目的:探讨PDCA在产科主要医用耗材病历记录质量管理中的应用效果.方法:选取2020 年4 月1 日～2022 年4 月30日产科收治的90 例患者的主要耗材病历资料进行研究,按照就诊时间顺序分为对照组(2020 年4 月1 日～2021 年4 月30 日)和观察组(2021 年 5 月 1 日～2022 年 4 月 30 日)各 45 例;对照组对主要医用耗材病历记录质量进行常规管理,观察组在对照组基础上采用PDCA.比较两组主要医用耗材病历记录质量、医护人员满意度及医护人员所掌握的主要医用耗材病历质量相关知识认知程度.结果:观察组产科主要医用耗材病历记录质量优良率高于对照组(P<0.05),缺陷病历、表格或记录单存在漏项、未张贴条形码、条形码贴错、诊疗记录不规范、医护记录不一致等不良管理事件发生率低于对照组(P<0.05);观察组医护人员满意度及医护人员所掌握的主要医用耗材病历质量相关知识认知程度评分均高于对照组(P<0.01).结论:将PDCA应用在产科主要医用耗材病历记录质量管理工作中,可提高主要医用耗材病历记录质量,医护人员的满意度较高,且医护人员所掌握的主要医用耗材病历质量相关知识认知程度也提高.

目的 探讨肺纤维化大鼠周围淋巴器官内PU.1和IL-9的表达以及1,25-(OH)2D3对其表达的影响.方法 150只雄性SD大鼠随机分为2个大组:预防组(对照组Ⅰ、模型组Ⅰ、给药组Ⅰ,n=30)和治疗组(对照组Ⅱ、模型组Ⅱ、给药组Ⅱ,n=20).大鼠气管内注射博来霉素建立肺纤维化模型,给药组腹腔注射1,25-(OH)2D3进行预防和治疗.用Real-time PCR和免疫组化方法研究了肺纤维化大鼠淋巴结节和脾脏内PU.1和IL-9的表达状况.结果 在建模14、21、28d3个时间点,模型组Ⅰ/Ⅱ的淋巴结和脾脏内IL-9蛋白质表达都明显高于对照组Ⅰ/Ⅱ中的表达(P＜0.05).建模21d时,模型组Ⅰ的脾内PU.1蛋白质表达明显高于对照组Ⅰ(P＜0.05);建模28 d时,模型组Ⅰ/Ⅱ的淋巴结和脾脏内PU.1 mRNA和蛋白质表达都明显高于对照组Ⅰ/Ⅱ(P＜0.05).而给药组Ⅰ/Ⅱ的淋巴结和脾脏内IL-9和PU.1的表达与模型组Ⅰ/Ⅱ相比,在各时间点都没有统计学差异(P＞0.05).结论 在肺纤维化大鼠的外周淋巴器官中,IL-9较早出现高表达(14 d),并一直维持,而PU.1在较晚时期出现高表达(21 d),提示这2种细胞因子在大鼠肺纤维化发生发展中可能都具有一定的作用.1,25 (OH)2D3对肺纤维化大鼠外周淋巴器官中的IL-9和PU.1表达没有明显的影响,说明其治疗作用可能与IL-9和PU.1无关.

Objective:To explore the role of active vitamin D3 in progression of pulmonary fibrosis through determining expression and function of matrix metalloproteinase 1 (MMP1),MMP3,tissue inhibitor of metalloproteinase 1 (TIMP1) and miR-29 in rats.Methods:Male SD rats were randomly divided into prevention group and treatment group,and subdivide into control,model and medicine subgroups respectively.Animals in model and medicine subgroups were injected with bleomycin through the trachea,while rats in control subgroups were injected with sterile saline through the trachea.The active vitamin D3,solvent and sterile saline were injected intraperitoneally into rats in medicine,model and control subgroups on postoperative day 2 and 14.Samples harvested from rats in prevention group on postoperative day 14,21 and 28,and from rats in treatment group on postoperative day 21 and 28 were submitted to detect levels of miR-29 and TIMP1 using real time qPCR and expressions of MMP1,MMP3 and TIMP1 by immunohistochemistry.Results..Considering the same postoperative time points,expressions of MMP1,MMP3 and TIMP1 in rats from model and medicine subgroups were significantly higher than those from control subgroups,while levels of miR-29 in model and medicine animals were obviously lower than that from control subgroups.Administration of active vitamin D3 caused significant downregulation of MMP1,MMP3 and TIMP1 and statistical upregulation in miR-29 compared to data from model animals.Conclusion:The active vitamin D3 could prevent formation of pulmonary fibrosis by regulating expressions of MMP1,MMP3,TIMP1 and miR-29,which may important players during the progression of pulmonary fibrosis.

