目的 探讨PDCA循环法结合360°教学考核评估体系在贵阳市住院医师规范化培训(住培)过程管理中的初步应用效果.方法 回顾性分析2013年—2018年贵阳市市属医院151名住培学员基本资料,对照组(2013级)按原贵州省专科医师培训要求进行常规管理及考核,PDCA-360°组(2015级)严格按国家标准执行PDCA循环法结合360°教学考核评价体系进行质量管控及评价.分析两组学员3年培训期期间学员流失率、执业医师资格通过率、理论-技能住培结业合格率、住培过程管理满意率、教师带教能力满意率.结果 共纳入对照组26人,PDCA-360°组125人;相比对照组,PDCA-360°组学员流失率较低,住培第一年执业医师资格通过率较高,住培三年执业医师资格累积通过率提高;PDCA-360°组理论考核合格率、技能考核合格率及结业考核通过率均高于对照组;PDCA-360°组学员对住培管理过程及带教老师整体满意度较好.结论 PDCA循环法结合360°教学考核评估体系提高了我市住培工作的管理及教学质量,为建立和完善贵阳市住培工作的科学化管理教学奠定基础.

目的:探讨复方斑蝥注射液联合放化疗在局部晚期鼻咽癌治疗中的应用价值.方法:以我中心2015年7月至2017年4月收治的157例初治局部晚期鼻咽癌患者为研究对象,将其随机分为试验组79例与对照组78例.试验组患者采用复方斑蝥注射液联合同步放化疗,对照组患者行常规同步放化疗治疗.收集临床资料,比较两组患者治疗期间相关不良反应发生率、机体免疫功能变化和近期疗效情况.结果:试验组与对照组的CR、PR、SD、PD差异无统计学意义(P=0.269>0.05),近期有效率(CR+PR)差异存在统计学意义(P=0.001),试验组较优于对照组;进一步分析两组患者的4级不良反应发生率存在统计学差异(P<0.05),两组患者治疗前后CD3+、CD4+、CD4+/CD8+、CD8+、CD19+淋巴细胞计数下降,试验组较对照组下降趋势缓和.结论:局部晚期鼻咽癌在规范抗肿瘤治疗过程中给予复方斑蝥注射液治疗可降低患者治疗期间严重不良反应的发生率,对机体免疫功能可能有一定的保护作用,并在一定程度上可辅助提高疗效,需开展多中心、大样本临床研究进一步证实.

目的:检测并分析老年原发性骨质疏松症患者血清25-羟维生素D[25-(OH)D]水平及其与骨代谢指标的相关性.方法:选取2013年4月到2019年5月期间在我院接受治疗的老年原发性骨质疏松症患者166例作为骨质疏松组,另选取同期在我院进行体检的无骨质疏松老年人群117例作为无骨质疏松组.检测所有研究对象的血清25-(OH)D、Ⅰ型胶原氨基酸延长肽(PINP)、β-胶原特殊序列(β-CTX)、N-端骨钙素(N-MID)的水平,并分析血清25-(OH)D与骨代谢指标的相关性.结果:166例老年原发性骨质疏松症患者的血清25-(OH)D水平为(16.82± 4.52)ng/mL,其中维生素D缺乏64例、占38.56％,维生素D不足72例、占43.37％,维生素D正常30例,占18.07％.不同性别的老年原发性骨质疏松症患者的血清25-(OH)D水平比较差异无统计学意义(P＞0.05),不同性别的老年原发性骨质疏松症患者的维生素D缺乏、不足、正常占比比较差异无统计学意义(P＞0.05).骨质疏松组血清25-(OH)D水平明显低于无骨质疏松组(P＜0.05),骨质疏松组血清β-CTX水平明显高于无骨质疏松组(P＜0.05),骨质疏松组和无骨质疏松组的血清PINP、N-MID水平比较差异无统计学意义(P＞0.05).经Pearson相关分析显示,老年原发性骨质疏松症患者的血清25-(OH)D与β-CTX呈负相关(P＜0.05),与PINP、N-MID无明显的相关性(P＞0.05).结论:老年原发性骨质疏松症患者存在明显的维生素D缺乏、不足,但无明显的性别差异,血清25-(OH)D与β-CTX呈负相关,联合检测血清25-(OH)D和β-CTX有助于老年原发性骨质疏松症的早期诊断和治疗.

