IMPAX PACS在黑龙江省区域化医疗远程会诊中的初步应用

目的:研究黑龙江省不同医疗机构之间新型协同服务模式,加强垦区各级医疗机构的信息化基础建设,建立基于医学影像存档与通信传输系统(Picture Archiving and Communications System,PACS)的数字化医疗区域。方法:将哈尔滨医科大学附属第四医院现有的影像数据归档,集成到IMPAX PACS数据中心(Internet Data Center,IDC),作为整个区域医疗的影像中心。通过IDC交换平台的延伸覆盖,以及医院信息系统(Hospital Information System,HIS)与XERO集成,可经网络调阅IDC中的影像,实现远程影像会诊。结果:建立基于IMPAX PACS的区域医疗;工程覆盖1家省会大医院和垦区2家综合性医院、5家二级医院、11家农场医院,实现联网医院间的影像学远程会诊。结论:PACS区域远程医疗系统的建立为基层百姓就医提供方便,影像学远程会诊可有效避免影像学重复检查,双向转诊、信息共享给患者带来更多的便利和实惠,具有巨大的社会效益。     

医疗信息集成交换平台技术及应用

随着医院信息化建设的深入发展,专科化的信息系统如雨后春笋,原来信息系统间点对点的接口方式已无法适应新的业务需求。需要通过建设医疗信息集成交换平台解决医院HIS、EMR、LIS、PACS、体检、手术麻醉等信息系统之间的数据交换及共享问题,实现异构业务系统的互联互通,使医院原有的各信息系统通过信息集成交换平台提供的接口实现整合,继承已有的数据资源和服务。     

全麻下颈动脉内膜剥脱术的麻醉体会

目的:评价颈动脉内膜剥脱术(CEA)麻醉疗效,以及经颅多普勒超声(TCD)、微血管多普勒超声(MVD)应用的价值,以及适合颈动脉内膜剥脱术的适合麻醉方法。方法:回顾性分析苏州大学附属一医院脑卒中中心2012年5月至2013年5月所进行的颈动脉内膜剥脱术治疗的19名颅外颈动脉狭窄患者的资料。患者临床症状均伴有不同程度的脑缺血症状。颈动脉狭窄程度2例中度狭窄,17例重度狭窄。所有手术操作均全麻下在显微镜下操作。1例采用补片成形。18例术中采用TCD及MVD监测下完成,1例未采用超声监测。结果:手术成功率为100%,无死亡率。术前脑缺血症状术后患者均有恢复。未发现过度灌注的并发症。麻醉效果达到预期目的。结论:颈动脉内膜剥脱术在多普勒超声MVD及TCD监测下治疗颅外颈动脉狭窄是一种安全、有效的措施;全身麻醉下行CEA手术安全可靠。     

基于药物临床试验项目管理系统的临床试验全程管理

我国药物临床试验机构经过多年的发展,临床试验的试验条件质量有了一定的改善,但与发达国家相比,还存在着很多不足,应用信息化管理有助于提高药物临床试验质量管理。文章对医院II～IV期药物临床试验项目管理系统的总体功能进行介绍,该系统从临床试验项目管理出发,结合药物临床试验运行特点及流程,实现临床试验项目及药物全过程化管理,并与医院信息管理系统（HIS）、实验室信息管理系统（LIS）、医学影像信息系统（PACS）接口,构建起机构办、药物管理部门、检验检查科室与研究者之间的公共信息平台,实现了数据共享。     

丙泊酚联合七氟烷复合麻醉对小儿麻醉苏醒期躁动评分的影响

目的:探讨丙泊酚联合七氟烷对小儿麻醉苏醒期躁动的临床效果。方法:选择2013年8月-2015年8月在我院接受手术治疗的患儿53例,根据麻醉方法不同,将研究对象分为丙泊酚组(17例)、七氟烷组(19组)和联合组(17例),分别给予丙泊酚,七氟烷以及丙泊酚联合七氟烷进行麻醉并维持。观察并比较各组患儿的手术时间、麻醉时间、清醒时间、躁动发生率以及苏醒期躁动评分。结果:三组患儿的手术时间和麻醉苏醒时间比较,差异均无统计学意义(P0.05);联合组患儿躁动发生率及躁动评分均低于七氟烷组和丙泊酚组,差异具有统计学意义(P0.05);三组患儿恶心、呕吐等不良反应的发生率比较,差异无统计学意义(P0.05)。结论:丙泊酚联合七氟烷可显著改善小儿麻醉苏醒期躁动情况,临床效果显著。     

