Objective To summarize the clinical experience of 38 cases of cardiac surgery with full sternotomy through minimal skin incision.Methods A total of 38 cases of selective cardiac surgery were performed from June 2004 to December 2005.The operation was conducted under full sternotomy through a skin mini-incision.Results The operation was successfully completed in all the 38 cases.The total operation time was 175~359 min(mean,84 min),the drainage volume was 110~760 ml(median,380 ml),and the postoperatine hospital stay,7~32 d(mean,10 d).Postoperative short-term complications included 1 case of arrhythmia and 2 cases of pyrexia,all of which were cured.No thoracotomy for hemostasis was required.The incision healed by first intention without infection or separation.Follow-up examinations for 3~18 months(mean,9 months) in 38 cases showed significat improrement of symptoms.The left ventricular ejection fraction after operation was 0.45~0.73(mean,0.62).Conclusions Full sternotomy through minimal skin incision for cardiac surgery is safe and micro-traumatic.This procedure provides advantages of simplicity of performance,no need of special surgical instruments,and good cosmetic outcomes.

ISO9000 quality management system (ISO9000QMS) emphasize on the customer-oriented, managers' leadership and all staff's joining, adopt the process method and system management, spread the taking facts as a basis to make decision and improve consistently, and establish win-win relation with the suppliers. So, the digital hospital can adopt the ISO9000QMS. In order to establish the ISO9000QMS, the digital hospital should: (1) Design integrally, including analyzing the operation procedure, clarifying the job duties, setting up the spreading team and setting the quality policy and objectives: (2) Learning the ISO9000 quality standards; (3) Drawing up the documents, including the quality manual, program files and operation guiding files; (4) Training according the documents; (5) Executing the quality standard, including the service quality auditing, quality record auditing and quality system auditing; (6) Improving continually. With the establishment of ISO900QMS, the digital hospital can appraise more accurately, analyze quality matters statistically and avoid the interference of artificial factors.
Hospital Administration/legislation & jurisprudence ; Hospital Administration/*standards ; Hospitals, Public/legislation & jurisprudence ; Hospitals, Public/*standards ; Management Audit/*standards ; Quality Assurance, Health Care/*organization & administration ; Quality Control ; Total Quality Management/methods ; Total Quality Management/*standards

The health check up flow of digital hospital can be consulted with the assembly line of industry factory. Because they have the following same features: highly specialized workstation, closeness and continuance, rhythm, balanced production, continuous production. The essential prerequisites are as the follows: The inspecting items and methods should be stable; advanced product mix and stable production design; standardized raw material, consumption, procedure, inspection method; there are lots of request for health inspection; the customers move at the least unit; the space arrangement should be reasonable; the time arrangement should be proportion. With the computer net, the digital inspection can achieves the raw material controlling accurately. The basis of check up line concerns about equipment, net and software, data collection, and personnel. The group technology is used in the health inspection flow design of the digital hospital in the field of items customers and zone redivided. The digital assembly linemic health inspect has the following stages: member registering, notice, check in, arrange order, time control, report, feedback and analysis. The assembly linemic has following advantages: increasing the productivity, the space utility, satisfaction of customer, fund returning, lowering the cost and ensuring the quality.
Computer Communication Networks ; *Delivery of Health Care ; *Hospital Administration/economics ; *Hospital Information Systems/organization & administration ; Preventive Health Services/economics ; Preventive Health Services/organization & administration

