Objective To investigate the clinical significance of intra-abdominal pressure measure in patients with liver transplantation by summarizing the data of 143 cases. Methods Intra-abdominal pressure was indirectly measured by urinary bladder pressure. Intra-abdominal pressure over 10 cm H2O (1 cm H2O=0.098 kPa) was regarded as intra-abdominal hypertension (IAH), and 10＜pressure≤15 cm H2O as gradeⅠ, 15＜pressure≤25 cm H2O as grade Ⅱ, 25＜pressure≤35 cm H2O as grade Ⅲ, over 35 cm H2O as grade Ⅳ. The parameters of circulatory system, respiratory system, renal function and the postoperative intra-abdominal pressure for 7 days were recorded to every patient, and the parameters of each grade IAH group were contrasted with non-IAH group. ResultsAmong 143 cases, 45 cases were IAH (31.5%), in which 18 cases belonged to grade Ⅰ, 13 cases belonged to grade Ⅱ, 11 cases belonged to grade Ⅲ, while 3 cases belonged to grade Ⅳ. Compared with those in non-IAH group, SCr and BUN significantly increased (P＜0.05, P＜0.01), PaO2 significantly decreased (P＜0.05, P＜0.01) in each grade IAH group; Respiratory frequency (RF), heart rate (HR) and PaCO2 significantly increased (P＜0.05, P＜0.01) in some grade IAH group (HR in grade Ⅱ, Ⅲ and Ⅳ, RF and PaCO2 in grade Ⅲ and Ⅳ). Conclusions Intra-abdominal hypertension would affect liver function by impaired circulatory, respiratory and renal function. So, it is necessary to measure intra-abdominal pressure for patients after liver transplantation, which can help to choose appropriate treatment.
ObjectiveTo investigate the effect of noninvasive positive-pressure ventilation for elderly patients with chronic obstructive pulmonary disease (COPD) combined with left heart failure. MethodsA total of 152 patients (70-85 years old) diagnosed with COPD combined with left heart failure and treated in our hospital between June 2011 and January 2015 were randomly divided into trial group (noninvasive positive-pressure ventilation with routine treatment, n=76) and control group (routine treatment, n=76). Respiratory rate, heart rate, blood pressure, pH, arterial partial pressure of carbon dioxide (PaCO2), arterial partial pressure of oxygen (PaO2) and left ventricular ejection fraction (LVEF) were analyzed and compared between the two groups after treatment. We did t-test to analyze the difference of these indexes between the two groups statistically. ResultsRespiratory rate, heart rate and PaCO2 in both of the two groups after the treatment were significantly lower than those before the treatment (P<0.001), while PaO2 and LVEF in both of the two groups after the treatment were significantly higher than those before the treatment (P<0.001). The systolic pressure and diastolic pressure in both of the two groups after the treatment didn't differ much from those before the treatment (P>0.05). The pH value after the treatment increased only in the trial group compared with that before the treatment (P<0.05). The respiratory rate, heart rate, pH value, PaO2, PaCO2 and LVEF after the treatment in trial group were meliorated compared with those in the control group (P<0.05). ConclusionTreatment with noninvasive positive-pressure ventilation for elderly patients with COPD combined with left heart failure is more efficient than the routine treatment.
ObjectiveTo explore the plan-do-check-action (PDCA) circulation method in reducing errors in general inspection items of health examination and to improve the quality of examination. MethodsUsing PDCA circulation method, the reasons of errors in general items of health examination for 39 individuals examinied between August and December 2010 were analyzed. Rectification was carried out according to the reasons, and the differences in the incidence rate of errors in general items of health examination before (from August to December, 2010) and after the rectification was (from Auguest to December, 2011) was compared. ResultsAfter the rectification, the incidence of errors in general items of health examination (0.08%) was significantly lower than that before the rectification (0.45%) (P<0.05). ConclusionPDCA circulation method can effectively reduce the incidence of errors in general items of health examination thus may ensure the medical quality.
