目的:探究实时三维超声心动图(RT-3DE)在冠心病节段性室壁运动异常患者动脉病变的临床价值.方法:选取接受冠状动脉造影检查的有明显节段性左室壁运动异常的冠心病患者100例为观察组;另选择同期100例冠脉造影正常者为对照组,两组均进行心脏RT-3DE检查分析,比较两组左室收缩末容积(LVESV)、左心室舒张末容积(LVEDV)、左心室射血分数(LVEF)、左心室心肌质量(LVM)、左心室重构指数(LVRI)数值,以及整体心功能参数,并对图像采用定量分析软件进行处理和分析.结果:与对照组比较,观察组患者的左心室基底段、中间段的局部舒张期末期容积(REDV)、局部收缩末期容积(RESV)均较高(均P＜0.05).与对照组比较,RT-3DE检测的观察组(单只、双只、多只病变)整体心功能参数LVEDV、LVESV升高,LVEF、LVRI降低(均P＜0.05),两组LVM比较无统计学差异(P＞0.05).对照组左心室容积-时间曲线(VTC)排列有序,各节段曲线形态一致,各曲线的波峰、波谷的横坐标位置接近,时间牛眼图上左室整体达收缩末期时间相近为绿色,位移牛眼图上运动正常为蓝色;观察组病变区域VTC形态不规则、杂乱,曲线的波峰、波谷后移,时间牛眼图上为红色,其周围节段出现蓝色、绿色,位移牛眼图上为黑色.受试者工作体征曲线(ROC曲线)结果显示,RT-3DE在冠心病节段性室壁运动异常患者冠状动脉病变检测的灵敏性为68.59％,特异度为85.72％,曲线下面积(AUC)值为0.866.结论:RT-3DE可分析评估冠心病患者节段性室壁运动异常,并可对冠状动脉病变进行定量分析,在临床检测中具有较高的应用价值.

目的 探讨某综合型医院住院患者呼吸系统死亡疾病的分布特点,为医院合理安排救治与预防保健工作提供科学依据.方法 利用统计工具从医院信息管理系统(HIS)中提取2010～2019年10年间北京市海淀区某医院呼吸系统死亡病例,回顾性分析死亡病例的性别、年龄、疾病病种等.结果 10年间呼吸系统死亡993例,病死率2.84％,其中男性2.97％,女性2.58％,男性病死率明显高于女性,差异有统计学意义(P＜0.05);各年龄段病死率随着年龄的增加而增加,病死率从0.09％上升到30.77％;呼吸系统疾病死亡有明显季节性,一季度死亡人数最多,占30.01％;死亡前3位疾病依次肺炎(病原体未特指),占37.97％,细菌性肺炎占27.59％,慢性阻塞性肺疾病占14.80％.结论 死亡患者中99.90％为下呼吸道感染患者,60岁以上的老年人是呼吸系统死亡的高危人群,应加强对呼吸系统死亡疾病及其相关危险因素的监测.

高钾血症是一种由于钾离子代谢异常引起的电解质紊乱疾病,主要是体内钾离子升高或是钾排除受限引起,肾脏功能受损是产生高钾血症的高危因素,不同浓度高血钾引起心电图不同程度的变化,本文就1例高血钾致窦室传导心电图改变进行报道.

训练性膝关节痛,即训练所致的膝关节非感染性创伤性滑膜炎[1]. 反复高强度训练是提高战士体能的主要手段,同时这种高强度单一动作可能造成关节滑膜损伤,导致膝关节痛. 训练性膝关节痛表现为滑膜组织水肿、渗出液增多,大量黏液素刺激神经末梢,引起关节疼痛,使之活动受限[2].

