目的 探讨利用排队论模型评估病区生命支持类设备配置数量的可行性,提高医疗设备精细化管理水平.方法 以我院两个病区的监护仪为例,利用排队论M/M/C模型建立使用数据与设备配置数量间的量化关系,评估最为合理的设备配置数量,监测实施效果.结果 按评估结果为各病区配置监护仪后,病区一由25台减至16台,病区二由13台减至12台,各病区未出现设备不足的情况,设备运行效率分别提升56.22％和9.36％.结论 利用排队论模型评估病区生命支持类医疗设备配置数量具有可行性,医院应不断创新管理模式,将先进的管理方法运用到工作中,加强医疗设备全生命周期管理,提升设备使用效率,降低医院运行成本.

目的 讨论呼吸机集中管理模式的可行性,探索医疗设备精细化管理模式.方法 建立呼吸机管理中心,收集近十年呼吸机的使用量、质量控制次数及现场维修次数等相关数据,探讨医疗器械集中管理模式的优劣之处.结果 呼吸机集中管理模式可以大幅提高呼吸机使用效率,便于开展质量控制工作,降低工程师现场维修次数,有效提高工程师工作效率.结论 呼吸机集中管理模式可有效提高设备使用效率,应重视对医疗设备使用过程中产生的数据收集和管理平台建设工作,加强医疗设备精细化管理.

目的:研究垂直方向放置位置对注射泵性能参数的影响,为规范注射泵性能检测和临床使用方法提供理论依据.方法:使用单一变量的实验方法,将输液设备分析仪摆放位置作为水平位置参考点,分别将注射泵放置于垂直方向+50 cm、+25 cm、0(水平位置)、-25 cm和-50 cm处,测试各位置状态下注射泵阻塞报警压力误差值及流速误差值.结果:注射泵放置于不同位置时阻塞压力误差值为-81～51 mmHg,阻塞报警压力测试值随放置位置高度的升高而增大,在垂直方向+25 cm时最接近于产品标定值,注射泵放置于不同位置时流速误差为-2.50％～0.03％,注射泵放置高度对于流速误差无显著影响.结论:垂直方向上的放置位置会对注射泵部分运行性能产生影响,容易导致错误的检测结论,并有可能对临床使用造成风险,各医疗机构在使用和管理环节中应加强规范细节,保障临床安全性.

目的:探究移动平台的信息化管理模式,设计研发输注设备质量控制模式管理系统.方法:建立移动网络和数据平台,设计研发输注设备质量控制模式管理系统.从降低医院在用输注设备质量控制操作难度、减少占用空间以及便于数据收集与整理3方面分析多平台互通输注设备质量控制模式管理系统的优势,以实现输注设备的质量控制管理.结果:设计的输注设备质量控制模式管理系统可极大降低设备质量控制操作难度,提高工作效率15％左右,减少检测设备占用工作台空间接近50％,提高检测结果记录准确性和互通性.结论:基于移动平台的输注设备质量控制模式便于对医疗设备全生命周期实施信息化管理,提升管理水平,实现医疗设备精细化管理.

目的:构建手术室腔镜精细化管理模型,对设备使用效益进行精确分析,为腔镜精细化管理提供数据支持.方法:在腔镜主机后加装一体机,内置图像分析软件,利用图像采集分析技术,搜集腔镜主机、采集单元和镜头的实际使用时长,将手术室腔镜精细化管理模式与手术麻醉系统、消毒供应系统建立接口,实现数据互通,对设备使用时长进行全面采集.结果:手术室腔镜精细化管理系统可完成对腔镜设备使用情况的全面分析,发现管理漏洞,制定解决方案,为设备的论证、采购、使用、维修、质量控制及报废提供理论支持.结论:腔镜精细化管理模型的构建是未来手术室管理的发展趋势,能够在一定程度上提高管理效率,为腔镜精细化管理提供数据支持.

