目的 构建医疗卫生服务与经济的耦合协调评价指标体系,为评价实现医疗卫生服务与经济可持续协调发展提供参考.方法 通过文献研究法和小组讨论初步拟定评价维度,利用德尔菲法经过两轮专家咨询确定评价指标.采用熵值法计算指标权重.结果 两轮咨询专家积极系数均为100％;一级指标专家权威系数在0.80～0.90之间;第一轮一级指标的重要性和可行性协调系数分别为0.434、0.148,二级指标的重要性和可行性协调系数为0.198、0.110;第二轮一级指标的重要性和可行性协调系数分别为0.492、0.209;二级指标的重要性和可行性协调系数为0.377、0.325.各指标协调系数的P值均＜0.05,差异有统计学意义.最终构建了5个一级指标,27个二级指标.结论 所构建的医疗卫生服务与经济的耦合协调评价指标科学、合理、全面且具有针对性,能够为医疗卫生服务与经济两系统协调发展评价提供参考.

目的 探索我国省域医疗卫生服务与经济协调发展状况,为促进医疗卫生服务与经济健康协调发展提供参考.方法 以2012—2020年为研究区间,运用综合评价指数分析医疗卫生服务与经济综合发展水平,采用耦合协调度测算我国医疗卫生服务与经济的协调水平.结果 (1)2012—2020年我国医疗卫生服务与经济综合评价指数年均增长率分别为21.03％和31.69％.其中,2019—2020年医疗卫生服务年均增长率高达36.72％,而经济年均增长率为-1.32％.从区域来看:东、中、西部医疗卫生服务综合评价指数年均增长率分别为-3.09％、-2.51％、-1.51％.经济综合评价指数年均增长率分别为-0.75％、-1.00％、-0.64％.(2)我国两子系统间耦合协调度由2012年的0.389增至2020年的0.920,年均增长率为11.36％,协调类型由2012年的轻度失调发展为2020年的优质协调.东、中、西部耦合协调度均数分别为0.64、0.52、0.47,协调类型分别为初级协调、勉强协调、濒临失调.东、中、西部耦合协调度均数年均增长率分别为-0.95％、-1.00％、-0.61％.(3)东部多数省(直辖市)除2016年为经济发展滞后型,其余年份均为医疗卫生服务滞后型;而中、西部大多数省(自治区、直辖市)除2014年为医疗卫生服务滞后型,其余年份皆为经济发展滞后型.结论 从整体上看,我国医疗卫生服务与经济综合发展及其耦合协调水平均呈上升趋势.从区域来看:东、中、西部医疗卫生服务与经济综合发展水平均呈下降趋势;耦合协调水平呈东、中、西部依次递减空间格局.各区域应结合自身实际,制定医疗卫生与经济发展战略措施,提高两系统协调发展水平,以实现两系统优质协调发展.

Objective:To study the effects of smoking cessation combined with breathing exercises on pulmonary function and quality of life in patients with chronic obstructive pulmonary disease (COPD) during stable disease phase.Methods:A total of 200 male patients with COPD followed up in outpatient department of the First Affiliated Hospital of Zhengzhou University from March 2018 to March 2019 were selected as research objects. They were divided into control group, smoking cessation group, breathing exercises group and smoking cessation combined breathing exercises group by random number table method, with 50 cases in each group. Ultimately, 18 of the 200 patients were lost to follow-up, resulting in 47 cases enrolled in control group, 45 cases allocated to smoking cessation, 43 cases enrolled in breathing exercises group and 47 cases in smoking cessation combined with breathing exercise group. The control group was given basic drug treatment. The smoking cessation group and the breathing exercise group were given quit smoking and breathing exercise intervention, respectively, based on the basic drug treatment. While the smoking cessation combined with breathing exercises group was given both interventions of quit smoking and breathing exercises, based on the basic drug treatment. Lung function, Modified Medical Research Council (mMRC) scale score, chronic obstructive pulmonary disease assessment test (CAT) score, and 6-minute walking distance (6MWD) of the four groups were evaluated before intervention and 3 months after intervention.Results:Before intervention, there was no significant difference in forced expiratory volume in one second (FEV1) as percentage of predicted volume (FEV1pre%), FEV1/forced vital capacity (FVC), mMRC score, CAT score and 6MWD among the four groups ( P>0.05). Compared to indexes values before intervention, FEV1pre%, FEV1/FVC, mMRC, CAT score and 6MWD had no significant change in the control group after 3 months of intervention ( P>0.05). After 3 months of intervention, FEV1pre%, FEV1/FVC, mMRC, CAT score, and 6MWD in smoking cessation group, breathing exercises group and smoking cessation combined with breathing exercises group were improved, and these indexes in smoking cessation combined with breathing exercises group were superior to those in smoking cessation group and breathing exercises group ( P<0.05). Conclusions:Smoking cessation combined with breathing exercises can improve lung function and quality of life in patients with COPD.

