目的 探討醫院信息系統（HIS）在超聲影像住院醫生培養中的應用價值。 方法 對2003年－2009年在超聲科參加住院醫生培訓的24名住院醫生，應用HIS前后3年在臨床、教學及科研方面的業績進行對比。所選用的指標包括超聲檢查的請會診次數、報告符合率、準備教學材料所花費的時間及質量、論文發表的數量。 結果 在HIS應用之前，24名超聲科住院醫生的請會診次數為平均每周96次，平均每周4次/人，報告符合率為92%，準備教學材料花費的時間平均50 h，論文發表的數量共9篇，平均0.33篇/人，其中個案報道6篇，占67%，無科學引文索引收錄論文。在HIS應用之后，24名超聲科住院醫生的請會診次數為平均每周62次，平均每人每周2.58次/人，報告符合率為95%，準備教學材料花費的平均時間為36 h，論文發表的數量共15篇，平均0.63篇/人，其中包括3篇科學引文索引收錄論文，個案報道9篇，占60%。 結論 超聲影像是實踐性很強的學科，HIS提供的素材和平臺有利于超聲科住院醫生學習效率的提高。
【摘要】 目的 探討外周血管動靜脈瘺的超聲特征及其鑒別診斷。 方法 回顧性分析2003年1月-2010年3月間收治的36例先天性及后天性動靜脈瘺患者的臨床資料，使用彩色超聲診斷儀觀察受累血管的內徑、血管壁的連續性，根據血流動力學變化尋找瘺口；對受累血管血流頻譜進行分析，并與健側對照。 結果 18例先天性動靜脈瘺查見紆曲擴張的血管網，無法辨認瘺口；18例后天性動靜脈瘺全部可顯示瘺口，2例合并靜脈破裂的為囊瘤型，其余后天性動靜脈瘺均為洞口型。受累動脈近心端血流為高速低阻型，全部患者受累靜脈出現動脈樣血流，近心端靜脈呈高速低阻型頻譜；10例患者遠心端靜脈內出現逆向離心血流。 結論 引流靜脈出現高速、動脈樣血流頻譜是動靜脈瘺的特征性表現；先天性動靜脈瘺可見異常血管網，不能辨認瘺口；后天性動靜脈瘺均可顯示瘺口。彩色超聲多普勒檢查對動靜脈瘺能夠正確診斷及鑒別診斷。【Abstract】 Objective To observe characteristic imaging of arteriovenous fistulas (AVF) of periphery vessel, and to evaluate the differential diagnosis of AVF by ultrasonography. Methods Thirty-six patients suffering from congenital and acquired AVF in this hospital from January 2003 to March 2010 were selected to undergo Doppler ultrasonography. The blood flow of arteriovenous fistulas, diameter, morphology and blood flow characters of affected vessels were observed. Spectral of fistula and affected vessels were analyzed and compared with the healthy side. Results Deformed vascular net was observed, and the localization of arteriovenous fistulas was not observed directly in 18 congenital AVF patients.Inversely the localization of arteriovenous fistulas was observed directly in 18 acquired AVF patients.Two acquired AVF patients with venous rupture belonged to kystoma form, and others acquired AVF patients belonged to orifice form.Spectral analysis of proximal arteries of the fistula revealed high velocity and low resistance.Arterialized flow pattern was observed in affected veins.Proximal veins of the fistula revealed arterialized spectral with high velocity and low resistance.Reversed blood flow was observed in the distal veins of the fistulas in 10 patients. Conclusion Arterialized flow with high velocity in veins are characteristic signs of AVF.Deformed vascular net is observed, and the localization of arteriovenous fistulas in not observed directly in congenital AVF patients, but the localization of arteriovenous fistulas is observed directly in acquired AVF patients.Color Doppler ultrasonography has great value in confirming diagnosis and differential diagnosis of AVF.
