Objective:To study the outcomes and post-discharge follow-up of neonatal tracheotomy in neonatal intensive care unit(NICU).Methods:This study included patients who were admitted to NICU in Beijing Children′s Hospital from January, 2016 to August, 2021, and less than 28 days or 44 weeks(corrected age)on admission, and required tracheotomy.The patients were divided into tracheotomy group and the non-tracheotomy group (the parents signed to refuse the tracheotomy) according to whether perform tracheotomy.Demographic data, general hospitalization information, diagnosis, indications for tracheotomy, follow-up outcomes at 3/6/12 months of age after discharge of patients were collected and analyzed.Results:Totally 26 patients were included in this study, 14 cases in tracheotomy group and 12 cases in non-tracheotomy group.The average gestational age was(37.7±3.80)weeks and(38.99±1.83)weeks, and birth weight was(2 823.57±948.89)g and (3 320.83±378.76)g, respectively.There were no significant differences in sex, gestational age, birth weight, age on admission, weight on admission, age at diagnosis, ratio of endotracheal intubation for respiratory support on admission between two groups( P>0.05). The commonest indications of tracheotomy group were bilateral vocal cord paralysis(50.0%) and congenital anomaly/defect of throat/larynx(21.4%), and the commonest indications of non-tracheotomy group were bilateral vocal cord paralysis(50.0%) and vocal cord/subglottic mass(25.0%), and there was no significant difference between two groups( P>0.05). The rate of discharge-against-medical order of tracheotomy and non-tracheotomy group was 7.14% and 66.67%( P=0.003), respectively.The total follow-up rate of tracheotomy and non-tracheotomy group was 88.9% and 38.9%, while the follow-up rates at 3 months, 6 months, and 12 months were 100.0% vs. 50.0%, 83.3% vs. 41.7%, and 81.8% vs. 25.0%, respectively, whose differences were statistically significant(all P<0.05). In the 14 cases of tracheotomy group, 3 cases died, 4 cases successfully removed the tracheal cannula, 5 cases did not remove the tracheal cannula, and 2 cases were lost. Conclusion:Bilateral vocal cord paralysis is the commonest indication of neonatal tracheotomy.Parents′ compliance in the tracheotomy group is significantly higher than that in non-tracheotomy group.To give caring skill training for parents of neonates with tracheotomy before discharge is beneficial for improving the overall prognosis of children.

目的:综合评价贮存式自体输血(preoperative autologous blood donation,PABD)在肺癌手术患者中的临床应用效果.方法:回顾性分析2018年08月至2020年05月在我院行肺癌根治手术的患者共415例.其中80例采用贮存式自体输血(PABD组),335例未采用(No-PABD组).采用倾向性评分匹配功能进行匹配,比较匹配后的两组患者的术中出血量、术中异体血输注量、输血不良反应、术后胸腔引流量、围术期的血红蛋白(Hb)、血小板(PLT)变化情况等指标.结果:采用1:1最邻近匹配法,经倾向性评分匹配后成功匹配80对患者.PABD组采血后Hb、红细胞(RBC)、红细胞压积(Hct)水平均低于采血前,差异有统计学意义(P<0.05);而PLT水平在采血前后无统计学差异(P>0.05).两组患者在术后1、3、7天的Hb和PLT变化基本一致,差异无统计学意义(P>0.05).PABD组术中出血量[(474.9±325.9)mL vs(458.1±281.5)mL]、术后胸水引流量[(873.0±360.3)mL vs(774.5±341.7)mL]及住院时间[(9.4±3.3)d vs(9.8±2.6)d]与No-PABD组比较无明显差异(P>0.05).而PABD组异体血输注量(4000 mL vs 8800 mL)、异体血输入率(8.8％vs 23.8％)及输血相关费用[(189.5±92.2)元vs(337.8±426.8)元]均低于No-PABD组.结论:贮存式自体输血在肺癌手术患者中的临床应用是安全的,可以降低异体血输入率,减少输血相关费用.

