目的 探讨数字病理技术及数字病理诊断在基层医院的应用。方法 回顾性分析2018年1月—2019年12月两家医院的病理诊断报告共18 688例。将2018年1月—2018年12月病例纳入A组(n=8 400),将2019年1月—2019年12月病例纳入B组(n=10 288)。采用云康远程病理会诊平台,所有病例依次按编号通过扫描绑定到平台软件的对应病例中,由同一位初诊病理医生和不同的远程病理平台专家分别完成初、复诊。通过三审发布专家团队来评价远程病理诊断初诊及复诊的准确率。结果 A组初诊病理医生正确诊断6 569例,准确率78.20%,复审病理医生正确诊断8 215例,准确率97.80%;B组初诊病理医生正确诊断9 444例,准确率91.80%,复审病理医生正确诊断10 102例,准确率98.19%;两组病理诊断中,B组初诊病理医生诊断正确率高于A组初诊病理医生准确率,差异有统计学意义(P＜0.05);两组的复审病理医生准确率比较,差异无统计学意义(P＞0.05)。结论 日常开展数字病理技术及数字病理诊断可以有效提高基层诊断医生的诊断水平,值得在基层医院广泛和长期应用推广。

Objective To explore the application of digital pathological technology and digital pathological diagnosis in primary hospitals. Methods A total of 18 688 cases of pathological diagnosis reported in two hospitals from January 2018 to December 2019 were retrospectively analyzed. Cases from January to December 2018 were included in group A (n=8 400), and cases from January to December 2019 were included in group B (n=10 288).Yunkang remote pathology consultation platform was adopted. All cases in turn were scanned and bound to the corresponding cases of the platform software by number. The same pathologist and different remote pathological platform experts completed the preliminary and follow-up respectively, to evaluate the accuracy of remote pathological diagnosis at the first and second diagnosis by releasing the expert team in the third audit. Results In group A, the pathologists correctly diagnosed 6 569 cases, with an accuracy rate of 78.20%, The correct diagnosis rate of 8 215 cases was 97.80%,The primary pathologists in group B correctly diagnosed 9 444 cases, with an accuracy rate of 91.80%.The correct diagnosis rate of 10 102 cases was 98.19%,In the two groups of pathological diagnosis, the diagnostic accuracy rate of pathologists in group B was higher than that in group A.The difference was statistically significant (P <0.05).The accuracy of pathologists in the two groups was compared.The difference was not statistically significant (P >0.05). Conclusion Daily development of digital pathological technology and digital pathological diagnosis can effectively improve the diagnosis level of grassroots doctors. It is worthy of extensive and long-term application in primary hospitals.

目的 观察联合缩宫素与间苯三酚在基层医院分娩中疗效。方法 选用高明区人民医院2013年8月—2014年10月要求自然分娩的初产妇200例,随机分成两组,孕妇进入临产时,观察组予双管输液,予缩宫素2.5U+5%葡萄糖注射液静滴,另一静脉通路5%葡萄糖注射液250 mL+间苯三120 mg静滴;对照组仅予缩宫素2.5U+5%葡萄糖注射液静滴。比较两组产妇各产程时间、分娩方式、新生儿情况、产后出血量。结果 观察组第一产程、第二产程、第三产程时间均短于对照组(P＜0.01),剖宫产率3%及新生儿窒息率3%均低于对照组21%,和13%;P＜0.01;产后2小时出血量较对照组少(109.38±16.13)mL vs(185.00±30.71)mL, P＜0.01。结论 临产孕妇联合间苯三酚与缩宫素,可缩短产程,降低剖宫产率,降低新生儿窒息发生率,减少产后出血量,推荐基层医院使用。

Objective To investigate the effect of oxytocin combined with phloroglucinol in childbirth in primary hospital. Methods A total of 200 primiparas admitted to department of obstetrics in Gaoming people's hospital from August 2013 to October 2014　were selected as study subjects. The cases were randomly divided into observation group (100 cases) and control group (100 cases). In labor, cases in control group were given oxytocin 2.5 U and 5% glucose injection 500 mL, and were given 5% glucose injection 250 mL and phloroglucinol 120 mg by double tube intravenous infusion. Cases in observation group were only given oxytocin 2.5 U and 5% glucose injection 500 mL intravenous infusion. The duration of delivery、delivery mode、the condition of newborn and volume of bleeding after labor were compared between two groups. Results For the first、second and third stages of labor, duration of delivery in observation group were significantly shorter than that in control group (P＜0.01), Both cesarean delivery rate [3%(3/100)] and the incidence of neonatal asphyxia[3%(3/100)] in observation group were significantly lower than that in control group 21%(21/100)and 13%(13/100;P＜0.01). The volume of bleeding during two hours after labor in observation group was less than that in control group (109.38±16.13)mL vs 185.00±30.71 mL, P＜0.01. Conclusion In the stages of labor, the use of oxytocin combined with phloroglucinol can shorten the duration of delivery, reduce the cesarean delivery rate and the incidence of neonatal asphyxia and reduce the volume of bleeding after labor. It is worth recommending to use in primary hospital.