目的 探讨贵阳市老年人群维生素D水平及与老年性疾病的相关性.方法 收集2013年4月～2019年6月在贵阳市第一人民医院进行过维生素D检查的老年患者资料,共5913例,检测患者血清25-羟维生素D3.检测结果分为维生素D缺乏、不足、正常情况,按临床诊断分组,分为高血压组、心力衰竭组、脑卒中组、糖尿病组及健康对照组5组,结合临床资料进行回顾性分析,探讨贵阳市老年人群维生素D水平及与老年性疾病的相关性.结果25-羟维生素D3平均水平为20.797 ng/mL,其中25-羟维生素D3缺乏(<20 ng/mL)3137例,占53.03％;维生素D3不足(20 ng/mL<D3<30 ng/mL)1722例,占29.13％;维生素D3正常(>30 ng/mL)1054例,占17.84％.健康正常对照组维生素D3水平显著高于血压组、心力衰竭组、脑卒中组和糖尿病组(P<0.05),而高血压组、心力衰竭组、脑卒中组、糖尿病组在血清25(OH)D水平上无统计学差异(P>0.05),高血压组、心力衰竭组、脑卒中组、糖尿病组不同严重程度间的血清25(OH)D水平具有统计学差异(P<0.05),病情严重程度越高,血清25(OH)D水平越低,血清25(OH)D水平与高血压、心力衰竭、脑卒中、糖尿病等老年性疾病存在负相关(P<0.05).结论 贵阳市老年人维生素D水平显著低于正常,老年人群维生素D水平与老年性疾病明显相关,适量补充维生素D有可能成为预防和治疗老年性疾病的有效手段.

目的 研究25-羟维生素D3[25(OH)D3]与老年人动脉粥样硬化的相关性.方法 选择2013年4月～2019年5月间我院老年医学科收治的577例老年心脑血管患者为研究对象.所有人均空腹抽血查25-羟维生素D3,根据维生素D3检查结果分为缺乏、不足、正常三组.同时对所有患者进行详细的病史采集、体格检查、常规辅助检查(肝肾功、尿酸、电解质等),检测研究对象的血管脉搏波传导速度及踝背指数.比较三组患者一般情况、体质量指数(BMI)、尿酸(UA)、磷(P)、血清钙(Ca)、血管脉搏波传导速度及踝背指数、血清25(OH)D3等指标,经Logistic回归分析法总结动脉粥样硬化致病的危险因素.结果 三组患者在性别、BMI、血Ca、血P方面比较差异无显著性(P>0.05);而在年龄、UA、25(OH)D3方面比较差异有显著性(P<0.05).以是否合并周围血管动脉粥样硬化作因变量,以年龄、UA、25(OH)D3要素作自变量,经Logistic回归分析明确年龄、UA为老年心血管病动脉粥样硬化的独立危险因素,而25(OH)D3为保护因素.结论 25(OH)D3有助于减少老年心血管病动脉粥样硬化的发生,是保护因素;年龄及血UA为老年人动脉粥样硬化的独立危险因素,故在实际治疗中,可从这三方面入手,以防治动脉粥样硬化病变,降低心脑血管病的发生率.但针对血清25(OH)D3与血UA是否具有相关性,临床仍需进一步研究与证实.

目的:探讨MRI/CT融合图像勾画局部晚期鼻咽癌诱导化疗后靶区对放疗计划的影响.方法:选取52例经局部晚期鼻咽癌患者,经诱导化疗2或3周期后分别在相同体位下同期采集鼻咽部CT定位图像及鼻咽部MRI T1 W1图像,并通过Pinnacle3 8.0放疗计划系统进行MRI/CT图像融合,分别对CT定位图像及MRI/CT融合图像资料进行GTVnx勾画,对转移淋巴结、CTV1、CTV2及正常组织均在CT图像进行勾画,形成两套靶区;两套靶区均由同一物理师分别进行调强放疗计划设计后给予相同处方剂量及正常组织限量,在勾画诱导化疗后分别比较两套放疗计划靶区适形指数(CI)及均匀指数(HI),统计靶区照射体积、剂量及正常组织受量.结果:与CT图像靶区放疗计划比较,局部晚期鼻咽癌诱导化疗后MRI/CT融合勾画靶区放疗计划CIPTVnx和GTVnx照射体积更大(P＜0.05);2套放疗计划的HI、PTV照射体积、PTV靶区适形CI、剂量均匀性HI、靶区剂量及正常组织受量比较,差异无统计学意义(P＞0.05).结论:MRI/CT融合图像方案可一定程度增加局部晚期鼻咽癌时辰诱导化疗后勾画靶区的照射体积,有较好的靶区适形度,可能会减少诱导化疗后放射治疗漏靶的发生.

