多参数监护仪的质控检测初探

目的通过对多参数监护仪的质控工作,掌握在用多参数监护仪的性能现状,提高其使用的安全性和准确性。方法心脏重症监护病房（CCU）的24台某品牌多参数监护仪。采用Fluke专业的质控设备对多参数监护仪的电气安全、心电、血氧、血压、呼吸等进行检测。结果一次合格率为75％,二次合格率为95．8％,其中心率检测有3台不合格,无创血压检测有2台不合格．血氧饱和度检测有2台不合格：不合格主要原因是心电导联线、袖带、血氧探头的老化。结论加强医疗设备的质量控制关系重大．要制定合理的质控方案,确保医疗设备的安全性和准确性。     

普美康DM系列除颤监护仪的维护与故障排除

除颤监护仪作为医院常用复苏急救设备,主要应用于急危重症状的抢救,除颤监护仪应该随时处于"待命"状态,一旦出现故障,将会严重影响到抢救工作的成败。本文主要介绍德国生产的普美康DM系列除颤监护仪的维护以及故障排除,以期为临床上普美康DM系列除颤监护仪的维护和故障排除提供相应帮助。     

新生儿疾病筛查不合格血片原因分析及对策

目的分析不合格血片的原因,采取相应对策提高工作质量。方法对2012年1月～2013年9月不合格新生儿疾病筛查血片的不合格原因进行分类统计分析。结果血片不合格率为0.43%,血片不合格主要原因为血斑被污染（36.6%）。乡镇卫生院不合格率最高。结论应采取措施对标本采集人员加强培训,提高血片合格率。     

医用注射泵质量控制与数据分析

目的 为进一步规范医用注射泵质量控制，探讨医用注射泵质量控制。方法 选择陆军特色医学中心在用医用注射泵941台，分布在中心56个临床病区，如重症监护病房、急诊科、麻醉科、神经外科等。医用注射泵品牌有12个，分别为德国贝朗、德国费森尤斯、日本泰尔茂、深圳迈瑞、山东威高等。依据军队规范《输液泵和注射泵质量检测技术规范（试行）》，采用Datrend Infutest 2000E型输注泵检定仪进行质量检测，并分析查找相应的原因。结果 2021年，医用注射泵周期检测941台，有67台初检不合格，初检合格率为92.9%。引起医用注射泵初检不合格的主要原因是科室人员操作不规范或对潜在风险危害不清楚，未及时替换设备进行维修。提出整改措施和建议。结论 探索医用注射泵质量控制与分析，有助于提升医疗安全和医疗质量，具有重要的现实意义。     

检验科应加强与护理工作的联系

随着现代医学的发展,临床与实验室的关系日益密切,大多数疾病的诊断、治疗以及预后观察都建立在实验室指标的准确可靠的基础之上的.这就对实验室提出了加强质量控制的要求.而在所有环节中,分析前质量控制在临床检验工作中又占有重要的位置,送检标本的合格率将直接影响到检测结果的准确性和首检的阳性率, 有文献报道,如采集标本不规范(占 6～8%)、采集时间不对(占2.2%)、标本采集后未及时送检(占22.2%)、标本不合格(占2.3%)等,给检测结果带来了不少影响.保证送检标本的合格是检测工作中分析前质控的主要环节,是保证检验结果真实性的前提和首要条件,而这一过程,就基本掌握在临床护理人员手中.     

自贡市无偿献血血液检测不合格率构成分析

目的 分析自贡市献血者血液检测不合格的构成情况,降低血液检测不合格率。方法 分析本市2012~2016年无偿献血者的构成、血液检测不合格情况,对不合格献血者的不合格项目、性别、文化程度进行相关性分析。结果 ①2012~2016年本市血液检测总体不合格率6.51%,不合格率呈逐年降低趋势;②文化程度大专及以上不合格率为1.71%,中等职业不合格率为1.56%,初中及以下文化程度不合格率为3.24%;③男性不合格率3.89%,女性不合格率2.62%;④ALT不合格占总不合格样本的36.01%,HBsAg不合格占总不合格样本的29.81%,两者所占比例最大,其次是抗-TP,占19.63%。结论 ①血液检测不合格的原因主要是ALT和HBsAg不合格,其次是抗-TP;②文化程度越低的献血者血液不合格率越高;③男性献血者血液不合格率大于女性献血者血液不合格率。     