Background and Objective:Liposuction is an effective treatment for fat disposition in lymphedema. Blood transfusion has been seldom investigated in lymphedema liposuction surgery. The purpose of the study was to analyze clinical factors associated with blood transfusion in liposuction surgery of lymphedema patients and compare the autologous and allogeneic transfusion patterns.Methods:A total of 1,187 cases of liposuction due to lymphedema were recruited. Demographic, laboratory tests and operation information were collected. Patients were divided into a transfusion and a non-transfusion group. Different transfusion patterns were compared and analyzed.Results:Between the two groups, there is a significant difference in postoperative hemoglobin levels, and as well as gender, age, surgery duration, body weight change, intraoperative transfusion volume and blood loss, hospital length of stay, and surgical site distribution. There is a significant difference in the comparison of hospital stay length, autologous transfusion volume, combined allogeneic volume, operative blood loss, intraoperative transfusion volume, and change in hemoglobin levels between predonation and acute normovolemic hemodilution (ANH) transfusion. In comparison with the allogeneic transfusion-only patients, the mean allogeneic transfusion volume in either ANH group, predonated transfusion group, or mixed group is statistically lower. Allogeneic transfusion volume in the predonated-only group is significantly lower than that of either the ANH-only group or the mixing ANH with predonation group. Ordinary least squares regression analysis suggests that autologous transfusion in the ANH-only mode is statistically associated with allogeneic transfusion.Conclusions:This study described the blood transfusion in lymphedema liposuction surgery and compared autologous and allogeneic transfusion patterns in these patients. Autologous transfusion can reduce the transfusion volume of allogeneic blood and might be a beneficial mode of transfusion in these patients.

目的:研究影响住院病例医疗服务收入占比达标率的因素.方法:选取2021年1月-6月在某医院住院的患者病历,以全市同类医院DRG组平均水平作为目标值,通过logistic回归分析内外科住院病例医疗服务收入占比达标的影响因素.结果:外科病例医疗服务收入占比达标率为33.56％,内科病例达标率为31.92％.影响达标率的因素有年龄、住院天数、DRG权重、耗材费用达标情况、医技费用达标情况、药品费用达标情况、是否手术/介入、中医非药物治疗费、手术介入费.外科科室控制耗材费用(OR:6.97(5.18,9.38),P＜0.01)、内科科室控制医技费用(OR:5.29(4.36,6.42),P＜0.01)将有助于病例医疗服务收入占比达标.结论:外科科室应加强耗材使用管理,管控成本;内科科室应规范检查检验行为,降低例均费用.作为中医医院,应发挥中医药特色优势,鼓励开展中医非药物治疗.基于DRG的标杆比较法具有一定客观性和可推广性.

Objective:To explore a convenient and effective method for calculating intraoperative blood loss in liposuction and volume reduction surgery for establishing intraoperative autologous blood transfusion threshold.Methods:Patients’ clinical, laboratory and surgery related information were collected. The influence of different factors such as the total amount of liposuction, bloody fluid, operation time, and patients’ weight change on blood loss during operation were analyzed. The difference of volume between blood loss recorded by doctors and theoretical calculations was compared. The formula of blood loss during operation was conducted, and then the threshold of autologous blood transfusion was established.Results:A total of 1 136 patients with liposuction due to lymphedema were recruited. There were 65 males and 1 071 females, the median age was 56 years in the non-transfusion group and 55 years in the transfusion group. The total amount of liposuction, bloody fluid, operation time, and body weight changes in patients with liposuction surgery were statistically positively correlated with intraoperative blood loss (spearman coefficient were 0.590, 0.584, 0.560, 0.520, respectively, P<0.01). The theoretical blood loss calculated by the Hemoglobin balance formula is (753.0±418.2) ml. According to the calculated value of blood loss, the intraoperative blood loss fitting formula y(ml)=0.082×total liposuction+ 365, is abtained. The threshold for reinfusion of autologous blood is 2 900 ml of liposuction amount. Conclusions:In this study, a convenient calculation method of blood loss in liposuction and volume reduction surgery was constructed, and a threshold for autologous blood transfusion in surgery was set up. Thus, the indication of early blood transfusion was established.

如何规范医师用血行为,促进临床合理用血,值得医院深入探讨.首都医科大学附属北京世纪坛医院以临床决策支持系统和人工智能为抓手,融合大数据技术,构建了临床输血智能管理系统.系统应用后,医院围术期红细胞输注预测准确率持续提高;管理和科研模块可以直接输出与输血有关信息,为管理部门提供了各类数据报告,并为科研提供了数据支持.

