【摘要】 目的 評價彩色多普勒超聲對腎動脈狹窄（ARAS）的診斷指標(biāo)及準(zhǔn)確性?！》椒ā?999年10月-2008年12月對患有高血壓病的58例共113根腎動脈進行彩色多普勒超聲檢查。每例患者均測量腎動脈峰值流速（PSV）與腎內(nèi)段動脈的阻力指數(shù)及腎臟長軸。在雙盲條件下，以患者腎動脈造影、MRI血管造影及CT血管造影為標(biāo)準(zhǔn)，評價彩色多普勒超聲診斷ARAS的診斷指標(biāo)及準(zhǔn)確性?！〗Y(jié)果 彩色多普勒超聲診斷腎動脈狹窄的敏感性為60%，特異性為83%，陽性預(yù)測值為83%，陰性預(yù)測值為61%?；紓?cè)腎長軸小于健側(cè)腎長軸，患側(cè)腎峰值流速高于健側(cè)腎峰值流速，患側(cè)腎阻力指數(shù)低于健側(cè)腎阻力指數(shù)?！〗Y(jié)論 腎動脈彩色多普勒超聲對于腎動脈狹窄初篩診斷以及評價腎動脈狹窄介入治療后的近、遠期療效，是一種簡便可靠的無創(chuàng)檢查手段。【Abstract】 Objective To evaluate the accuracy and index of color Doppler ultrasonography (CDU) diagnosing renal artery stenosis (RAS).〖WTHZ〗Methods〖WTBZ〗A total of 113 renal arteries of 58 patients with hypertension from October 1999 to December 2008 were examined by CDU. The peak systolic velocity (PSV) of the renal artery, resistant index of interior artery of kidney,and long axis of kidney of each patient were obtained. Under the double-blind condition, accuracy and diagnostic index of CDU for diagnosing RAS were evaluated according to the standard of renal arteriography, magnetic resonance angiography or computerized tomography angiography. Results The sensitivity of CDU for diagnosing RAS was 60%, specificity was 83%, positive predictive value was 83%, and negative predictive value was 61%. Long axis of kidney in patients with RAS was shorter than that in the healthy ones. The PSV in patients with RAS was higher than that in the healthy ones, and the resistant index of section artery of kidney in patients with RAS was lower than that in the healthy ones. Conclusion CDU is an easy and reliable non-invasive examination for early diagnosis and screening of RAS and for evaluating a short-or long-term therapeutic effect.
目的 探討醫(yī)院信息系統(tǒng)（HIS）在超聲影像住院醫(yī)生培養(yǎng)中的應(yīng)用價值。 方法 對2003年－2009年在超聲科參加住院醫(yī)生培訓(xùn)的24名住院醫(yī)生，應(yīng)用HIS前后3年在臨床、教學(xué)及科研方面的業(yè)績進行對比。所選用的指標(biāo)包括超聲檢查的請會診次數(shù)、報告符合率、準(zhǔn)備教學(xué)材料所花費的時間及質(zhì)量、論文發(fā)表的數(shù)量。 結(jié)果 在HIS應(yīng)用之前，24名超聲科住院醫(yī)生的請會診次數(shù)為平均每周96次，平均每周4次/人，報告符合率為92%，準(zhǔn)備教學(xué)材料花費的時間平均50 h，論文發(fā)表的數(shù)量共9篇，平均0.33篇/人，其中個案報道6篇，占67%，無科學(xué)引文索引收錄論文。在HIS應(yīng)用之后，24名超聲科住院醫(yī)生的請會診次數(shù)為平均每周62次，平均每人每周2.58次/人，報告符合率為95%，準(zhǔn)備教學(xué)材料花費的平均時間為36 h，論文發(fā)表的數(shù)量共15篇，平均0.63篇/人，其中包括3篇科學(xué)引文索引收錄論文，個案報道9篇，占60%。 結(jié)論 超聲影像是實踐性很強的學(xué)科，HIS提供的素材和平臺有利于超聲科住院醫(yī)生學(xué)習(xí)效率的提高。
【摘要】 目的 探討外周血管動靜脈瘺的超聲特征及其鑒別診斷。 方法 回顧性分析2003年1月-2010年3月間收治的36例先天性及后天性動靜脈瘺患者的臨床資料，使用彩色超聲診斷儀觀察受累血管的內(nèi)徑、血管壁的連續(xù)性，根據(jù)血流動力學(xué)變化尋找瘺口；對受累血管血流頻譜進行分析，并與健側(cè)對照。 結(jié)果 18例先天性動靜脈瘺查見紆曲擴張的血管網(wǎng)，無法辨認瘺口；18例后天性動靜脈瘺全部可顯示瘺口，2例合并靜脈破裂的為囊瘤型，其余后天性動靜脈瘺均為洞口型。受累動脈近心端血流為高速低阻型，全部患者受累靜脈出現(xiàn)動脈樣血流，近心端靜脈呈高速低阻型頻譜；10例患者遠心端靜脈內(nèi)出現(xiàn)逆向離心血流。 結(jié)論 引流靜脈出現(xiàn)高速、動脈樣血流頻譜是動靜脈瘺的特征性表現(xiàn)；先天性動靜脈瘺可見異常血管網(wǎng)，不能辨認瘺口；后天性動靜脈瘺均可顯示瘺口。彩色超聲多普勒檢查對動靜脈瘺能夠正確診斷及鑒別診斷。【Abstract】 Objective To observe characteristic imaging of arteriovenous fistulas (AVF) of periphery vessel, and to evaluate the differential diagnosis of AVF by ultrasonography. Methods Thirty-six patients suffering from congenital and acquired AVF in this hospital from January 2003 to March 2010 were selected to undergo Doppler ultrasonography. The blood flow of arteriovenous fistulas, diameter, morphology and blood flow characters of affected vessels were observed. Spectral of fistula and affected