Objective: To research the effects of time of flight (TOF) technique and point spread function (PSF) algorithms on the image quality of PET in the image reconstruction of integrated PET-MR. Methods: The NU 2-2007 protocol of NEMA was followed. The image quality phantom following IEC Standard 61675-1 was adopted in the research. All scan and image reconstruction were performed on PET/MR and matched AW4.6 workstation of GE SIGNA. Different algorithms (TOF+PSF, TOF+non-PSF, non-TOF+PSF, and non-TOF+non-PSF) were applied in image reconstruction of PET. The obtained PET images were quantitatively evaluated and analyzed by following parameters: contrast recovery of hot and cold spheres (QHand QC), background variability (Nj) and the signal-to-noise ratio (SNR) of hot spheres. Results: For quantitative image quality evaluation, results of (non-TOF+non-PSF) were used as reference. The average QHof (non-TOF+PSF), (TOF+non-PSF) and (TOF+PSF) were increased 7.61%, 20.94% and 40.17%, respectively. The average QCof TOF alone and (TOF+PSF) were increased 11.29% and 12.32%, respectively. The average Nmeanof PSF alone, TOF alone and (TOF+PSF) were decreased 2.28%, 21.44% and 30.03%, respectively. And the SNR of PSF alone, TOF alone and (TOF+PSF) were increased 11.52%, 44.28% and 92.70%, respectively. Conclusion: Both TOF and PSF can improve the overall image quality of PET, and it is more obvious when they are used in combination.

目的:研究不同测试条件对注射泵阻塞报警压力测试值造成的误差,为改善检测方法和完善检测标准提供理论基础依据.方法:实验分为两组,选取3台COMPACT型注射泵,第一组实验对比注射泵不同运行速率情况下各阻塞报警档位的阻塞报警压力测试结果,第二组实验比较使用新旧程度不同的注射器情况下各阻塞报警档位阻塞报警压力测试结果.结果:注射泵阻塞报警测试值随着注射泵运行速率的提高而提升,注射泵运行速率为99 ml/h时与运行速率为20 ml/h时相比,阻塞报警测试值最多,提升了189.3 mmHg.与选取新注射器相比,选取重复使用的旧注射器会明显降低注射泵运行时阻塞报警压力测试值,实验中最多的一组降低了55.69％.结论:注射泵运行速率及注射器新旧程度均对注射泵阻塞报警压力测试值会产生一定影响,甚至导致错误的检测结论,应适当完善检测标准,并在质量控制中统一检测条件.

Objective The clinical engineers will be engaged in equipment operation and the solution of equipment failure by the training of life support equipment under the high simulation condition. At the same time,they will have further understanding of the clinical work by learning relative medical knowledge,which can improve their abilities of judging and handling clinical problems. Methods Students need to select the corresponding life support equipment for the human patient simulator ( HPS) according to different medical requirement,change the treatment plan with the change of HPS procedures, and make a quick judgment of equipment failure according to the various fault descriptions. The standard teaching model includes 4 parts which are brief theory teaching, group practice, comprehensive simulation training and video summary. The teacher examines the students by the evaluation form. Results The score of the second examination has been greatly improved compared with the first examination after the video summary model, and the difference is statistically significant ( P<0. 05 ) . Conclusions It is necessary for clinical engineers to attend the training regularly which can make them devote into the treatment process and improve the ability to operate equipment, diagnose fault and solve the problems. This work cancombine the engineering and clinical medical which has great significance to the discipline development.

Objective:To analyze the significance of quality control system of infusion pump and injection pump in enhancing use value of equipment and ensuring safety of clinical usage. Methods: The quality control plan and test method of infusion pump and injection pump were concluded. The trend of routine repair of infusion pump and injection pump from 2013 to 2016 was analyzed. The repairing data of injection pump in recent 2 years were classified according to various failure reasons, and then all of these data were analyzed.Results:The establishment and implement of quality control system of infusion pump and injection pump can reduce daily failure rate of the two kind of pumps, and especially reduce the failure caused by self-aging of equipment. However, it has no obvious improvement on the routine failure due to mal-operation and human damage of paramedics.Conclusion:The hospital shall strengthen the management for the formulating and implementing of quality and control planning and for the training and assessing of paramedics so as to ensure the safety of clinical care and reduce the occurrence of adverse event in medical treatment.