目的:评价三氧化二砷(ATO)联合免疫抑制剂环孢霉素A(CsA)治疗再生障碍性贫血(AA)的临床疗效,从细胞分化角度分析原因.方法:54例AA患者分为试验组和对照组,每组27例.试验组接受ATO联合CsA治疗,对照组接受CsA治疗,患者同时常规口服司坦唑醇片,比较2组患者的临床疗效.获取治疗前患者骨髓,分离骨髓间充质干细胞(MSC),实验组加入0.001 mmol/L的ATO和2.5 mmol/L CsA,对照组加入2.5 mmol/L CsA,观察2组MSC成脂与成骨分化的情况.结果:试验组22例完全缓解,5例为部分缓解,有效率为100.0％.对照组5例完全缓解,6例为部分缓解,有效率为40.7％.2组治疗效果比较差异有统计学意义(P<0.05).细胞形态学观察发现实验组骨髓MSC促进成骨细胞分化及抑制成脂细胞分化的作用强.结论:ATO联合CsA通过调控AA患者骨髓MSC成脂与成骨分化,可以较好地治疗AA.

Objective To investigate and analyze the signs and symptoms of renal injury patients with mercury poisoning. Methods From 2010 to 2015,93 patients with mercury intoxication in Henan institute of occupational disease prevention and control were selected. According to kidney injury,the participants were divided into renal injury group and non renal injury group. Statistical analysis was em-ployed to detect positive indicators with symptoms,physical examination indicators between different uri-nary mercury concentration groups. Results There was no significant difference in dizziness,the memo-ry loss,muscle pain,insomnia,nystagmus,hand-trembling,tongue-trembling between the two groups. There were significant differences in headache(χ2 = 4. 86,P ﹤ 0. 05),changes of spirit and character (χ2 = 4. 31,P ﹤ 0. 05),polyuria(χ2 = 5. 56,P ﹤ 0. 05),edema(χ2 = 5. 1,P ﹤ 0. 05),suggesting that these were influencing factors of renal injury patients with mercury poisoning. Conclusions Headache, mental character,urine volume change and edema are positive symptoms in renal injury patients with mercury poisoning.

Objective To investigate the clinical significance of IgH/ IgK gene rearrangement in the early diagnosis of B cell lymphoma. Methods DNA was extracted from paraffin embedded tissues in 50 lymphomas,and 12 lymphonode inflammation(negative controls). The gene rearrangements were am-plified by multiplex primer polymerase chain reaction,analyzed by double stranded heterologous for capil-lary electrophoresis and compared with results of pathological biopsy. The correlation between IgH/ IgK gene rearrangement and LDH level in patients with B cell lymphoma was analyzed. Results Totally 45 cases of lymphomas were positive for PCR rearragement using heteroduplex technique detecting,while 12 cases of Lymphonode inflammation were all negative(P < 0. 05). LDH levels in IgH/ IgK positive patients were 91. 1% ,and the level of negative patients was 40% ,the difference was statistically significant(P <0. 05). Conclusions The gene rearrangements might be used as a specific indicator for early diagnosis of lymphomas,and it might be related with scrum LDH level.

Objective To compare the effect of intrapleural injection of glucocorticoid in the treatment of tubercu-lous pleurisy and analyse the influence on inflammatory cytokines. Methods Sixty-four tuberculous pleurisy patients were selected, they were randomly divided into two groups:experimental group with chest injection of glucocorticoid treatment, control group treated with oral glucocorticoids, clinical effect and changes of inflammatory cytokines of the two groups were observed before and after medication. Results The total effective rate of experimental group was 96. 88%, and 75. 00% of control group, the difference was significant (P<0. 05). At the ninth day after medication,the IL-6 level was (291. 00 ± 77. 70)pg/ml in experimental group and (79. 24 ± 18. 93)pg/ml in control group(P<0. 05);the IL-8 level was (616. 74 ± 169. 51) pg/ml in experimental group and ( 178. 00 ± 71. 50 ) pg/ml in control group ( P <0. 05 ); the IL-18 level was (1143.49 ±136.88)pg/ml in experimental group and (1166.00 ±148.54)pg/ml in control group(P>0.05). Conclu-sions Intrapleural injection of glucocorticoid in the treatment of tuberculous pleurisy, can make the drug directly ACTS on the chest, better realize the control of inflammatory cytokines, encourage pleural effusion absorption, improve the clinical treatment effect, is worth promoting.

