The injuries caused by earthquake were characterized as complicated injuries, multiple injuries, crush injury, commonly accompanied by the impairment of the organs, open wound with susceptibility to contamination, difficulties in the implementation of in-time treatment, and resource-limited settings. Considering the specialty of early treatment of earthquake victims and existing misconduct, we propose recommendations according to general principles of early rationale use of antibiotics, in order to treat the earthquake victims safely, effectively and feasibly, and to decrease wound infection rates after surgery.
目的:探讨老老年患者颈动脉中层厚度(IMT)及其相关危险因素的关系,为老老年患者心脑血管疾病的预防及治疗提供临床参考。方法:根据年龄将139例老老年患者纳入分析,有血糖、血压、血脂代谢紊乱的123例作为观察组,无血糖、血压、血脂代谢紊乱的16例作为对照组,分别进行颈动脉超声检查、动态血压监测、糖化血红蛋白及血脂等生化指标检查,并结合临床资料进行分析。结果: 老老年患者均无一例外地存在着IMT增厚,在相同的年龄情况下,吸烟史、血脂紊乱、糖调节异常、血管炎症反应与IMT的增厚呈正相关,各组未显示出统计学差异,IMT的发生发展与年龄、性别、吸烟史、血糖、血压控制水平及血脂紊乱等因素在两组对照中均未显示出统计学差异,多因素Logistic回归分析,显示年龄、吸烟史及病程为危险因素(OR为0500～1196)。结论:老老年患者均不同程度地存在着IMT增厚,其中增龄是其最主要的危险因素,但是对合并有血糖、血压、血脂代谢紊乱的老老年患者也应该积极重视对各种危险因素的筛选和干预,特别在疾病发生发展的早期可能对延缓病变的进展和减少心脑血管事件有一定意义,可是其用药的安全性在该类患者就显得尤为重要。
ObjectiveTo explore the scientific method of hospital disease cost management under the disease payment system.MethodsThe data of " breast mass” disease in the case hospital of 2018 were collected, and the cost accounting of the disease was calculated by the income and expenditure ratio method, cost-to-charge ratio method, project-adding method, clinical path method, and activity cost method, respectively. Comprehensive evaluation was conducted for the five methods.ResultsThe direct costs of the disease calculated by income and expenditure ratio method, cost-to-charge ratio method, project-adding method, clinical path method, and activity-based cost method were 3 021.14, 3 387.79, 3 744.45, 3 997.44, and 4 297.18 yuan, respectively, and accounting for 63%, 67%, 70%, 74%, and 80% of total cost, respectively. The standard deviations of direct cost were 514.37, 495.23, 231.22, 317.33, and 197.47, respectively, of which the standard deviation of direct cost of the activity-based costing method was the smallest. The comprehensive scores of key performance indicator of the income and expenditure ratio method, cost-to-charge ratio method, project-adding method, clinical path method, and activity-based cost method were 4.15, 5.40, 7.85, 7.10, and 8.55, respectively.ConclusionsIn terms of the cost results and index evaluation of the disease, the activity-based costing method is the optimal method. The accounting process is close to the real path, which can track the cost drivers, enhance the cost controllability, and is conducive to the management of disease resource consumption.
ObjectiveTo systematically review the incidence of social isolation in Chinese elderly population. MethodsCNKI, WanFang Data, VIP, CBM, PubMed, EMbase, Web of Science and CENTRAL databases were electronically searched to collect studies on the incidence of social isolation in China from inception to May 2022. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies, then, meta-analysis was performed by using Stata 15.1 software. ResultsA total of 20 studies involving 86 111 subjects were included. Meta-analysis results showed that the incidence of social isolation among the elderly in China was 27.54% (95%CI 22.15% to 57.74%). The results of subgroup analysis showed that gender, age, educational level, marital status, self-assessment of health, living style, year of publication, and region surveyed were all influential factors of the incidence of social isolation among the elderly in China. ConclusionCurrent evidence shows that the incidence of social isolation among the elderly in China is relatively high. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.