Objective: To compare the influence of different reconstruction condition for the spatial resolution of integrative PET-MR image through experiment research of model. Methods: The standard of NEMA was referred to produce point source, and the signa PET-MR of GE was used to implement scan. Different image reconstruction condition of PET were used to reconstruct image, and then the FWHM of point source were obtained. The influences of TOF, PSF, iterations and AC for spatial resolution of image were compared. Results: The point source FWHM was between 3.40~4.31mm when PSF technique was used to reconstruct image, while it was 4.56~5.83mm without PSF technique. Therefore, PSF could reduce FWHM in reconstructed image. Besides, there were few influences of TOF and AC for FWHM. Conclusion: PSF and iterations could effectively enhance spatial resolution of image, while there were few the influences of TOF and AC for FWHM. In the scan for lesions by using PET-MR, patients should be placed on centre of aperture. And in the diagnosis for small lesion, the using of PSF technique is necessary, and the iteration should properly be increased as the actual situation.

Objective:To analyze the characteristics of time of flight(TOF) and High definition(HD) recon struction was analysis on PET/CT for clinical use guidance.Methods:The NEMA body phantom was scaned by PET/CT and reconstructed in the condition of TOF+HD+OSEM, TOF+OSEM, HD+OSEM and OSEM and was analyzed according to the NEMA standard respectively.Results: The image contrast of group TOF+HD+OSEM and group OSEM are 41.70%~92.53% and 32.10%~81.32% respectively. The background variability of group TOF+HD+OSEM and group OSEM are 1.48%~2.88% and 1.71%~2.97% respectively. The accuracy of attenuation and scatter corrections of group TOF+HD+OSEM and group OSEM are 11.5% and 20.25% respectively.Conclusion: The image contrast, background variability and accuracy of attenuation and scatter corrections with the reconstruction condition of TOF+HD+OSEM were superior to other groups. The contrast of small lesions has improved significantly by application of both TOF and HD technology.

Objective To retrospectively analyze safety and feasibility of the suction curettage in the treatment of endogenous scar pregnancy guided with ultrasound. Methods We included sixty-eight patients diagnosed as endogenous cesarean scar pregnancy at Xuanwu Hospital,Capital Medical University in the past five years.Forty-six patients treated with suction curettage guided with ultrasound,another twenty-two patients treated with hysteroscopy.We compared the outcomes of the two groups with success rate,the bleeding volume,time for β-hCG returning to normal,and the total cost of inpatient. Results Of the forty-six patients underwent curettage guided with ultrasound,forty-four patients achieved success,another two failed.The success rate was 95.7%.Of the twenty-two patients treated with hysteroscopy,one failed,and the remaining twenty-one were successful.The success rate was 95.5%.Average blood loss during suction curettage was (89.4 ±58.3)ml,while the hysteroscopy group was (1 75.1 ±69.3)ml.Mean time for achieving a normalβ-hCG level was (58.0 ±21 .2)days for the suction curettage group,and (46.2 ±1 2.4)days for the hysteroscopy group. Total cost of inpatient was (1 545.3 ±437.2)yuan for the suction curettage group,and (5 893.0 ±1 785.4 )yuan for the hysteroscopy group.We found no statistically significant difference in the success rate between the two groups.Compared with hysteroscopy group,the suction curettage group had less blood loss,shorter operation time,lower cost of inpatient,but longer time for serum β-hCG returning normal levels. Conclusion Suction curettage guided by ultrasound is a safe and effective method,with low damage and cost.