目的 观察和分析奥扎雷格纳联合阿司匹林治疗进展性脑梗死的临床症状进展,为进展性脑梗死的临床治疗提供参考依据.方法 选择郑州大学人民医院2012年4月至2013年4月收治的112例进展性脑梗死患者为研究对象,采用数字随机法,将其分成观察组(n=56)和对照组(n=56),两组患者均给予阿司匹林肠溶片治疗,观察组患者在此基础上给予阿扎格雷钠治疗,比较两组患者的临床治疗效果.结果 两组患者治疗2周后的NI-HSS评分和SSS评分均显著低于入院时,P<0.01;观察组患者治疗2周后的NIHSS评分和SSS评分均显著低于对照组,P <0.01;观察组患者治疗2周后的MMSE、算术、视空间、数字广度和记忆评分均显著高于对照组,数据差异具有统计学意义P<0.01;观察组治疗两周后的RI、PI低于对照组,PSV和Vmean高于对照组,P<0.01.结论 奥扎雷格纳联合阿司匹林治疗进展性脑梗死可以有效促进患者临床症状的缓解,是一种安全、高效的方法,对提高患者的生活质量具有重要意义,值得参考.

目的 分析生长抑素与垂体后叶素分别联合泮托拉唑治疗肝硬化并食管静脉曲张破裂出血的疗效及安全性.方法 选择河南省某医院2013年1月至2014年9月期间收治的68例因肝硬化而并发食管静脉曲张破裂出血患者,采用随机数字表法将其分为实验组34例和对照组34例,实验组给予生长抑素联合泮托拉唑治疗,对照组给予垂体后叶素联合泮托拉唑治疗,分析两组患者的止血效果及不良反应发生情况.结果 经药物治疗后,实验组止血时间为(21.5±5.8)h,对照组止血时间为(38.1±11.7)h;实验组患者24 h内止血率(79.41％)与对照组(50.00％)比较差异有统计学意义(P＜0.05);实验组患者经药物治疗后总有效率为94.12％,高于对照组的67.65％ (P ＜0.05);治疗期间两组患者均未出现严重不良反应.结论 生长抑素联合泮托拉唑在肝硬化并静脉曲张破裂出血中止血效果可靠,临床应用安全性较高,适合在基层医院进行推广应用.

Trough the practice experience of implementing digitalization to papermade medical record,this paper sets forth the relationship among management mode of digitalization medical record,electronic medical record and paper-made medical record.It puts forward the solution to problems about light influence,slow rate of progress,inconsistent of image classification and software failure in medical record digitalization.It links traditional paper-made medical record management,emerging electronic medical record management and remote medical together.

Objective To learn about the imaging digitization scanning systems to better play the role in improving medical records management. Methods Imaging digitization scanning systems were installed in medical records rooms to scan original data for microcomputer storage. Results Ensure that medical records were saved safely,accessed to conveniently and fast copied. Conclusion Imaging digitization scanning systems has significant effects,with great improvement of work efficiency in medical records management.

目的 探讨青年女性肺腺癌发病特点及早期误诊原因,以提高对该病认识减少早期误诊.方法 对1995年8月～2008年6月在我院住院的、早期均误诊为其他疾病、后经病理学检查确诊的76例青年女性肺腺癌患者的首发症状及误诊原因进行回顾分析.结果 76例中Ⅲ、Ⅳ期病人占78.95%,初发病时曾被误诊为肺炎22例,肺结核14例,结核性胸膜炎1O例,支气管炎9例,支气管扩张5例,肺间质纤维化2例,肺脓肿1例,肺囊肿1例,颈椎病5例,风湿性关节炎3例,腰椎增生2例,头颅占位性病变2例.分析早期误诊原因:(1)青年女性肺腺癌早期临床表现多样,无特异性;(2)影像学不典型;(3)病理活检取材困难或患者早期不接受病检而贻误诊断;(4)各专科医师对青年女性肺腺癌认识不足.结论 青年女性肺腺癌近年发病率增长较快,易早期转移,易误诊,应提高认识,对可疑病例尽早行病理检查,并要注意多次检查和动态观察,必要时应开胸探察.

