以某医院改造项目为例,提出在感染控制、信息化建设、后勤保障及环保等多方面可能存在的问题及解决方案,为同类型项目提供参考.

目的 探讨心理评量技术干预对重症监护室(ICU)心衰患者心脏功能的改善效果.方法 选取128例确诊为心力衰竭且具备手术指征者作为研究对象,随机将其分实验组和对照组,各64例.对照组采用常规抢救监护,实验组在抢救监护的基础上采用心理评量技术.比较两组干预前后心脏功能指标的差异性,评估其心理状态,然后进行差异性分析.结果 两组出院时左心室舒张末期内径、肌酸激酶(CK)低于入院时,左心室射血分数、排血量高于入院时;而实验组左心室舒张末期内径、CK减小低于对照组,左心室射血分数、排血量高于对照组,差异均有统计学意义(各P＜0.05).两组出院时NYHA Ⅰ级较入院时增加,而出院时,实验组NYHA Ⅱ、Ⅲ级明显少于对照组;两组焦虑量表评分(SAS)和抑郁量表评分(SDS)出院时较入院时减小,而出院时,实验组SAS评分和SDS评分均低于对照组,差异均有统计学意义(各P＜0.05).结论 针对ICU心力衰竭患者给予心理评量技术干预可显著改善患者心脏功能,且有助于缓解焦虑和抑郁心理状态.

目的 探讨优质护理应用于ICU护理中对气压泵血栓的预防作用.方法 我院2013年2月至2015年2月全髋关节置换术后患者60例,随机分组为观察组和对照组,各组为30例,对照组按照常规进行护理,观察组在常规护理的基础上给予优质护理,比较两组患者手术前后的凝血酶原时间、活化部分凝血活酶时间、纤维蛋白原、血小板计数以及下肢深静脉血栓发生率.结果 观察组术前术后与对照组术前术后:凝血酶原时间、活化部分凝血活酶时间、纤维蛋白原、血小板计数均在正常范围,仅下肢深静脉血栓发生率有差异.观察组为10%(3/30),对照组为20%(6/30)(P<0.05).结论 优质护理应用于ICU护理中对气压泵血栓的预防作用显著,可有效地减少血栓形成,有利于促进患者术后恢复.

Objective To evaluate the cost effectiveness of opportunistic screening for colorectal cancer in community population. Methods From April to July in 2013,we conducted opportunistic screening for colorectal cancer on 5 270 in -service or retired staffs of an institution who received physical examination in No. 731 Hospital of CASIC. The cost and effectiveness of screening was measured,and cost -effectiveness analysis was conducted. Results Among the subjects,the compliance to colorectal cancer risk factor scale ( QA ) was 100. 00%( 5 270/5 270 ), and the positive rate was 11. 95%(630/5 270);the compliance to immune fecal occult blood test(IFOBT)was 83. 91%(4 422/5 270),and the positive rate was 2. 28%(101/4 422);a total of 666 subjects with high risk for colorectal cancer were found(with either QA positive or IFOBT positive),and the positive rate was 12. 64% (666 /5 270). Among high - risk subjects,202 subjects received colonoscopy examination with a compliance of 30. 33% ( 202/666 ). We found 3 cases of colorectal cancer by colonoscopy examination,with a detection rate of 1. 49%(3 /202);we detected 45 cases of precancerous lesions(adenomatous polyp)with an detection rate of 22. 28%( 45/202 ) . The average screening cost for one case of high risk for colorectal cancer was 55. 95 yuan,the average screening cost for one case of precancerous lesions was 2 612. 88 yuan,and the average cost for one case of colorectal cancer was 39 193. 13 yuan. Conclusion The opportunistic screening for colorectal cancer in community population is effective and economical with high screening compliance,thus it is suitable for widespread promotion.

目的 探讨适当低浓度对比剂在冠状动脉CTA成像中的应用价值.方法 对136例拟行冠状动脉CTA检查的患者行前瞻性研究,按所用对比剂浓度不同分为三组,所用对比剂浓度分别为320 mgI/ml、350 mgI/ml、370 mgI/ml,将扫描所得原始数据进行后处理重组,然后对重组后的冠状动脉图像质量进行主观评价,并对主动脉起始部及同层面降部的CT值进行测量,对其结果分别进行统计学分析.结果 三组冠状动脉图像质量的主观评价差异无统计学意义(x2 =0.785,P=0.675).采用前瞻性心电门控扫描的三组患者主动脉起始部CT值的分析结果为:F值=0.992、P值=0.376;主动脉降部CT值的分析结果为:F值=1.527、P值=0.224,采用回顾性心电门控扫描的三组患者主动脉起始部CT值的分析结果为:F值=1.206、P值=0.307;主动脉降部CT值的分析结果为:F值=1.703、P值=0.191,各组CT值的差异无统计学意义.结论 适当低浓度对比剂(320 mgI/ml)能够满足冠状动脉CTA的诊断要求,在行冠状动脉CTA检查时推荐使用.