Objective:To access the effectiveness and safety of intravaginal misoprostol following mifepristone administration to terminate 14-20weeks gestation.Methods: Eighty patients requesting legal termination of pregnancy at gestational between 14 to 20 weeks were from the Xuan Wu Hospital of capital University of medical of science between January 2012 and December 2012. They were divided randomly into two groups. Both 40 women (experimental group) and 40 women (control group) received 50mg of oral mifepristone every 12h for three times. Then, the experimental group was given 200μg misoprostol intravaginal at 7am on the third day and the control group received intra-amniotic injection of rivanol.Results: Comparing with intra-amniotic injection of rivanol, the combination of mifepristone and misoprostol intravaginally has higher success rate, lower tissue residue rate and curettage of uterus, shorter labor and less hemorrhage, the difference were statistically significant. As to the side effects, nausea, vomiting are statistically significant.Conclusion: It is a safe and effective method for mifepristone and vaginal misoprostol to termination of mid-pregnancy.

目的 探讨左炔诺孕酮宫内缓释系统(LNG-IUS)对子宫腺肌病患者痛经、月经异常及子宫增大的临床疗效.方法 子宫腺肌病患者39例,于月经周期第3～7天放置LNG-IUS,于放置前及放置后1、3、6、12个月观察痛经程度(视觉模拟评分法VAS评分),月经量,血红蛋白,子宫体积大小,血清CA125数值的变化.结果 放置LNG-IUS后,患者痛经明显减轻,月经量减少,子宫体积缩小,血色素升高,血清CA125数值降低,与放置前比较,差异有显著性(P＜0.05).结论 LNG-IUS治疗子宫腺肌病能明显缓解患者临床症状,改善生活质量,疗效肯定,安全可靠.

Objective:To investigate the clinical characteristics,diagnosis,treatment,outcome of pregnancy in second trimester among pregnant women(14～27w)with nervous system diseases.Methods:The clinical data of 21 pregnant women in second trimester with nervous system diseases who were treated in Xuanwu hospital in nearly 10 years were retrospectively analyzed.Results:Among the 21 patients,18 patients were complicated with brain damage,in which 4 patients with epilepsy,3 with intracranial venous sinus thrombosis,2 with vascular malformations,2 with intracranial aneurysms,2 with cerebral infarction,2 with encephalitis,3 with acute inflammatory demyelinatiny encephalomyelitis,2 with Spinal cord arteriovenous malformation,1 with myasthenia gravis.The main clinical features were:headache,nausea,vomiting,convulsion,even status epilepticus,numbness,general fatigue.After diagnosis by examination such as EEG,CT,MRI,MRV,DSA,and so on,and corresponding treatment according to the type of nervous system.among the 21 patients,19 are alive,and out of them 1 is discharged,out of them 1 died.2 cases remain functionally impaired.12 routine in ethacridine totally amniotic cavity induced puncture,4 cases of drug abortion,1 case accepted the caesarean section.2 cases maintain pregnancy to term cesarean section technique,the newborn live.Conclusions:The patients in second trimester complicated with nervous system diseases should be payed special attention,diagnosed as soon as possible and treated actively.For the mother′s safety,termination of pregnancy should be conducted after evaluation of the necessity of middle induced labor after stabilizing the condition of nervous system diseases,and the safe method shouled be choosed to terminate the pregnancy.

Objective:To appraise the clinical management of terminating pregnancy in first and second trimester among women with VTE.Methods:Retrospectively analyzed the terminating of pregnancy in 13pregnant women with VTE from 2005 to 2011.Results:8 with cerebral venous thrombosis,3 with pulmonary thromboembolism,PTE,2 with deep venous thrombosis,DVT.In the first trimester,7 in 9 patients received vacuum aspiration,In the second trimester,5 patients received Rivanol induction.One patient with increased intracranial pressure accepted the caesarean section.Conclusion:They were treated with anticoagulants and thrombolytics before termination of pregnancy.The method of choice in patients depend on the obstetric condition.

