推广电子病历应用加快医院信息化建设

随着电子计算机技术的迅猛发展,医院信息化管理系统逐步向以病人信息为重点的综合信息管理体系发展。基于纸张的传统病历已经不能适应现代医学发展的需要。电子病历(Computer-based Patient Record,CPR)又称计算机化的病案系统或基于计算机的病人记录,是医院信息化管理系统的重要组成部分,它利用先进的信息技术来存储和管理患者的病历,     

慢性心力衰竭患者心脏再同步治疗疗效观察

Objective This study was designed to evaluate the clinical outcome of cardiac resynchro-nization therapy(CRT) during short and mid-long term follow-up. Methods Consecutive patients treated with CRT between 1999 and 2008 were registered. Clinical information was collected from baseline and last follow-up. Clinical information included survival, chnical cardiac function, echocardiography parameters and QRS wave width from surface ECG. Results Ninety-five patients who were treated with CRT successfully were included. These patients were divided into two groups: those with only short term follow-up and those with mid-long term follow-up. In the short term follow-up group,survival was 89.1% with follow-up of(18±10) month(median = 18 months). Survival was 66.6% in mid-long term group with follow-up of(57±17) months (median = 54 moths). While clinical cardiac function was significantly improved in both groups the intrinsic QRS wave width did not show significant change. Those patients' medical therapy for chronic heart failure has been changed dur-ing the period of follow-up. Conclusion CRT can improve clinical cardiac function in parts of patients with chronic heart failure and increased survival during mid-long term and short term follow-up. However, there re-mains a need for more sensitive indicators.     

心脏再同步化治疗中经胸心外膜起搏导线的植入技术

目的探讨经胸心外膜左心室导线植入在慢性充血性心力衰竭心脏再同步化治疗中的意义。方法对1例经静脉植入左心室导线因冠状静脉窦开口畸形而放弃的患者行经胸植入左心室心外膜导线植入。结果右心房、右心室心内膜起搏导线植入及两根心外膜起搏导线缝合均顺利,术后未出现严重并发症。术后2周后临床症状逐渐改善,NYHA心功能分级从术前Ⅲ、Ⅳ级提高至Ⅱ级,LVEDD从72mm减至66mm,优化程控起搏器后超声心动图描记术检查室间隔基底部与左心室侧壁间失同步性改善,第3天心外膜起搏导线阈值从术中的2.0V降为0.5V且稳定。已随访12周临床症状、心功能改善,组织多普勒显像示左心室内恢复同步化。结论心脏再同步化治疗经胸心外膜左心室导线植入是安全、可行的,特别是对经静脉途径失败的患者,是可选择的方法之一;术中左心室导线的定位及术后的综合处理十分重要。     

慢性心力衰竭患者心脏再同步治疗疗效观察

Objective This study was designed to evaluate the clinical outcome of cardiac resynchro-nization therapy(CRT) during short and mid-long term follow-up. Methods Consecutive patients treated with CRT between 1999 and 2008 were registered. Clinical information was collected from baseline and last follow-up. Clinical information included survival, chnical cardiac function, echocardiography parameters and QRS wave width from surface ECG. Results Ninety-five patients who were treated with CRT successfully were included. These patients were divided into two groups: those with only short term follow-up and those with mid-long term follow-up. In the short term follow-up group,survival was 89.1% with follow-up of(18±10) month(median = 18 months). Survival was 66.6% in mid-long term group with follow-up of(57±17) months (median = 54 moths). While clinical cardiac function was significantly improved in both groups the intrinsic QRS wave width did not show significant change. Those patients' medical therapy for chronic heart failure has been changed dur-ing the period of follow-up. Conclusion CRT can improve clinical cardiac function in parts of patients with chronic heart failure and increased survival during mid-long term and short term follow-up. However, there re-mains a need for more sensitive indicators.     