目的 了解慢病管理人群对结直肠癌筛查的知识、信念、行为现状及影响因素,并与自然人群相比较,为探索基于慢病管理的结直肠癌筛查模式提供参考依据.方法 2014年3月,对北京市右安门社区卫生服务中心前来就诊的慢病管理人群(慢病组)和自然人群(对照组)进行结直肠癌筛查问卷调查,有效问卷381份,其中慢病组193份,对照组188份.结果 慢病组与对照组结直肠癌及结直肠癌筛查知识部分中位数分别为10分和8分,差异有统计学意义(Z=-1.98,P＜0.05);信念部分平均分分别为(49.17±7.33)分和(44.47±6.45)分,差异有统计学意义(t=6.64,P＜0.05).两组分别仅有7.77％和5.85％的居民参加过结直肠癌筛查,差异无统计学意义(P＞0.05);80.31％和67.55％的居民有筛查意愿,差异有统计学意义(x2 =0.06,P＜0.05).两组人群中不愿意参加筛查的前三位原因均是身体健康没必要、没时间、结肠镜检查痛苦.但筛查过程麻烦无法坚持、筛查有商业目的以及不相信社区卫生服务中心的筛查技术等原因两组人群差异较大.logistic回归分析显示,组别、婚姻状况是居民结直肠癌筛查参与意愿的影响因素.结论 慢病管理人群及自然人群的结直肠癌及结直肠癌筛查知识均不足、筛查行为均较差,但慢病管理人群筛查信念及意愿均高于自然人群.

结直肠癌是当今最常见的恶性肿瘤之一,我国结直肠癌的发病率与死亡率飞速增长.结直肠癌筛查是早期发现、早期治疗结直肠癌及癌前病变的重要途径.相对于伺机性筛查,人群筛查是更理想的结直肠癌筛查模式,但在我国却面临着依从性低、财政负担过重的问题.基于慢病管理的结直肠癌筛查模式,作为人群筛查的一种,针对高危人群更多、依从性更好、成本更低且更易组织管理的特殊群体——慢病管理人群进行干预.这种新型筛查模式既保留了人群筛查的固有特性,又在一定程度上吸收了伺机性筛查的优势,有助于有限资源的效益最大化,也是更适合我国现阶段国情的结直肠癌筛查模式.

Objective To investigate the status of knowledge,attitude and practice of colorectal cancer screening and the influencing factors for the willingness for the screening among urban residents. Methods From July 1 to July 21 in 2013, using complete random sampling method, we enrolled 600 residents from Taoranting Community and Tianqiao Community in Beijing,with 300 residents in Taoranting Community and 270 in Tianqiao Community. Self-designed questionnaire for interview was adopted,and survey was conducted in the form of on-site investigation combined with household investigation. The content of the questionnaire included the basic information and the KAP status of colorectal cancer screening. A total of 482 residents who completed questionnaires well were included. Results The median score of the knowledge of colorectal cancer screening was 9 (3),and the numbers of residents with excellent,medium,and poor scores were 48(10. 0%),207(42. 9%)and 227 (47. 1%)respectively;the average score of attitude was(44 ± 10),and the numbers of residents with excellent,medium,&nbsp;and poor scores were 245(50. 8%),233(48. 4%)and 4(0. 8%);as for the willingness for colorectal cancer screening, the number of patients who were willing,unwilling and uncertain for the colorectal cancer screening free of charge were 337 (69. 9%),107(22. 2%)and 38(7. 9%). Spearman correlation analysis showed that there was positive correlation between knowledge and attitude(rs =0. 19,P﹤0. 05),between knowledge and willingness for the screening(rs =0. 12,P﹤0. 05) and between attitude and willingness for the screening(rs =0. 15,P﹤0. 05). Residents with different ages,education levels and scores of attitude were significantly different in the willingness for the screening of colorectal cancer ( P﹤0. 05 );residents with different genders,marital status,occupation,home monthly income per capita,medical insurance and scores of knowledge were not significantly different in the willingness for the screening of colorectal cancer ( P ﹥0. 05 ) . Binary non -conditional logistic regression analysis showed that gender,age and the score of attitude have significant influence on the willingness for the screening of colorectal cancer(P ﹤0. 05). Conclusion The levels of knowledge,attitude and practice of colorectal cancer screening among urban residents need to be improved. Gender,age and the attitude towards the screening are influencing factors for the willingness for the screening of colorectal cancer. The KAP theory should be taken as the basis,precaution measures should be formulated,the levels of knowledge and attitude of residents about the colorectal cancer screening should be improved,so as to improve the behaviors in colorectal cancer screening.

