新医改将药品供应保障改革作为重点关注内容之一,而医用耗材由于在产品特征、使用方式、流通特点等方面的特性,且存在更新快、品种多、流通体系复杂、行业规范较少等突出特点,成为本次改革中的难点,通过对医疗器材流通领域的变化进行预测研究,为从业者提供可供参考的转型方向.通过对医用耗材流通领域改革政策及措施的解读,分析新医改措施对医疗器材行业造成的影响,以成本分析的方法为基础,对流通领域的变化进行预测.提出医疗器材流通领域将由垂直化体系向扁平化体系变化,相关行业主体分工将发生改变.预测结果对从业者行业定位,制订应对措施,具有积极意义.

组建产—儿多学科团队,从生命孕育期开始,由产科、新生儿科、儿科共同进行连续性延伸护理服务.产—儿多学科连续性延伸护理服务项目的开展,构建了多学科连续性延伸护理服务模式,充分发挥了护士价值,体现了护理专业内涵质量,提高了家长满意度,提升了医院知名度.

实现医用耗材精细化管理,关键是构建精准管控体系.分析了当前医用耗材在购入和溯源环节存在的缺陷,依托医用耗材来源、流通、使用等过程管理规范,开发出连通供应目录库、中心库、二级库的医用耗材精准管控体系,实现了计划、领用、计费、使用的全过程精准管控,达到供应渠道清晰、出入库业务规范、库存周转快速、收费准确、溯源到位的管理目标.

Objective To evaluate the corrective effects of platelets stored at 4℃ with the help of a in vitro hemorrhage model Platelets agitated at 22℃ were used as comparison.we hope this study would provide valuable experimental bata for the preservation of platelets in clinical applications.Methods Sample platelets with a total volume of 5×200 mL were divided into 2× 100 mnL each 200 mL for storage at 4℃ and 22℃,respectively.An in vitro model of hemorrhage was established with the in vitro hemodilution method where blood was diluted with normal saline (NS) with a ratio of 1∶9.The in vitro corrective effects of the platelets stored at 4℃ and 22℃ were evalutaed by Thromboelastography (TEG) test and routine blood marker level tests,where these two groups of platelets were prepared in a mix of suspended erythrocytes and fresh frozen plasma with a ratio of 1 ∶ 1 ∶ 1.Results Platelets stored at 4℃ and those agitated at 22℃ for 1,3,and 5 days were determined to be corrected in the in vitro hemorrhagie model,where platelet counts (× 109/L) were corrected from 20-27 to 127-161 and 128-160,respectively (P＞0.05).The TEG-MA (mm) were corrected from 12.7-14.4 to 45-51 and 47-50 while TEG-R values were corrected from 27.7-9.9 to 4.4-4.3 and 4.5-4.7,respectively (P＞0.05).For platelets stored at 4℃ for 7-14 days,platelet counts (× 109/L) were corrected from 18-27 to 162-161 and TEG-MA(mm)were corrected from 8.8-14.5 to 46-43 with TEG-R(min) corrected from 24-13 to 5.5-5.2(P＜0..05).Conclusion Correction has been detected using the hemorrhage model.The platelet counts,TEG-R,and TEG-MA values have been corrected,thus supporting the claim that platelets stored at 4℃ for 10-14 days presents fine coagulation quality.

Objective To execute experimental study injection rate and volumetric error and to explore their correlations with sizes of injectors and extension tube,so as to lay a foundation for the quality control of the injection pump.Methods Simulation experiment was carried out with involving in 10,20 and 50 ml of injectors and 80 and 120 cm extension tubes,and 6 kinds of connection systems were formed with auxiliary appliances.The injection rate and flow reading of the flow meter were obtained and then compared with the set values,and the correlations were proved between sizes of auxiliary appliances and the precision of injection dose and rate.Results In case other conditions kept the same,the injector with larger capacity behaved better in controlling injection rate and dose,and the shorter extension tube gained advantages over the longer one in regulating the precision for injection and injection dose.Conclusion The experiment contributes to the selection of auxiliary appliances and the enhancement of quality control,and the further research provides references for process design and materials selection of the injector.

Endotracheal intubation can enhance anaesthesia effect and ensure patient safety. Conventional intubation anesthesia existence hidden danger, lumen by extrusion deformation, lead to ventilation, and may damage the patient 's lip and tongue. The incidence of oral-tongue injury was 2.0 % in 200 patients with general anesthesia by new oral-tongue protection device, which was lower than that of conventional method. It is showed that the device is safe and effectively protect the oral-tongue of patient, which with the promotion and conversion value.

