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高壓氧治療不依從性的原因分析

目的　探討高壓氧治療時患者不依從性的原因，以積累經驗，指導臨床工作。 方法　2011年1月－2012年1月間采用自制調查問卷進行回訪，總結、分析未遵醫囑進行高壓氧治療患者的不依從性的原因。 結果　由于客觀原因，患者高壓氧治療依從性與多種主觀因素有關，因缺乏高壓氧知識、恐艙、治療不便等綜合因素為主要原因。 結論　加強高壓氧知識的普及和宣教，加強人文關懷，提高患者的依從性。

Causes and solutions of dissatisfied complaints about frame glasses wearing after medical optometry

Objective To explore the causes and solutions of dissatisfied complaints about frame glasses wearing after medical optometry to improve service quality. Methods Patients with dissatisfied complaints about frame glasses wearing after medical optometry in West China Medical Center of Optometry Glasses between January 2013 and December 2014 were selected. Targeted re-examination and corresponding treatment was performed on them. The causes of their complaints were clustered and analyzed. Result There were 105 cases of complaints out of the 58 278 patients with frame glasses wearing after medical optometry, including complaints about wearing glasses uncomfortable in 58 cases (55.2%), mainly related to abnormal binocular vision, high myopia and progressive glasses lens fitting; quality of glasses in 23 cases (21.9%), in whom 16 were dissatisfied with the frame; quality of service in 10 cases (9.5%); glasses assembly / calibration in 7 cases (6.7%); and other dissatisfaction in 7 cases (6.7%). Conclusions In medical optometry, optometrists and sales staff should establish a good communication with patients according to individual differences, attach importance to the selection of right frame and lens in patients with high myopia or progressive piece of glasses, introduce the right wearing method of progressive piece of glasses, and enhance the follow-up service. For patients with obvious eye fatigue, it is needed to check the binocular visual function, if the visual fatigue is closely related to abnormal binocular visual function, special glasses fitting and functional training should be instructed to the patients.

Forensic Pathologic Analysis of Traumatic Brain Injury

【摘要】 目的 探討顱腦損傷(BI)死亡的法醫病理學特點,以及繼發性腦干損傷、并發癥的發生與死亡之間的因果關系。方法 從性別、年齡、致傷方式、損傷類型、生存時間、死亡原因等方面,對四川大學華西法醫學鑒定中心1998年1月-2008年12月127例BI死亡尸檢案例進行回顧性統計研究分析。結果 127例法醫病理學檢案中,原發性BI死亡51例(402%),繼發性腦干損傷死亡61例(480%),并發癥死亡15例(118%),其中傷后12 h內死亡者直接死因均為嚴重原發性腦損傷,存活12 h～1周者直接死因以繼發性腦干損傷居多,生存時間超過1周者約半數死于并發癥。結論 在BI案例的死亡原因確定時,應在全面系統的病理學檢驗基礎上,結合案情及臨床資料進行綜合分析。【Abstract】 Objective To explore the characteristics of forensic pathology in traumatic brain injury and the relationships between secondary brainstem damage, complications and the causes of death. Methods 127 cases were reviewed from gender, age, manner of injury, survival time and the direct causes of death from January 1998 to December 2008. Results Of the 127 cases, the key direct cause of death was secondary brainstem damage, followed by severe primarily brain injury and complications. For those who died within 12 hours after injury, the direct cause was severe primarily brain injury; for those who survived between 12 hours to one week, secondary brainstem damage was in the majority of the causes and for those who survive more than one week time, complication was an important cause. Conclusion In the cases of traumatic brain injury, we should take comprehensive and systematic examination of forensic pathology, and refer to clinical data at the same time to determine the direct cause of death.

老年患者反復住院治療且擇同一病房原因調查

【摘要】 目的 了解老年患者反復入院治療且擇同一病房的原因。 方法 通過自行設計的調查表于2008年1月-2009年1月對老年患者反復住院治療的原因進行調查。 結果 老年患者選擇再次入院的主要原因:①腫瘤、慢性阻塞性肺病、冠心病及腦梗死等慢性疾病；②與老年患者自理能力衰退有關，其自理能力與調查前6個月相比，有19.1%～43.1%下降；③選擇入住同一病房，主要因為醫生護士熟悉患者病情、且醫療護理技術好、離家近等。④與現行醫療報銷制度也有一定的關連性。 結論 應注重對此類患者全面評估觀察、健康教育及加強社區醫療護理，減少再次入院。

91 例感染性不明原因發熱臨床分析

目的 分析感染性不明原因發熱( FUO) 患者的臨床資料, 探討感染性FUO 的病因。方法 回顧性分析確診的91 例感染性FUO病例臨床資料。結果 91 例感染性FUO 患者中, 細菌性感染63 例( 69. 2% ) , 病毒性感染19 例( 20. 9% ) , 真菌性感染6 例( 6. 6% ) ; 病原學檢查確診32 例( 35. 2% ) , 病理檢查確診11 例( 12. 1% ) , 影像學檢查確診7 例( 7. 7% ) , 臨床分析和( 或) 依據診斷性治療的反應確診40 例( 44. 0% ) 。結論 結核病是感染性FUO 中的主要病因, 完善結核病的輔助檢查有利于提高檢出率; 診斷性治療需綜合評估后運用; 感染性FUO經全面的臨床資料采集和分析, 確診率較高。

