目的:研究诊疗质量控制全流程精细化管理对急性缺血性脑卒中(AIS)患者预后及满意度的影响.方法:选取院收治的500例AIS患者,按照管理方式的不同将其分为对照组(256例)和观察组(244例),所有患者均采用静脉溶栓治疗,对照组按临床指南组织化管理,观察组按诊疗质量控制全流程精细化管理.比较两组患者静脉溶栓疗效、溶栓流程各环节时长、患者临床预后以及患者满意度和投诉率的差异.结果:观察组患者静脉溶栓疗效明显好于对照组,差异有统计学意义(x2=14.96,P<0.05);观察组患者发病至静脉溶栓4个环节时长少于对照组,差异有统计学意义(t=12.456,t=23.015,t=26.356,t=1.896;P<0.05);观察组患者出院后6个月临床预后数据优于对照组,差异有统计学意义(x2=9.99;P<0.05);观察组患者满意情况好于对照组,投诉率低于对照组,差异有统计学意义(x2=33.58,x2=8.03;P<0.05).结论:诊疗质量控制全流程精细化管理可显著降低患者发病到溶栓时间,改善临床预后,提升AIS患者满意度.

目的:构建神经外科无痛病房多学科疼痛管理模式,探讨其对开颅术后患者疼痛管理效果.方法:组建由神经外科医生、护士及疼痛科医生组成的多学科疼痛管理小组,将超前镇痛、多模式镇痛和个体化镇痛策略相结合,构建神经外科无痛病房多学科疼痛管理模式.选取医院收治的1056例开颅手术患者,依据疼痛管理模式的不同将其分为观察组与对照组,每组528例;观察组采用无痛病房多学科疼痛管理模式;对照组采用常规无特殊疼痛干预模式.对比两组患者术后4 d内的数字量表(NRS)疼痛评分、中重度疼痛比例、术后舒芬太尼使用量、镇痛满意度及生活质量.结果:观察组术后4 d的疼痛评分低于对照组,差异有统计学意义(F=1227,P<0.001),中重度疼痛比例低于对照组,差异有统计学意义(x2=214.6,P<0.001);观察组术后总舒芬太尼用量低于对照组,差异有统计学意义(t=48.5,P<0.001),患者对镇痛效果满意度高于对照组,差异有统计学意义(x2=61.3,P<0.001);观察组生活质量的总体问题、生理领域和心理领域得分高于对照组,差异有统计学意义(Z=-17.7,Z=-23.0,Z=-22.7;P<0.001).结论:神经外科无痛病房多学科疼痛管理模式能最大程度地缓解患者术后疼痛,提升患者镇痛满意度和生活质量.

新型冠状病毒肺炎(COVID-19)的爆发与流行严重威胁人民生命安全,疫情后的防控工作任务重大.医院是COVID-19发生和聚集性感染的高危场所,故应实行预检分诊制度,采用加强入院筛查管理,启动隔离手术间,设置急诊入院过渡病房等措施,确保做好疫情防控的同时,保障人民群众日常医疗服务需求,对全面助力打赢疫情防控阻击战具有重要意义.

Effective communication between doctors and patients can reduce the occurrence of medical complaints and disputes. The office of doctor-patient relationship acts as the complaints management department of the medical institution and undertakes the management of medical complaints. Since 2017, our hospital has introduced the staff of the doctor-patient relationship office to participate in major preoperative conversations. The mode establishes a communication bridge between clinicians and surgical patients and their families, so that patients′ informed consent is more complete and more realistic, and the sufficiency and effectiveness of doctor-patient communication is enhanced. It has a positive effect on medical complaints and dispute risk prevention. Key words: Informed consent; Preoperative conversation; Doctor-patient relationship office; Medical complaint; Medical dispute

在我国医疗卫生体制改革过程中,医生的执业边界一直未有一个明确的划分.当下医生多点执业成为热门探讨话题,但在法律角度却少有文献对此问题进行探究.多点执业制度推进,医生集团兴起,医生“飞刀”执业饱受争议;从法律角度为医生执业划定边界,使得医生在安全范围内充分发挥自己的专业能力,服务更多需要的患者,取得相应的社会价值,这些是值得医院管理者们思索的问题.

Objective To investigate the postoperative analgesic activity offlurbiprofen to intracranial aneurysm patients who went under endovascular treatment with propofol and remifentanil anesthesia.Methods Totally 40 ASA physical status Ⅰ - Ⅱ intracranial aneurysm patients were randomly scheduled flurbiprofen group (group F, 20 cases) and control group (group C, 20 cases). The patients in group F were given flurbiprofen 1 mg/kg respectively at 10 min before operation and at the end of the operation; while the patients in group C were given fat milk at the same time. The patients' circulation of the two groups before and after operation,the headache visual analog scores (VAS) and body comfort score (BCS) were observed.Results The mean arterial pressure(MAP) in group C after operation 1,2 and 3 h were significantly higher than that before operation (P ＜ 0.05 ); the heart rate in group C after operation had no significantly difference compared with before operation (P ＞0.05). The MAP and the beart rate in group F had no significantly differences before and after operation(P ＞ 0.05 ). The VAS of postoperation headache after operation 1,2 and 3 h were (0.30 ± 0.65 ), (0.30 ± 0.57) and (0.25 ± 0.44) scores in group F, which were significantly lower than those in group C [ (3.25 ± 1.58), (3.00 ± 1.56) and (2.90 ± 1.48 ) scores](P ＜ 0.05 ) ; the BCS after operation in group F after operation 1,2 and 3 h were (3.30 ±0.86), (3.45 ±0.86) and (3.62 ±0.86)scores, which were significantly higher than those in group C [ ( 1.20 ± 1.00), ( 1.45 ± 0.94) and ( 1.50 ±1.00)scores](P＜ 0.05 ). Conclusion Flurbiprofen can reduce intracranial aneurysm patient's postoperative headache under endovascular treatment.

Objective To explore the understanding status of perioperative period knowledge among neurosurgery patients in the hospital,and to analysis the influencing factors and the demand for health education. Methods Random sampling was adopted among neurosurgery patients in the hospital and questionair was carried out among 120 patients. The questionair contented five questions. Results The ages of the respondents were from 16～78. There were 45 peasants,31 workers,13 people with professions of medicine and 31 the others. The number of correct answers for all five questions was three,accounted 2.50%. The knowledge awareness rates of 5 items were all below 55%. There was significant difference in knowledge awareness rate among patients of different careers,and the peasant' was the lowest(P<0.01). There was significant difference in knowledge awareness rate among patients of different academic degrees,and the awareness rate of the patients with high education level was higher(P<0.01). Conclusion There was significant difference among patients with different careers and academic degrees on perioperative period knowledge understanding. A multiple grades and departments union should be established to improve health education. Publicity should be improved according to local situation.

Objective To investigate the effect and side effects of flurbiprofen axetil combined with fentanyl in postoperative patient-controlled analgesia (PCA) after craniotomy.Methods 60 patients undergoing scheduled craniotomy were randomly divided into the treatment group and control group with 30 cases in each group, and received flurbiprofen axetil combined with fentanyl and only fentanyl respectively in PCA after craniotomy. The visual analogue scale (VAS), sedation score (SS) and the side effects were evaluated in 24 h after craniotomy.Results There was no significant difference in VAS between the two groups ( P0.05). The SS, side effects such as nausea and vomiting in the treatment group were significantly less than that in the control group ( P0.05).Conclusion Flurbiprofen axetil combined with fentanyl in PCA can reduce the side effects of fentanyl and offers overall favorable analgesic responses.