ObjectiveTo compare the effect of rehabilitation training after surgical intervention of knee stiffness (SIKS) between femoral nerve block (FNB) and epidural nerve block (ENB).Methods60 patients undergoing SIKS at one knee joint were randomly assigned to two groups: 40 patients accepting a catheter for FNB in group A and 20 patients accepting a catheter for ENB in group B. All patients participated in passive rehabilitation therapy (PRT) and active rehabilitation therapy (ART) at 12 hours, 24 hours, 36 hours, and 48 hours after operation. 10 ml of lidocaine were applied via these catheters before rehabilitation therapy. The visual analogue score (VAS) for pain in PRT, the time needed from the end of PRT to the start of ART, and the incidence of side effects such as hypotension or nausea were recorded.ResultsThere was no significant difference in VAS between groups A and B. The time needed from the end of PRT to the start of ART in group A was significantly less than that of group B. The incidence of hypotension or nausea in group A was significantly less than those of group B.ConclusionFNB provides the same analgesic effect as ENB, has less time needed from the end of PRT to the start of ART, and lowers incidence of hypotension or nausea.

Objective To observe the effect of ropivacaine in infiltration anesthesia before the end of surgical procedures for postoperative analgesia on patients with spinal cord injury. Methods 60 patients with spinal cord injury undergoing internal fixation of spine fractures under combined general anesthesia were assigned in 3 groups, who received 0.25% ropivacaine in infiltration anesthesia (group RL, n=20),0.5% ropivacaine in infiltration anesthesia (group RM, n=20), or no infiltration anesthesia (group C, n=20) before the end of surgical procedures.The time for post-anesthesia recovery (PART), agitation score (AS), and Visual Analogue Score (VAS) for pain 2 h, 6 h, 24 h, and 48 h post operation were recorded, and related side effects were observed. Results AS within 6 h postoperation was significantly less in group RL and RM than in group C (P<0.05), as well as VAS, PART, mean of arterial pressure and heart rate 2 h, 6 h, and 24 h post operative (P<0.05).There was no significant difference in side effects including postoperative nausea and vomiting, and pruritus among these groups (P>0.05). Conclusion Ropivacaine in infiltration anesthesia would provide better postoperative analgesia, decrease the incidence of postoperative agitation, and increase the safety of patients with spinal cord injury in the postoperative period.

AIM: To study the role of post-hemorrhagic shock mesenteric lymph (PHSML) drainage on the balance of angiotensin-converting enzyme ( ACE) and ACE2 in the kidney.METHODS:A hemorrhagic shock model was established and then fluid resuscitation was performed to the animals in shock and shock+drainage groups, and the PHMSL was drained in shock+drainage group after fluid resuscitation.After 6 h of resuscitation, the mRNA expression of ACE, ACE2, angiotensin II (Ang II) type 1 receptor (AT1R) and Mas-related G-protein-coupled receptor (MasR), and the levels of Ang II and Ang (1-7) in the renal tissues were observed.RESULTS:Hemorrhagic shock increased the levels of ACE mRNA, AT1R mRNA and Ang II, and decreased the levels of ACE2 mRNA, MasR mRNA and Ang(1-7) in the kid-ney.PHSML drainage abolished the effect of hemorrhagic shock on ACE2 and AT1R mRNA expression.Meanwhile, PHSML drainage reduced the hemorrhagic shock-induced increases in the ratios of ACE/ACE2, Ang II/Ang(1-7) and AT1R/MasR.CONCLUSION:The PHSML drainage restores the balance of ACE/ACE2, which is beneficial to alleviate acute kidney injury following hemorrhagic shock in the mice.

AIM: To observe the effects of shock lymph on apoptosis relative gene expressions of pulmonary micro-vascular endothelial cells(PMVECs),and explore its mechanism.METHODS: The model of severe hemorrhagic shock was established by maintaining the blood pressure of rats in the condition of sepsis,mesentery lymph and shock portal vein blood was taken out.As control,mesentery lymph,portal vein blood of normal rats was taken out.The primary PMVECs of passages 3 were treated by different treatment factors,respectively.The apoptosis rate was analyzed by flow cytometry,and the expressions of relative genes of apoptosis such as fas,fas L,bcl-2 and bax were detected by RT-PCR.RESULTS: The apoptosis rate of PMVECs was 9.86%?3.24% after exposed to shock lymph at the final concentration of 4% for 4 hours and significantly higher than that in control(P

