目的 探討膿毒癥患者的病情預后與高密度脂蛋白（HDL）之間的關聯性。 方法 2008年3月1日－2010年2月28日選擇50例嚴重膿毒癥患者（膿毒癥組）和30例非膿毒癥的健康人（對照組），比較兩組急性生理學與慢性健康狀況評分Ⅱ（APACHEⅡ）和HDL水平。 結果 膿毒癥組的HDL水平為（1.10 ± 0.39）mmol/L，對照組HDL水平為（1.61 ± 0.42） mmol/L，兩組差異有統計學意義（t=6.786，P=0.000）。多因素非條件logistic回歸分析顯示，HDL水平（OR=0.877，P=0.025）和APACHEⅡ評分（OR=15.556，P=0.009）是影響膿毒癥患者患病程度的兩個有效獨立因素。 結論 膿毒癥能夠導致患者的脂代謝出現紊亂，HDL水平是評估膿毒癥患病程度的較好指標。
Objective To explore the value of applying intelligent quality control systems to the quality management of hospital health examination services, and to provide a reference for quality control improvement in the health examination industry. Methods The Department of Health Management Center of Zigong Fourth People’s Hospital used an intelligent quality control system to optimize the health management service process. The work efficiency and feedback of health examinations in the Department of Health Management Center before (From October to December 2019) and after (From October to December 2023) the intelligent upgrade of the health management service system were compared. Results During the research period, 27047 individuals were tested before the intelligent upgrade, and 33868 individuals were tested after the upgrade. Before the intelligent upgrade, there were 205 cases (14.24%) of errors that the system failed to detect; 208 cases (8.72%) were missed in the initial examination system; 18 cases (13.53%) were missed in the overall examination system; 90 cases (0.33%) had overdue physical examination reports. After the intelligent upgrade, there were 38 cases (2.42%) of errors that the system failed to detect; 56 cases (1.93%) were missed in the initial examination system; 10 cases (3.31%) were missed in the overall examination system; 67 cases (0.20%) had overdue physical examination reports. After the intelligent upgrade, the system showed better performance than before in detecting errors in health examinations, avoiding initial and total leak diagnosis, timely report submission, and improving the satisfaction and complaint situation of health management services among examinees (P<0.05). Conclusion The intelligent quality control system is conducive to improving the quality management of hospital health examination services and enhancing the efficiency of examination services.
ObjectiveTo explore the clinical diagnosis and treatment of Talaromyces marneffei (TM) infection by bone marrow examination, and to clarify the important role and significance of bone marrow smear and pathogenic examination.MethodsRetrospective analysis was conducted on a case of disseminated TM infection that was clearly diagnosed through bone marrow related examination. Literature review of TM infection was conducted by retrieving relevant case reports at home and abroad from 1990 to 2018.ResultsThe patient was a 23-year-old man with recurrent cough and onset of fever, superficial lymph node enlargement in multiple parts of the body, no abnormal chest CT sign, and poor efficacy in anti-infection treatment. The patient developed progressive abdominal pain, accompanied by systemic papulosis, decreased consciousness, and progressive decline of blood cells. The patient underwent bone marrow puncture surgery in our hospital, and developed circulatory and respiratory failure half an hour after surgery. TM was confirmed bybone marrow smear and pathogenic culture. In the literature review, 2 855 cases of TM infection were retrieved, among which the majority of cases were confirmed through blood and bone marrow related examination. The positive rate of bone marrow culture was significantly higher than that of blood culture (72.4% and 66.8%, respectively, P=0.007). Compared with bone marrow culture, the misdiagnosis and missed diagnosis rate of bone marrow smear microscopy was 27.6%. Patients diagnosed with TM infection by bone marrow examination had the highest HIV positive rate (95.7%).ConclusionsThe examination of bone marrow cells and the culture are of great clinical significance for the diagnosis of TM infection. TM infection should be identified in patients suspected of HIV positive with fever, lymph node enlargement and abnormal blood routine.