目的 分析日间手术患者当日取消手术的原因,制定整改对策,以提高医疗质量.方法 通过医院信息系统收集2012年1月至2017年12月期间日间手术病房当日取消手术患者的临床资料,分析取消手术的原因并通过电话、短信及微信等方式进行随访了解其转归.结果 2012年-2017年日间手术病房当日取消手术例数整体上逐年下降.各科室中,乳腺外科当日取消率最高(5.43％),其次为消化内科(5.22％)、胃肠外科(4.02％)、眼科(3.24％).取消原因以患者因素为主(41.26％),其次为医疗因素(30.26％)、管理因素(28.48％).随访结果显示,当日取消手术的患者中,超过半数延期手术(51.51％),少数(11.43％)转院,另34.87％患者随访期内未进行手术.结论 应通过对患者加强健康宣教,强化医护人员责任心,完善医院管理制度和流程等措施,进一步降低日间手术当日取消率.

Objective To explore the application effects of innovative health education on patients undergoing ambulatory laparoscopic cholecystectomy (LC).Methods A total of 139 patients undergoing ambulatory LC from November to December 2016 were selected as the control group,receiving the traditional health education;and other 141 patients undergoing ambulatory LC from February to March 2017 were selected as the observation group,receiving the innovative health education.The two groups were followed up and observed 1 day,2,and 28 days after the discharge,and the incidence rates of adverse reactions such as postoperative pain,bleeding and incision infection were measured,and the disease knowledge mastery,self-care skills,medication compliance and satisfaction to nursing and hospital were evaluated.Results The total incidence rate of adverse reactions was 7.8％ in the observation group and 25.2％ in the control group (P＜0.001).Medication compliance from high to low was 90,46 and 5 cases in the observation group and 59,64 and 16 cases in the control group (P＜0.001).In the observation group,the scores of disease knowledge mastery,self-care cognition,nursing satisfaction and hospital satisfaction were 93.4±5.5,91.4±4.5,96.4±3.7 and 98.1±3.7,respectively,which were higher than those in the control group (83.8±8.7,83.2±9.1,91.5±9.2 and 94.8±7.3,respectively) with statistical significance (P＜0.001).Conclusion Innovative health education has certain application effects on ambulatory LC,and it can significantly improve disease knowledge mastery and self-care cognition,and help to ensure the medical quality and safety during perioperative period,and improve the patients' satisfaction.

目的 探讨15 MHz高频超声小探头检查对血管球瘤的术前诊断价值及定位价值.方法 回顾分析2006～2012年间本院病理确诊为血管球瘤的病例,对有完整术前超声检查记录、病历资料、手术记录及病理结果的手指、足趾占位性病例进行分析,将超声检查结果与手术病理结果对比.结果 共纳入符合条件的血管球瘤共53例,皆为单发病灶;男∶女为13∶40,年龄15～70岁,平均(39.9±12.0)岁.其中51例良性,2例恶性潜能,无恶性病例.手指、足趾(48/53,90.6％)分布较其它部位多,尤其以甲下、甲沟旁及指腹(48/53,84.9％)分布最多.手指、足趾部位血管球瘤病灶最大径[(6.2±2.7)mm,范围2～13 mm]较其它占位病灶[(15.6±9.8)mm]小(P＜0.05).以病理结果为金标准,15 MHz超声小探头对手、趾部位血管球瘤的敏感性、特异性、准确度及阳性似然值分别为:90.3％,96.8％,94.0％,28.2％,而12 MHz的分别为:58.8％,93.5％,84.0％,12.8％.术前经15MHz超声检查诊断为血管球瘤者同时给予标记定位后行微创手术彻底切除病灶,随访期间无一例复发.结论 术前高分辨率的15 MHz高频小探头对手指、足趾部位的血管球瘤可作为首选影像诊断方法,且可用于术前准确定位.

腺瘤样瘤(adenomatoid tumor of epididymis)是一种间皮细胞起源的良性肿瘤,发生在男性和女性生殖道[1],最早由Godman和Ash在1945年提出[2],临床少见.多数患者在20～40岁发病,青春期前罕见,无明显临床症状,偶然触及阴囊内孤立肿物,多数为单发,以附睾尾居多,其次是附睾头,肿块生长缓慢.本研究回顾分析我院2006年3月至2012年8月的9例附睾腺瘤样瘤的超声表现特点,旨在探讨二维及彩色多普勒超声对附睾腺瘤样瘤的诊断价值。

OBJECTIVE To discuss the feasibility of reasonable applications and management strategy of antibiotics during perioperative period of breast surgery,and to observe the impact of these strategies on the quality of medical care and hygienic economical parameters. METHODS A total of 94 breast surgery patients were arranged into intervention group(47 cases) and control group(47 cases),respectively.The intervention group received management strategies of rational use of antibiotics in perioperative period and the control group were under conventional surgical treatment methods.Then the Days of hospitalization,the total cost of hospitalization and antibiotics,the proportion of rational drug use and hospital infection rates were compared using the 1∶1 case-control study. RESULTS Compared with the control group(9.19±2.04),hospitalization time of the intervention group(7.28±2.16 days) was significantly shorter(P=0.0000).The total cost of hospitalization and antibiotics of the intervention group were(4222.59±1056.57) yuan and(685.82±299.94) yuan respectively was significantly reduced,compared with the control group(5457.84±1768.18) yuan and(1049.50±453.05 yuan)(P0.05).The ratio of rational drug use of intervention group is 87.24%,while the control group was 23.40%,and the difference was statistically significant(P0.01).Additionally,there is no nosocomial infection both in two groups. CONCLUSION After the implementation of the perioperative management strategies of rational use of antibiotics,the perioperative prophylactic use of antibiotics is more reasonable and the hospitalization and drug costs are significantly reduced in breast surgery.Then these strategies promote the safety,effects,economical and rational use of antibiotics,and provide an effective and viable model to reduce the single disease hospital cost.

1病例摘要 现病史:患者男,59岁.因"右上肢肿块4个月,尿量减少3 d"于2008-09-12入我科.4个月前,患者无明显诱因出现右上肢肿胀疼痛,局部皮温稍升高,无发热寒战,无关节疼痛,无关节活动障碍,未予重视.之后肿块进行性增大,质硬不活动,肢体活动明显受限,且右大腿根部出现近似上肢的肿块,于院外中药外敷,无明显好转.

尿毒症维持性血液透析患者发生胸腔积液时,通过充分血液透析(HD)及营养支持,胸腔积液常常可减少或消失.但在临床工作中,我们仍会遇到一些通过加强血液透析治疗后胸腔积液仍不能减少的病例,经采用腹膜透析往往能获得较好疗效,现报告2例如下.

长期以来,消化道出血病人在出血期间的大便情况往往引起医护人员甚至病人家属的高度重视而出血控制后的排便情况却很少引起注意.笔者通过对我科1997年3月～2003年3月收治的消化道出血病人排便时间进行观察,发现不少人出现排便时间延缓(超过48 h才排便),甚至有典型的便秘症状、体征,并提出相应的干预措施,旨在降低这类病人出现排便时间延缓甚至便秘的发生率.