vessels were analyzed and compared with the healthy side. Results Deformed vascular net was observed, and the localization of arteriovenous fistulas was not observed directly in 18 congenital AVF patients.Inversely the localization of arteriovenous fistulas was observed directly in 18 acquired AVF patients.Two acquired AVF patients with venous rupture belonged to kystoma form, and others acquired AVF patients belonged to orifice form.Spectral analysis of proximal arteries of the fistula revealed high velocity and low resistance.Arterialized flow pattern was observed in affected veins.Proximal veins of the fistula revealed arterialized spectral with high velocity and low resistance.Reversed blood flow was observed in the distal veins of the fistulas in 10 patients. Conclusion Arterialized flow with high velocity in veins are characteristic signs of AVF.Deformed vascular net is observed, and the localization of arteriovenous fistulas in not observed directly in congenital AVF patients, but the localization of arteriovenous fistulas is observed directly in acquired AVF patients.Color Doppler ultrasonography has great value in confirming diagnosis and differential diagnosis of AVF.
目的 分析汶川地震災(zāi)后四川省的衛(wèi)生防病工作，為今后應(yīng)對類似重大突發(fā)事件后的衛(wèi)生防病工作提供借鑒和參考。 方法 收集、整理、分析汶川特大地震災(zāi)后四川省抗震救災(zāi)指揮部醫(yī)療保障組工作檔案資料。 結(jié)果 汶川地震后，四川省衛(wèi)生防病工作采取衛(wèi)生防病與醫(yī)療救援同步、衛(wèi)生防病關(guān)口前移、全覆蓋下狠抓防控重點、衛(wèi)生防病規(guī)范化、長期化等幾大策略，使衛(wèi)生防病工作有力有序有效推進，取得顯著成效。 結(jié)論 汶川地震后，四川省的災(zāi)后衛(wèi)生防病工作策略正確、措施有效，值得在今后應(yīng)對重大突發(fā)事件的衛(wèi)生防病工作中推廣。
【摘要】 目的 探討腎上腺髓樣脂肪瘤的彩色多普勒超聲表現(xiàn)和超聲診斷價值?！》椒ā』仡櫺苑治?005年3月-2010年9月58例61個經(jīng)手術(shù)及病理證實的腎上腺髓脂肪瘤病灶的彩色多普勒超聲表現(xiàn)，對病變的大小、內(nèi)部回聲特點及血流特點進行分析?！〗Y(jié)果 在2005年3月-2007年12月的28個病灶超聲診斷出腎上腺病變23個，正確率82.1%；診斷為髓脂肪瘤2個，正確率7.1%；漏診1個，誤診4個。2008年1月-2010年9月，33個病灶超聲診斷出腎上腺病變30個，正確率90.9%；診斷為髓脂肪瘤19個，正確率57.6%；無漏診，誤診3個。52個病灶超聲表現(xiàn)為邊界清晰，形態(tài)基本規(guī)則，內(nèi)部呈均勻中等強回聲（與腎集合系統(tǒng)回聲相當(dāng)），內(nèi)部未測及血流信號， 另8個病灶表現(xiàn)為中等強回聲與低回聲相間?！〗Y(jié)論 腎上腺髓樣脂肪瘤具有特征性的彩色多普勒超聲聲像圖表現(xiàn)， 可用于發(fā)現(xiàn)病變并對多數(shù)腎上腺髓樣脂肪瘤做出定性診斷。【Abstract】 Objective To evaluate the value of sonographic diagnosis of adrenal myelolipoma. Methods Sonographic findings from 58 patients with pathologically proved adrenal myelolipoma from March 2005 to September 2010 were retrospectively analyzed. The size of the lesion, internal echo features, and characteristics of blood flow were observed and analyzed. Results In 28 patients with pathologically proved adrenal myelolipoma from March 2005 to December 2007, adrenal lesions was diagnosed in 23 with an accurate rate of 82.1%; adrenal myelolipoma was diagnosed in two with an accurate rate of 7.1%; missed diagnosed in one; misdiagnosed was in four. In 33 patients with pathologically proved adrenal myelolipoma from January 2008 to September 2010, adrenal lesions was diagnosed in 30 with an accurate rate of 90.9%; adrenal myelolipoma was diagnosed in 19 with an accurate rate of 57.6%; no missed diagnosed occurred; misdiagnosed was in three. The sonographic features in 52 lesions were smooth borders and homogeneous hyperechoic; no color Doppler flow signal inside was detected. Conclusion Adrenal myelolipoma has special sonographic features. Ultrasonography is a reliable imaging method for the diagnosis of adrenal myelolipoma.