Objective Idiopathic pulmonary fibrosis ( IPF) is a chronic inflammatory disease with unknown etiology and is lack of effective therapy. The aim of this study is to explore the function of Ca2+ and PI3K/AKT/mTOR pathway in the pathogenesis of IPF, and the impact of 1,25?( OH) 2 D3 on Ca2+ and PI3K/AKT/mTOR pathway in type Ⅱalveolar epithelial cells of rat with IPF. Methods 150 male SD rats were randomly divided into 2 groups: prevention group ( control groupⅠ, model groupⅠ, medication groupⅠ) and treatment group ( control groupⅡ, model groupⅡ, medication groupⅡ) . The tracheal exposure surgery was operated in control groupⅠ/Ⅱ, and then 200μL sterile physiological saline was administered by intraperitoneal injection of each rats 2 days and 14 days after surgery, separately. Bleomycin(BLM)(5 mg/kg) was in?jected into the trachea of model groupⅠ/Ⅱ, and then vitamin D3 solvent(0.1%ethanol and 99.9%glycol propylene, 1μL/g) was ad?ministered by intraperitoneal injection 2 days and 14 days after surger?y, separately. Bleomycin( BLM) ( 5 mg/kg) was injected into the tra?chea of medication groupⅠ/Ⅱ, and then 1,25?( OH) 2 D3( 2μg/kg) was administered by intraperitoneal injection 2 days and 14 days after&nbsp;surgery, separately. IPF model was built by injecting Bleomycin into the trachea of rats, 1,25?(OH)2D3(2μg/kg) was used to prevent and treat IPF by intraperitoneal injection in medication group. The hydroxyproline content of lung tissue in each group was measured, type Ⅱalveolar epithelial cells were separated from lung tissue and labeled with Fluo?3AM, then concentration of Ca2+ was detected by Laser scanning confocal microscope. The mRNA levels of PI3K, AKT and mTOR in the typeⅡalveolar epithelial cells were tested by RT?PCR. Results Compared with control groupⅠ/Ⅱ at each time point, hydroxyproline content of lung tissue, Ca2+ concentration and expression of PI3K, AKT and mTOR in typeⅡalveolar epithelial cells in model groupⅠ/Ⅱand medication groupⅠ/Ⅱwere sig?nificantly raised( P<0.05 or P<0.01) , but these were significantly reduced in medication groupⅠ/Ⅱcompared with model groupⅠ/Ⅱ( P<0.05 or P<0.01) . Correlation analysis showed that there is significant positive correlation between Ca2+ concentration and mRNA expression levels of PI3K, AKT and mTOR in model groupⅠ/Ⅱ(r=0.5988, r=0.6230, r=0.6603,P<0.01)and medication groupⅠ/Ⅱ( r=0.701 2, r=0.632 3,r=0.740 3,P<0.01) . Conclusion The PI3K/AKT/mTOR pathway plays an important role in devel?opment of IPF. 1,25?( OH) 2 D3 is able to reduce Ca2+concentration in typeⅡalveolar epithelial cells and inhibit the PI3K/AKT/mTOR pathway, and then inhibit the development of IPF.

目的 探讨单人结肠镜操作中俯卧位防袢的效果.方法 结肠镜单人操作,判断镜身成袢后首先解袢,之后将患者体位改变为俯卧位,再继续进镜.结果 共200例次单人结肠镜检查采用解袢后改为俯卧位的方法,镜身未再次成袢,均顺利到达回肠末段,耗时3～10 min,进镜长度70～90 cm,术中、术后患者无明显痛苦及并发症发生.结论 结肠镜单人操作时,遇到成袢后首先解袢,之后将患者体位改变为俯卧位可有效防止再次成袢,从而顺利无痛苦地完成结肠镜检查及治疗.

目的评价健康教育对支气管哮喘患者治疗依从性的影响。方法对患者进行哮喘相关知识的问卷调查,将其随机分为实验组60例,分别给予关于哮喘知识、自我管理计划等内容的健康教育;对照组45例,给予常规的治疗与护理。6个月后跟踪调查患者哮喘相关知识的掌握程度,并以患者的医疗行为与医嘱、健康指导建议的符合程度作为依从性指标。结果6个月后,实验组患者哮喘相关知识的掌握程度和治疗依从性明显好于对照组(P<0.05)。结论健康教育对提高患者的治疗依从性,改善患者的生活质量有重要意义。

目的采用中西医结合方法治疗产后尿潴留,观察其临床治疗效果。方法采用辅助综合治疗、诱导排尿、中西医结合治疗、口服蚯蚓汤、药物等综合治疗,对2004年1月到12月80多例发生尿潴留的患者采用上述综合治疗。结果80例患者全部治愈。结论了解产后尿潴留的发生原因,有助于采取相应的护理措施;中西医结合治疗产后尿潴留,无不良反应,方法简便,疗效满意,易于推广应用。

结肠镜检查包括双人操作法和单人操作法,目前后者在国际上已成为主流,国内正在逐渐推广.2004年7月～2007年7月,我们采用单人操作法完成结肠镜检查500例次,现将做法与体会报告如下.

Objective The aim of this study was to describe the interdigestive gastroduodenal motility in patients with decompensated cirrhosis. Methods The interdigestive gastroduodenal motility was detected by means of perfused gastrointestinal motility manometer in fifteen healthy subjects and twelve decompensated cirrhotic patients. Results The mean duration of both MMC (migrating motor complex) phaseⅠand phaseⅡin patients with cirrhosis was not different from that of controls (P0.05). However, phaseⅡwas significantly longer in cirrhotic patients in comparison with controls(P0.01).The duration of MMC was also significantly prolonged in patients with cirrhosis as compared with controls (P0.01). Furthermore, multiple clusters of contractions separated by quiescent periods during duodenal phase Ⅱ were more often observed in patients with cirrhosis(P0.05). Conclusion We concluded that the prolonged duration of MMC was caused by a longer phase Ⅱ in patients with cirrhosis. The prolonged duration of MMC results in decreased frequency of phase Ⅲ, which may cause an impairment of the main mechanism responsible for sweeping the small bowel content. The lack of motor activity between clusters observed in phase Ⅱ might be associated with delayed intestinal transit.

自动超声雾化内镜消毒机应用临床消毒内镜以来减轻了工作量,增加了工作效率,但临床应用后实际消毒效果未见报道,特别对活检通道、活检钳的实际消毒效果更是空白.自应用超声雾化内镜消毒机以来,我们进行了大量的细菌培养,现将观察到的资料报告如下.