Cancer is the leading killer of human beings. Population- based screening is the basic means for cancer prevention and control. Cancer screening has been listed as a major public health project in China at present and relevant government departments regularly organizes screening for different cancers. However,under the premise of guaranteed fund and technology,the low participation rate of population- based screening has become the main factor influencing the efficiency of cancer screening. Based on the community participation theory,community- based participation research can effectively improve the participation rate of the community population- based cancer screening. In this study,we summarized the participation status of population- based cancer screening and its research status to improve the participation rate at home and abroad. We also elaborated the community- based participation research and its application status in this field,thus providing a scientific basis for improving the community participation of various kinds of public health service.

Objective To evaluate rural residents' willingness and behaviors of colorectal cancer screening, investigate the influencing factors of rural residents' willingness of CRC screening and build a frame diagram of these factors,on the basis of KAP theory and community involvement theory. Methods We enrolled rural residents of two randomly selected villages in Hancunhe Town,Beijing in March,2014. Cluster sampling method was used. Questionnaires were completed by the rural residents during household visits. Content of the questionnaire included basic data, KAP status in CRC screening and community condition. The number of valid questionnaires was 707. Descriptive analysis, Spearman rank correlation coefficient analysis,contingency coefficient analysis and logistic regression analysis were conducted. Results Of 707 rural residents, 38. 6%(273/707)knew about colorectal cancer,10. 0%(71/707)knew about CRC screening,2. 4%(17/707)received CRC screening before,87. 3%(617/707)were willing to receive CRC screening with appropriate time and place. The M( Q) of the score of knowledge about colorectal cancer and CRC screening was 0(3),and that of the score of attitude was 35(9). There was weak positive correlation ( P ﹤ 0. 05 ) between knowledge and attitude, and between attitude and participation willingness,while the correlation between knowledge and participation willingness was not statistically significant( P﹥0. 05).&nbsp;Among 707 rural residents,51. 9%( 367/707 )were satisfied with the general condition of community,47. 1%( 333/707 ) were dependent on community,59. 0% (417/707)thought the neighborhood association were close,69. 3% (490/707) enjoyed communicating with neighbours,and 70. 0%(495/707)were ready to help neighbors in trouble. There was positive correlation(P﹤0. 05)between the willingness of CRC screening and dependence on community,communication and mutual assistance in neighbourhood. The logistic regression analysis showed marriage,income,attitude,dependence on community and mutual assistance in neighbourhood were the influencing factors on willingness of CRC screening. Conclusion Knowledge, attitude and community factors all have influence on rural residents' willingness of CRC screening to some extent. Community involvement mode should be used with the guidance of KAP theory and community involvement theory. The knowledge of rural residents about CRC screening should be improved,and the favorable mutual effects among rural residents should be promoted, thus the rural participation rate in CRC screening could be increased.

Objective To explore the application of MSCT lymphangiography in diagnosing primary intestinal lymphangiectasis( PIL).Methods Imaging materials of 16 patients with pathologically confirmed PIL confirmed were retrospectively analyzed.Direct lymphangiography was carried out in all patients,which was followed by thoracic and abdominal MSCT scanning and endoscopy examination.MSCT manifestations were compared with operational,pathological and endoscopic findings.Results In all patients MSCT lymphangiography could clearly display the intestinal and extra-intestinal lesions,which included dilatation of intestinal canal( n = 14),bowel wall thickening( n = 13),pleural effusion( n = 5),ascites( n = 7),pericardial effusion( n = 3),mesenteric edema( n = 12),mesenteric nodules( n = 6),abdominal lymphangioma( n = 2),intestinal lymph trunk reflux( n = 7),lumbar lymph trunk reflux( n = 13),pleural and pulmonary lymph reflux( n = 3),pericardial and mediastinal lymph reflux( n = 3),mediastinal and pulmonary lymph reflux( n = 4),obstruction of thoracic duct at T8 level( n = 1) and exit obstruction of thoracic duct( n = 14).Conclusion MSCT lymphangiography can clearly display the location,extent and degree of intestinal and extra-intestinal lesions of PIL,providing the basic evidence for the diagnosis and treatment of PIL.

