目的 探讨从病案编码入手的失效模式与效应分析管理(failure mode and effect analysis management,FMEA)在降低阴道分娩并发症的应用,为产科医疗质量安全改进提供循证支持.方法 从某院2018-2020年出院病案首页入手,按照国家卫健委监测的阴道分娩并发症疾病编码提取并发症病历.成立FMEA小组全面梳理问题病历,进行多层次、维度剖析阴道分娩并发症潜在影响因素和风险环节,梳理出孕前与孕期、产前、产时、产后4个主流程20个子流程,计算风险指数,并以此将12个极高、高风险点作为改善重点,制定改进措施和政策,对比改进后2021年数据和改进前2020年数据.结果 2021年阴道分娩率较2020年有显著提高(x2=9.27,P＜0.01),阴道分娩会阴切开较2020年显著下降(x2=96.01,P＜0.01),产科裂伤较2020年显著下降(x2=35.53,P＜0.01),产后出血、胎盘胎膜滞留不伴出血对比未见差异有统计学意义(x2=0.64,x2=1.91,P＞0.05).故阴道分娩并发症发生率总体降低.结论 从病案编码入手的FMEA分析可助力产科医疗质量安全改进,有效降低阴道分娩风险,后续工作要加强病案编码和首页质控.

Background Blood transfusion therapy is extremely important for certain neonatal diseases, but the threshold for neonatal blood transfusion is not the same in different countries. Until now, clinical studies to determine the suitable threshold for newborns in China are lacking. Therefore, it is of high importance to establish a multi-center cohort study to explore appropriate transfusion thresholds for newborns in China. Methods This retrospective cohort study investigated neonatal blood transfusion therapy administered from January 1, 2017 to June 30, 2018, with the aim of evaluating the effect of restricted and nonrestricted blood transfusion on neonatal health. The subjects were enrolled in 46 hospitals in China. A total of 5669 neonatal cases were included in the study. Clinical diagnosis and transfusion treatment of these neonates were collected and the data were retrospectively analyzed. The neonates were followed up 1 week and 1 month after leaving the hospital. The newborns’ and their mothers’ data were collected containing 280 variables in the database. The primary outcome of the study was mortality, and the secondary outcomes were complications, hospital stays, NICU hospital stays and hospital costs. Results Results from the < 1500 g group showed that there was a higher mortality rate in the restricted transfusion group (11.41%) when compared with the non-restricted transfusion group (5.12%) ( P = 0.000). Among the secondary outcomes, the restricted transfusion group had fewer costs. Results from the 1500-2500 g group showed that the mortality rates of the restricted and non-restricted transfusion groups were 3.53% and 4.71%, respectively, however there was no statistical significance between the two groups ( P = 0.345). Among the secondary outcomes, the restricted transfusion group had fewer hospital stays, NICU hospital stays and hospital costs. The incidence of necrotizing enterocolitis was lower in the restricted transfusion group (OR, 2.626; 95% confidence interval [CI], 1.445 to 4.773; P = 0.003). The results from the ≥ 2500 g restricted transfusion group suggested that the mortality rate of (3.02%) was significantly lower than that of non-restricted transfusion group (9.55%) ( P = 0.000). Among the secondary outcomes, the restricted transfusion group had fewer hospital stays and hospital costs. The incidence of retinopathy of prematurity was lower in the restricted transfusion group (OR, 4.624; 95% confidence interval [CI], 2.32 to 9.216; P = 0.000). Conclusions Current transfusion protocols for newborns weighing less than 1500 g may be inappropriate and lead to higher mortality. The current transfusion threshold performed better for the other two weight groups.