医院信息系统在传染病医院管理中的应用

目的:目前医院信息系统在全国多家医院得到普遍使用,它不仅能提高医务工作人员的工作质量和效率,还能提高医院的医疗水平,而且它在传染病医院的管理中也发挥着巨大的作用.本文旨在通过医院信息管理系统的反馈实践研究分析医院信息系统在传染病疫情报告中的重要作用.方法:随机抽取我院建立信息系统前后两个时间段内的传染病报告卡,然后分析比较这两个时间段内的传染病报告卡情况.结果:信息系统应用后漏报数和迟报数明显比应用前降低并且应用后的传染病报告卡的填写质量比应用前好,应用前后相比较,差异有统计学意义(P＜0.05).结论:医院信息系统的应用不仅能提高医务工作人员的工作质量和效率,提高传染病管理水平,为患者更好的服务,还能够促进医院的整体现代化建设,是每一个医院建设的发展方向.每家医院都应该加强医院的信息系统建设,提高医院的管理水平,特别是传染病医院更应该加强医院的信息化建设,以便提高传染病管理.     

医院绩效考核信息管理系统的建设与思考

医院绩效考核的有效实施有赖于信息化的大力支持。开发建设基于临床数据集成平台的智能化绩效考核信息管理系统,有利于绩效考核数据的准确性和时效性,有利于绩效考核信息的实时分析和动态监管,有利于医院改善服务绩效的正向激励和引导作用,可有效促进绩效考核与分配的科学化、信息化、智能化,实现医院内部绩效考核管理的跨越式发展。

     

磁场麻醉

磁场麻醉简称为磁麻，我国于１９７６年开始应用于临床，是在磁场镇痛效应的实验研究工作中取得成效的基础上进行的，目前磁麻效果尚无统一评定标准，故磁麻效果均参照１９７５年全国针刺麻醉效果的评级统一标准。为了促进磁场麻醉研究的发展，对近几年来发表的有关文献综述如下。应用敷磁法进行磁场麻醉体穴磁麻行五官科手术手术前将磁片贴敷于合谷、内关、东风穴，以剥离圈套法摘除扁桃体１６例；又以磁片贴于四白、迎香穴行鼻息肉摘除３例，中鼻甲切除２例，双侧下鼻甲部分切除１例，青光眼手术１例。１５分钟后即可按常规操作进行手术，…     

腰麻硬膜外联合麻醉与硬膜外麻醉对剖宫产患者血流动力学的影响

目的:探讨腰麻硬膜外联合麻醉与硬膜外麻醉对剖宫产患者血流动力学的影响。方法:选择我院2013年12月至2014年12月收治的80例行剖宫产手术产妇,按随机数字表法平均分为A组及B组各40例,A组产妇使用腰麻硬膜外联合麻醉(CSEA),B组产妇使用硬膜外麻醉(EA),比较两组产妇麻醉效果,血流动力学变化、新生儿Apgar评分及产妇不良反应发生情况。结果:A组产妇麻醉效果Ⅲ级比率85.0%,明显高于B组的22.5%(P0.05)。A组产妇心率(HR)在胎儿娩出10 min(T3)及手术结束(T4)时刻明显高于B组,收缩压(SBP)和舒张压(DBP)在胎儿娩出即刻(T2)明显高于B组,平均动脉压(MAP)在麻醉前(T1)和麻醉后(T4)明显高于B组,每博输出量(SV)在T2时刻明显低于B组,比较差异具有统计学意义(P0.05);两组产妇心输出量(CO)各时刻比较差异无统计学意义(P0.05)。A组新生儿在娩出1 min时Apgar评分明显高于B组(P0.05)。A组不良反应发生率为5.0%,B组产妇不良反应发生率为10.0%,两组比较差异无统计学意义(P0.05)。结论:对剖宫产手术患者使用CSEA麻醉效果明显优于EA,且患者血流动力学更为稳定,麻醉效果较完善,安全性高,可应作为剖宫产手术首选的麻醉方式。     