目的:探讨影响血浆输注效果的相关因素,以期进一步提高患者血浆输注有效率和临床输注的合理性.方法:根据输血后患者临床症状改善情况和实验室凝血检测值将患者分为血浆输注有效和无效2组.对4 423例患者的基本临床资料和13 090.8 U的血浆输注过程中涉及的主要因素如输血浆前PT、APTT、血浆种类、保存时间、输注血浆体重比(kg/ml)等进行分类统计分析.结果:外科监护室患者血浆用量最多,占总血浆输注比例最大(30.36％),人均用血浆量最大的科室为心外科(3.96 U).从输注效果上看,不同年龄组患者的输血效果有差别(P＜ 0.001),＜18岁组患者血浆输注有效率(53％)高于18-60岁和＜60岁组,18-60岁组和＞60岁组患者血浆输注有效率分别为41％和30％;女性患者输血浆有效率(42％)高于男性(37％)(P＜0.001);按不同血浆体重比进行血浆输注效果比较显示无显著差异(P＞0.05);通过多因素Logistic回归分析,普通冰冻血浆、去白细胞血浆和新鲜冰冻血浆3类血浆的临床输注效果间没有差异;输注前血浆保存时间与输注效果之间无显著相关性.去白细胞血浆与未经去白的血浆相比,并未降低非溶血性发热性输血反应的发生率.结论:血浆输注效果的主要影响因素有患者年龄、性别,但与血浆体重比、血浆种类和血浆保存时间关系不大;只要于保存期内输注,保存时间的长短与输注效果间没有显著相关性.

目的 探讨影响结直肠肿瘤患者围术期用血量的相关因素,以期进一步提高患者临床输血的合理性.方法 收集本院207例结直肠肿瘤患者临床信息、实验室检测信息以及围术期输血情况等资料.对输血过程中涉及的主要因素如患者年龄、性别、术前血红蛋白水平、术前凝血、手术时间、肿瘤部位、肿瘤体积、等进行分类统计分析.结果 手术患者术中出血量大于600 mL者18.8％ (39/207),而术中输血率为28.5％(59/207),较高的输血率与20.29％ (42/207)患者术前贫血(Hb＜ 100 g/L)相关.术中红细胞用血量占围术期用血量56.95％.通过多因素Logistic回归分析,对术中输红量影响最大的因素是手术时长和术前血红蛋白(P＜0.001).肿物大小与红细胞输注总量相关性很高,“部位_结肠”也有一定影响(P＜0.05).患者年龄、性别与围术期输血量无显著相关性(P＞0.05).术中红细胞和血浆输注比例合理,无搭配“全血”输注情况.结论 患者围术期输血量的主要影响因素有术前血红蛋白水平、手术时间、肿瘤大小及肿瘤部位,但与其年龄、性别关系不大.

Objective: To reduce the occurrence of adverse events of clinical blood use by analyzing the clinical adverse events of blood use except for the adverse reactions of blood transfusion. Methods: A retrospective analysis was performed on 294 cases of adverse events of clinical blood use other than adverse blood transfusion reactions in Shijitan hospital from January 2014 to December 2017, and a statistical analysis was made on the types of adverse events of clinical blood use, blood transfusion related departments, and internal and surgical blood use. Results: The incidence of adverse events of clinical blood use was 10.3‰, 9.6‰, 4.2‰ and 4.6‰ in these 4 years respectively, and there were 216 cases (73.5%) of external departments, 49 cases (16.7%) of internal departments, 8 cases (2.7%) of nursing departments, and 21 cases of others(7.1%), which includes 12 cases of errand department, 4 cases of the clinical laboratory and 5 cases of transfusion department. The adverse events of clinical blood use were divided into 4 types: 71 cases (24.1%) of transfusion process problems, 36 cases (12.2%) of clinical communication between departments, 182 cases (61.9%) of clinical unreasonable transfusion and 5 others (1.8%). There were statistically significant differences in the occurrence of adverse events of different types of blood use in external and internal departments based on the property of the department, among which there were significant differences in unreasonable transfusion between them. According to the purpose of blood use, there were statistically significant differences in the occurrence of different types of adverse events between the two departments, and the incidence of different types of external departments were higher than that of internal departments. Conclusions: The incidence of adverse events of blood use in external departments is higher than that in internal departments. Reasonable transfusion should be strengthened to avoid the occurrence of adverse events of clinical blood use, so as to ensure the safety of blood transfusion.