Objective To explore the influence of sputum specimens by three different collecting methods on sputum outcomes in patients with pulmonary fungal infection. Methods 512 patients with suspected diagnosis of pulmonary fungal infection admitted into our hospital from March 2008 to January 2014 were selected.Ordinary expectoration,dis-posable sterile suction tube and bronchofiberscope anti-pollution brush were used to collect sputum specimens for fun-gal smear and culture.Together with clinical data,a retrospective analysis was implemented aiming at comparing quali-fied rate and detection rate of sputum specimen and clinical diagnostic significance by different methods. Results Qual-ified rates of sputum specimens collected by disposable sterile suction tube,bronchoscopy and sputum stain brush bron-chofiberscope anti-pollution brush and ordinary expectoration respectively was 91.02%,92.60% and 35.08%.Detection rates of smear for direct microscopic examinations /culture on sputum specimens by these three methods respectively-was 61.56%/60.09%,63.24%/64.84% and 45.38%/33.11%.There was no statistical difference in detection rate of the first two sputum specimens (P>0.05),but the detection rates by the first two collecting methods were both significantly higher than that by ordinary expectoration with statistical differences (P<0.01).The sensitivity,specificity,positive predic-tive value and negative predictive value of sputum specimens outcomes collecting by the first two methods in the diag-nosis of pulmonary fungal infection was 66.76%,97.79%,98.82%,51.55%in turn. Conclusion Qualified rate and detec-tion rate of specimens by disposable sterile suction tube and bronchofiberscope anti-pollution brush are in good consis-tency under physician’s full supervision. In comparison with ordinary expectoration,they are both beneficial to improve the diagnosis of pulmonary fungal infection. However,disposable sterile suction tube is more simple and economical,and applicable for grass-root medical organizations.

Objective To explore the related factors ( host ), clinical feature, etiology, prevention and control measures of 376 patients with pulmonary fungal infection in emergency intensive care unit( EICU). Methods A total of 376 patients with pulmonary fungal infection were selected out of 2 165 patients admitted to Department of EICU, the Affiliated Hospital of Guiyang Medical College from March 2008 to January 2014,clinical data including related factors(host)(including underlying diseases, complications, common risk factors ), clinical feature, etiology, treatment and prognosis was retrospectively analyzed. Results In the 376 cases,364 cases were hospital-acquired,accounted for 16. 81% of all of the 2 165 cases. In the 376 cases,364 cases ( 96. 81%) existed at least 1 kind of underlying diseases, mainly were primary lung diseases(60. 63%),and the incidence of multiple organ dysfunction syndrome ( MODX ) was 42. 55%. The risk factors including using wide-spectrum antibiotics(over 1 week),hyperglycemia(blood glucose﹥7. 0 mmol/L),invasive diagnosis and treatment,hypoproteinemia and breathing machine ventilation( over 48 hours). The clinical feature was not specific. A total of 475 strains of fungus was separated out,including 225 strains(47. 37%)of Monilia Albicans,250 strains(52. 63%)of&nbsp;non Monilia Albicans,and 132 cases(35. 11%) were mixed infection. The effective rate was 71. 63%,and the mortality rate was 28. 37%. Conclusion Patients in EICU have higher incidence of pulmonary fungus infection, it is related to kinds of underlying diseases and multiple risk factors;the main etiology is opportunistic pathogen, but the proportion of non Monilia albicans is increasing,part of patients are mixed infection;the clinical feature is not specific,so it is hard to be diagnosed and treated,the prognosis is poor.

Objective:To investigate the acute coronary syndrome(ACS)correlation with membrane protein(Moesin)antibody,the Global Registry of Acute Coronary Events(GRACE)by detecting the serum levels of anti Moesin antibody in patients with ACS.Method:We selected 126 patients with ACS and divided them into singlevessel group,the double-vessel group and three-vessel and left main vessel group according to the results of the coronary angiography.Then we calculated the GRACE risk scores.In the same period,41 patients excluded coronary heart disease served as control group.We detected serum anti moesin antibody of the patients by enzymelinked immunosorbent assay(ELISA)and observed the anti Moesin antibody positive expression rate and OD value.Result:①In 126 patients with ACS,the positive detectable rate and OD detection value of moesin antibody were significantly higher than those in the control group(P0.01);With the coronary artery lesions getting severe,the GRACE risk scores also gradually rise,the positive detectable rate and OD detection value of Moesin antibody were gradually increasing,and there was significant difference between three-vessel and left main vessel group and single-vessel group(P0.05),while other two groups had no such differences(P0.05).②Correlation analysis showed that there was significantly positive correlation between the OD detction value of anti moesin antibody and the GRACE risk scores(r=0.452,P0.05).Conclusion:The moesin antibody can be used as a new evaluation index to judge the coronary artery lesion severity of the ACS patients.Moesin antibody with GRACE score is positively correlation in ACS.