通过招募广东发达地区退休医务人才,对口帮扶广西基层医院的"银龄行动"模式,探索出解决边远落后地区高端医疗人才缺乏,医疗技术水平低的可行性方案.对实施"银龄行动"模式3年工作进行效果分析,结果表明,此行动为当地患者提供了优质的医疗服务,帮助基层医院规范诊疗服务行为,增加临床新技术新业务的开展,积极培养基层医院医疗技术人才,加强临床学科建设.显著提高广西基层医院的医疗技术服务能力."银龄行动"模式充分利用发达地区退休医务工作者技术水平,帮扶落后地区和少数民族的爱心,通过他们短时间的医疗行为,满足基层医院对高端医学人才和技术提升需求,实现对基层医院有效地精准帮扶.

Objective:This study aims to investigate the awareness of and continuing medical education (CME) needs among primary medical staff involved in medical assistance programs. The findings offer valuable insights for enhancing medical assistance initiatives.Methods:Starting from August 2022, we distributed a questionnaire within WeChat groups to collect data on the awareness and requirements of CME among medical staff in the Guangxi and Guangdong regions. The collected data was subjected to statistical analysis using the χ2 test or Mann-Whitney U test. Results:The survey included 151 respondents from dispatched hospitals and 930 from assisted hospitals participating in the medical assistance program. Significantly higher proportions of individuals from assisted hospitals, compared to those from dispatched hospitals, believed that the medical assistance programs had a substantial impact on medical technology, talent development, and educational mentorship [636(68.4%) vs. 75(49.7%), 551(59.2%) vs. 59(39.1%), and 545(58.6%) vs. 51(33.8%), respectively, all P<0.001]. Regarding the participation of doctors with moderate clinical skills from dispatched hospitals in medical assistance, 109(72.2%) from dispatched hospitals and 750(80.6%) from assisted hospitals believed they should contribute to ″medical education″ ( P< 0.05), while 58 (38.4%) from dispatched hospitals and 184(19.8%) from assisted hospitals believed that such doctors ″should not be deployed″ for medical assistance ( P<0.05). Among the 588 staff members in assisted hospitals with more than 10 years of service, 505(85.9%) expressed a need for ″knowledge/skills training, ″ compared to 273(79.8%) among the 342 staff members with 10 or fewer years of service ( P< 0.05). Conclusions:There are differences in the cognitions of medical assistance between dispatched hospitals staff and assisted hospitals staff, and there are also differences in CME needs of assisted hospital staff with different lengths of service. Efforts should be made to increase the emphasis placed on CME by the dispatched hospitals staff, and to actively carry out medical theoretical knowledge and skill training based on the educational needs of grassroots medical staff, in order to further improve the effectiveness of medical assistance.

Objective To investigate the value of cerebral state index (CSI) in monitoring the consciousness state of patients with brain trauma.Methods The consciousness sates of 218 patients with craniocerebral trauma were assessed by three experienced specialists by Glasgow Coma Scale (GCS),and the CSI of the patients were measured by Cerebral State Monitor.Correlation between GCS and CSI as well as the distribution of CSI in various consciousness defined by GCS were discussed.The predictive value of CSI in discriminating different conscious states of the patients was also analyzed.Results The Cochran Q test showed that there was a consistency of the GCS judged by three specialists (P ＞ 0.05),and the CSI of the patients was positively correlated with the GCS (r=0.819,P＜0.001).A gradual decrease in the CSI was found across categories of the various consciousness states,including sobriety,somnolence,confusion,light coma,coma in moderate depth and deep coma.The receiver operating characteristic curve (ROC) analysis showed that CSI could significantly discriminate the different consciousness states of the patients (P ＜0.001).The area under the curve (AUC) for the consciousness was 0.995 for deep coma,0.984 for sobriety,0.815 for coma in moderate depth,0.769 for somnolence,0.768 for light coma and 0.695 for confusion,respectively.Conclusion CSI can be used to monitor the severity of craniocerebral trauma.