Objective:To explore the clinical management of first and second trimester pregnancy complicated with cerebral venous sinus thrombosis (CVST). Methods:Retrospective analysis of 10 pregnancy(8 in first and 2 in second trimester)complicated with CVST from 2000 to 2011.Results:6 patients(4 in first and 2 in second trimester) who were unconsciousness and ensured the diagnosis of cerebral venous sinus thrombosis by DSA were treated with focal thrombolysis by medication and mechanical thrombectomy via femoral or jugular vein approach. Among them, two patients in first trimester also had angioplasty of venous sinus. 2 patients (1 in first and 1 in second trimester) preserved the micro catheter in vivo postoperation. 5 of 6 patients came to consciousness 2 to 7 days after operation ,the clinical symptoms improved markedly. 1 patient (in first trimester) had spontaneous abortion after operation. 2 patients (in first trimester) received abortion when in stable condition. one patient in second trimester received ethacridine induction, the other accepted the caesarean section for increased intracranial pressure. Only one patient in first trimester who preserved the micro catheter in vivo suffered from systemic bleeding tendency after operation. She maintained till the second trimester and had ethacridine induction. 3 conscious patients (in first trimester) received dehydration and anticoagulation treatment, then had abortion 1 week after the situation became stable .1 patient(in first trimester) who fell in coma because of diffused intracranial hemorrhage and cerebral herniation was dead after the craniotomy decompression. 9 patients had no complications after termination of pregnancy.2 patients had mild neurological function defect, 1 patient suffered blurred vision, the other 6 patients had a good prognosis. Conclusions:Pregnancy complicated with CVST should be actively treated, anticoagulation and thrombolysis in advance, then termination of pregnancy when in stable condition is prefered. The choice of pregnancy termination method can be based on the characteristics of obstetrics.

<正>在临床上终止中期妊娠的方法有两种,一种是钳刮术,对患者损伤大,并发症多,另一种是药物引产术。我们使用米非司酮与卡孕栓、米非司酮与米索前列醇合用,不同用药组合,患者在临床上表现的症状、心理状态各有不同,因此对使用两

Objective The present study was designed to investigate the possible association between estrogen receptor(ER) β gene polymorphisms and leiomyoma in a Chinese(Han) population.Methods The distribution of the ERβ gene polymorphisms were examined in 285 Chinese(Han) females: 92 patients and 193 healthy controls.Genomic DNA was obtained from whole blood.ERβ gene polymorphisms were assessed by the method of polymerase chain reaction-restriction fragment-length polymorphism(PCR-RFLP).Results No significant differences between the leiomyoma patients and the controls in the frequencies of the polymorphisms in the ERβ gene were found in the subjects.Conclusion The RsaI and AluI polymorphisms of the ERβ gene were not associated with the establishment of leiomyoma of the uterus in the Chinese(Han) population.

Objective:To assess the use of oral contraceptive(OC) in women undergoing artificial abortion. Methods:A total of 400 women were randomized by computer to receive either OC or not,200 women in OC group taking Maxvelon 1 pill/d×21 d immediately after artificial abortion,the other in control group without taking any west medicine. Survey volume of blood,bleeding time,time of menstruation turn over were observed,as well as thickness of endometrium,negative rate of urine hCG,and rate of pelvis infection after 2 weeks. Results:There was no difference in volume of blood,bleeding time,thickness of endometrium between the two groups. There was a statistically significant decrease in time of menstruation turn over in the OC group. There was a tendency in preventing pelvis infection in the OC group. The negative rate iof urine hCG in OC group was more than that in control group. Conclusion:It is safe to offer women combined OC pills immediately after artificial abortion as an option of contraception. It dose not affect vaginal bleeding or the complete abortion rate,having exact time of menstruation turn over,decreasing pelvis infection.