不同麻醉方式处理休克病人的46 例临床研究

目的：观察并分析对休克病人实施不同的麻醉处理方式的临床效果。方法：选取2012 年2 月至2013 年2 月我院收治的临 床休克患者46 例，选择性的实施不同的麻醉方式进行处理。比较患者麻醉前后各项监测指标的变化情况。结果：实施麻醉术后， 有43 例患者表现为正常；2 例因大出血抢救无效而死亡；1 例因多器官功能发生衰竭而死亡；术中未发生因麻醉不当而导致的患 者死亡。术后生命体征正常的患者明显高于死亡的患者，差异有统计学意义(P＜0.05)。患者手术之后各项指标显著优于手术前，差 异有统计学意义(P＜0.05)。结论：对临床休克病人采取合适的麻醉方式，可以有效的辅助手术顺利进行，提高手术的成功率和患 者的存活率，值得临床推广。     

老年患者全身麻醉气管插管后致下呼吸道感染的相关因素分析及对策

目的:探讨老年患者全身麻醉气管插管后致下呼吸道感染麻醉相关影响因素,并采取相对应的处理措施,以期提高临床治疗水平。方法:回顾性分析2010年1月-2013年1月103例老年全身麻醉气管插管患者,对其中出现下呼吸道感染的13例患者进行回顾性麻醉影响因素分析。结果:老年患者全身麻醉气管插管后下呼吸道感染麻醉相关影响因素有插管过深、插管不熟练、拔管指征不完全、拔管延迟(3 h)、麻醉时间长(3 h)等(P0.05)。而与患者插管途径、插管方式、拔管延迟(3 h)无关(P0.05)。结论:老年患者全身麻醉气管插管后致下呼吸道感染麻醉相关影响因素较大,临床上要加以规范。     

Anesthesia effect on rabbit hypothalamic neuron impulse activity

Neuronal impulse activity in the thermoregulation center in the anterior and posterior sections of the rabbit hypothalamus was studied in chronic experiments and in intravenously injected anesthetics (urethane and chloralose). Anesthesia decreased the neuronal firing rate, changed the impulse activity pattern, and decreased the number of neurons responding to skin thermal stimulation. These changes were most pronounced in the posterior hypothalamic section.I. P. Pavlov Institute of Physiology, Academy of Sciences of the USSR, Academy of Sciences of the USSR, Leningrad. Translated from Neirofiziologiya, Vol. 23, No. 5, pp. 574–579, September–October, 1991.     

硬膜外分娩镇痛转行硬膜外剖宫产麻醉失败的相关因素分析*

摘要目的：探讨采用硬膜外分娩镇痛中途转行硬膜外剖宫产麻醉失败的相关因素并对其进行分析。方法：选择来我院进行硬膜 外分娩镇痛转而形硬膜外剖宫产麻醉的产妇218 例,根据硬膜外麻醉失败的定义将其划分为成功组和失败组,对两组的一般资 料、产程中的平均动脉压、硬膜外分娩镇痛情况分别进行比较分析。结果：成功组192 例,失败组26例,两组产妇在一般资料上无 差异（P>0.05）,在转行剖宫产前成功组平均动脉压显著低于失败组（P<0.05）,补救给药的次数上成功组显著低于失败组（P<0. 05）,在镇痛持续时间上成功组显著少于失败组（P<0.05）。结论：影响硬膜外剖宫产麻醉失败的危险因素是分娩镇痛时需要补救给 药的次数增加以及镇痛所持续的时间延长,对于出现此类危险因素的产妇,应改变剖宫产麻醉方式,以最大限度地降低剖宫产麻 醉的失败率,这对于母婴并发症的减少起着积极的作用。     