目的 研究妊娠中期唐氏综合征筛查血清标志物水平与妊娠结局间的关系.方法 纳入2018年1月—2019年4月在某三甲医院行妊娠中期唐氏综合征筛查在本院产检分娩并随访到妊娠结局者共1 549例,化学发光免疫法测孕妇血清甲胎蛋白(AFP)、人绒毛膜促性腺激素(hCG)及游离雌三醇(uE3)水平,分析不良妊娠组的影响因素,并逐一分析血清标志物异常和各妊娠不良结局(流产、妊娠高血压、妊娠糖尿病、胎儿宫内死亡、胎儿宫内生长受限、胎儿体表及结构异常、早产)间的关系.结果 1 549例孕妇中出现妊娠不良结局者共计296例,对比不良妊娠组与其余妊娠组唐筛总风险差异无统计学意义(P＞0.05),在年龄、体质量、住院时间及住院费用差异有统计学意义(P＜0.01).因筛查指标AFP、hCG及uE3的绝对值会受年龄、体质量及孕周等影响,转化为排除干扰因素的AFPMOM、hCGMOM及uE3MOM值纳入分析显示hCGMOM值和不良妊娠结局差异有统计学意义(P＜0.01),最终验证并构建了不良妊娠结局影响因素的logistic回归模型:Logit(p)=-7.059+0.088×年龄+0.030×体质量+0.128×住院天数+0.390×hCGMOM.分别分析流产、妊娠高血压、妊娠糖尿病、胎儿宫内死亡、胎儿宫内生长受限、胎儿体表及结构异常及早产与AFPMOM、hCGMOM及uE3MOM关系为:AFPMOM异常增高(AFPMOM≥2.00)和妊娠糖尿病、早产的发生相关(P＜0.05),hCGMOM异常增高(hCGMOM≥2.00)和妊娠高血压发生相关(P＜0.05),uE3MOM异常降低(uE3≤0.5)和胎儿体表和结构异常相关(P＜0.05).结论 不良妊娠会造成住院时间延长,住院费用增加,尤其威胁母婴健康,要把控最佳生育年龄,做好孕期体质量管理.应密切监测唐筛血清学指标异常的孕妇,加强风险评估和对策制定,减少妊娠不良结局发生.

目的 调查全国住院输血新生儿血气检测指标,为深入研究不同阶段新生儿血气分析参考范围提供数据支持.方法 本研究采用多中心回顾性调研方式,以全国46家医院2017年1月1日～2018年6月30日收治的输血新生儿5669例为研究对象,按照统一的数据采集表,采集新生儿住院诊治数据,对采集数据按胎龄分为<32 w组,32～36 w组,≥37 w组三组,统计分析新生儿住院期间输血干预前血气分析数据.结果 随着新生儿日龄及胎龄的增大,pH值呈小幅波动,但总体呈升高的趋势.PO2结果显示<32 w组随日龄增大呈降低趋势,≥37 w组自0～1 d(61.80 mmHg)升高至4～5 d(72.50 mmHg)后趋于平稳,相同日龄三组间PO2值比较,日龄0～3 d时早产儿PO2大于足月儿.PCO2结果显示相同日龄三组间比较,随着胎龄的增大PCO2逐渐降低.新生儿随着日龄和胎龄的增大,HCT值均呈逐渐降低的趋势.SaO2结果显示≥37 w组自0～1 d(93％)升高至2～3 d(96.40％)后趋于稳定.结论 不同胎龄不同日龄新生儿血气相关指标变化显著,依据胎龄日龄制定新生儿血气指标参考范围有助于指导临床对新生儿疾病的精准诊疗.

ABO blood groups distribution shows obvious geographical differences globally, but the reliability of the Blood data for assessing relationships between population groups is limited. This is mostly due to the lack of availability and interchange of this important data. We collected data of 23 million ABO blood group population from 34 provincial-level administrative regions in China. To ensure the reliability of the results, we standardized the 23 million data by the China seventh census data. The ranking of ABO blood groups phenotypic distribution in China is O > A > B > AB. The proportions of A, B, O and AB type in China population are 28.72%, 28.17%, 34.20%, and 8.91%, respectively. Accordingly, the frequencies of p [A], q [B], and r [O] gene at the ABO blood group are 0.211, 0.208, and 0.584, respectively. China blood phenotype is dominated by O type, but the r gene frequency is obviously lower than other countries. The distribution of ABO blood groups in China varies geographically. Clustering analysis results show that ABO blood groups divide into four regions from north to south in China, and reveal that the r [O] gene shows an increasing trend from North to South, and conversely the q [B] gene exhibited a decreasing trend at these coordinates. These analyses present interesting characteristics of the blood group distribution across the geography of China.