Objective:To compare the detective effect between color Doppler twinkling artifact and B-mode ultrasonography for kidney stones in order to develop an ultrasonic model that can more easily and more accurately detect kidney stone.Methods: 9 patients with kidney stone who were confirmed by CT scan in recently were selected to accepted two methods (color Doppler twinkling artifact and B-mode ultrasonography) to detect kidney stone. The video fragments of upper pole, interpolar and lower pole were created by three radiologists and the results were diagnosed by them.Results: In dual kidneys of the nine patients, 32 stones with average size of (8.9±7.5) mm were found. The sensitivity, specificity, positive predictive value and negative predictive value of the B-mode ultrasonography were 71%, 48%, 52% and 68%, respectively, while those of color Doppler twinkling artifact were 56%, 74%, 62% and 68%, respectively.Conclusions: In the detection of kidney stones, B-mode ultrasonography is more sensitive when is used alone, but color Doppler twinkling artifact has more high specificity. The color Doppler twinkling artifact should be applied in more clinical practices, and a new commercial ultrasonography mode that used basic acoustic difference and is special for detection of kidney stone should be researched and developed so as to improve the detection of kidney stone.

In order to adapt to the new health management localization requirements of the physical examination center and develop the scientific allocation strategy for hardware resources, this paper analyzed many kinds of functional requirements such as disease diagnosis and monitoring, risk early warning and intervention, health promotion and keep and so on. Then the allocation strategies of hardware resource that included the inspection, early warning type and the type 3 instruments and the information coordinating platform was clarified, which had an important guiding significance for the transformation of health care market orientation.

Objective To explore and study the mechanism of quality control for that using traditional medical equipment risk source recognition cannot fully explain the injection pump in the clinical use of adverse events. Methods According to the typical case, we studied the influence of injection pump alarm reliability on the different auxiliary materials through the simulation experiment and data analysis. Results The experimental data and statistical analysis results shown that the larger capacity of the syringe was, or the longer of the extension tube was, the longer of the delay time on blocking alarm was. The delay of blocking alarm was related to the rate of injection. The syringe had no obvious effect on the delay of the pump discharge alarm. Conclusion The auxiliary materials influenced the alarm reliability of injection pump in different infusion conditions. This study can not only provide a high guiding value to reduce the risk of the clinical use of injection pump, but also can enrich and perfect the medical equipment risk source in theory in a certain extent.

针对现行高值医用耗材管理存在的医疗风险,通过构建新的管理机制以及新的服务运行体系,研究分库房模式管理的必要性和可行性,为高值医用耗材的院内流通和使用提供解决方案.

This paper introduced the realization of medical consumables purchase source path control in our hospital by scientiifcally establishing and applying mutatis mutandis libraries and supply directory libraries. The practical application proved that the method not only had great feasibility, but also could reflect significant management benefits. The method lays a foundation for the improvement of the management level of hospital medical consumables procurement.

目的 探讨微信平台在早产儿出院随访干预中的应用效果.方法 将本院新生儿科收治的100例早产儿随机分为观察组和对照组,对照组仅给予出院指导,出院后定期复诊评估.观察组出院后采用微信平台随访干预,比较2组早产儿家长的健康知识掌握以及早产儿的发育情况.结果 观察组家长的喂养知识、生活护理、生长发育知识及早期护理干预知识的掌握率显著高于对照组(P＜0.05).观察组出院后6个月的体质量和身长增长速度大于对照组,各项智能发育评分显著高于对照组(P＜0.05).结论 微信平台随访能够提高早产儿家长早期护理干预知识的掌握率,促进早产儿的身体和智能的发育.

As the auxiliary equipment for life supporting and drug treatment, the safe use of the injection pump has always been the key point for the quality control of medical equipment. This paper analyzes the typical clinical adverse events and expounds the mechanism of quality risk sources for injection pumps in various aspects including the engineering technology, medical care and clinical pharmacy, which provides theoretical bases for prevention of the clinical application risks so as to improve the application and operation of injection pumps.

This paper made an analysis of the existing problems in the medical and health system and the service model in China, on the basis of which multiple solutions were put forward, including adjustment of the hospital income structure, reformation of drug promotion and provision of health insurance support. As a consequence, the remodeling of the active doctor-patient service relationship was advanced so as to realize the design of a new health insurance operation mechanism for Chinese people.