The national policy on high-quality development of hospitals proposes to strengthen information technology support and actively promote the multi-disciplinary team (MDT) model. How to use the “Internet Plus” technology and operation mode to promote MDT communication and improve the efficiency of diagnosis and treatment in the digital and intelligent information age is a direction worthy of attention and research. This paper systematically reviews the current development status of MDT informatization construction at home and abroad. Based on the current challenges and opportunities, it makes prospects for the future development of MDT informatization construction from the aspects of strengthening the digital and intelligent support of MDT operation, connecting MDT “information silos”, and deepening the construction of MDT supervision and effect evaluation system, etc.
Social Evaluation is an important reference to guide the reform and development of a public hospital. In view of the patient, hospital stakeholders and the public, West China Hospital of Sichuan University creatively constructed a social evaluation system, including patient satisfaction degree, expert appraisal and online public comment, in order to maintain a good medical environment. After several years of construction and application, the system has been quite effective in promote the development of the hospital. In the assessment of patients' satisfaction degree toward the hospital, we made a great improvement.
Rare diseases are a kind of diseases with very low incidence and prevalence. They are difficult to diagnose, treat and use drugs. Multi-disciplinary team (MDT) has become the main mode of modern medical diagnosis and treatment. Many hospitals at home and abroad have begun to apply MDT in the diagnosis and treatment of rare diseases. This paper introduces the MDT mode of rare diseases at home and abroad, focusing on the mode, work flow and content of the MDT service system for rare diseases in West China Hospital of Sichuan University, and discusses the problems and optimization suggestions of the current construction of the MDT service system for rare diseases. The purpose is to provide some reference for the establishment of MDT model of rare diseases in China.
In 2021, West China Hospital of Sichuan University established a rare disease diagnosis and treatment and research center. The center adopts the rare disease management model of “one cohesion + four integration”, condenses the core of management, integrates clinical resources, regional alliance resources, training resources and research resources, and explores solutions for all-round services for patients with rare diseases. This article aims to explore the rare disease management model of regional central hospitals and introduces the above-mentioned rare disease management model. The purpose of this article is to promote this model, focus on the advantages of clinical departments and research institutes (offices), increase regional integration, give play to the synergy of regional alliances in clinical diagnosis and treatment and personnel training, and use international cooperation as an opportunity to promote breakthroughs in new drugs and technologies for rare diseases to benefit patients with rare diseases in China.
ObjectiveTo explore whether platelet activation is associated with systemic inflammatory responses. MethodsWe conducted a cross-sectional study to enroll all aortic dissection (AD) patients (AD group) from January 1, 2015 to June 30, 2015 in the Emergency Department. According to the characteristics of AD patients, we matched hypertension (hypertension group) and health participants (health group) with AD patients at a proportion of 1:1:1. Blood samples were collected on admission for blood routine test [mean platelet volume (MPV)/platelet (PLT)] and inflammatory cytokines [tumor necrosis factor (TNF)-α and interleukin (IL)-6] analysis. We compared all parameters among the three groups and performed bivariate correlation analyses. ResultsExpressions of TNF-α and IL-6 in the AD group [(20.9±4.5), (168.8±75.1) pg/mL] were significantly higher than those in the hypertension group [(4.3±1.9), (8.4±2.9) pg/mL] and healthy group [(5.4±1.6), (8.7±3.8) pg/mL] (P＜0.05). MPV/PLT in the AD group was significantly higher than that in the hypertension group and healthy group (0.106±0.035 vs 0.049±0.010, P＜0.05; 0.106±0.035 vs 0.054±0.019, P＜0.05). There were positive correlations between MPV/PLT and TNF-α (r=0.516, P=0.002), and between MPV/PLT and IL-6 (r=0.633, P＜0.001) in the AD group. ConclusionIn summary, our study shows that platelets of AD patients can be activated, and the degree of activation is associated with systemic inflammatory responses.