目的 探討超聲造影對肝血管瘤的診斷價值。方法 采用造影劑SonoVue及CnTI造影成像技術(shù)對29例共35個肝血管瘤行實時超聲造影檢查，分析其超聲造影表現(xiàn)。結(jié)果 35個病灶的增強模式： 30個（85.7%）表現(xiàn)為動脈期及門脈期邊緣結(jié)節(jié)狀增強并逐漸向內(nèi)充填式增強，延遲期呈強回聲或等回聲； 4個(11.4%) 表現(xiàn)為動脈期及門脈期的快速整體增強，延遲期2個(5.7%)呈等回聲，2個(5.7%)呈稍弱回聲； 1個 (2.9%)表現(xiàn)為邊緣環(huán)狀增強, 內(nèi)部無增強。造影前常規(guī)超聲檢查僅6個（17.1%）病灶診斷為血管瘤； 造影后30個（85.7%）病灶診斷為血管瘤，5個（14.3%）診斷為其它腫瘤。結(jié)論 肝血管瘤超聲造影表現(xiàn)具有特征性，根據(jù)其增強模式，多數(shù)可以作出明確診斷。
臨床護士的創(chuàng)新行為對護士自身的職業(yè)發(fā)展及護理服務(wù)質(zhì)量的提升有重要意義，該研究主題受到國內(nèi)外學(xué)者的持續(xù)關(guān)注。當(dāng)前國內(nèi)臨床護士的創(chuàng)新行為水平尚有較大的提升空間，構(gòu)建提升我國臨床護士創(chuàng)新行為的有效干預(yù)方案是推動護理信息化及護理質(zhì)量發(fā)展的迫切要求。該文針對國內(nèi)外臨床護士創(chuàng)新行為的干預(yù)形式、干預(yù)理論支撐、干預(yù)效果及局限性進行綜述，提出對未來干預(yù)方案的展望，旨在為護理管理者制訂本土化及科學(xué)有效的干預(yù)方案提供思路和借鑒。
目的系統(tǒng)評價基于電話的認知行為療法（CBT）對失眠癥的療效。 方法計算機檢索PubMed、EMbase、PsycINFO、The Cochrane Library（2015年7期）、CBM和CNKI數(shù)據(jù)庫，搜集基于電話的CBT治療失眠癥的相關(guān)隨機對照試驗（RCT），檢索時限均為建庫至2015年7月。由2位研究者獨立篩選文獻、提取資料并評價納入研究的偏倚風(fēng)險后，采用RevMan 5.2軟件進行Meta分析。 結(jié)果共納入5個研究，共322例患者。Meta分析結(jié)果顯示：干預(yù)結(jié)束時，與等待組相比，基于電話的CBT組患者的入睡潛伏期更短[MD=–30.31，95% CI（–40.41，–20.22），P＜0.00001]、入睡后覺醒時間更短[MD=–15.59，95% CI（–24.09，–7.09），P=0.0003]、睡眠效率更高[MD=11.02，95% CI（7.87，14.18），P＜0.00001]，且差異均有統(tǒng)計學(xué)意義；但在總睡眠時間方面，兩組差異無統(tǒng)計學(xué)意義[MD=13.45，95% CI（–37.01，63.92），P=0.60]。 結(jié)論基于電話的CBT對失眠癥具有較好療效，是失眠癥治療的有效手段。受納入研究數(shù)量和質(zhì)量限制，上述結(jié)論尚需開展更多大樣本高質(zhì)量的RCT予以驗證。