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find Keyword "原因" 96 results
  • 产后出血的原因分析及干预措施

    【摘要】 目的 正确识别产后出血的原因并及时的处理,减少产后大出血的发生。 方法 对2003年1月-2008年12月收治的223例产后大出血的产妇进行出血原因分析。 结果 胎盘因素93例占41.7%,子宫收缩乏力88例占39.5%,软产道损伤36例占16.1%,凝血功能障碍6例占2.6%。24 h内发生产后出血156例,其中2 h内为110例,占总数的49%。 结论 针对产后出血的原因给予及时正确的快速处理,可减少产后大出血的发生,降低产妇围产期的死亡率。

    Release date:2016-09-08 09:51 Export PDF Favorites Scan
  • 包裹性胰腺坏死被误诊为胰腺囊实性肿瘤的原因分析:附 12 例报道

    目的 探讨包裹性胰腺坏死(walled-off pancreatic necrosis,WOPN)误诊为胰腺囊实性肿瘤(pancreatic cystic neoplasm,PCN)的原因。 方法 回顾性分析 2009–2013 期间华西医院胰腺外科收治的术前诊断为胰腺 PCN 而术后病理学诊断为 WOPN 的 12 例患者的临床资料。 结果 12 例患者术前诊断为胰腺 PCN,而术后病理学诊断为 WOPN。其中女 2 例,男 10 例;年龄 36~68 岁、(47.1±10.7)岁;病程 0.5~48.0 个月,中位数为 1.0 个月;主要临床表现:腹痛 12 例,体质量减轻 7 例;术前 1 例总胆红素水平增高,2 例血淀粉酶水平增高,4 例癌胚抗原(CEA)水平增高,4 例 CA19-9 水平增高,4 例 CA-125 水平增高。8 例行腹部增强 MRI 检查,7 例行腹部增强 CT 检查,1 例行正电子发射计算机断层显像(PET-CT)检查,提示 7 例包块位于胰头,5 例位于胰尾;肿块最大径 1.8~11.0 cm、(4.9±2.9)cm,其中 4 例最大直径超过 5 cm;3 例腹腔内发现肿大淋巴结;4 例肿块内部分隔;8 例呈类肿瘤表现。 结论 WOPN 与 PCN 的鉴别需要根据临床、实验室检查及影像学特点进行综合判断,影像学检查是主要的鉴别方法,但同时也是误诊的主要原因。此外,男性患者可能更易误诊。

    Release date:2018-01-16 09:17 Export PDF Favorites Scan
  • 甲状腺再次手术喉返神经损伤的原因及预防策略

    目的探讨甲状腺再次手术中喉返神经损伤的原因及预防策略。 方法回顾性分析2010年1月至2016年1月期间肇庆市第一人民医院收治的59例甲状腺再次手术患者的临床资料。 结果59例患者再次手术术式:一侧叶全切除+对侧叶部分或次全切除34例,甲状腺全切除+双侧中央区淋巴结清扫12例,甲状腺全切除+双侧中央区及颈侧区淋巴结清扫7例,一侧叶残余甲状腺全切除+双侧中央区淋巴结清扫1例,一侧叶残余甲状腺全切除+双侧中央区及颈侧区淋巴结清扫4例,中央区及侧颈区淋巴结清扫1例。再次术后病理诊断:结节性甲状腺肿22例,甲状腺功能亢进5例,结节性甲状腺肿并甲状腺乳头状腺癌(包括微小乳头状腺癌)25例,甲状腺乳头状腺癌6例,甲状腺乳头状腺癌颈部淋巴结转移1例。术后7例发生RLN损伤,其中6例为暂时性损伤,1例为永久性损伤。 结论甲状腺再次手术因解剖层次紊乱、组织瘢痕粘连,致RLN损伤发生的风险增大。术者熟悉RLN解剖、识别变异或病理状况下的RLN、选择合理的途径、精细化操作显露RLN,以及术中应用神经监测仪,均有利于降低RLN损伤的发生率。