Objective To explore the factors influencing 2-month sputum smear conversion (2m-SSC) in patients with systemic lupus erythematosus (SLE) and tuberculosis, and to establish a prediction model for 2m-SSC. Methods The initial and follow-up medical records of inpatients with SLE and sputum smear-positive tuberculosis in West China Hospital of Sichuan University from December 2013 to September 2019 were retrospectively reviewed. Single factor analyses and multivariable Firth’s logistic regression were used to determine the influencing factors of 2m-SSC, and a prediction model for 2m-SSC was established. The area under the receiver operating characteristic curve (AUC), sensitivity, and specificity were calculated to evaluate the performance of the model. Results A total of 91 patients with SLE and sputum smear-positive tuberculosis were ultimately included, with 8 cases in the non-conversion group and 83 in the conversion group. There were statistically significant differences in white blood cell count, total bilirubin, indirect bilirubin (IBIL), triglyceride, and rheumatoid factor (RF) between the two groups (P<0.05). Serum RF [odds ratio (OR)=2.271, 95% confidence interval (CI) (1.312, 4.350), P=0.003], IBIL [OR=2.363, 95%CI (1.206, 5.045), P=0.013], and glucose [OR=2.058, 95%CI (1.016, 4.280), P=0.045] were identified as risk factors unfavorable to 2m-SSC outcomes. The constructed model (including three variables: RF, IBIL, and glucose) had a good ability in predicting 2m-SSC [AUC=0.893, 95%CI (0.744, 1.000)], with a sensitivity of 87.5% and a specificity of 84.3%. Conclusion This study established a prediction model for 2m-SSC in patients with SLE and tuberculosis, and found the value of serum RF, IBIL, and glucose in predicting 2m-SSC, providing certain guidance for clinicians in treatment decisions.
【摘要】 目的 評價彩色多普勒超聲對腎動脈狹窄（ARAS）的診斷指標及準確性。 方法 1999年10月-2008年12月對患有高血壓病的58例共113根腎動脈進行彩色多普勒超聲檢查。每例患者均測量腎動脈峰值流速（PSV）與腎內段動脈的阻力指數及腎臟長軸。在雙盲條件下，以患者腎動脈造影、MRI血管造影及CT血管造影為標準，評價彩色多普勒超聲診斷ARAS的診斷指標及準確性。 結果 彩色多普勒超聲診斷腎動脈狹窄的敏感性為60%，特異性為83%，陽性預測值為83%，陰性預測值為61%。患側腎長軸小于健側腎長軸，患側腎峰值流速高于健側腎峰值流速，患側腎阻力指數低于健側腎阻力指數。 結論 腎動脈彩色多普勒超聲對于腎動脈狹窄初篩診斷以及評價腎動脈狹窄介入治療后的近、遠期療效，是一種簡便可靠的無創檢查手段。【Abstract】 Objective To evaluate the accuracy and index of color Doppler ultrasonography (CDU) diagnosing renal artery stenosis (RAS).〖WTHZ〗Methods〖WTBZ〗A total of 113 renal arteries of 58 patients with hypertension from October 1999 to December 2008 were examined by CDU. The peak systolic velocity (PSV) of the renal artery, resistant index of interior artery of kidney,and long axis of kidney of each patient were obtained. Under the double-blind condition, accuracy and diagnostic index of CDU for diagnosing RAS were evaluated according to the standard of renal arteriography, magnetic resonance angiography or computerized tomography angiography. Results The sensitivity of CDU for diagnosing RAS was 60%, specificity was 83%, positive predictive value was 83%, and negative predictive value was 61%. Long axis of kidney in patients with RAS was shorter than that in the healthy ones. The PSV in patients with RAS was higher than that in the healthy ones, and the resistant index of section artery of kidney in patients with RAS was lower than that in the healthy ones. Conclusion CDU is an easy and reliable non-invasive examination for early diagnosis and screening of RAS and for evaluating a short-or long-term therapeutic effect.