目的 分析不同胎龄不同日龄住院输血新生儿输血前肝功能检测指标,为深入研究不同胎龄新生儿肝功能指标参考范围提供数据支持.方法 本研究采用多中心回顾性调研方式,以全国46家医院2017年1月1日～2018年6月30日收治的5669例输血新生儿为研究对象,按照统一的数据采集表,采集新生儿住院诊治数据,对采集数据按胎龄分为<32周组,32～36周组,≥37周组三组,分析不同日龄不同胎龄的新生儿输血前肝功能检测指标.结果 (1)ALT结果显示,早产儿两组ALT中位数0～28 d分别为5～8 U/L和8～11 U/L,足月儿ALT较高为11～22 U/L,不同胎龄组内比较差异有统计学意义.相同日龄组间比较,ALT随胎龄增大逐渐增高,足月儿ALT值最高.各组间比较时除日龄13～14 d无差异外,其余日龄组间差异均有统计学意义.(2)不同胎龄新生儿随日龄增大,TBIL及DBIL呈先升高后减低趋势,相同日龄组间比较时,随胎龄增大TBIL及DBIL值更高.(3)三组TP值比较显示,出生后1～2 d下降,随后呈现逐渐上升趋势,不同日龄比较差异均有统计学意义,相同日龄组间比较时,随胎龄增大TP多呈现增高趋势.(4)相同日龄组间比较时,随胎龄增大ALB呈现增长趋势.结论 肝功能指标参考区间与新生儿胎龄和日龄有关,研究不同胎龄不同日龄新生儿肝功能指标范围,有助于提高对新生儿疾病的精准治疗.

This study aims to identify the relationship between blood donation and malignant and benign tumour hospitalization risk. The cohort study was constructed in Shaanxi, China, to include blood donors and match nonblood donors one-to-one by gender, age, and county of residence. The study compared the hospitalization records of two groups from 2012 to 2018. A log-binomial regression model was used to estimate the relative risk (RR) of tumour risk between donors and nonblood donors among different age groups. A total of 1,625,599 donors were recruited (including 968,823 males) and compared with the matched nonblood donor group. Significantly lower risk of malignancy in males was found among donors (adjusted RR: 0.82, 95% CI: 0.75–0.92). Lower risks for specific types of tumours among donors were observed, including liver (0.42, [0.28–0.67]), lung (0.74, [0.59–0.87]), lymphoma (0.75, [0.62–0.85]), and oesophagus (0.55, [0.41–0.72]). However, the risk of brain cancer was higher among male donors (RR 1.19 [1.06–1.29]). Among female donors, lower risk of liver (0.57, [0.42–0.79]) and oesophagus malignancy (0.73, [0.62–0.88]) was observed. For benign tumours, male donors have a lower risk of benign skin tumour (0.79, [0.62–0.94]) and hemangioma and lymphangioma (0.75, [0.51–0.89]), while female donors have a lower risk in hemangioma and lymphangioma (0.65, [0.44–0.83]). We also found that the risk decreased with age among donors in the prevalence of tumours compared to that in nonblood donors (p<0.05). Blood donation appears to be significantly associated with various tumour risks among both males and females. Overall, the risk of tumours decreased more substantially with age in blood donors compared with nonblood donors. Further research is warranted to investigate the impact of ‘health donor effects’ on these findings.

PurposeThe Shaanxi Blood Donor Cohort was set up to investigate the impact of blood donation on the health of donors compared with non-blood donors. The specific aims of the study include (1) identifying the geographical and temporal trends of incidence for diseases in both blood donors and non-blood donors; (2) assessing the impact of environmental exposures, lifestyle, body mass index (BMI) and blood type on disease burdens, stratified between blood donors and non-blood donors; and (3) among blood donors, investigating if regular blood donation has a positive impact on donors’ health profiles, based on a cohort with a mixed retrospective and prospective study design.ParticipantsA total of 3.4 million adults, with an equal number and identical demographic characteristics (year of birth, sex and location of residence) of blood donors and non-blood donors, were enrolled on 2012. The one-to-one matching was conducted through a repeated random selection of individuals without any history of blood donation from the Shaanxi Electronic Health Records. The cohort has been so far followed up to the end of 2018, summing to nearly 24 million years of follow-up. The cohort will be followed up prospectively every 3 years until 2030.Findings to DateOf the 1.7 million blood donors, 418,312 (24.5%) and 332,569 (19.5%) individuals were outpatients and inpatients, accounting for 1,640,483(96.2%) outpatient and 496,061 (29.1%) inpatient visits. Of the same number of non-blood donors, 407,798 (23.9%) and 346,097 (20.3%) individuals were hospital outpatients and inpatients, accounting for 1,655,725 (97.1%) outpatient and 562,337 (33.0%) inpatient visits. The number of outpatient and inpatient visits by non-blood donors was 0.9 and 3.9% higher than those of the blood donors (p < 0.01). Blood donors demonstrate significantly fewer inpatients visits than non-blood donors for major chronic disease categories (p < 0.01).Future PlansWe are currently exploring the long term benefits of blood donation on major chronic disease categories and multimorbidities in this large population cohort. The study results are adjusted by the “healthy donor effect.” This cohort study will continue until 2030.