麻醉蒸发器输出浓度的影响因素与蒸发器校准研究进展

麻醉蒸发器是麻醉呼吸机的核心部件。它能够体现麻醉呼吸机的品质水平,直接影响吸入麻醉的临床效果,并进而关乎接受麻醉的患者的安全。随着现今临床患者周转率提高、手术量增大,应用到全麻手术中的吸入麻醉技术也占了更大比重,蒸发器临床使用频率也因此不断提高,蒸发器本身使用年限也在逐年增大--这些因素皆可能会引起蒸发器实际输出浓度的偏差,继而或对临床麻醉的实施和患者麻醉效果造成影响。本文立足于对麻醉蒸发器结构及相关原理的综述,着眼于不同条件对挥发效率的影响和输出浓度的检测校准的最新标准与进展;为指导临床麻醉过程中蒸发器更为科学精准的应用提供科学理论依据。     

先天性食管闭锁和气管食管瘘麻醉及围手术期管理

目的:探讨先天性食管闭锁和气管食管瘘(EA/TEF)的麻醉及围手术期管理方法.方法:回顾性分析40例手术治疗的新生儿EA/TEF的临床资料.总结麻醉及围手术期管理及转归情况.结果:40例麻醉过程较平稳顺利完成手术,3例术后拔管,37例继续呼吸支持.术后死亡7例,其中4例术后死亡,3例术后监护人放弃治疗出院后死亡.活33例中重症肺炎7例,低体温8例,吻合口瘘5例,切口感染2例,均经治疗后痊愈出院.结论:良好的麻醉及围术期管理是EA/TEF手术治疗的重要组成部分,是手术顺利进行及术后成功的关键.     

硬膜外分娩镇痛转行硬膜外剖宫产麻醉失败的相关因素分析

目的：探讨采用硬膜外分娩镇痛中途转行硬膜外剖宫产麻醉失败的相关因素并对其进行分析。方法：选择来我院进行硬膜外分娩镇痛转而形硬膜外剖宫产麻醉的产妇218例,根据硬膜外麻醉失败的定义将其划分为成功组和失败组,对两组的一般资料、产程中的平均动脉压、硬膜外分娩镇痛情况分别进行比较分析。结果：成功组192例,失败组26例,两组产妇在一般资料上无差异（P〉0．05）。在转行剖宫产前成功组平均动脉压显著低于失败组（P〈O．05）,补救给药的次数上成功组显著低于失败组（P〈0．05）,在镇痛持续时间上成功组显著少于失败组（P〈0．05）。结论：影响硬膜外剖宫产麻醉失败的危险因素是分娩镇痛时需要补救给药的次数增加以及镇痛所持续的时间延长,对于出现此类危险因素的产妇,应改变剖宫产麻醉方式,以最大限度地降低剖宫产麻醉的失败率,这对于母婴并发症的减少起着积极的作用。     

Anesthesia rapidly suppresses insulin pulse mass but enhances the orderliness of insulin secretory process

Induction of anesthesia is accompanied by modest hyperglycemia and a decreased plasma insulin concentration. Most insulin is secreted in discrete pulses occurring at approximately 6- to 8-min intervals. We sought to test the hypothesis that anesthesia inhibits insulin release by disrupting pulsatile insulin secretion in a canine model by use of direct portal vein sampling. We report that induction of anesthesia causes an abrupt decrease in the insulin secretion rate (1.1 +/- 0.2 vs. 0.7 +/- 0.1 pmol. kg(-1). min(-1), P < 0.05) by suppressing insulin pulse mass (630 +/- 121 vs. 270 +/- 31 pmol, P < 0.01). Anesthesia also elicited an approximately 30% higher increase in insulin pulse frequency (P < 0.01) and more orderly insulin concentration profiles (P < 0.01). These effects were evoked by either sodium thiamylal or nitrous oxide and isoflurane. In conclusion, anesthesia represses insulin secretion through the mechanism of a twofold blunting of pulse mass despite an increase in orderly pulse frequency. These data thus unveil independent amplitude and frequency controls of beta-cells' secretory activity in vivo.     