Objective To evaluate effects of intervention trial about reporting notifiable communicable diseases,and provide foundation to promote the subject.Methods Adopted multistage stratified cluster sampling,and in each sample county 4 towns were chosen as samples.There were a total of eight samples township,four of which as control ones.Result The people who were obliged to report the epidemic grasped more knowledge about reporting notifiable communicable diseases in the pilot towns than ones in the control towns;the quality of reports still increased significantly.Conclusion Effect of intervention trial of reporting notifiable communicable diseases is significant and meets the expectation of the subject.Further promotion of achievements should be considered.

目的探讨鸦胆子油乳注射液联合紫杉醇治疗老年晚期恶性肿瘤临床疗效。方法选取不能手术或术后复发的老年晚期恶性肿瘤患者86例,随机分为治疗组44例和对照组42例。治疗组选用鸦胆子油乳注射液联合紫杉醇方案治疗,对照组单用紫杉醇化疗,每21天为1个治疗周期,3个周期后进行疗效评定。结果治疗组完全缓解(CR)2例,部分缓解(PR)15例,稳定(NC)18例,进展(PD)9例。有效率、控制率、进展率分别为38.6%、79.5%、20.5%。对照组CR1例,PR13例,NC10例,PD18例,有效率、控制率、进展率分别为33.3%、57.1%、42.9%。主要不良反应为血液学毒性和恶心、呕吐等胃肠道反应。结论鸦胆子油乳注射液联合紫杉醇方案是治疗老年晚期恶性肿瘤的有效方案,而且毒性较小。

Objective To evaluate the clinical value of DNA ploidy of gastrointestinal carcinoma.Methods DNA ploidy of 184 cases with malignant cancer of the gastrointestinal tract was measured by flow cytometry.The DNA ploidy and cell cycle distribution were analyzed.Results With the increase of pathologicalgrading,the DNA aneuploidy of carcinoma and the elevated proportion in the S phase tended to increase,but there was no significant difference.Conclusions There was no significant difference between DNA aneuploidy of gastrointestinal carcinoma and the clinicopathological feature in gastrointestinal carcinoma.

Objective To study effect of vascular endothelial growth factor(VEGF) and cox-2 expression to prognosis survival of lung adenocarcinoma. Methods We elected 63 lung adenocarcinoma patients who were cured in breast surgery section of Henan Tumor Hospital in 2003 and had observed them for 3 years.And making survival analysis by Product-Limit Method.Results The survival rate of lung adenocarcinoma patients with VEGF and COX-2 expression from 1 to 3 years were 43.45%、15.80%、0.00%.The median survival time was 12 months.The survival rate of contrast group from 1 to 3 years were 64.71%、37.25%、12.42%.The median survival time was 24 months.The survival rate of experiment group was lower than the survival rate of contrast group.The statistic result was P0.05 by Log-Rank method.And the result was significant.Conclusion The effect of VEGF and COX-2 expression to prognosis of lung adenocarcinoma may be an index that can be used to estimate prognosis of lung adenocarcinoma and constitute logical Rx.

Objective To study the correlation between drug-resistance of paclitaxel and the expres- sion levels of anti-apoptotic protein survivin and the role of matrine reversal resistance of PTX in non-small cell lung cancer.Methods The expressions of survivin in 120 samples of human lung cancer with paclitaxel chemotherapy were detected by immunohistochemical staining.Results The positive expression rate of sur- vivin was 57.5%.In the positive expression of survivin group,chemotherapy combined matrine could improve response rate and survival time(P0.05).However,in the negative expression of survivin group,matrine could not improve response rate and survival time.Compared between different groups,expression of survivin protein had no effect on response rate and survival time when paclitaxel combined with matrine(P0.05).Conclusion The survivin expression was related to the response rate of paclitaxel in lung cancer.It might be a valuable new marker to predict the drug-resistance of paclitaxel.In this prospective research,survivin protein,which promoted the apoptosis caused by paclitaxel,may be the target of martine.It could partly reverse the drug re- sistance to paclitaxel.