(医务科调查分析与总结)临床检查适宜性定期分析和评价 (1).doc

沭阳中山医院2013年9月份临床检查适宜性调查考核序号科室抽查病历数临床检查适宜性合格率1神经内科697%2心内科695%3消化内科691%4骨科695%5泌胸科 696%6普外科694%7妇产科693%8儿科697%沭阳中山医院临床检查适宜性定期分析和评价医务科通过对2013年九月份全院各临床科室抽取相应数目的病历，检查医生开具的检查适宜性进行了分析和评价。各临床科室医生在诊疗活动中开具的检查单，应符合相关检查适宜性。具体检查结果总结如下：1、内科和外科抽查病历中出现无指征的化验项目，合格率90%。其余科室化验检查项目基本符合临床工作需要，适宜性合格率96%。2、外科存在一部分病历中出现无指征的影像学检查项目，如ct，mri，彩超等，合格率93%。其余科室影像学检查项目基本符合临床工作需要，适宜性合格率96%。 医务科 2013-12-25备注：各临床科室应根据患者以下适应症，按照要求开具检验报告单：一、肝功能检查方面：【检查项目】1门诊肝功能检查：谷丙转氨酶（alt）、谷草转氨酶（ast）、（a/g）、碱性磷酸酶（alp）-谷氨酰转肽酶(ggt)、总胆红素（tbil）、直接胆红素（dbil）、间接胆红素（i-bil）、白蛋白/球蛋白(a/g)。2住院肝功能检查：谷丙转氨酶（alt）、谷草转氨酶（ast）、碱性磷酸酶（alp）、-谷氨酰转肽酶(ggt)、乳酸脱氢酶（ldh）、单胺氧化酶（mao）、胆碱脂酶（che）、脂肪酶（lps）、ggt/alt、ggt/ast、ast/alt、白蛋白/球蛋白（a/g）、总胆汁酸（tba）、总胆红素（tbil）、 直接胆红素（dbil）3肝硬化指标（免疫室做）：包括型胶原、粘蛋白、透明质酸4血氨（nh3）【检查适应症】体检、各种肝胆疾患、急慢性肝炎、 肝硬化、 脂肪肝、肝脏肿物、用药过程中监测肝脏功能、有机磷中毒以及相关疾病的治疗复查二、肾功能检查【检查项目】肾功能：尿素（urea）、尿酸（ua）、肌酐（cr）、总胆固醇（tcho）、甘油三脂（tg）、肌酐清除率、微球蛋白三、糖尿病监测【检查项目】1血糖（glu）、胆固醇（tcho）、甘油三脂（tg）、-羟丁酸、糖化血清蛋白2糖耐量试验【检查适应症】 体检、肥胖人群、有糖尿病家族史者、型糖尿病患者疗效观察和用 药监测、心脑血管疾病以及相关疾病的治疗复查。四、血脂检查【检查项目】1血脂分析：甘油三酯（tg）、总胆固醇（tcho）、高密度脂蛋白胆固醇（hdl-c）、低密度脂蛋白胆固醇（ldl-c）载脂蛋白a（apo-a）、载脂蛋白b（apo-b）、脂蛋白a(lpa)2动脉硬化危险因素检测：甘油三酯（tg）、总胆固醇（tcho）、高密度脂蛋白胆固醇（hdl-c）、低密度脂蛋白胆固醇（ldl-c）、载脂蛋白a（apo-a）、载脂蛋白b（apo-b）、脂 蛋白a(lpa)、同型半胱氨酸（hcy）【检查适应症】 体检、肥胖人群、心脑血管疾病、有高胆固醇、高甘油三酯家族史者，糖尿病、肾病、肝脏病变 以及相关疾病的治疗复查。五、心肌损伤相关指标检测【检查项目】1心肌酶谱：谷草转氨酶（ast）、肌酸激酶（ck）、肌酸激酶mb亚型（ck-mb）、-羟丁酸脱氢酶（-hbdh）、乳酸脱氢酶（ldh）2心肌损伤指标：心肌肌钙蛋白i（c-tni）、ck-mb、ck3心梗危险因素预测：心肌肌钙蛋白t（c-tnt）、ck-mbmass、 超敏急性时相反应蛋白（超敏crp）【检查适应症】 急性心梗，心肌炎，多发性皮肌炎，怀疑心肌损伤以及相关疾病的治疗复查六、贫血检测【检查项目】贫血：血清铁、总铁结合力、转铁蛋白受体（免疫室做），叶酸、维生素b12【检查适应症】 帮助诊断贫血原因 以及相关疾病的治疗复查七、离子检查（血、尿）【检查项目】1微量元素（血清、头发）：钙（ca）、磷（p）、镁（mg）、锌（zn）、铜（cu）、铁（fe）2电解质（血清、尿液）：钾（k）、钠（na）、氯（cl）、二氧化碳（co2）【检查适应症】 怀疑缺钙、肾脏疾病、糖尿病、高血压肾病、肾上腺疾病、营养不良以及相关疾病的治疗复查。八、血、尿淀粉酶（amy）【检查适应症】 急慢性胰腺炎english is the most widely spoken language in the history of our planet, used in some way by at least one out of every seven human beings around the globe. half of the worlds books are written in english, and the majority of international telephone calls are made in english. english is the language of over sixty percent of the worlds radio programs. more than seventy percent of international mail is written and addressed in english, and eighty percent of all computer text is stored in english. english has acquired the largest vocabulary of all the worlds languages, perhaps as many as two million words, and has generated one of the noblest bodies of literature in the annals of the human it is now time to face the fact that english is a crazy language - the most lunatic and loopy and of all languages. in the crazy english language, the blackbird hen is brown, blackboards can be green or blue, and blackberries are green and then red before they are ripe. even if blackberries were really black and blueberries really blue, what are strawberries, cranberries, huckleberries, raspberries, and gooseberries supposed to look add to this insanity there is no butter in buttermilk, no egg in eggplant, no grape in grapefruit, no bread in shortbread, neither worms nor wood in wormwood, neither mush nor room in mushroom, neither pine nor apple in pineapple, neither peas nor nuts in peanuts, and no ham in a hamburger. (in fact, if somebody invented a sandwich consisting of a ham patty in a bun, we would have a hard time finding a name for it.)to make matters worse, english muffins werent invented in england, fries in france, or danish pastries in denmark. and we discover even more culinary madness in the that sweetmeat is made from fruit, while sweetbread, which isnt sweet, is made from this unreliable english tongue, greyhounds arent always grey (or gray); panda bears and koala bears arent bears (theyre marsupials); a woodchuck is a groundhog, which is not a hog; a horned toad is a lizard; glowworms are fireflies, but fireflies are not flies (theyre beetles); ladybugs and lightning bugs are also beetles (and to, a significant proportion of ladybugs must be male); a guinea pig is neither a pig nor from guinea (its a south american rodent); and a titmouse is neither is like the air we breathe. its invisible, inescapable, indispensable, and we take it for granted. but, when we take the time to step back and listen to the sounds