微种植体支抗压低磨牙的临床研究

目的:探讨微种植体支抗在压低磨牙中的疗效。方法:选择7例需要压低磨牙的患者(包括5例开牙合患者和2例因对牙合牙缺失而致磨牙伸长的修复前正畸患者),使用微种植体支抗压低磨牙,治疗前后拍摄头颅定位侧位片,测量并比较磨牙在矫治前后的压低量。结果:矫治结束后开牙合患者前牙达到正常的覆牙合、覆盖,修复前正畸患者矫治至缺牙区能进行常规修复。磨牙压低范围2～4mm。结论:应用微种植体支抗能有效地压低磨牙,为磨牙伸长的修复前正畸和开牙合畸形的矫治提供了思路。     

房间隔起搏临床应用的体会

目的　探讨有适应症的阵发性房颤患者行永久房间隔起搏的可行性及有效性。方法　先行心内电生理标测 ,寻找使双心房同步激动的房间隔最佳起搏点 ,采用主动固定起搏导线固定于该部位。结果　 4例患者窦性心律时房间传导为 10 6 0± 4 3ms ,标测后房间隔起搏房间传导时间为 11 0± 1 1ms,(P <0 0 0 1)。达到了双心房同步起搏。 3例患者成功地植入房间隔主动固定导线 ,一例患者失败。结论　永久房间隔起搏方法在伴有房间传导阻滞的阵发性房颤患者中的应用是安全可行的。     

奥扎格雷钠与阿斯匹林合用对不稳定型心绞痛患者血液流变学影响

目的　观察奥扎格雷钠与阿斯匹林合用对不稳定型心绞痛 (UAP)患者血液流变学影响。方法　随机将收治的 4 2例UAP患者分为对照组 2 1例和治疗组 2 1例 ,对照组给予口服阿斯匹林片等常规治疗 ;治疗组则在常规治疗基础上 ,每天用奥扎格雷钠 16 0mg溶于 5 0 0ml生理盐水中静滴 ,连用 2周 ,监测治疗前后血液流变学参数、心电图和心绞痛症状等。结果　治疗组在心绞痛缓解和消失时间等方面优于对照组 (P均 <0 0 1)。治疗组治疗后纤维蛋白原含量、血细胞比容、血小板聚集率均较治疗前显著降低 (P <0 0 1～ 0 0 5 ) ,全血比黏度较治疗前有所降低 ,但无统计学意义 (P >0 0 5 ) ;对照组治疗后血小板聚集率较治疗前显著降低 (P<0 0 5 ) ,其余各指标差异无统计学意义 (P <0 0 5 ) ;两组用药过程中均无出血并发症。结论　在常规治疗基础上加用奥扎格雷钠能显著降低血小板聚集率等血液流变学参数 ,更有效治疗UAP。     

导线绝缘层破裂致起搏器电池提前耗竭一例

患者女性，54岁。1998年9月因胸闷，心悸6年来院就诊，诊断为病态窦房结综合征，行双腔起搏器植入。起搏器型号为Biotronik Actors D，心房导线型号PX53-JUP，心室导线型号PX60-UP，当时心房导线采用右锁骨下静脉穿刺植入，心室导线采用右头静脉径路，术中测试心房起搏阈值0.4V、电流0.7mA。     

拉米夫定联合干扰素-α1b抗乙型肝炎病毒疗效观察

慢性乙型肝炎治疗的关键是抗病毒治疗，但单用一种抗乙型肝炎病毒(HBV)药物疗效往往不佳，目前国内外公认的抗HBV药物为拉米夫定和干扰素-α，国内有学者认为采用拉米夫定干扰素-α序贯疗法进行治疗，虽能减少YMDD变异，但不能提高抗HBV疗效。因此我们采取两者开始联合应用以了解其能否提高抗病毒疗效，现总结如下。     

颅脑损伤所致精神障碍司法鉴定中智能障碍的影响因素

目的:探讨颅脑损伤所致精神障碍类型,听力、视力异常对智力测定的影响,以及颅脑受损程度与智力障碍程度的关系。方法:对269例颅脑损伤患者的司法精神医学鉴定资料进行回顾性分析。结果:1269例颅脑损伤所致精神障碍患者中,有听力、视力异常情况智力测定结果与无异常的患者有明显差异(P<0.01);2以智力障碍为首位,共195例患者(72.5%);患者智力障碍程度与脑损伤的程度有相关性(P<0.05)。结论:颅脑损伤所致精神障碍,有听力、视力异常患者的IQ值与听力、视力无异常患者的IQ值有明显差异;智力障碍患者占首位,颅脑损伤程度与智力障碍有明显相关性。