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高压氧治疗不依从性的原因分析

目的　探讨高压氧治疗时患者不依从性的原因，以积累经验，指导临床工作。 方法　2011年1月－2012年1月间采用自制调查问卷进行回访，总结、分析未遵医嘱进行高压氧治疗患者的不依从性的原因。 结果　由于客观原因，患者高压氧治疗依从性与多种主观因素有关，因缺乏高压氧知识、恐舱、治疗不便等综合因素为主要原因。 结论　加强高压氧知识的普及和宣教，加强人文关怀，提高患者的依从性。

Research advances in embolic stroke of undetermined source

In 2014, the new concept of embolic stroke of undetermined source (ESUS) was first proposed by cryptogenic stroke/ESUS International Working Group. In the past 5 years, related clinical researches of ESUS have been deepened, and the results of many large clinical studies have been published. However, the guiding significance of this new concept to clinical practice is still controversial. By reviewing the background, diagnostic criteria, assessment, common emboli sources, anticoagulant therapy research advances and related limitations of ESUS, and analyzing the possible causes of negative anticoagulant therapy results, we explored the clinical value of this new classification.

Retrospective Analysis of the Causes of Death and Its Clinical Data in 149 of Dead Inpatients with Diabetic Nephropathy

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.

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.

影响剖宫产术后母乳喂养的因素分析及干预措施

目的　讨论提高剖宫产妇母乳喂养率的方法及途径。 方法　2010年2月－2011年2月，将300例拟择期行剖宫产术的单胎初产妇，按随机抽取法分为观察组和对照组，对其进行母乳喂养宣教及干预，并就术后两组母乳喂养状况进行观察对比。 结果　观察组母乳初动时间早于对照组，两组差异有统计学意义（Z=?6.771，P=0.000）；观察组母乳量充足时间早于对照组，两组差异有统计学意义（Z=?4.748，P=0.000）。 结论　术前对产妇进行母乳喂养宣教，术后对产妇母乳喂养给予相关协助与指导是提高母乳喂养的关键。

外科监护室退药现象分析及对策

目的　通过对外科监护室退药现象的分析，从而寻求控制退药的途径与方法。 方法　收集外科监护室2011年1月－6月发生的退药信息，并对各退药原因进行统计分析。 结果　引起退药的原因依次是患者转出占49.4%、医生调整医嘱25.9%、出院死亡8.6%、医生错开5.1%、医院信息系统不完善3.6%、操作电脑失误2.5%、其他占4.9%。 结论　降低外科监护室退药比例应从控制转出患者退药、医生更改医嘱等方面入手，同时尽量降低因医生错开、电脑系统操作失误和信息系统不完善导致的退药。

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。

冠状动脉旁路移植术后并发症及死亡原因分析

目的分析冠状动脉旁路移植术后并发症发生和死亡的原因，以采取有效的措施进行防治。 方法回顾性分析2011年1月至2012年12月武汉亚洲心脏病医院行冠状动脉旁路移植术1 146例患者的临床资料，其中男823例，女323例；年龄（62.27±8.39）岁；体重（67.60±10.73）kg。对冠状动脉旁路移植术后并发症发生原因和死亡原因进行分析。 结果围术期死亡15例，手术死亡率为1.30%（15/1 146）。死亡原因包括：恶性心律失常4例、多器官功能衰竭4例、低心排血量综合征2例、心脏压塞1例、循环衰竭1例、术中新发主动脉夹层1例、围术期心肌梗死1例、术中主动脉插管脱落致严重酸碱平衡失调1例。手术后发生并发症131例，发生率为11.43%（131/1 146）。并发症包括：出血38例、呼吸功能衰竭35例、伤口愈合不良29例、围术期心肌梗死14例、急性脑梗死4例、恶性心律失常4例、Ⅲ度房室传导阻滞安装永久起搏器2例、心脏压塞2例、急性肠梗阻1例、肺栓塞1例、酸碱平衡失调1例。上述并发症均经相应的处理好转或治愈。随访1 131例，随访时间为3个月至2年。随访期间因感染、呼吸功能衰竭、大面积脑出血、大面积脑梗塞、恶性心律失常、大量心包积液引起心脏压塞死亡5例。其余患者随访期间无心绞痛复发，无心肌梗死发生。 结论冠状动脉旁路移植术后常见并发症为手术出血、呼吸功能衰竭、伤口愈合不良、围手术期心肌梗死等。恶性心律失常、多器官功能衰竭、低心排血量综合征是冠状动脉旁路移植术后死亡的主要原因。围术期应采取积极有效的措施进行预防和治疗，以降低并发症发生率及死亡率。

Forensic Pathological Reports of Neonatal Autopsy with Medical Dispute

【摘要】 目的 探讨新生儿死亡医疗纠纷中临床及法医病理学特点,启示儿科医护人员在防范此类医疗纠纷时应注意的相关问题。方法 对四川大学华西基础医学与法医学院法医病理教研室1998年1月—2007年12月的60例新生儿死亡尸检案例进行回顾性统计分析。结果 60例中除3例非正常死亡外,57例为自然性疾病死亡。其中出生后24 h死亡32例(56.1%),死亡男婴40例(70.2%)。死亡原因主要为胎粪吸入综合征、肺透明膜病、肺出血等窒息性疾病(49.1%)。其中医疗过失性纠纷21例(36.8%),医疗过失的原因主要为观察不仔细、处理不及时、误诊漏诊、产前检查或助产处理不当、告知不足等。涉及纠纷的医院以市级医院居多(58.7%)。结论 医护人员应严格遵守诊疗常规和操作规范,对新生儿加强监护,及时抢救,同时应积极与家属沟通,以减少医疗纠纷的发生。