目的 胸片普查延迟诊断的周围型小肺癌早期x线表现及动态变化特点.方法 回顾性分析15例胸部X线摄片延迟诊断的周围型小肺癌的影像学特征.将本组病例按检出前和检出时病灶形态、大小、密度和边缘进行了对比.结果 回顾性分析延迟诊断的15例患者初次胸片均有异常改变,包括:1)微结节伴有纹理聚集3例.2)灶状浸润7例.3)不规则结节状5例.检出时全部病灶均发展成(20.7±9.1)mm结节.从初次显现至病灶检出相距时间为8～47个月,平均16.3个月,倍增时间为35～233 d.结论 周围型小肺癌胸片较容易漏诊,认识其早期表现、动态比较观察以往胸片和及早行建议胸部CT扫描有助于降低小肺癌的延迟诊断率.

Objective Discuss detecting meaning of cerebral state index (CSI) for patients with brain trauma coma complicated with pulmonary infection ,so as to make conclusion for related nursing intervention .Method Choose 65 cases of patients with brain trauma coma complicated with pulmonary infection in our hospital during July ,2011 to July .2013 ,and process CSI and clinical pulmonary infection (CPIS) to analyze the relationship of them and summa-rize the preventive nursing measures .Result The lower CPIS score ,the higher CSI score and the relationship between them is negative correlation .Conclusion CSI and CPIS score have a certain value for brain injury prognosis judgment , and implement preventive nursing can effectively reduce the incidence of pulmonary infection ,so as to help to im-prove the prognosis ,reduce mortality .

目的 分析脑状态指数(CSI)在脑外伤患者意识监测中的应用价值,总结护理体会.方法 筛选2012年1月～2013年3月我院收治的200例脑外伤患者为研究对象,入ICU 6h内监测CSI,根据CSI指数水平分为4组:CSI 70～80组、CSI 60～70组、CSI 40～60组、CSI 20～40组,每组50例.比较一般情况、手术率、遵医嘱运动百分率、并发症情况,并给予相应护理.结果 随着CSI递减,组间手术率依次增加,遵医嘱运动百分率依次降低(P＜0.05)；皮肤及呼吸、消化、心血管系统并发症发生率也依次升高(P＜0.05).结论 CSI可以作为脑外伤患者意识障碍的监测指标,对制定护理措施具有积极的指导作用.

Objective To investigate the effect of CT virtual endoscopy imaging method. Methods From January 2010 to January 2012 ,20 cases checked with colon endoscopy were included as research subject.The patients used CT virtual endoscopy, received the check virtual endoscopy and stereo section 3D image, and the imaging results were analyzed. Results Among 20 patients, 19 cases were correctly diagnosed ,1 case was misdiagnosed,the accurate rate was 95%. CT virtual endoscopy could clearly display the examination part of internal structure, the imaging of the fiber electronic endoscope was more clearer, could accurately reflect the location of lesions. Conclusion CT virtual endoscopy imaging for patients with colon can be observed accurately on the lesions ,accurately reflect the tumor surface details, but also find abnormal mucosal folds and beside tumor promoter lesions. CT virtual endoscopy is a painless, noninvasive, rapid, accurate and advantages, its image clarity, the result of diagnosis is good.

目的:探讨CT导引下三维立体定向术在颅内肿瘤诊断中的应用及治疗效果。方法:回顾性分析应用CT导引下三维立体定向术诊断和治疗的62例颅内肿瘤患者的临床资料。结果:62例患者经CT导引下三维立体定向术明确诊断60例,有2例被误诊为非瘤性囊肿,诊断准确率为96.77%,与手术病理学诊断结果相比,差异无统计学意义(P>0.05)。且经CT引导下三维立体定向术明确诊断和治疗后,所有患者的临床症状均不同程度改善,1个月个经CT复查结果显示颅内肿瘤缩小或消失。有5例患者术后发生手术并发症,其中胃肠道反应3例,颅内出血2例,但经相应处理后,均得到良好的恢复,无不良反应发生。结论:CT导引下三维立体定向术对颅内肿瘤检查具有高分辨率特征,明显提高了颅内肿瘤的诊断率,具有重要的临床应用价值。可作为临床诊断首选方法。

Objective To investigate the CT delayed CT in differential diagnosis of liver tumors using value. Methods In our hospital from June 2009 to March 2012 application of enhanced and delayed CT diagnosis technology,later confirmed by operation and pathology in 68 cases of patients with liver tumors were retrospectively reviewed the clinical data analysis.Results 68 cases of enhanced and delayed CT technology after definitive diagnosis,65 patients with operation pathology diagnosis results are the same,3 cases of misdiagnosed cases,the correct diagnosis rate was 95.59%,and operation pathology diagnosis results are compared, the difference was not statistically significant (P>0.05).Conclusion Spiral CT enhanced and delayed technique has high accuracy rate of diagnosis,patients with less pain,high security features,significantly improve the liver tumor diagnosis rate,in the differentiation of liver tumors has important clinical application value, can be used as a clinical examination of the liver tumor and the first choice identification method.

