仍低于基础值(P<0.05)。结论硬膜外镇痛对肝癌切除术患者镇痛效果好,且对手术后的免疫功能抑制较轻且恢复快。