目的：观察间断性蓝光照射治疗新生儿黄疸的临床疗效，并评价其安全性。方法选择134例黄疸新生儿，依照不同蓝光照射方式将其分为2组，对照组给予常规综合治疗＋持续性蓝光照射，观察组给予常规综合治疗＋间断性蓝光照射治疗；比较2组临床效果和不良反应发生情况。结果2组治疗后的血清胆红素水平、临床总有效率比较差异无统计学意义（P均＞0．05）；观察组不良反应发生率显著低于对照组（P＜0．05）。结论间断性蓝光照射治疗新生儿黄疸能够达到与持续性蓝光照射疗法相同的治疗效果，且不良反应发生率低于持续性蓝光照射疗法，有较高的临床应用价值。

早产儿出生时身体各器官未完全发育成熟，在母体外生活能力较弱，出生后还要完成追赶性生长的问题［1］。极低体质量早产儿的出院后的健康问题已经成为世界各国备受关注的问题。为改善早产儿远期预后，短期的住院护理已经远远不能满足需求［2］。居家护理是对住院患者出院后的延伸性护理服务，由于具有良好的成本效益，已经成为许多国家的基本卫生政策［3］。本次研究中主要探究居家护理对极低体质量早产儿出院后生长发育的影响，报道如下。

目的：探讨优质护理干预对早产儿生长发育的影响。方法选择2012年4月至2014年4月期间本院收治的90例早产儿，随机分为观察组和对照组，每组各45例。对照组采用常规护理，观察组采用优质护理干预，对干预后的早产儿生长发育指标、疾病发生情况、出院时相关指标及家长对护理工作满意度进行比较。结果①干预后观察组的体重增长量及身长增长量均显著高于对照组，差异具有统计学意义（P＜0．05）。②干预后观察组的腹泻、呼吸道感染及贫血的发生率显著低于对照组，差异具有统计学意义（ P＜0．05）。③干预后观察组出院时的奶量摄入量、体重增长量及住院天数均明显优于对照组，差异具有统计学意义（P＜0．05）。④干预后观察组家长的护理满意度（95．6％）显著高于对照组（82．2％），差异具有统计学意义（P＜0．05）。结论对早产儿实施优质护理干预，可明显促进其生长发育，减少疾病的发生，提高家长对护理的满意度，值得临床推广与应用。

目的 对比研究液态奶与配方奶粉在临床应用中对早产儿营养及生长的影响.方法 回顾性分析在陕西省人民医院新生儿科住院2周以上的体重低于2 000g的早产儿89例,对比观察患儿体重增加情况;静脉营养应用时间;达到口服喂养足量时间;住院时间;小于胎龄儿纠正情况等,并进行统计分析.结果 两组在住院时间、出院时小于胎龄儿比例,体重下降最低百分比、恢复至出生体重时间、住院期间体重增长百分比、平均每日体重增加量及两组的贫血、低血糖、电解质紊乱、代谢性酸中毒、坏死性小肠结肠炎及胆汁淤积综合征发生率比较差异均无统计学意义(均P>0.05);但在应用静脉营养时间(t=2.345)、达到足量喂养时间(t=2.742)、疾病治愈比例(t=3.919)、出院体重(t=2.192)、最低体重(t=2.798)方面比较差异存在统计学意义(均P<0.05).结论 液态奶优于常规早产儿低出生体重儿配方奶粉.

目的 总结新生儿肺炎克雷伯杆菌院内感染的早期诊治、易感因素及暴发预警的可行性方法 .方法 回顾性分析了陕西省人民医院新生儿科2008年11月～2009年1月收治的7例新生儿肺炎克雷伯杆菌感染病例.结果 发病者体重:1 240～1 740g;发病时住院日12～20天;均有败血症"五不"表现;早期血白细胞减少症(1.4×109/L～3.4×109/L)5例,血小板减少症(9×109/L～69×109/L)4例,高血糖(8.2～20.9μmol/L)4例;感染症状典型,血气分析提示进行性代谢性酸中毒;C反应蛋白增高;血凝系列异常,且易并发休克.结论 早产儿,住院2周左右,有败血症表现,白细胞计数、血小板计数均下降,血糖增高者需警惕肺炎克雷伯杆菌院内感染,休克可疑者需立即采取强有力抗生素及抗休克治疗,同时果断采取消毒隔离措施,是减少死亡的主要手段和预防暴发院感流行的主要方法 .

目的解决RhHDN换血治疗时Rh阴性血液供应困难问题。方法采用Rh阳性血代替Rh阴性血对6例RhHDN患儿进行换血治疗。结果6例患儿全部治愈出院。结论用Rh阳性血替代Rh阴性血对RhHDN患儿进行换血治疗方法可行。