目的 探讨孕中期唐氏综合征筛查报告各指标不同孕周变化趋势和影响因素,建立该地区孕中期不同孕周指标参考区间及中位数参考值,提高筛查效率.方法 选取2015年1月至2019年12月在陕西省人民医院行孕中期唐氏综合征产前筛查的26140例自然妊娠孕妇为研究对象,记录血清生化甲胎蛋白(AFP)、游离雌三醇(uE3)、绒毛膜促性腺激素(HCG)水平,描述不同孕周孕妇筛查指标的参考区间及中位数.结合产前检查资料用软件评估计算21-三体综合征(DS)、18-三体综合征(ES)、开放性神经管缺陷(NTD)风险率,并分析不同年龄、不同体质量、不同孕周孕妇DS、ES、NTD检出情况的差异.结果 初步建立了该地区的孕中期不同孕周血清DS筛查指标参考区间及中位数参考值,AFP、uE3水平从孕14～21周逐步上升而HCG值从孕14～21周逐步降低.26140例孕妇中DS高风险1841例(7.04％)、ES高风险166例(0.64％)、NTD高风险456例(1.74％).不同年龄组间孕妇DS、ES筛查高风险率差异有统计学意义(P<0.05),且年龄>35岁组的孕妇DS、ES筛查高风险率高于其他年龄组(P<0.05),而不同年龄组间孕妇NTD筛查高风险率差异无统计学意义(P=0.12);不同体质量组孕妇DS、ES筛查高风险率差异有统计学意义(P<0.05),而不同体质量组孕妇NTD筛查高风险率差异无统计学意义(P=0.62),体质量>65 kg组的孕妇DS、ES筛查高风险率高于其他体质量组(P<0.05);不同孕周组孕妇DS、ES、NTD筛查高风险率差异有统计学意义(P<0.05).DS筛查高风险率在孕14、15周与其他孕周(16～21周)间差异有统计学意义(P<0.05);ES筛查高风险率在孕14、15周与孕16～19周间差异有统计学意义(P<0.05),而NTD筛查高风险率仅在孕15周和19周间差异有统计学意义(P<0.05).结论 建立该地区孕中期不同孕周血清唐氏综合征筛查指标参考区间及中位数参考值意义重大;高龄及高体质量孕妇患DS、ES的风险提高,育龄妇女应把握生育年龄并做好体质量管理;最佳唐氏综合征筛查的孕周时机为孕16～18周.

目的 通过分析住院死亡患者最后一次住院期间的用血情况,探究人的一生用血概率,提倡健康适龄人群积极献血.方法 根据《国际疾病分类》原则、献血年龄及血液成分分类,对该院2011～2020年8053例住院死亡病例进行用血情况统计分析.结果 2011～2020年该院住院患者平均输血率为13.13％,病死患者平均输血率为47.42％.死亡患者输血率最高的前三位疾病为妊娠、分娩和产褥期,血液及造血器官免疫性疾病,消化系统疾病,输血率分别为90％、89.74％和79.52％.<18岁、18～60岁及>60岁死亡患者输血率逐渐降低,输血率分别为64.13％、56.00％、44.80％(P<0.05).死亡患者平均红细胞输血量为2.05 U,血浆和血小板分别为4.19 U和2.8 U.结论 住院死亡患者输血率较高,提示人们在适龄健康时应积极参与无偿献血,利己利人提高献血意识,促进我国无偿献血事业发展.