The regular screening is effective in reducing morbidity and mortality of colorectal cancer. However,the screening in large populations is extremely costly,the growth of economy and medical resources are limited. What the screening providers' main concern is how to find more people suffered from precancerosis or early cancer with the limited resources. The dif-ferent screening method results in different effect,so it is critical to select the most cost-effective screening program. The paper summarize the current colorectal screening methods from cost-effectiveness perspective. Combined with the related research con-ducted by the authors,the research plan evaluate the cost-effectiveness of colorectal screening program by using schemes com-posed by different objects,methods and processes. This explorative study may provide decision-making basis for the choice of colorectal screening program.

目的:探讨256层螺旋CT大范围心电门控扫描胸腹部血管联合成像对冠状动脉成像质量的评价.方法:对34例因胸痛就诊的患者用256层螺旋CT行大范围心电门控扫描检查,检查完成后,进行冠状动脉图像重建,并与常规CT冠脉扫描的图像进行比较.结果:行大范围心电门控扫描检查组的冠状动脉图像质量优良率为89.7％ (456/508),能够满足诊断要求的为95.5％(485/508),常规冠状动脉扫描组中,图像质量优良率为89.8％(460/512),能够满足诊断要求的为96.3％ (489/512).两组的图像优良率无明显差异(X2=1.072,P=-0.192).结论:256层螺旋CT大范围心电门控扫描能够满足冠状动脉成像的要求,具有较高的临床应用价值.

Objective To investigate MSCT lymphangiography features of diffuse lymphangiomatosis.Methods MSCT images of 32 patients with diffuse lymphangiomatosis confirmed with clinical comprehensive diagnosis,surgery and pathology were retrospectively reviewed.Thoracic and abdominal MSCT examinations were performed after direct lymphangiography in all patients.Among them,13 patients underwent enhanced MSCT examination.The site and extent of the lesions were recorded,and the ratio of descriptive statistics was used according to categorical variable data.Results MSCT lymphangiography showed various degree of abnormal lymphatic vessels in all 32 patients:Obstructed thoracic duct was seen in 15 cases(46.9％),obstructed right lymphatic vessel in 3 cases(9.4％),unilateral (bilateral) cervical lymphatic stem reflux in 5 cases(15.6％),unilateral(bilateral) bronchial-mediastinal lymphatic stem reflux in 4 cases(12.5％).Lumbar trunk and iliac lymphatic vessel were dilated on the lymphangiography side in 32 cases(100.0％),while 28 cases(87.5％) reflux to contralateral lumbar trunk and iliac lymphatic vessel,reflux to bilateral renal sinus in 2 cases(6.2％),the contrast materials leak into unilateral(bilateral) thoracic cavity in 9 cases(28.1％),abdominal cavity in 6 cases(18.8％) and intestinal cavity in 2 cases(6.2％).The contrast materials were found in bone in 8 cases(25.0％),mediastinum in 5 cases (15.6％),pericardium in 3 cases(9.4％),spatium intermusculare in 3 cases(9.4％),pathological fractures were found in 5 cases(15.6％).Conventional MSCT images showed different locations,multiple and various sizes cystic lesions.Conclusion MSCT lymphangiography can display the features of diffuse lymphangiomatosis.Thus,it provides an important basis for diagnosis and differential diagnosis of diffuse lymphangiomatosis.

<span id="ChDivSummary" name="ChDivSummary" class="abstract-text">目的:了解炼化企业职工常见症状发生情况及其影响因素,为健康促进提供科学依据。方法:采用概率比例规模抽样法,自行设计调查问卷,对5328名职工健康状况进行调查。用二分类logistic回归分析职工常见症状的影响因素。结果:职工中有症状的人数为3990人,占调查总人数的74.9%;易忘事的发生率最高,心情烦躁、视力下降、耳鸣、头晕、情绪低落等13种症状发生率大于10.0%,为职工常见症状;多因素分析显示,吸烟、睡眠较差、噪声和苯及苯系物接触是职工健康的危险因素,OR值分别为1.29、5.05、1.35和1.41;运动为其保护因素,人群归因分值为-7.92%;结论:职工健康不仅受职业因素影响,工作场所也应成为实施基本公共卫生服务和一般健康促进措施的地点。</span>