目的 观察碘伏在脓肿切开引流术患者中的临床应用效果.方法 经患者知情同意后,将160例深部脓肿切开引流术患者分为2组即试验组和对照组.试验组(n=86)用3％过氧化氢溶液和0.9％氯化钠注射液充分冲洗脓腔后,采用0.5％碘伏纱条引流.对照组(n=74)用3％过氧化氢溶液和0.9％氯化钠注射液充分冲洗脓腔后,采用凡士林纱条引流.结果 试验组换药次数(7.8次)及伤口愈合时间(9.7 d)明显少于或短于对照组(分别为15.2次和16.4 d),差异有统计学意义(P＜0.01).结论 碘伏消毒液引流脓腔能加快伤口愈合,操作简便,安全性能好,值得临床推广应用.

Objective To investigate clinical effect of atorvastatin combined with valsartan treatment in patients with early diabetic nephropathy ( DN) and its possible mechanisms. Methods 90 patients with definitive diagnosis of early DN were randomly divided into two groups, and 86 of them completed all the clinical experiments with complete records. Among them, 42 cases were in control group and 44 cases were in treatment group. Both groups were given routine treatment and in addition the control group was given valsartan (160 mg/d), while the treatment group was given valsartan (160 mg/d) and atorvastatin (20 mg/d) simultaneously, the treatment course was six months in both groups. Systolic blood pressure, diastolic blood pressure and mean arterial blood pressure, total cholesterol ( TC) , triglyceride ( TG) and low-density lipoprotein choles-terol ( LDL-C) , serum creatinine ( Cr) , blood urea nitrogen ( BUN) , serum cystatin C ( Cys-C) and retinol-binding protein ( RBP) and urinary albumin excretion rate ( UAER) were measured and compared before and after treatment in two groups. Results After six months' of treatment in two groups, systolic blood pressure, diastolic blood pressure and mean arterial pres-sure were significantly lower than that of baseline (P<0. 01), but there were no differences between the two groups (P>0. 05). After treatment, TC, TG and LDL-C in treatment group were significantly lower than that of baseline (P<0. 01), their values were significantly lower than that of control group, too (P<0. 01). Cys-C and RBP in treatment group significant-ly decreased (P<0. 05), while Cys-C and RBP in control group had no statistical change (P>0. 05), there were still differ-ences between the two groups after treatment. UAER in both group was significantly reduced, compared with the baseline (P<0. 01), while UAER in treatment group was lower than that of control group (P<0. 01). Cr and BUN level in the two groups also had a slight decrease, but there was no significantl change in the two groups. Conclusion Atorvastatin with val-sartan treatment in diabetic patients with nephropathy can reduce blood pressure and lipids effectively, and reduce Cys-C, RBP and UAER significantly, therefore it can obviously improve renal function and prevent the progress of diabetic nephropathy.

远航通常是在海上航行时间较长、航行距离较远、演训任务较为集中、补给较为困难的军事任务。官兵们生活在狭小拥挤的舰艇上，面对着复杂艰苦的海上环境，要经受许多与常人不同的特殊复杂因素的影响［1］。

Objective To study the tissue synchronization imaging(TSI) in assessment of left ventricular desynchronous contractions due to conduction block in elderly patients with MI.Methods Fifty-two elderly MI patients were divided into right bundle branch block group(n=14),left bundle branch block group(n=21),and atrioventricular block group(n=17) according to their ECG.Their myocardial contraction peak time of basal and middle segments of the posterior septal,lateral,anterior,inferior,anterior septal and posterior walls was detected by TSI technology and analyzed.Results The time to peak systolic velocity was longer in the middle segments of anterior septal,basal and posterior walls of the right and left bundle branch block groups,in the middle segments of posterior,basal,inferior,anterior walls of the left bundle branch block group,and in the middle segments of lateral,basal,posterior walls of the atrioventricular block group.Conclusion The sites of left ventricular desynchronous contractions due to conduction block were different in elderly MI patients.TSI could directly show and quantify them.