目的 通过分析全国住院输血新生儿疾病谱及前五名疾病患儿入院后进行干预治疗前的血液检测指标,比较不同疾病血液指标特征,为新生儿精准医治提供数据支持.方法 采用多中心回顾性调查,收集2017年1月1日～2018年6月30日全国46家三级公立医院接受输血治疗的5669例住院新生儿相关诊疗数据,按照国际疾病分类编码(ICD-10)的疾病主要诊断进行统计分析,获得住院输血新生儿疾病谱.对入院后干预治疗前患儿的血常规指标、肝功能指标、凝血功能及血气分析指标进行分析,获得不同疾病干预前血液检测指标的区间范围.结果 导致新生儿住院输血前五名疾病依次为早产儿(25.44％)、新生儿肺炎(15.82％)、新生儿高胆红素血症(10.65％)、新生儿溶血病(6.40％)、新生儿呼吸窘迫综合征(6.07％).前五名疾病各组间的血常规指标、肝功能指标、凝血功能及血气分析指标进行统计分析检验结果差异均有统计学意义(P<0.05).新生儿肺炎和新生儿呼吸窘迫综合征患儿的血常规指标(RBC、HGB、HCT、WBC)、凝血指标(PT、APTT、INR)、肝功能指标(ALT、TBIL、TP、ALB)、血气指标(PO2及SO2)有统计学差异;新生儿高胆红素血症和新生儿溶血病患儿血常规指标(RBC、HGB、HCT、WBC)、凝血功能指标(APTT、FIB)、肝功能指标(TBIL、TP)、血气指标(PH、PO2、HCT)有统计学差异.结论 我国输血新生儿疾病主要以早产儿、呼吸系统疾病、高胆红素血症为主,不同疾病血液检测指标存在差异,提示针对新生儿诊治要根据不同疾病进行精准化个体性诊疗.

Objective By investigating the distribution of ABO and Rh blood groups in Shaanxi Province, to discuss the influence of regional division and population migration on blood group distribution. Methods The data of 3 691 624 blood donors from 10 cities in Shaanxi province in the past 20 years was collected. According to the geographical characteristics of Shaanxi province, the data was divided into three regions: Northern Shaanxi, Southern Shaanxi, and Guanzhong, to statistically analyse the distribution of ABO and Rh blood groups across different regions. Heat map software was used to present the ABO blood group on Shaanxi map. The temporal and spatial characteristics of ABO blood group distribution during 2008 and 2018 were analysed and compared. Results ABO blood group distribution of Shaanxi people was O>B>A>AB, with a Rh negative ratio of 0.41%. Based on the ABO blood group distribution map of Shaanxi Province, obvious regional differences were found in ABO blood group distribution. The ABO blood group distribution in Guanzhong, Southern Shaanxi and Northern Shaanxi was B>O>A>AB, O>A>B>AB, and O>B>A>AB respectively, with the lowest proportion of type A being 26.12% in Northern Shaanxi, the lowest proportion of type B being 27.48% in Southern Shaanxi, and the highest proportion of type O being 32.60% and 32.10% in Northern Shaanxi and SouthernShaanxi respectively. Compared with 2008, the distribution of ABO blood groups in the three regions of Shaanxi province changed significantly in 2018. Conclusion The distribution of ABO blood group in Shaanxi province is O>B>A>AB in general. However, there are significant differences in blood group distribution among different regions. It was also found that population migration had an impact on blood group distribution from 1998 to 2018.

择期手术是指在一段时间内进行充分的术前准备,使患者具有良好的心理和生理条件,再选择有利的时间进行手术,以保证患者手术安全[1]. 然而,择期手术当日临时叫停现象在各级医疗单位均有发生,不仅打乱手术室工作安排,也导致手术患者反复进行禁食、禁饮等术前准备,增加患者及家属的痛苦和医护人员的工作量,更易引起医患纠纷[2,3]. 本研究旨在分析我院耳鼻咽喉头颈外科择期手术当日叫停的情况,为减少叫停手术提供更好的管理对策.

