为解决患者挂号难、排队次数多,等待时间长等就医痛点问题,基于互联网+医疗健康,利用北京京医通官方微信服务平台,打造患者线上线下联动就医全流程服务.通过京医通平台,有效改善患者服务能力,号源共享,解决患者挂号难问题;手机和自助机挂号、充值和缴费,减少排队次数.相比2017年11月,2018年11月的就诊等待时间缩短了22.13 min,检验报告打印率下降了7.27％,2018年患者满意度相比2017年提升了4.00％.京医通平台为患者提供高效便捷、内容丰富、标准统一的互联网医疗服务新体验,延展了服务时空,提升患者满意度.

目的 规范临床科室血气分析仪配置、控制其检测试剂成本支出、加强体外诊断试剂精细化管理.方法 基于全院血气分析仪资产配置、使用次数、运行成本和检测收入等指标,对我院血气分析仪使用效率与效益进行调研、分析、评估和整改.结果 全院核减3台血气分析仪,并纳入固定资产管理;全部血气分析仪月均成本降幅43.27％,单次检测次均成本降幅44.65％;月均收入升幅约2.95％,实际检测综合成本率由原先的41.00％下降到27.00％左右.结论 优化血气分析仪的配置,对其进行专项使用效率、效益的评估评价,有助于降低检测综合成本,规避风险.

目的:解决医院临床科研数据利用问题,唤醒临床工作中产生的“沉睡的数据”.方法:引入基于Hadoop、MongoDB等技术框架的大数据技术,通过ETL工具抽取清洗,整合各临床业务系统的数据,采用ElasticSearch等自然文本语言处理技术,再将其归一、结构化,以便于进行多学科临床科研系统建设探索.结果及结论:满足临床科研人员回顾性研究多重条件检索的要求,并进一步讨论了临床大数据应用重点思考的问题,对提高临床科研工作效率具有较大意义.

The imagine data sharing of across-medical institutions is clinical demands in the process of hierarchical medical and regional medical alliance construction. This article introduces the construction situation of medical imagine remote diagnosis system and across-medical institutions medical imagine platform system of Beijing Shijitan hospital affiliated to Capital Medical University, and puts forward the methods on hospital internal imaging platform construction as well as registration and retrieval of across-medical institutions imagine data. It provides reference for medical imagine data sharing of cross-medical institutions.

OBJECTIVE:To provide reference for rational utilization of antibiotics for special use. METHODS:Medical orders of antibiotics for special use in clinical departments of our hospital during 2013 to 2015 were selected from hospital information sys-tem. The consumption sum and its ratio,DDDs,DDC,DUI and the utilization of antibiotics for special use in clinical departments were calculated and analyzed. RESULTS:The consumption sum and its ratio of antibiotics for special use in our hospital during 2013 to 2015 both reduced year by year,decreasing from 21 872 200 yuan(48.00%)to 20 877 700 yuan(39.41%). The consump-tion sum ratio of carbapenems,cephalosporins and anti-deep fungal drugs showed descending tendency. The consumption sum ratio of anti-MRSA antibiotics changed slightly. DDDs of Meropenem for injection always took up the first place in recent 3 years,but the values were decreasing. DUI of Imipenem and cilastain sodium for injection was far less than 1,while those of Panipenem and betamipron for injection,Cefepime sodium for injection and Caspofungin acetate for injection(70 mg/injection)were far more than 1. The types of drug with DUI ranged 0.9-1.1 increased year by year,increasing from 3 types in 2013 (18.75%) to 10 types in 2015 (62.50%). Within 3 years, the utilization ratio of antibiotics for special use always took up the first place in ICU (86.64%-87.78%). CONCLUSIONS:The consumption sum and its ratio of antibiotics for special use in our hospital during 2013 to 2015 decreased year by year,and the utilization of antibiotics for special use become increasingly rational. But,there still are some problems,such as inadequate dose of Imipenem and cilastain sodium for injection,overdose of Panipenem and betamipron for injection,Cefepime sodium for injection and Caspofungin acetate for injection(70 mg/injection).

目的:观察动脉压力波形心排量监测法(arterial pressure-based cardiac output,APCO)监测下,妊娠合并重度肺动脉高压孕妇剖宫产术中血流动力学变化规律及APCO在该类患者的临床应用.方法:妊娠合并先天性心脏病(先心病)重度肺动脉高压行择期剖宫产术患者30例,所有患者术中均采用APCO监测.均采用连续硬膜外麻醉,用药按照缓慢、分次给药、逐渐扩散麻醉平面的原则.记录各观察时点的脉搏氧饱和度(SpO2)、HR、中心静脉压(CVP)、SBP、DBP、平均动脉压(MAP)、心排量(CO)、心脏指数(CI)、每搏量(SV)、心搏指数(SVI)、体循环阻力(SVR)及体循环阻力指数(SVRI).结果:与硬膜外给药前相比,硬膜外给药3 min后HR、SpO2、CVP及CO无明显变化,但BP、SVR下降(P＜0.05).与胎儿娩出前相比,胎儿娩出后、子宫体注射缩官素10U(T6)时,BP、SpO2、SVR降低及HR、CO增加等变化均差异有统计学意义(P＜0.05),但CVP的变化并差异无统计学意义(P＞0.05).给予缩宫素2min后,以上变化更为明显.结论:该类患者剖宫产术血流动力学变化主要发生在连续硬膜外麻醉起效阶段以及胎儿娩出前后,主要表现为SVR和SpO2下降.APCO监测,因其微创及不受心内分流影响具有较高的可行性与可信度,适用于妊娠合并先心病重度肺动脉高压者的围术期监测.

高血压是围术期特别是手术中经常遇到的问题.围手术期高血压和动脉血压不稳在80%的心脏手术患者中发生,在重大的非心脏手术中的发生率达到25%[1].