目的 探讨肿瘤细胞减灭术(CRS)加腹腔热灌注化疗(HIPEC) (CRS+HIPEC)应用于腹膜癌围手术期的输血总体情况与综合止血技术临床疗效.方法 以“首都医科大学附属北京世纪坛医院腹膜肿瘤外科临床科研数据库”中采用CRS+HIPEC治疗445例腹膜癌病例资料为研究对象,分析患者的临床病理特征和围手术期输血情况,进而对器官切除数量、腹膜剥除区域数量与围手术期输血量做相关性分析;为分析输血变化情况,按照手术日期顺序、肿瘤中心手术例次对患者收益程度影响的学习曲线规律,将患者分为第1时间段(2015.4.28-2017.3.1)组(n=220)和第2时间段(2017.3.2-2018.1.24)组(n=225),比较二者围手术期输血量.结果 本组患者的术中红细胞、血浆输注量约占围手术期总量的73.26％(1 564 U/2 135 U)、80.14％(276 500 mL/345 000 mL).术中、围手术期红细胞输注量与器官切除数量呈正相关性均为(r=0.24,P＜0.05),血浆输注量与腹膜剥除区域数量亦呈正相关性(r值分别为0.37、0.38,P＞0.05).第1、2时间段术中输血量,分别为红细胞(U):3.9±3.8vs3.1±3.0(P＜0.05);血浆(mL):673.6±450.2 vs570.2±371.6(P=0.01).结论 CRS+HIPEC围手术期患者的输血量与器官切除数量、腹膜剥除区域数量呈正相关,术中综合止血技术可减少这类手术围手术期输血需求.

Objective To improve understanding of the students about the theory of discharge of aortic nerve on blood pressure adjustment, along with their hands-on ability, observational and problem-solving skills.Methods To observe the characteristics of Aortic Nerve Impulse in rabbits, along with the relations of neurohormonal factors and discharge of aortic nerve and blood pressure adjustment.Results There is a positive correlation between the amplitude of aortic nerve impulse and the changes of blood pressure in a cardiac cycle. The amplitude of Aortic nerve impulse was increased by clamping the common carotid artery or by norepinephrine. The amplitude of Aortic nerve impulse was decreased by acetylcholine.Conclusion We summarize the problems we encounter and solutions we use in doing these student experiments into experimental notes and evaluation methods which can guide us in future experiments.

目的 实施新的临床用血申请分级管理制度,评价临床用血申请分级审核的监管效果.方法 对2013年7月～2014年6月5 476张临床用血申请单进行质量审核,按照PDCA循环原理重新修订和实施医院临床用血申请分级管理制度,HIS系统建立主治或以上专业技术职称医师开具临床用血电子申请自动授权管理,输血科建立临床用血申请单全面质量审核及实时记录,定期统计分析、上报、公示临床用血申请分级审核签字情况,实施全医院临床用血申请分级管理的综合质量目标控制.结果 临床用血申请上级医师审核签字合格率大于96.97％;临床用血申请单科主任审核签字合格比例由22.97％上升到95.00％(P ＜0.01);医务处审核签字合格率由88.00％上升到95.00％.结论 执行新的临床用血申请分级管理制度可显著改善质量,有利于临床合理用血水平的提高.

Objectives To analyze the objective indicators for evaluating clinical blood transfusion and the characteristics of using blood components for the patients in the Intensive Care Unit(ICU) and to improve appropriate blood use in critically ill patients.Methods A retrospective review for the usage of blood components and clinical basic data of the ICU patients from 2010 to 2013 has been done with the homegrown data mining software.The objective indicators for evaluating clinical blood transfusion and the characteristics of using blood components in patients of ICU were analyzed and compared.Results The numbers of patients were growing at over 30% in the ICU during past four years.At the same time,total incidence rate of blood transfusion,incidence rates of red cell transfusion,plasma transfusion,platelet transfusion,and average transfused units of red blood cell,plasma and platelet blood components per discharge patient and per transfused patient from the ICU exhibited an obvious downward trend.During the same period,total mortality,average length of stay,total cost,and incidence rate of nosocomial infection have shown a consistent decline.The indicators related with blood transfusion compared between transfused and non-transfused patients were significantly different(P0.01).Conclusion The effects of the patient blood management have shown an apparent improvement during the past four years in our ICU.A transfusion trigger based on evidence-based medicine was implemented,and was beneficial for monitoring appropriate blood use in clinical transfusion and improving overall health quality of ICU patients.

Objective To establish a electronic platform for the clinical blood transfusion quality and education and training management systems,and to promote the clinical blood transfusion management and the construction of the blood transfusion culture in the hospital. Methods A electronic platform has been built in the HIS Local Area Network in accordance with the technical standards and system architecture based on Web,which had an independent server address. The portal page of the electronic platform was instantly browsed on all workstationu0027s IE of the clinical departments for implementation of the clinical blood transfusion management and education training. A lot of contents,such as the objective,indicators for evaluating clinical blood transfusion and so on,were displayed to public. The electronic and pre- formatted quality records and technical records for ISO15189 accreditation have been put into effect. Results The electronic platform of the clinical blood transfusion quality and education and training management systems has been with a reliable software and hardware during last three years. It has a substantial platform for a more convenient communication between blood transfusion department and other clinical departments. Conclusion The electronic platform of the Clinical Blood Transfusion Quality and Education and Training Management Systems based on Web can improve the quality of clinical blood transfusion management and enhance the culture of rational blood transfusion.

