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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。

非计划取消手术原因及对策

【摘要】　目的　分析患者非计划取消手术的原因，研究其应对办法。　方法　对2008年10月-2010年8月期间临时取消的350例手术原因进行归类分析，从中寻求解决措施。　结果　350例非计划取消手术中，生命体征异常占10.3%，检查结果不完善及结果异常的占39.4%，患者及家属意见不统一占27.4%，血库缺血占6%，女患者月经来潮占2%，其他占15.1%。　结论　术前详细评估患者具体情况，做好护患沟通及心理护理，完善和强化术前各项准备措施，可保障手术按计划顺利进行。

精神科门诊投诉原因分析与对策

目的　分析精神科门诊医疗投诉事件的发生率和原因，采取对策以减少精神科门诊医疗纠纷，提高医疗护理质量。 方法　回顾性分析2009年1月－2012年12月发生的112例各类投诉事件资料，对投诉内容及回访结果进行归类统计分析。 结果　2009年－2012年精神科门诊患者总数为789 485例次,其中发生医疗投诉112例，发生率为0.142‰。112例投诉中，医源性投诉78例，占69.64%，且呈逐年上升趋势；非医源性投诉34例，占30.36%，呈逐年下降趋势。 结论　精神科门诊投诉主要是医源性投诉，转变服务理念,建立并完善医患沟通制度，提高医务人员的责任心和技术水平，开展多形式的优质护理是减少精神科门诊投诉的方法与途径。

包裹性胰腺坏死被误诊为胰腺囊实性肿瘤的原因分析：附 12 例报道

目的 探讨包裹性胰腺坏死（walled-off pancreatic necrosis，WOPN）误诊为胰腺囊实性肿瘤（pancreatic cystic neoplasm，PCN）的原因。 方法 回顾性分析 2009–2013 期间华西医院胰腺外科收治的术前诊断为胰腺 PCN 而术后病理学诊断为 WOPN 的 12 例患者的临床资料。 结果 12 例患者术前诊断为胰腺 PCN，而术后病理学诊断为 WOPN。其中女 2 例，男 10 例；年龄 36～68 岁、（47.1±10.7）岁；病程 0.5～48.0 个月，中位数为 1.0 个月；主要临床表现：腹痛 12 例，体质量减轻 7 例；术前 1 例总胆红素水平增高，2 例血淀粉酶水平增高，4 例癌胚抗原（CEA）水平增高，4 例 CA19-9 水平增高，4 例 CA-125 水平增高。8 例行腹部增强 MRI 检查，7 例行腹部增强 CT 检查，1 例行正电子发射计算机断层显像（PET-CT）检查，提示 7 例包块位于胰头，5 例位于胰尾；肿块最大径 1.8～11.0 cm、（4.9±2.9）cm，其中 4 例最大直径超过 5 cm；3 例腹腔内发现肿大淋巴结；4 例肿块内部分隔；8 例呈类肿瘤表现。 结论 WOPN 与 PCN 的鉴别需要根据临床、实验室检查及影像学特点进行综合判断，影像学检查是主要的鉴别方法，但同时也是误诊的主要原因。此外，男性患者可能更易误诊。