【Objective】In order to find out the relationship of arch enteric symptoms,mental health and social support during grassroots troops,and to give instructions about psychological prevention.【Methods】A questionnaire survey was conducted among 185 cases of Grassroots troops,by the way of symptom checklist(SCL-90),social support rating scale(SSRS) and some simple forms about arch enteric symptoms.【Results】All the members are divided into two groups: symptom group(n = 134)and control group(n = 51),then compare two groups,according the score of arch enteric symptoms questionnaire.Comparing with control group,the symptom group has higher scores of SCL-90(P 0.01),and lower utilization of social support and total score of social support(P 0.01).There was significantly positive correlation between arch enteric symptoms and various dimensions of SCL-90,except for the correlation between hematemesis and some factors of SCL-90.Having a poor appetite,nausea,abdominal distension and the total score of enteric symptoms have significantly negative relationship with utilization of social support.【Conclution】TArch enteric symptoms of grassroots troops have lower mental health and poor utilization of social support.

Objective:To enhance nursing safety management in out-patient dressing room,so as to avoid nursing mistake or accident and improve nursing quality.Methods:Since 2009,several measures had been put forward in our out-patient dressing room,such as perfecting rules and regulations,making clear of duties and responsibilities of medical staff on each level,enhancing safety prevention,strengthening infection surveillance and strict sterilization in the whole process,enhancing technician skill training and so on,so as to reduce the occurrence of in-hospital infection and other complications.Results:The infection surveillance showed that,total eligibility rate of cleaning degree of air,the hands of medical staff,the disinfection solution,and sterilized sample was 100% in 2010 year and no patient occurred in-hospital infection in out-patient dressing room.Conclusion:Enhancing nursing safety management and continuous quality improvement in out-patient dressing room could significantly reduce the prevalence of in-hospital infection and some other complications,it′s great important to reduce nursing risk.

目的探讨对心内科老年患者实施综合护理干预后患者服药依从性的变化。方法选取126例心内科住院老年患者为研究对象,住院期间给予综合护理干预,在入院第1天和出院后1周分别对患者进行问卷调查,比较患者对药物的认知情况及服药依从性。结果出院后1周患者服药依从性及对药物的认知情况均优于入院第1天,差异均有统计学意义。结论根据心内科老年患者的特点进行有针对性的护理,能够提高老年患者的服药依从性。

目的:加强门诊换药室护理安全管理,规范各项护理程序和护理行为,防范护理差错、事故的发生,全面提高护理质量.方法:2009年始,我院门诊换药室采取了一系列安全管理措施,主要包括:强化护理人员法律法规意识,建立完善门诊换药室各项规章制度与操作流程,明确各类人员职责,加强教育培训,优化工作流程,强化质量管理,定期对门诊换药室的空气、工作人员手、消毒液及无菌包进行抽样检测,提高护理人员专业技能和责任意识.结果:各项措施落实到位后,2010年门诊换药室抽样调查合格率为100%,无1例患者发生医源性感染.结论:加强门诊换药室护理安全管理并行持续质量改进,能明显减少医院内感染等并发症的产生,降低护理风险.

Objective To explore the psychological needs of retried veterans when they hospitalized,so that take effective nursing intervention.Methods 270 retried veterans were investigated of their psychological needs by questionnaire,and compared with the cognition of 90 nurses about the same question.Results Retried veterans have multidimensional and higher degree psychological needs than average.The cognition of nurses needs to improve.Conclusions Nurses of outpatient department must understand the psychological needs of retired veterans well when they hospitalize.The health care quality need to be improved by the follow nursing interventions: predigest the medical flow,strengthen the communication of nurse-patient,and develop the psychology knowledge,and so on.