Electroencephalographic Variation during End Maintenance and Emergence from Surgical Anesthesia

The re-establishment of conscious awareness after discontinuing general anesthesia has often been assumed to be the inverse of loss of consciousness. This is despite the obvious asymmetry in the initiation and termination of natural sleep. In order to characterize the restoration of consciousness after surgery, we recorded frontal electroencephalograph (EEG) from 100 patients in the operating room during maintenance and emergence from general anesthesia. We have defined, for the first time, 4 steady-state patterns of anesthetic maintenance based on the relative EEG power in the slow-wave (<14 Hz) frequency bands that dominate sleep and anesthesia. Unlike single-drug experiments performed in healthy volunteers, we found that surgical patients exhibited greater electroencephalographic heterogeneity while re-establishing conscious awareness after drug discontinuation. Moreover, these emergence patterns could be broadly grouped according to the duration and rapidity of transitions amongst these slow-wave dominated brain states that precede awakening. Most patients progressed gradually from a pattern characterized by strong peaks of delta (0.5–4 Hz) and alpha/spindle (8–14 Hz) power (‘Slow-Wave Anesthesia’) to a state marked by low delta-spindle power (‘Non Slow-Wave Anesthesia’) before awakening. However, 31% of patients transitioned abruptly from Slow-Wave Anesthesia to waking; they were also more likely to express pain in the post-operative period. Our results, based on sleep-staging classification, provide the first systematized nomenclature for tracking brain states under general anesthesia from maintenance to emergence, and suggest that these transitions may correlate with post-operative outcomes such as pain.     

Ventilatory response to helium-oxygen breathing during exercise: effect of airway anesthesia

Krishnan, Bharath S., Ron E. Clemens, Trevor A. Zintel,Martin J. Stockwell, and Charles G. Gallagher. Ventilatory response to helium-oxygen breathing during exercise: effect of airwayanesthesia. J. Appl. Physiol. 83(1):82-88, 1997.The substitution of a normoxic helium mixture(HeO₂) for room air (Air) during exercise results in a sustained hyperventilation, which is present evenin the first breath. We hypothesized that this response is dependent onintact airway afferents; if so, airway anesthesia (Anesthesia) shouldaffect this response. Anesthesia was administered to the upper airwaysby topical application and to lower central airways by aerosolinhalation and was confirmed to be effective for over 15 min. Subjectsperformed constant work-rate exercise (CWE) at 69 ± 2 (SE) % maximal work rate on a cycle ergometer on three separate days: twiceafter saline inhalation (days 1 and3) and once after Anesthesia(day 2). CWE commenced after a briefwarm-up, with subjects breathing Air for the first 5 min (Air-1),HeO₂ for the next 3 min, and Airagain until the end of CWE (Air-2). The resistance of the breathingcircuit was matched for Air andHeO₂. BreathingHeO₂ resulted in a small butsignificant increase in minute ventilation(I) anddecrease in alveolar PCO₂ in both theSaline (average of 2 saline tests; not significant) and Anesthesiatests. Although Anesthesia had no effect on the sustainedhyperventilatory response to HeO₂breathing, theI transientswithin the first six breaths ofHeO₂ were significantly attenuatedwith Anesthesia. We conclude that theI response to HeO₂ is not simply due to areduction in external tubing resistance and that, in humans, airwayafferents mediate the transient but not the sustained hyperventilatoryresponse to HeO₂ breathing duringexercise.

     

Cardiovascular responses to metabolic and respiratory acidosis and anesthesia in larval Ambystoma tigrinum

Larval Ambystoma tigrinum were examined to determine their cardiovascular responses to three types of acidosis: metabolic acidosis via NH₄Cl gavage; respiratory acidosis via hypercapnia; and anesthetic-induced acidosis, via triacine methanesulphonate. In addition, another group of (metabolic acidosis) animals were tested to determine the role of -mediated catecholamine control on cardiovascular and acid-base regulation. The metabolic and respiratory acidoses produced typical amphibian responses. Anesthesia produced a significant mixed acidosis with respiratory and metabolic components. The cardiovascular responses to metabolic and respiratory acidosis were increased heart rate and pulse pressure. There were no significant changes in diastolic pressure, however, systolic pressure increased as a result of the increased pulse pressure. Animals subjected to metabolic acidosis via -blockade with propranolol did not display the increased heart rate and pulse pressure and the acidosis was deepened and prolonged. Anesthesia resulted in a cardiac slowing and increased pulse pressure, probably explained by the Frank-Starling relationship. There was no change in diastolic pressure. Anesthetized animals had depressed blood O₂ tension and elevated blood lactate.Abbreviations HR heart rate - RBC red blood cell(s) - TMS triacine methanesulphonate