Objective: To explore the diagnostic value of contrast enhancement CT and CT after direct lymphangiography in intestinal lymphangiectasia (IL). Methods: Imaging data of 28 patients with IL were analyzed retrospectively. All the patients underwent direct lymphangiography and abdominal CT scan, 4 underwent contrast enhancement CT scan before direct lymphangiography and 5 after direct lymphangiography. Results: Diffuse nodular small bowel wall thickening and edema were detected in 15 patients, mesenteric edema in 21 patients, and pleural and peritoneal effusions were observed in 16 patients. The abnormal findings of CT scan after direct lymphangiography included contrast-enhanced leakage into the intestinal lumen or distributed in the intestinal wall 7 cases, mesenteric lymph duct dilatation in 10, iodine oil distribution to the stomach wall in 1, contrast agent reflux to the hepatic portal, splenic hilum, around the pancreas, contralateral iliac lymph duct and thoracic cavity in 21 cases. Contrast enhancement CT scan showed "halo sign" of the small bowel wall in 3 patients and linear enhancement of the small bowel wall in 7 patients. Conclusion: CT and contrast enhancement CT after direct lymphangiography are helpful for demonstrating the extent of disease, therefore can be used in observation of pleural and peritoneal effusions and organ, as well as in following up.

Objective To explore the collateral shunt pathways of cirrhotic portal hypertension and analyse the clinical significances in CTPV with 16-MDCT.Methods 145 patients with cirrhotic portal hypertension were analysed who underwent CTPV in 16-MDCT.Routine plain scans and post-triphase enhancement CT scans were performed.Post-processing including MIP,VR,MPR were done.Results The collateral shunt pathways were forty-five superior vena cava(31%) purely,eleven inferior vena cava(7.7%) purely,eighty-nine(61.3%) superior vena cava and inferior vena cava bidirectionally.Conclusion CTPV could clearly reveal all kinds of the porto-caval collateral shunt for cirrhotic portal hypertension,which is helpful to the treatment and following up for the complications of cirrhotic portal hypertension such as upper gastrointestinal bleeding.

Objective:To assess the clinical value of 256i CT angiography in the arteriosclerotic occlusive disease(ASO) of lower extremity.Methods:A total of 119 patients with symptomatic arteriosclerotic occlusive disease of lower extremity underwent 256i CT angiography.The scan ranged from the celiac to thenar artery.Original axial images were transferred to EBW workstation and 3D reconstruction images were performed.75 patients underwent digital subtraction angiography(DSA) between 0 and 14 days after CT angiography.The manifestations of 256i CT angiography were compared with those of DSA.Results:Of 1575 segments of arteries,1505 were displayed on both DSA and CTA.DSA images as the gold standard,the sensitivity,specificity and accuracy of 256i CTA were 100.0%,98.8%,99.7% in displaying the segments occluded and 99.3%,97.8%,98.2% in detecting the segments that had more than moderate stenosis.Therefore,there was excellent agreement between 256i CT angiographic and DSA findings in the assessment of ASO(k = 0.945).Of 975 segments,905 were found atherosclerotic plaques,12 were simple mural thrombus.Conclusion:The diagnostic performance of 256i CT angiography is excellent in patients with clinical symptoms of the arteriosclerotic occlusive disease of lower extremity.The results can be used to effectively guide therapeutic decision making in these patients.

<正>与传统CT比较,256层智能CT(iCT)具有扫描速度快、分辨率高、图像清晰和一站式大范围扫描等优点[1]。CT检查过程中碘造影剂的使用频率越来越高,对于对比剂的注射速度和剂量、对比剂副作用的诊治以及检查过程中的护理配

Objective To explore the influence law of offset distance(Do) between ionization chamber center scale and X-ray beam plane of multi-slices CT to the CTDI100 measurement result.Methods Head body mold(T6M164) and long pole ionization chamber,which meet IEC standards,are used to measure the CTDI100 value of Philips Brilliance iCT 256 on axial scanning condition of different offset distance.Results when Do is 1cm,relevant deviation(Dr) is 0%～5%,when Do is 3cm,Dr is 5%～15%,and when Do is 5cm,Dr is 25%～75%.Conclusion The measurement result of CTDI100 has greater sensitivity for Do,which means the operator should make sure no deviation exist between X-ray beam and ionization chamber center,besides,more attention should be paid to radiation dose in penumbra area.Scattering beam causes the measurement of CTDI100 at 4 points around more discrete,effect of bed to measurement result shows that symmetry of CTDI100 at 4 points outside the center reduces.