    Release date:2016-12-21 03:35 Export PDF Favorites Scan
  • 医嘱口服药执行单常见缺陷分析及对策

    【摘要】 目的 调查临床口服药执行单中存在的缺陷,分析产生原因,寻求改进对策。 方法 2009年1月-2010年12月,每月随机抽取50份在院病历,共对1 200份在院病历的口服药执行单存在的缺陷进行统计和分析。 结果 192份口服药执行单存在243处医疗缺陷,发生率为20.3%。涂改、仿签62处,多签、漏签41处,超前签字28处,满格后未及时转抄34处,转抄执行单时间与医嘱执行时间不一致26处,缺项28处,未及时起、停医嘱17处,抄错药物7处。引起医疗纠纷1起。 结论 口服药执行单存在各种缺陷。加强护士培训与学习,建立完善的质量控制体系,规范护理文书,可以有效地减少口服药执行单中存在的缺陷,规避医疗纠纷。

    Release date:2016-09-08 09:26 Export PDF Favorites Scan
  • Reason, Prevention, and Treatment of Gastrointestinal Unplanned Reoperation

    ObjectiveTo investigate the reason, prevention, and treatment measures of gastrointestinal unplanned reoperation. MethodsClinical data of 21 patients who carried out gastrointestinal unplanned reoperation for various reasons from Jun. 2012 to Jun. 2013 in our hospital were retrospectively analyzed. ResultsTwenty-one of 2 492 patients with gastrointestinal tract surgery carried out gastrointestinal unplanned reoperation, and the incidence of reoperation was 0.8%. The causes of reoperation were intra-abdominal hemorrhage in 10 cases, gastrointestinal fistula in 7 cases, inflammatory intestinal obstruction with peritonitis in 1 case, and incision dehiscence in 3 cases. After undergoing suture hemostasis, colostomy, anastomotic fistula repair, debridement, and suture,20 cases were cured or improved, and 1 case died. The median of hospitalization expense was 76 000 yuan(46 000-116 000 yuan), and the median of hospital stay was 25-day(16-49 days). ConclusionsGastrointestinal unplanned reoperation can cause more serious economic and emotional burden to patients, standardizing surgical procedure and enhancing perioperative monitoring can reduce the incidence of unplanned reoperation. In addition, grasp legitimately the indications of reoperation, implement timely, and effective reoperation can avoid further deterioration of the disease.

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  • Forensic Pathologic Analysis of Traumatic Brain Injury

    【摘要】 目的 探讨颅脑损伤(BI)死亡的法医病理学特点,以及继发性脑干损伤、并发症的发生与死亡之间的因果关系。方法 从性别、年龄、致伤方式、损伤类型、生存时间、死亡原因等方面,对四川大学华西法医学鉴定中心1998年1月-2008年12月127例BI死亡尸检案例进行回顾性统计研究分析。结果 127例法医病理学检案中,原发性BI死亡51例(402%),继发性脑干损伤死亡61例(480%),并发症死亡15例(118%),其中伤后12 h内死亡者直接死因均为严重原发性脑损伤,存活12 h~1周者直接死因以继发性脑干损伤居多,生存时间超过1周者约半数死于并发症。结论 在BI案例的死亡原因确定时,应在全面系统的病理学检验基础上,结合案情及临床资料进行综合分析。【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.

    Release date:2016-09-08 09:45 Export PDF Favorites Scan
  • 心瓣膜置换术后患者围术期死亡原因分析

    摘要: 目的 分析心瓣膜置换术后患者围术期死亡的原因,探讨降低围术期病死率的措施。 方法 回顾性分析2004年1月至2009年1月广西医科大学第一附属医院行心瓣膜置换术后死亡的54例患者的临床资料,男28例,女26例;年龄20~65岁(45.5±11.6岁)。全组均在全身麻醉低温体外循环(CPB)下行心瓣膜置换术,其中37例行中低温(26~28 ℃)心脏停搏手术,17例行浅低温(31~33 ℃)心脏不停跳手术。对围术期死亡的原因进行分析。结果 术中死亡15例,手术死亡率1.78%(15/845);其余39例患者的死亡时间为术后3 h~106 d(8.2±17.2 d),死亡原因主要为低心排血量综合征(LCOS)、不能停CPB、心脏及主动脉出血、呼吸功能衰竭、肾功能衰竭、恶性心律失常和多器官功能衰竭等。 结论 选择恰当手术时机、充分术前准备、改善心功能,术中谨慎操作、良好心肌保护、术后加强监护,可提高手术成功率。