目的:调查我国新生儿输血热点问题,为进一步研究新生儿输血达成专家共识提供依据.方法:采用现场问卷调查和头脑风暴法,对参与中国新生儿输血多中心队列研究项目启动会的101人,按照不同医师执业类型设计新生儿科医生问卷和输血科医生问卷,进行现场问卷调查.结果:①调查对象基本情况博士及硕士分别占比11.9％及55.4％;正高职称及副高职称分别占比18.0％及5o.8％.②新生儿科医生对体重1 000 g以下新生儿红细胞输注阈值不同职称医师选择差异有统计学意义(P＜0.05);体重1 000～1 499 g及1 500～2 499 g新生儿红细胞输注阈值不同职称之间选择差异无统计学意义(P＞0.05).③新生儿科医生对新生儿输血后症状体征改善指标排序为:肤色-呼吸心率-胃肠-代谢-神志黄疸-体温.④仅有20％医生关注医源性失血,不同职称医生关注程度差异无统计学意义(P＞0.05).⑤86.9％的输血科医生采用正反定型鉴定新生儿ABO血型,仅有13.1％采用正定型鉴定血型;68.9％输血科医生认为新生儿交叉配血标本应采用3d以内的血液标本;血小板制品选择方面有85.2％的医院选择机采血小板.结论:在我国临床医生对于新生儿输血指征多依靠个人经验,无统一的规范及标准,在医源性失血问题上关注程度低;输血科医生在实验室检测方法学及血制品选择上仍存在差异,本研究结果为制定我国新生儿输血专家共识提供重要的数据支撑.

Objectives To compare the differences in hospitalization costs of cesarean section in lower uterine segment in different case classification types, analyze the factors that affecting the cost of cesarean delivery in the lower uterine segment, providing a reference for medical cost control.Methods To collect 2820 cases of uterine cesarean section hospitalized patients from 1st June 2015 to 31st May 2016 in a Three A and Tertiary Hospital, apply computer screening combined with expert using medical records to determine the types. Using variance analysis and degree structure variation analysis of the cost and the structure in different groups, and make multiple linear regression analysis of hospitalization costs finally.Results There were 1155 cases, 920 cases, 392 cases and 353 cases of type A(simple type), type B(type of acute obstruction), type C(complicated and difficult type) and type D(complex critical type) respectively. Analysis of variance showed differences in hospitalization between different groups(F=106.392). Analysis between each fee structure changes from big to small A-D(33.06), followed by B-D(30.34), A-C(18.83), B-C(18.38), C-D(17.99), A-B(3.68). Multivariate regression analysis suggested that impact hospitalization costs were admission, hospitalization costs, complications,case classification.ConclusionIt was a scientific, convenient and reasonable method to judge the cost of disease based on case classification, which could provide thinking for health care policy reform.

Objective:To investigate the correlation between the types of unicate process (UP) superior attachment and the chronic frontal sinusitis without nasal polyps(CFSsNP).Method:The images of 240 sides of frontal recess were evaluated. The types of UP superior attachment was compared between the CFSsNP group and the control group. The correlation between UP the superior attachment and CFSsNP were analyzed. Result:Seven types of UP superior attachment were identified. The most common type in the two study groups was type 1(insertion into the lamina papyracea). The occurrence rate of type 1 of UP superior attachment in the CFSsNP group was significantly higher than that in the control group(59.8% and 36.4%,respectively P<0.01),but type 5(insertion into both the lamina papyracea and the skull base) was significantly less frequent in the CFSsNP group than in the control group(9.8%，28.8%,P<0.01). Logistic regression analysis revealed that the type 1 of UP superior attachment was an independent risk factor for CFSsNP(OR=1.181,P<0.05),and that type 5 of UP superior attachment was a protective factor for CFSsNP(OR=0.391,P<0.05). Conclusion:UP superior attachment varied significantly,with the most common type being type 1; This type is intimately related to CFSsNP.

Objective To investigate the significance of expressions of carcinoembryonic antigen(CEA),fibrinogen degrada-tion products(FDP)and D-dimer(DD)in the pleural effusion specimens for differential diagnosis between the benign and malignant pleural effusion.Methods 40 patients with benign pleural effusion patients and 30 patients with malignant pleural effusion were divided into benign or malignant group.The levels of CEA in pleural effusion was detected by electrochemilu-minescence,and FDP and DD were measured by turbidimetry.The value of diagnosis of three separate indicators and combine detection was compared by ROC analysis.Results The levels of CEA,FDP and DD in the pleural effusion specimens of ma-lignanat group were significantly higher than the benign group(t=2.523~3.889,all P<0.01).The sensitivity of combined detection of CEA,FDP and DD was 76.7%,and the rate of correct diagnosis was 82.9%.The sensitivity and diagnostic dffeiciency of combined detection were higher than separate indicators(χ2=1.036~3.324,all P<0.05).Conclusion Com-bined detection of CEA,FDP and DD is helpful to differential diagnosis of benign and malignant pleural effusion.