The health check up flow of digital hospital can be consulted with the assembly line of industry factory. Because they have the following same features: highly specialized workstation, closeness and continuance, rhythm, balanced production, continuous production. The essential prerequisites are as the follows: The inspecting items and methods should be stable; advanced product mix and stable production design; standardized raw material, consumption, procedure, inspection method; there are lots of request for health inspection; the customers move at the least unit; the space arrangement should be reasonable; the time arrangement should be proportion. With the computer net, the digital inspection can achieves the raw material controlling accurately. The basis of check up line concerns about equipment, net and software, data collection, and personnel. The group technology is used in the health inspection flow design of the digital hospital in the field of items customers and zone redivided. The digital assembly linemic health inspect has the following stages: member registering, notice, check in, arrange order, time control, report, feedback and analysis. The assembly linemic has following advantages: increasing the productivity, the space utility, satisfaction of customer, fund returning, lowering the cost and ensuring the quality.
Computer Communication Networks ; Delivery of Health Care ; Hospital Administration ; economics ; Hospital Information Systems ; organization & administration ; Humans ; Preventive Health Services ; economics ; organization & administration

Objective To explore the application of Airtraq(R) optical laryngoscope combined with bronchofibroscope for endotracheal in-tubation (EI) in patients with cervical spine injury (CSI). Methods 50 patients with CSI undergoing spine surgery under combined general anesthesia were randomly assigned to two groups, group A (n=25) received EI by using Airtraq(R) optical laryngoscope and group AF (n=25) received EI by using Airtraq(R) optical laryngoscope combined with bronchofibroscope. The intubation time (IT), success rate of single intuba-tion (SRSI), hemodynamic changes in endotracheal intubation, and complications related to EI were observed. Results IT was significantly longer in group A than in group AF (P<0.001), and SRSI was significantly lower than in group A in group AF (P<0.05). There was no signif-icant difference in hemodynamic changes in EI and complications related to EI between two groups (P>0.05). Conclusion Airtraq(R) optical laryngoscope combined with bronchofibroscope would be safely and effectively used for EI in patients with CSI.

AIM: To observe the changes of morphology, the activity of myeloperoxidase (MPO) and membrane pump activities of spleen tissue in acute renal failure (ARF) rabbits, and to inquire into the role of spleen on pathogenesis of immune function disorders during ARF. METHODS: 42 rabbits were divided into control group, HgCl_2 group and glycerinum group. The ARF model was established by hypodermic injection of 1% HgCl_2 at dose of 1.3 mL/kg in HgCl_2 group, intramuscularly injection of 50% glycerinum at dose of 10 mL/kg in glycerinum group, respectively, and the animals were divided into the 12 h, 24 h, 48 h secondary groups (6 rabbits each group). At different time points, the rabbits were cannulated to facilitate the collection of blood sample to examine the biochemical indexes of renal function. The spleen microscopic sections were prepared for observing the morphology. The spleen homogenate was made for determining the activities of MPO and membrane pumping. RESULTS: Pathological sections of spleen showed that the different degree of congestion was found and spleen trabecula was increased in two model groups at multiple-time points. The MPO activity of spleen homogenate in HgCl_2 group and glycerinum group at all time points were obviously higher than that in control group, and at 24 h, the MPO activitie in two model groups was significantly increased than that in the same group at 12 h and 48 h. The activities of Na~+-K~+-ATPase, Ca~(2+)-ATPase, Mg~(2+)-ATPase, Ca~(2+)-Mg~(2+)-ATPase of spleen homogenate in two model groups at multiple time points were significantly lower than those in control group. Following ARF development, the ATPase activitie in two model groups at 48 h was lower than that at 12 h except the Mg~(2+)-ATPase in glycerinum group. CONCLUSION: Spleen as an immune organ has histological damage, arrest of polymorphonuclear neutrophils and dysfunction of membrane pump during the development of ARF in rabbits, leading to immune disorders.