Objective To standardize statistics of the Objective Indicators for assessing clinical blood transfusion during last three years and promote patient blood management.Methods Retrospective review of the clinical blood transfusion and the medical foundation data of the hospital with standard statistics methods from 2010 to 2012.The Objective Indicators for assessing clinical blood transfusion with the three years are defined and calculated for analyzing their effects of improving the patient blood management.Results The total rate of blood transfusion of the different year is respectively:5.26%,4.83%,4.08%.The rate of red blood cell transfusion and plasma transfusion,mean number of units transfused red blood cell,fresh frozen plasma and platelet per inpatient and per surgical operation show a obvious reduction.Autologous blood transfusion rate of surgical department and the hospital are raised significantly.There are some queues for prior to 30 numbers with the departments,the diseases,the doctors,the operations transfused different blood components.Conclusion To standardize define and statistic of the Objective Indicators for assessing clinical blood transfusion.It has made significant progress for clinical reasonable blood transfusion and patient blood management in the hospital during the last three years.

目的 研究左旋紫草素肠道及Caco-2细胞转运特征及其机制.方法 应用翻转肠囊法和Caco-2细胞模型考察时间、浓度对左旋紫草素转运吸收特性的影响,应用P-糖蛋白抑制剂维拉帕米对左旋紫草素转运吸收机制进行研究,采用HPLC法测定左旋紫草素的浓度,计算其表观渗透系数(Papp).结果 在Caco-2细胞模型,随浓度增加和时间延长,左旋紫草素的累积转运量逐渐增加;加用维拉帕米后,使AP侧到BL侧的表观渗透系数Papp(AP→BL)显著增加,而从BL侧到AP侧的表观渗透系数Papp(BL→AP)显著降低.在翻转肠囊模型,100 μmol·L-1左旋紫草素中加入维拉帕米后Papp显著增加.结论 左旋紫草素的转运存在被动转运和主动转运2种形式,P糖蛋白参与主动转运过程;该药经肠道吸收中等,加入维拉帕米可能促进吸收.

目的 分析腹膜后肿瘤切除术围手术期临床用血,加强围手术期血液输注管理.方法 回顾分析108例腹膜后肿瘤切除术患者围手术期临床用血情况,分析腹膜后肿瘤切除术围手术期临床用血合理性和特点.结果 108名患者围手术期输注异体血患者80名,异体血输血率74.00％；RBC、血浆、血小板输注率分别为74.00％、69.40％、12.04％；手术例均RBC、血浆、血小板输注量分别为10.30 U、953.70 mL、0.42 U；总自体输血率38.90％,例均自体采血量795.00 mL；108例腹膜后肿瘤患者围手术期不合理异体RBC输注9例,不合理异体RBC输注率为8.33％；术中出血量＞500 mL“RBC过量输注”25例,占比23.15％；“RBC过量输注”患者术前Hb、Hct及术后1dHb、Hct水平明显高于无“RBC过量输注”患者,2组结果比较,P＜0.01.结论 腹膜后肿瘤切除术围手术期不合理RBC输注比例为8.33％；“RBC过量输注”率为23.15％,术前高Hb、Hct患者更易导致“RBC过量输注”；外科围手术期临床用血管理需进一步加强.

现代医学证明脊椎动物的损伤很复杂,特别是人类,大量临床研究表明,脊椎损伤治愈率很低,这还是一个医学难题。然而从一个侧面观察动物实验针刺疗效,再结合中医中药强筋健骨散淤止痛方剂,可能对探究人类脊椎损伤治疗机理有一定意义。

现从实验教学现状出发,结合实验教学改革的实践,探讨将病理生理学机能实验与病理学形态实验整合在激发学生实验兴趣、提高学生操作技能与综合分析能力等方面的作用。病理学与病理生理学实验的整合进一步提高实验教学的质量,也为实验教学模式的改革提供一个新的思路。

温振英教授为首都医科大学附属北京中医医院儿科主任医师,国家级名老中医,全国第三、四批老中医药专家学术经验继承指导老师.从事儿科临床、教学及科研50余年,在临诊时强调"脾胃为后天之本",时时注意对脾胃的顾护与调理,发挥中医特色整体治疗的优势,临床常获良效.笔者有幸侍诊左右,兹将老帅治疗脾胃病的经验介绍如下.