Objective Through the specific practice of cesarean section in the lower uterine segment, compare different groups of hospitalization days and hospitalization costs, which provided the ideas for the clinical pathway of hospital management. Methods Retrospective review of three A Tertiary hospital discharged patient of total 2820 cases between June 1, 2015 to May 31, 2016. Application of computer screening combined with experts to determine the classification of medical records, analyze differences between the different types of cases.Results 2820 cases of hospitalized patients with only 1.31% of pure pregnancy, pregnancy complications accounted for 98.69%. There were 1155 cases of type A(simple type), 920 cases of type B(simple acute type), 392 cases of type C(complicated type)and 353 cases of type D(complicated and critical type). The variance analysis showed significant difference between different case classification, which including hospitalization day(F=270.337) and hospitalization cost(F=248.167), Further comparison between the groups,Suggest that A, B group respectively different from C, D group between hospital costs and days. A, B type accounted for 73.6%, and the two groups have no difference in hospital costs. Suggesting that hospital develop a realistic plan of cesarean section pathway can start from AB patients to further treatment process decomposition. Conclusion Hospital can use case classification to form clinical pathway text, implement the pathway, evaluate quality work, and finally prepare for the medical insurance payment reform.

目的 分析国产期发生胎膜早破与生殖道病原菌感染的关系.方法 依照病例定义选择2011年6月～2012年5月陕西省人民医院产科的正常孕妇112例和胎膜早破的孕妇108例,采集孕妇的阴道分泌物和宫颈分泌物用定量PCR检测解脲支原体(ureaplasma urealyticum,UU)、沙眼衣原体(chlamydia trachomatis,CT)、B族链球菌(group B streptococcus,GBS)、白色念珠菌(candida albicans,C.albicans)、淋病奈瑟菌(neisseria gonorrhoeae,NG)、单疱病毒Ⅰ(herps simple virus Ⅰ,HSV-Ⅰ)和单疱病毒Ⅱ(herps simple virusⅡ,HSV-Ⅱ)共7种病原菌,对研究数据用卡方检验和Fisher判别分析病原菌感染与胎膜早破的关系.结果 7种病原菌中UU,GBS和CT的感染在正常孕产妇组和胎膜早破孕产妇组之间的差异有统计学意义(x2 =3.644～6.093,P＜0.05),而C.albicans,NG,HSV-Ⅰ,HSV-Ⅱ的感染在二组间差异无统计学意义(x2=0.000～0.046,P＞ 0.05).同时阴道分泌物病原菌定量检测:UU≥105 copy/ml,CT≥103 copy/ml和GBS≥l0s copy/ml的含量在正常孕产妇和胎膜早破孕产妇之间的差异有统计学意义(x2 =0.278～7.015,P＜0.05).采用Fisher判别分析病原菌的分类正确性,对UU按照＜103 copy/ml,103～104 copy/ml,≥105 copy/ml分为三段;GBS按照＜10s copy/ml和≥103 copy/ml分为两段;CT按照＜103 copy/ml和≥103 copy/ml分为两段作散点图,投影显示UU,GBS和CT感染分类区分明显,说明病原菌感染的数量与胎膜早破的发生是密切相关的,为临床提供了判断感染的依据.结论 围产期发生胎膜早破与生殖道病原菌感染的数量有关,临床应结合病原菌的感染数量来评估其与胎膜早破发生的相关性.

目的:探讨复发性尖锐湿疣患者的心理状况及临床特征.方法:用症状自评量表(SCL-90)对120例复发性尖锐湿疣患者和60例健康对照组进行心理健康状况评估,并对临床资料进行回顾分析.结果:与健康对照组比较,病例组在躯体化、强迫、焦虑等因子评分高于对照组(P＜0.01).患者临床特征以性活跃、文化程度较低、合并其他性病及非正规治疗等人群为主.结论:复发性尖锐湿疣患者存在一定的心理障碍,其复发与多种因素相关;对复发性患者采用综合治疗是降低复发的关键.