目的 分析基层医院ICU VAP的危险因素及病原学情况。方法 回顾性分析2013年1月—2014年12月本院ICU收治的机械通气>48 h 的118例患者,分VAP组和非VAP组,分析VAP的危险因素及病原学情况。结果 VAP组与非VAP组在紧急气管插管,机械通气时间,抗生素种类,糖皮质激素,PPI及镇静药物使用>7天,返流,MODS,ICU停留时间的项目,两组比较差异有统计学意义。紧急插管:52.2％ vs 31.9％,P＝0.029;机械通气时间:(9.8±3.5)vs(7.3±2.8)天,P＝0.038;抗生素种类>2种:52.2％ vs 26.4％,P＝0.005;使用糖皮质激素:56.5％ vs 27.0％,P＝0.001;PPI使用>7天:65.2％ vs 40.3％,P＝0.008;镇静药物使用>7天:58.7％ vs 38.9％,P＝0.035;返流:50％ vs 29.2％,P＝0.022;合并MODS:47.8％ vs 22.2％,P＝0.004;ICU停留时间:(13.6±6.6)vs(10.2±5.3)天,P＝0.023。使用糖皮质激素、机械通气时间、ICU停留时间是VAP的独立危险因素(多因素Logistic分析的OR值:2.481、1.234、1.075)。基层医院ICU VAP主要以革兰氏阴性菌(82.3%)为主。结论 使用激素、机械通气时间、ICU停留时间是基层医院ICU VAP的独立危险因素;而VAP病原菌感染以G-菌为主,可经验使用G-菌敏感的抗生素。

Objective To analyze pathogens and risk factors of VAP in a general ICU of a primary hospital. Methods Totally 112 patients(from 2013-01 to 2014-12) under mechanical ventilation over 48 h were retrospectively studied. The patients were assigned into VAP group and non-VAP group. The independent risk factors and pathogens of VAP were analyzed. Results There was significant difference between VAP group and non-VAP group in terms of emergent tracheal intubation, MV time, types of antibiotics used, the use of hormones,the use of PPI and sedative drugs for more than 7 days, regurgitation, MODS, ICU stay time. Emergent tracheal intubation:52.2％ vs 31.9％,P＝0.029;MV time:9.8±3.5day vs 7.3±2.8day,P＝0.038;types of antibiotics used > 2 kinds:52.2％ vs 26.4％,P＝0.005;the use of hormones:56.5％ vs 27.0％,P＝0.001;the use of PPI >7day:65.2％ vs 40.3％,P＝0.008;the use of sedative drugs >7day:58.7％ vs 38.9％,P＝0.035;regurgitation:50％ vs 29.2％,P＝0.022;MODS:47.8％ vs 22.2％,P＝0.004;ICU stay time:13.6±6.6day vs 10.2±5.3day,P＝0.023. The use of hormones,MV time, ICU stay time were the independent risk factors of VAP[odds ratio(OR) of multivariate logistic regression:2.481、1.234、1.075]. The main pathogens of VAP were gram-negative bacteria (82.3%). Conclusion The study shows that the use of hormones,MV time, ICU stay time are the independent risk factors of VAP; gram-negative bacteria are the main pathogens of VAP. Once VAP occurs, they can be treated with anti-gram-negative bacteria antibiotics.

       目的  识别医院在医患沟通、服务态度、医疗服务和医疗质量方面存在的问题，研究提升医院医疗质量与安全的对策。方法   通过收集和整理2024年1-6月某三甲医院医患沟通科处理的医疗诉求数据，包括患者投诉、咨询、建议及求助调查结果，采用定性分析和定量分析相结合的方法，对134件医疗诉求数据进行详细分类和统计，深入分析投诉事由，并结合实际有责投诉量与诊疗总人数，计算投诉千人发生率。投诉千人发生率与2023年同期对照。结果   共处理医疗诉求134件，其中投诉116件（占86.56%）、求助11件（8.21%）、咨询5件（3.73%）、建议2件（1.5%）。投诉中，医患沟通不畅和服务态度问题占42%，医疗服务问题32%，医疗质量问题占26%。实际有责投诉量为63件，投诉千人发生率约为0.12‰。通过对诉求数据的深入分析，识别出医疗服务过程中的薄弱环节和改进点。结论   针对分析结果及同期对照，提出相应的对策建议，包括加强医患沟通培训，改善服务态度，优化医疗服务流程，并对投诉高发科室进行特别关注和改进等措施，以提高患者满意度和医院整体医疗质量。

Objective To identify issues in hospital communication, service attitude medical services, and medical  quality and to explore strategies for enhancing hospital medical quality and safety.  Methods  By collecting and organizing medical  appeal data processed by the Medical Communication Department of a tertiary hospital from January to June 2024, including patient  complaints, inquiries, suggestions, and requests for help. A combined qualitative and quantitative analysis was conducted on 134  medical appeal cases. Detailed classification and statistics were performed on these cases, and an in-depth analysis of the  reasons  for complaints was carried out. Furthermore, the actual number of  responsible complaints was compared with the total number of  treated patients to calculate the complaint rate per thousand people. This complaint  rate was then compared with the same period  in 2023.  Results  A total of 134 medical appeals were processed including 116 complaints（accounting for 86. 56%）, 11  requests for help（8. 21%）, 5 inquiries（3. 73%）, and 2 suggestions（1. 5%）. Among the complaints, issues  related to poor  communication between doctors and patients and service attitude accounted for 42%, medical service issues accounted for 32%, and  medical quality issues accounted for 26%. The actual number of responsible complaints was 63, and the complaint rate per thousand  people was approximately 0. 12‰. Through in-depth analysis of the appeal data, weak links and improvement points in the medical  service process were identified.  Conclusions Based on the analysis results and comparisons with the same period, corresponding  countermeasures and suggestions are proposed, including strengthening communication training between doctors and patients,  improving service attitude, optimizing medical service processes, and paying special attention to and improving departments with high  complaint rates in order to improve patient satisfaction and overall hospital medical quality.