【摘要】 目的 探討腎上腺髓樣脂肪瘤的彩色多普勒超聲表現和超聲診斷價值。 方法 回顧性分析2005年3月-2010年9月58例61個經手術及病理證實的腎上腺髓脂肪瘤病灶的彩色多普勒超聲表現，對病變的大小、內部回聲特點及血流特點進行分析。 結果 在2005年3月-2007年12月的28個病灶超聲診斷出腎上腺病變23個，正確率82.1%；診斷為髓脂肪瘤2個，正確率7.1%；漏診1個，誤診4個。2008年1月-2010年9月，33個病灶超聲診斷出腎上腺病變30個，正確率90.9%；診斷為髓脂肪瘤19個，正確率57.6%；無漏診，誤診3個。52個病灶超聲表現為邊界清晰，形態基本規則，內部呈均勻中等強回聲（與腎集合系統回聲相當），內部未測及血流信號， 另8個病灶表現為中等強回聲與低回聲相間。 結論 腎上腺髓樣脂肪瘤具有特征性的彩色多普勒超聲聲像圖表現， 可用于發現病變并對多數腎上腺髓樣脂肪瘤做出定性診斷。【Abstract】 Objective To evaluate the value of sonographic diagnosis of adrenal myelolipoma. Methods Sonographic findings from 58 patients with pathologically proved adrenal myelolipoma from March 2005 to September 2010 were retrospectively analyzed. The size of the lesion, internal echo features, and characteristics of blood flow were observed and analyzed. Results In 28 patients with pathologically proved adrenal myelolipoma from March 2005 to December 2007, adrenal lesions was diagnosed in 23 with an accurate rate of 82.1%; adrenal myelolipoma was diagnosed in two with an accurate rate of 7.1%; missed diagnosed in one; misdiagnosed was in four. In 33 patients with pathologically proved adrenal myelolipoma from January 2008 to September 2010, adrenal lesions was diagnosed in 30 with an accurate rate of 90.9%; adrenal myelolipoma was diagnosed in 19 with an accurate rate of 57.6%; no missed diagnosed occurred; misdiagnosed was in three. The sonographic features in 52 lesions were smooth borders and homogeneous hyperechoic; no color Doppler flow signal inside was detected. Conclusion Adrenal myelolipoma has special sonographic features. Ultrasonography is a reliable imaging method for the diagnosis of adrenal myelolipoma.
Objective To analyze the performance of epidemic prevention in Sichuan Province after Wenchuan earthquake, so as to provide references for future epidemic prevention when such emergencies occur. Methods Data about the relief work after the Wenchuan earthquake were collected from the archives of medical care assurance group of the anti-seismic and disaster relief headquarter. And then the data were classified and analyzed. Results After the Wenchuan earthquake, the strategies of epidemic prevention included emphasis on both epidemic prevention and medical relief, early implementation of hygienic measures, wide coverage of different measures for disease prevention with focuses on the most important diseases, as well as standardization and long lasting of epidemic prevention efforts. Owing to these strategies, the epidemic prevention in Sichuan Province was conducted vigorously, orderly and effectively. Conclusion The post-quake epidemic prevention strategies in Sichuan Province are accurate and effective, which could be recommended when such emergencies occur in the future.
The innovative behavior of clinical nurses is of great significance for the professional development of nurses and the improvement of nursing service quality. This research topic has received continuous attention from domestic and foreign scholars. There is still significant room for improvement in the level of innovative behavior among clinical nurses in China. Constructing effective interventions to enhance innovative behavior among clinical nurses in China is an urgent requirement to promote the development of nursing informatization and nursing quality. This article reviews the intervention forms, theoretical support, effectiveness, and limitations of innovative behaviors among clinical nurses both domestically and internationally. It proposes prospects for future intervention plans, aiming to provide ideas and references for nursing managers to develop tailored, scientific, and effective intervention strategies.