目的 探讨地震应激对胃泌素、生长抑素、血清超氧化物歧化酶（SOD）活性和丙二醛（MDA）水平的影响，为震后灾区人群应激性溃疡的防治提供理论依据。 方法 随机抽取四川省人民医院2008年5月15日－31日间收治的60名5.12汶川地震灾民为研究组，58名健康体检者作为对照组。分别对两组人群进行心理调查，采用酶联免疫吸附法测定血清胃泌素和生长抑素水平，利用生化法检测血清SOD活性和MDA含量，并对上述各指标在两组间的分布进行比较。 结果 研究组症状自评量表得分高于对照组（P＜0.05）；两组血清胃泌素分别为（1.04 ± 0.67）、（0.74 ± 0.58） ng/mL，研究组高于对照组（P＜0.01）；两组MDA水平分别为（7.16 ± 5.58）、（4.83 ± 4.48） nmol/mL，研究组高于对照组（P＜0.05）；而两组生长抑素分别为（0.74 ± 0.94）、（1.92 ± 3.05） ng/mL，研究组低于对照组（P＜0.01）；两组SOD分别为（6.06 ± 2.20）、（7.79 ± 1.58）U/mL，研究组低于对照组（P＜0.01）。 结论 地震可引起生理应激状态，导致机体在免疫、抗氧化能力、胃肠激素等方面出现一系列变化，胃泌素、生长抑素等均参与应激性疾病的形成，这些变化可能导致地震灾区消化性溃疡高发。
【摘要】 目的 探讨2型糖尿病（T2DM）胰岛素抵抗导致糖尿病性心功能不全的临床表现特点及相关激素的改变。 方法 2008年1-4月对T2DM患者35例（胰岛素抵抗指数HOMA-IRlt;2.69者19例为A1组，HOMA-IR≥2.69者16例为A2组）及健康体检者20人B组测体重指数（BMI）、空腹血糖（FPG）、胰岛素、心钠素（ANP）、脑钠素（BNP）水平；心脏彩色多普勒超声分别测E/A、e/a、S/D、LVEF、DT期。 结果 A2组BMI较A1、B组均明显增加（Plt;0.05），A1、B组间差异无统计学意义（Pgt;0.05）。ANP、BNP及DT值在A1、A2组均较B组增高（Plt;0.05），BNP在A2组高于A1组（Plt;0.05），ANP、DT值在A1、A2组间差异均无统计学意义（Pgt;0.05）。E/A、e/a和S/D在A1、A2组均较B组降低（Plt;0.05），A1、A2组间差异均无统计学意义（Pgt;0.05）。A2组患者LVEF较A1、B组均明显降低（Plt;0.05），A1、B组间差异无统计学意义（Pgt;0.05）。 结论 随着胰岛素抵抗加重，心肌舒张顺应性较差和收缩力下降，伴随相关激素（心脏利钠肽）分泌增加，最终产生心功能不全的临床表现、体征及多普勒超声心动图表现。【Abstract】 Objective To investigate the clinical features and related hormone changes of diabetic cardiac insufficiency leaded by insulin resistance in type 2 diabetes mellitus (T2DM). Methods From January to April 2008, 35 patients with T2DM (group A1: HOMA-IRlt;2.69, n=19; group A2: HOMA-IR≥ 2.69, n=16) and 20 subjects without T2DM (group B) were enrolled. The body mass index (BMI), fasting plasma glucose (FPG), insulin (FINS), atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), and E/A, e/a, S/D, LVEF and DT stage of all subjects were detected. Results The BMI in group A2 was higher than those in group A1 and group B (Plt;0.05), while the difference between the later two groups was not statistically significant (Pgt;0.05). The ANP, BNP and DT stage were all higher than those in group B (Plt;0.05), the BNP was higher in group A2 than in group A1 (Plt;0.05), while the difference of neither ANP nor DT stage between the later two groups was statistically significant (Pgt;0.05). The values of E/A, e/a and S/D in group A1 and A2 were all lower than those in group B (Plt;0.05), while there were no statistically significant diferences between group A1 and A2 (Pgt;0.05). The values of LVEF of group A1 and A2 were both significantly reduced than that in group B (Plt;0.05), and the values in group A2 were the lowest (Plt;0.05). Conclusion With the aggravating of insulin resistance, myocardial contractility and diastolic function will decline, meanwhile the ANP and BNP secretion will increase, and then the clinical and echocardiographic manifestation will appear.
“Valve-in-valve” technique is an effective method to treat the bioprosthesis structural valve degeneration. In this paper, an 82-year-old male patient with severe aortic valve regurgitation had underwent surgical aortic valve replacement. He had a bioprosthesis structural valve degeneration which caused severe aortic stenosis more than 3 years after surgery. His symptoms of chest distress and short breath were aggravated progressively, and not relieved by conventional treatment. As the deterioration in his unstabled circulation system, an emergency transcatheter aortic valve replacement was conducted for him. The operation was finally successful, the symptoms were relived significantly after operation, and then the follow-up indicated that he had a good recovery.