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  • 老年患者反复住院治疗且择同一病房原因调查

    【摘要】 目的 了解老年患者反复入院治疗且择同一病房的原因。 方法 通过自行设计的调查表于2008年1月-2009年1月对老年患者反复住院治疗的原因进行调查。 结果 老年患者选择再次入院的主要原因:①肿瘤、慢性阻塞性肺病、冠心病及脑梗死等慢性疾病;②与老年患者自理能力衰退有关,其自理能力与调查前6个月相比,有19.1%~43.1%下降;③选择入住同一病房,主要因为医生护士熟悉患者病情、且医疗护理技术好、离家近等。④与现行医疗报销制度也有一定的关连性。 结论 应注重对此类患者全面评估观察、健康教育及加强社区医疗护理,减少再次入院。

    Release date:2016-09-08 09:51 Export PDF Favorites Scan
  • The Analysis and Prevention of Bile Duct Injury Due to Laparoscopic Cholecystectomy

    ObjectiveTo explore the causes of bile duct injury due to laparoscopic cholecystectomy (LC) and the preventive methods. MethodsA total of 18 patients with bile duct injury (with the occurrence rate of 0.4%) after LC between January 2003 and December 2012 were included. The patients included 5 males and 13 females with the age of 29-63 years old[averaging (42.3±3.6) years old]. The clinical data of the patients were retrospectively analyzed. ResultsIn the 18 cases of bile duct injury, 5 cases occur in emergency operation, 13 cases in selective operation. The operators were attending physician in 13 cases, and senior position in the other 5 cases. The reasons of the injury included misjudgment of the cystic duct in 9, duct aberrance in 3, excessive stretch of cystic duct in 2, 2 Mirizzi syndrome withⅠ-type surgical injury in 2, and right liver duct injury because of inappropriate stripping of gallbladder in 1. ConclusionThe operator's experience, severe conglutination and the bile duct aberrance are the chief causes. Preventive methods include strict system of operation accession, careful selection of candidates, timely laparotomy, and paying attention to the accumulation of operation experience and skills.

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  • Aromatase Inhibitors in Ovulation Induction for Women with Unexplained Infertility: A Systematic Review

    Objective To evaluate the effectiveness and safety of aromatase inhibitors in ovulation induction for women with unexplained infertility. Methods The databases such as CNKI (1994 to June 2011), WanFang Data (1982 to June 2011), PubMed (1966 to June 2011) and The Cochrane Library (Issue 6, 2011) were searched to collect randomized controlled trials (RCTs) and quasi-randomized controlled trials (quasi-RCTs) for the comparison between aromatase inhibitors (AIs) and clomiphene citrate (CC). The quality of the retrieved trials was critically appraised and meta-analyses were conducted using RevMan 5.0.1 software. Results Nine studies were included; all of them were published in English. The results of meta-analyses showed there were no significant differences between AIs and CC in the pregnancy rate (RR=1.02, 95%CI 0.71 to 1.47), miscarriage rate (RR=1.00 95%CI 0.61 to 1.63), multiple pregnancy rate (RD= –0.02, 95%CI –0.07 to 0.03), and incidence rate of adverse events (RD=0.00, 95%CI –0.01 to 0.01); there were still no significant differences between the AIs+gonadotropin (Gn) group and the CC+Gn group in the pregnancy rate (RR=0.98, 95%CI 0.68 to 1.42), miscarriage rate (RR=1.23, 95%CI 0.70 to 2.15), multiple pregnancy rate (RD=0.00, 95%CI –0.10 to 0.10), and incidence rate of adverse events (RD=0.00, 95%CI –0.10 to 0.01). Conclusion Whether aromatase inhibitors can replace clomiphene citrate in ovulation induction for women with unexplained infertility is still an issue that has to be identified by performing well-designed large scale RCTs with longer follow-up duration.

    Release date:2016-09-07 11:00 Export PDF Favorites Scan
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