Objective Through the cerebral state monitor(cerebral state monitor,CSM) to quantify coma depth and degree of brain functional lesions,clinical nursing.Methods In 96 cases with brain injury patients with coma for CSI monitoring,analysis of these indicators and with physical reflection,Glasgow coma score(GCS) and Glasgow Outcome Scale(GOS) to guide the clinical nursing.Results CSI100-0 is from awake,then to deep coma and brain death continue to scale,and patients with coma degree have a great relationship,and symptoms reflecting corresponding drawdown;especially in the long time constant stimulation,CSI will appear change,according to the cerebral state index,quantitative alterations in brain function to guide their corresponding clinical nursing the clinical significance of.Conclusion Through the development of a noninvasive CSM dynamic real-time detection,quantification and digital brain function damage,constructing the related impairment clinical criteria,Objective clinical nursing and prevention of complications.

Objective To study the application experience of nursing intervention which prevent fracture in lower extremities with deep vein thrombosis nursing and preventive strategy for deep venous thrombosis following fracture of leg.Methods 250patients with fracture of leg after 2 hours of operation were deal with active regular exercises as early as possible,and carefully nursing,watching.Results 3 of them had deep venous thrombosis recovered after early diagnosis early treatment.Conclusion early active regular exercises as early as possible,carefully nursing,watching are which the key way of preventive strategy for deep venous thrombosis following fracture of leg.

我院2004年9月引进了一台法国产STEPHANIXTR3D数字胃肠X线机,该机投入使用后经常出现高压触摸屏控制台"死机"故障,以下介绍故障产生原因和解决方法.

目的:探讨输尿管结石的静脉尿路造影(IVU)表现.方法:回顾性分析65例输尿管结石(直径＜10mm)患者的临床和IVU表现.结果:所有病例均经治疗或输尿管镜取石证实.结石5.1～10mm者34例;≤5mm者31例,结石易停留在输尿管生理狭窄部位,多为卵圆形.结石近侧输尿管轻度扩张者59例,肾盂肾盏扩张积水者39例.结论:IVU结合平片能很好地显示尿路的形态,具有易于发现结石、定位准确等优点,在尿路结石检查中仍占主导地位.

Objective:To evaluate the ability of dynamic intravenous urography (DIVU) in the evaluation of the upper urinary tract by comparing with intravenous urography (IVU).Methods:158 cases suspected with upper urinary tract disease were imaged by DIVU,other 120 cases underwent IVU for comparison. Opacification scores for the two groups (normal and abnormal cases) of urinary tracts were then compared. Ability of DIVU and IVU was compared in the diagnosis of upper urinary tract disease.Results:The score of DIVU was higher than that of IVU for lower ureters(P=0.000). The score of DIVU was higher than that of IVU for pelvis of the abnormal urinary tracts,the differences in scores were statistically significant(P=0.001).The score of DIVU was higher than that of IVU for upper, middle and lower ureters(P= 0.001). The accuracy rate of DIVU in diagnosing renal duplication and hydronephrosis was 100%, which was higher than that of IVU. DIVU was also more reliable in detecting the ectopic ureteral orifice and ureterocele than IVU.Conclusion:DIVU is a reliable technique for the diagnosis of urinary tract diseases. In patients suspected with congenital anomaly,hydronephrosis etc, DIVU could be selected as the first choice.

泌尿系统疾病是常见病、多发病,尤其在我国南方及沿海地区更为常见.泌尿系统疾病中以结石发病率最高.泌尿系统造影几十年来一直沿用传统的静脉尿路造影(IVU),随着医疗技术设备的进步和发展,传统的IVU越来越不能满足患者和临床提出的诊断要求,故动态静脉尿路造影术(DIVU)应运而生.动态静脉尿路造影术(DIVU)因腹部不用加压,术前仅禁食、不需肠道准备,头低足高位,静脉推注造影剂在电视监视下直接进行静脉尿路造影,而深受患者与临床医生的欢迎.我院自1999年11月至2000年7月共作DIVU 98例,现总结如下: