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find Author "徐忠" 3 results
  • Discussion on the strategy of selection and evaluation of medical equipment warranty contract

    ObjectiveTo explore a strategy for selecting and evaluating the warranty contract of medical equipment.MethodsBased on the operating costs of the two linear accelerators between 2016 and 2019, we obtained the criticality of medical equipment by using the five indicators, including necessity of maintenance, function, risk, importance, and age of medical equipment, selected the warranty strategy by comparing the cost of key components, and adjusted and optimized the warranty strategy based on the economic benefit assessment during the implementation process of warranty contract.ResultsThe criticalities of the two linear accelerators were both 18 points, and it was recommended to purchase warranty service. By comparing the cost of key components, the annual average maintenance cost of the key components of the two accelerators was lower than the annual warranty cost, so we chose the semi-guaranteed contract. Finally, according to the economic benefit accounting and evaluation in the implementation process of the warranty contracts of the two linear accelerators, the linear accelerator 1 remained unchanged, and the linear accelerator 2 was turned from the semi-guaranteed contract into the full insurance contract when we renewed the warranty contract.ConclusionsThe warranty contract selection and evaluation strategy proposed in this paper has certain guiding significance for the choice of strategy of warranty contract. By choosing the appropriate warranty service scope and warranty strategy, and continuous adjusting and optimizing according to the actual performance of the contract, we can effectively guarantee the operational efficiency of medical equipment, and reduce operating costs simultaneously.

    Release date:2019-06-25 09:50 Export PDF Favorites Scan
  • 胃溃疡穿孔破入胸腔1例诊治体会

    患者,男,67岁,因饱餐后突感左侧胸、腹部疼痛,伴呼吸困难8 h入院。1年前行胃镜检查证实为“胃溃疡”,未经正规治疗。查体: 急性痛苦病容,呼吸急促,36次/分,紫绀明显,气管右移,左胸上部叩呈鼓音,下部叩呈浊音,左肺呼吸音减低。腹部软,无压痛,未扪及包块,肝脏未扪及、无移动性浊音。胸片示: 左侧膈肌抬高,纵膈右移,左侧液气胸,肺组织压缩约70%,少量胸腔积液。上消化道X线吞钡检查: 见钡剂通过贲门顺利,胃泡形态正常,未见钡剂外漏至胸腔。诊断为左侧自发性液气胸,给予对症治疗,患者吸呼困难、紫绀进行性加重,并出现休克征象。即行胸、腹部CT检查,见左侧胸腔内大量气体及液体,肺组织压缩,纵膈右移,胸腔内未见其它异常脏器影及钡剂影。急诊行左侧胸腔闭式引流术,引流出大量气体及胃液样液体约1 600 ml,诊断为“食管裂孔疝破裂”。在气管插管全麻下行胸、腹联合切口探查,发现胃体沿系膜轴方向扭转,胃体小弯侧与左膈肌粘连,分离时发现胃液及钡剂流出,解剖游离后,见胃体小弯侧有一0.8 cm×1.0 cm大的穿孔,周围组织水肿、增厚、僵硬,左膈肌顶部食管裂孔左前方有一0.6 cm×0.6 cm大的裂口,胸、腹腔贯通,并见有大量液体自该孔流入腹腔,其性状与胸管引流液一致。探查膈肌食管裂孔无异常,根据手术所见,诊断为胃扭转、胃穿孔(破入胸腔)、膈肌破裂、左侧脓气胸,行胃穿孔及膈肌破裂修补术,术后给予胸、腹腔引流,抗感染等治疗后获痊愈。术后病理诊断为慢性胃溃疡,炎性活动期。讨论胃溃疡穿孔是外科常见急腹症,而胃穿孔破入胸腔导致脓气胸则临床较少见。本例患者,既往有胃溃疡病史,未经正规治疗,溃疡因水肿、粘连,牵拉胃体,改变了胃的正常位置,形成继发性系膜轴胃扭转,即胃小弯侧胃体与左膈肌之间发生粘连,而形成的胃扭转,最终发生溃疡穿孔,溃疡基底组织坏死穿破膈肌,大量胃内容物进入左侧胸腔形成脓气胸,临床鲜为罕见,并一度在诊断上造成困惑,最终经手术探查后得以确诊。因此,在临床工作中遇到既往有“胃溃疡”病史,饱餐后突发左侧胸、腹部剧痛,伴进行性呼吸困难,甚至出现休克,胸穿见有胃液样引流液,应警惕本病的可能,并要注意与食管裂孔疝、急性胃扭转、食管裂孔疝破裂等疾病相鉴别。胸、腹部X线透视、上消化道X线钡餐检查对诊断有一定帮助。一旦确诊,应积极在气管插管全麻下行胸、腹部探查,术中根据探查所见,选择适当手术方式。术中应注意对胃液外漏至胸腔造成的污染进行彻底的冲洗,并放置胸、腹腔引流管,术后加强呼吸道管理。选用敏感抗生素治疗,防止脓胸及肺部感染等并发症。

    Release date:2016-08-28 04:49 Export PDF Favorites Scan
  • Analysis of gastrointestinal endoscopy failure components based on analytic hierarchy process and maintenance data

    ObjectiveTo explore the main failure components related to maintenance cost and downtime of gastrointestinal endoscopy.MethodsThe analytic hierarchy process (AHP) was used to process and analyze the maintenance data of gastrointestinal endoscopy in West China Hospital of Sichuan University from January 2010 to April 2019.ResultsThe results involved 110 gastrointestinal endoscopy, 322 major repairs, 364 minor repairs, and a total of 1 651 failed components, in which the top three components were buttons (380 pieces, 23.02%), the insertion tubes (223 pieces, 13.51%), and lenses (179 pieces, 10.84%). The main failure components causing high maintenance cost and long downtime of major repairs were charge coupled devices (F=849.702, P<0.001; F=9.525, P=0.002) and light guides (F=8.190, P=0.005; F=6.384, P=0.012). The failure components affecting the maintenance cost of minor repair were lenses (F=25.464, P<0.001) and angle steel wires (F=5.652, P=0.018). The failure components prolonging the maintenance time of minor repair were lenses (F=10.384, P=0.001) and electrical interfaces (F=4.816, P=0.029).ConclusionQuantitative analysis of maintenance data is helpful to objectively analyze the main failure components of maintenance cost and downtime.

    Release date:2019-06-25 09:50 Export PDF Favorites Scan
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