碎米糖化液的脱色工艺研究

目的:探讨碎米糖化液脱色的工艺条件。方法:以活性炭为脱色剂,在单因素基础上进行正交试验,对碎米糖化液进行脱色剂用量、脱色时间、pH和加热温度等因素的考察。结果:碎米糖化液活性炭脱色的最佳工艺为:糖化液加入3%～5%的活性炭后,在70～80℃下脱色35～50 min。结论:本文所建立的脱色工艺简单可行,可为进一步制备注射用葡萄糖的脱色工艺研究提供试验依据。     

经皮二尖瓣球囊扩张术治疗老年人二尖瓣狭窄的临床观察

目的 探讨经皮二尖瓣球囊扩张术(PBMV)治疗老年人二尖瓣狭窄的疗效、安全性及并发症的预防.方法 采用改良的房间隔定位法及运用跨二尖瓣技术对老年二尖瓣狭窄患者行逐步球囊扩张.手术前后分别记录即刻左心房压、肺动脉平均压、二尖瓣跨瓣压差及二尖瓣口面积,并进行手术后随访.结果 PBMV有效扩大了二尖瓣口面积,与术前比较,术后左心房压下降[分别为(25.3±6.7)mm Hg(1 mm Hg=0.133 kPa)与(16.4±5.8)mm Hg]、二尖瓣跨瓣压下降[分别为(17.6±6.7)mm Hg与(6.8±2.9)mm Hg]、肺动脉压下降[分别为(38.6±12.1)mm Hg与(29.2±9.8)mm Hg],二尖瓣口面积增加[分别为(1.05±0.22)cm2与(1.61±0.38)cm2],心功能明显改善,差异均有统计学意义(P＜0.05或P＜0.01).随访结果表明,PBMV疗效稳定.结论 PBMV操作技术的改进能明显改善老年患者二尖瓣狭窄症状,显著降低手术的并发症.

Abstract：

Objective To evaluate the efficacy and safety of the improved percutaneous balloon mitral valvuloplasty (PBMV) in elderly patients with mitral stenosis. Methods Elderly patients with severe mitral stenosis received an improved PBMV which included a modified way of atrial septal puncture and technique across the mitral valve. The left atrial pressrue (LAP), mean pulmonary pressure (MPA), mean gradient across the mitral value (MPG) and mitral valve area (MVA) were recorded and compared before and after the operation. Long term follow up were made. Results After operation, the LAP decreased [(25.3±6.7) mm Hg vs.(16.4±5.8) mm Hg,1 mm Hg=0.133 Kpa], MPG decreased [(17.6±6.7) mm Hg vs.(6.8±2.9) mm Hg], MPA decreased [(38.6±12.1) mm Hg vs. (29.2±9.8) mm Hg], MVA increased [(1.05±0.22)cm2 vs.(1.61±0.38)cm2] and the New York heart association heart function classification improved. The follow-up result showed that the effect of PBMV was constant. Conclusions Improved PBMV may be an effective and safe measure for patients with mitral stenosis.     

上海市公立医院集团化改革的SWOT分析

从优势、劣势、机遇和挑战4个方面入手,深入分析了上海市公立医院实施重组和集团化改革的环境因素,提出未来上海在推行医院集团化改革过程中应注重各医院不同的特点,不存在普适模式;政府应致力于引导合理有序的竞争,加强监管,推进产权制度改革,为医院集团的成长创造良好的条件;医院集团化改革的短期目标可设定为实现上海市民主动选择社区-综合医院-社区的就医路径,中长期目标可设定为落实医院集团的独立法人地位.