<正>流程管理是一种以规范化的、构造端到端的卓越业务流程为中心,以持续的提高组织业务绩效为目的的系统化方法;是一种以顾客为导向,通过跨职能协作,不断提高企业所有流程增值能力的系统化管理方法与技术[1]。将流程管理引入医院管理,优化医院管理和医疗服务流程,有利于为患者创造更

Objective To observe the effect of xiaoaiping injection combined with GP regimen in the treatment of advanced non-small cell lung cancer.Methods The 48 patients with advanced non-small cell lung cancer were randomly divided into two groups,the 24 patients in the control group used GP regimen chemotherapy,and the 24 patients in the treatment group used GP regimen chemotherapy combined with xiaoaiping injection,the effect was evaluated after 2 cycles of chemotherapy.Results The recent effects of the two groups were not statistically different(P>0.05);the quality of life,immune function of the treatment group were better than those of the control group(P<0.05);the toxicities were lower than those of the control group(P<0.05).Conclusion Xiaoaiping injection can reduce the toxicities of GP regimen,and can improve immunity and the tolerance of chemotherapy.

<正>门诊是医院工作的重要组成部分,随着医院的发展和患者医疗需求的变化,门诊护理管理的重要性也越来越明显。在实际工作中,门诊护理质量的高低在很大程度上影响着患者对医院的选择和评价。因此,找出门诊护理管理的难点和重点,研究出切实可行的对策,为患者提供优质、快捷、安

1病例报告 患儿女,3岁.接种A+C群脑膜炎球菌多糖疫苗0.5 ml,次日出现发热,最高体温38.5℃,并于头部、背部发现丘疹、水疱,第3天面部、眼结膜、腹部、四肢、会阴等部位也相继出现疱疹.实验室检查:血白细胞计数5.6×109/L,淋巴细胞计数4.5×109/L,疱疹刮片取新鲜疱疹基底物,采用瑞特染色检查为多核细胞,酸性染色示核内包涵体,确诊为接种疫苗偶合水痘.给予口服板蓝根颗粒抗病毒治疗,炉甘石洗剂外涂止痒,红霉素软膏涂抹疱疹破溃处,预防继发感染.1周后水疱干燥、结痂、脱落.

目的:借鉴大型机场管理模式,实现我院门诊管理理念的全方位改进。方法:采取完善制度、提升服务质量和人文关怀等多种措施实现门诊传统就医模式向机场式管理模式的转变。结果:各项整改措施落实到位后,门诊就医人数、医疗质量、患者对医疗服务满意度等各项指标较前明显进步。结论:采用机场式门诊管理模式后,能更加安全、便捷、高效地满足不同类型患者各种形式的就医需求,实现医院经济利益和社会效益双丰收。

目的探讨健康教育对老年糖尿病患者治疗依从性的影响。方法97例门诊老年糖尿病患者随机分为干预组(n=49)和对照组(n=48),通过自行设计的调查问卷对患者治疗依从性及其影响因素进行调查,随后干预组给予为期3个月的有针对性的全程糖尿病教育。干预后对2组患者治疗依从性、空腹血糖、餐后2 h血糖和糖化血红蛋白水平进行了对比分析。结果97例老年糖尿病患者治疗不依从的发生率为61%(59/97);文化程度、经济状况及对糖尿病知识了解程度与治疗依从性呈显著正相关(P均<0.05)。经健康教育3个月后,干预组治疗依从性明显优于对照组(P<0.01);空腹血糖、餐后2 h血糖下降幅度亦较对照组更明显(P均<0.05)。结论老年糖尿病患者治疗依从性差,健康教育有利于改善其治疗依从性及血糖控制。

目的加强门诊手术室感染监控与管理,预防院内感染的发生。方法采取规范制度,明确职责,加强教育培训,每月定期对门诊手术室的空气、物体表面、工作人员手、使用中的消毒液及无菌包进行抽样检测,严格消毒、隔离及无菌操作,合理安排手术等措施,防止医院感染的发生。结果2005—2008年连续4 a,感染监控抽样调查示空气、物体表面、工作人员手、使用中的消毒液和灭菌物品监测总合格率达97.3%,2007—2008年连续2 a抽样调查达100%,无一例患者发生医源性感染。结论对门诊手术室采取严格消毒灭菌、加强感染监控和科学合理的管理,是预防和控制院内感染的重要措施。