that escape from the holes in peoples faces and to ex- the paradoxes and vagaries of english, we find that hot dogs can be cold, darkrooms can be lit, homework can be done in school, nightmares can take place in broad daylight while morning sickness and daydreaming can take place at night, tomboys are girls and midwives can be men, hours - especially happy hours and rush hours - often last longer than sixty minutes, quick- sand works very slowly, boxing rings are square, silverware and glasses can be made of plastic and tablecloths of paper, most are dialed by being punched (or pushed?), and most bathrooms dont have any baths in them. in fact, a dog can go to the bathroom under a tree - no bath, no room; its still going to the bathroom. and doesnt it seem a little bizarre that we go to the bathroom in order to go to the is it that a woman can man a station but as man cant woman one, that a man can father a movement but a woman cant mother one, and that a king rules a kingdom but a queen doesnt rule a? how did all those renaissance men reproduce when there dont seem to have been any renaissance writer is someone who writes, and a stinger is something that stings. but fingers dont grocers dont, haberdashers dont, hammers dont ham, and humdingers dont the plural of tooth is teeth , shouldnt the plural of booth be ? one goose, two geese - so one moose, two one index, two indices - one kleenex, two if people ring a bell today and rang a bell yesterday, why dont we say that they a ball? if they wrote a letter, perhaps they also their tongue. if the teacher taught, why isnt it also true that the preacher? why is it that the sun shone yesterday while i shined my shoes, that i treaded water and then trod on the beach, and that i flew out to see a world series game in which my favorite player flied we conceive a conception and receive at a reception, why dont we grieve a and believe a? if a horsehair mat is made from the hair of horses and a camels hair brush from the hair of camels, from what is a mohair coat made? if adults commit adultery, do infants commit infantry? if olive oil is made from olives, what do they make baby oil from? if a vegetarian eats vegetables, what does a humanitarian eat? (and im beginning to worry about those authoritarians.)and if pro and con are opposites, is congress the opposite of you have to believe that all english speakers should be committed to an asylum for the verbally insane. in what other language do people drive in a parkway and park in a driveway? in what other language do people recite at a play and play at a recital? in what other language do privates eat in the general mess and generals eat in the private mess? in what other language do people ship by truck and send cargo by ship? in what other language can your nose run and your feet can a slim chance and a fat chance be the same and a bad licking and a good licking be the same, while a wise man and a wise guy are opposites? how can sharp speech and blunt speech be the same and quite a lot and quite a few the same, while overlook and oversee are opposites? how can the weather be hot as hell one day and cold as hell the next? how can the expressions whats going on? and whats coming off? mean exactly the samton and unbutton and tie and untie are opposites, why are loosen and unloosen and ravel and unravel he same? if bad is the opposite of good, hard the opposite of soft, and up the opposite of down, why are badly and goodly, hardly and softy, and upright and downright not opposing pairs? if harmless actions are the opposite of harmful why are shameful and shameless behavior the same and pricey objects less expensive than priceless appropriate and inappropriate remarks and passable and impassable mountain trails are opposites, why are flammable and inflammable materials, heritable and inheritable property, and passive and impassive people the same and valuable objects less treasured than invaluable ones? if uplift is the same as lift up, why are upset and set up opposite in meaning? why are pertinent and impertinent, canny and uncanny, and famous and infamous neither opposites nor the same? how can raise and raze and reckless and be opposites when each pai