Treatment of Complex Anal Fistulae

Cause-of-death analysis in low-risk cardiac surgery patients during postoperative period

ObjectiveTo analyze the cause of death in low-risk cardiac surgery patients during postoperative period and discuss the prevention and treatment methods to increase the survival rate.MethodsWe retrospectively analyzed the clinical data of 132 patients dead after cardiac surgery from January 2014 to December 2018, among whom 35 patients had a EuroSCORE Ⅱ score <4% (low-risk cardiac surgery patients), including 20 males and 15 females aged 62.7±13.4 years. The cause of death in these low-risk patients was analyzed.ResultsThe main causes of death were cardiogenic and brain-derived causes (60.0%), and infections and ogran failure (45.7%). Pulmonary infection and low cardiac output after surgery were the main causes of death. Cerebral infarction, malignant arrhythmia and multiple organ failure were the common causes of death. There were 4 deaths (11.4%) caused by accidents, including gastrointestinal bleeding caused by esophageal ultrasound probe, cough and asphyxia caused by drinking water, postoperative paralytic ileus and multiple perioperative allergic reactions caused by allergic constitution.ConclusionPostoperative treatment and prevention for low-risk cardiac surgery patients should be focused on postoperative infection, and cardiac and brain function protection. Changes in various organ functions need to be closely monitored for preventing organ failure, accidents should be strictly controlled, and more details of intraoperative and postoperative treatment still need to be further improved.

Retrospective analysis of death causes and relevant factors in victims of the 2008 W enchuan earthquake

Objective To analyze death causes and relevant factors in victims of Wenchuan earthquake．Methods Medical records of 27 dead patients admitted to W est China Hospital during the first 30 days after Wenchuan earthquake were analyzed retrospectively．Patient census data，diagnoses，dispositions，and prognoses were collected． Results A total of 2702 patients with earthquake related injuries were admitted to West China Hospital．The overall mortality rate was 1％(27／2702 patients)．The death were associated with age≥70．severe cerebral injuries and severe underlying illness．Mortality rate was highest in aged patients with comorbidities．Conclusions Insufficient pre-hospital treatment and inappropriate transfer procedure may contribute to the early death．Complicated with comorbidities is the leading cause of late death．Earlier involvement of intensivist in medical intervention in such a disaster is demanded．

甲狀腺再次手術喉返神經損傷的原因及預防策略

目的探討甲狀腺再次手術中喉返神經損傷的原因及預防策略。 方法回顧性分析2010年1月至2016年1月期間肇慶市第一人民醫院收治的59例甲狀腺再次手術患者的臨床資料。 結果59例患者再次手術術式：一側葉全切除+對側葉部分或次全切除34例，甲狀腺全切除+雙側中央區淋巴結清掃12例，甲狀腺全切除+雙側中央區及頸側區淋巴結清掃7例，一側葉殘余甲狀腺全切除+雙側中央區淋巴結清掃1例，一側葉殘余甲狀腺全切除+雙側中央區及頸側區淋巴結清掃4例，中央區及側頸區淋巴結清掃1例。再次術后病理診斷：結節性甲狀腺腫22例，甲狀腺功能亢進5例，結節性甲狀腺腫并甲狀腺乳頭狀腺癌（包括微小乳頭狀腺癌）25例，甲狀腺乳頭狀腺癌6例，甲狀腺乳頭狀腺癌頸部淋巴結轉移1例。術后7例發生RLN損傷，其中6例為暫時性損傷，1例為永久性損傷。 結論甲狀腺再次手術因解剖層次紊亂、組織瘢痕粘連，致RLN損傷發生的風險增大。術者熟悉RLN解剖、識別變異或病理狀況下的RLN、選擇合理的途徑、精細化操作顯露RLN，以及術中應用神經監測儀，均有利于降低RLN損傷的發生率。

影響剖宮產術后母乳喂養的因素分析及干預措施

目的　討論提高剖宮產婦母乳喂養率的方法及途徑。 方法　2010年2月－2011年2月，將300例擬擇期行剖宮產術的單胎初產婦，按隨機抽取法分為觀察組和對照組，對其進行母乳喂養宣教及干預，并就術后兩組母乳喂養狀況進行觀察對比。 結果　觀察組母乳初動時間早于對照組，兩組差異有統計學意義（Z=?6.771，P=0.000）；觀察組母乳量充足時間早于對照組，兩組差異有統計學意義（Z=?4.748，P=0.000）。 結論　術前對產婦進行母乳喂養宣教，術后對產婦母乳喂養給予相關協助與指導是提高母乳喂養的關鍵。