始兴县2009-2013年医疗机构消毒质量监测分析

目的了解始兴县城乡医疗机构消毒质量现状,分析存在的问题,为科学指导消毒工作、预防和控制院内感染提供科学依据。方法收集2009-2013年按照统一的技术方案对医疗机构进行消毒质量监测的数据,并用SPSS11.0软件进行统计分析。结果 2009-2013共检测样品5 059份,合格4 057份,合格率为80.19%,5年的合格率比较差异有统计学意义（χ^2=55.32,P〈0.01）。县、镇、村三级医疗机构的消毒质量监测总的合格率依次为92.88%、86.07%、73.60%,差异有统计学意义（χ^2=190.85,P〈0.01）,尤其是村卫生站的消毒质量合格率很低。监测项目中,以使用中消毒液的合格率89.98%为最高,其次物体表面87.84%。医务人员手合格率为72.78%,空气中细菌含量的合格率最低（66.51%）。结论始兴县近年医疗机构消毒质量逐年提高,但仍存在较大问题,以村卫生机构最为突出。     

多参数心电监护仪无创血压校准及质量控制应用

多参数心电监护仪可以连续实时检测患者的生命体征,帮助医生了解病人生理参数的变化。其参数准确性就显得尤为重要。本文中采用监护仪血压参数不准实例,通过监护仪分析仪进行血压测试和校准,然后对比所测数据并分析是否符合国家计量规定的误差范围值,从而确保医用监护仪在临床中的安全使用,保障患者的安全。【关键词】监护仪;血压校准;质量控制;检测方法     

医学实验室标本不合格的情况分析

目的探讨医学实验室标本不合格的特点和原因,以采取预防措施,保证检验质量。方法回顾性分析广东省中医院芳村分院检验科2008-2009年不合格标本的特点和原因。结果不合格标本数为1945份,标本总不合格率为0.65%;所有不合格标本中,血气标本和细菌标本不合格率最高,分别为1.94%和1.98%;不合格标本的主要原因为抗凝标本有凝块、条码错误和标本溶血。结论临床医护人员标本采集操作不规范是造成不合格标本的根本原因,因此,加强对检验标本的采集和处理等分析前质量控制力度显得尤为重要。     

新疆南疆地区2015年度新生儿疾病筛查首次采集血片质量情况分析

目的分析新疆南疆5市37区县2015年度新生儿疾病筛查血片质量情况,探讨南疆地区2015年新生儿疾病筛查不合格血片的原因。方法根据《新生儿疾病筛查血片采集技术规范》对南疆地区2015年新生儿疾病筛查的血片质量进行分析,统计不合格血片数量并分析造成不合格的原因。结果新疆南疆地区2015年度筛查新生儿192 633例,筛查率为62.716%;首次采集血片不合格数5900例,不合格率为3.000%;首次补采血片2029例,平均首次补采率为34.39%;共有六类不合格血片构成,最主要原因是血片污染。结论血片采集是新生儿疾病筛查的重要环节,血片质量是否合格将直接影响新生儿疾病筛查检测结果的准确性,提高血片质量对南疆地区新生儿疾病筛查有重要的意义。     

腹腔镜手术机器人应用质量与安全评价标准体系研究

腹腔镜手术机器人能提高操作精度,缩短手术用时,患者出血少,恢复速度快。近年来,国产创新手术机器人的研发取得了显著成果,但目前国内外缺乏相关评价标准,增加了临床应用的风险。为科学评价腹腔镜手术机器人的应用质量与安全,急需研究建立质量检测与评价标准。该研究从控制系统、图像质量、机械精度、电气安全4个维度优选评价指标。在控制系统方面选取软件功能检测规范指标;在图像质量方面选取图像质量检测规范指标;在机械精度方面选取机械臂检测规范指标;在电气安全方面选取设备外观检测规范和产品故障预防与维护控制规范两个指标。通过验证试验研究合理可行的检测与评价方法,为腹腔镜手术机器人的应用质量与安全评价提供依据,填补国内外腹腔镜手术机器人相关标准方面的空白。     

Temporal stability and precision of ventricular defibrillation threshold data.

Over 200 measurements of the minimum damped sinusoidal current and energy for transchest electrical ventricular defibrillation (ventricular defibrillation threshold) were made to determine the stability and precision of threshold data in 15 pentobarbital-anesthetized dogs. Threshold was determined by repeated trials of fibrillation and defibrillation with successive shocks of diminishing current, each 10% less than that of the preceding shock. The lowest shock intensity that defibrillated was defined as threshold. In three groups of five dogs each, threshold was measured at intervals of 60, 15, and 5 min over periods of 8, 5, and 1 h, respectively. Similar results were obtained for all groups. There was no significant change in mean threshold current with time. Owing to a decrease in transchest impedance, threshold delivered energy decreased by 10% during the first hour of testing. The standard deviations for threshold peak current and delivered energy in a given animal were 11% and 22% of their respective mean values. Arterial blood pH, Pco2, and Po2 averaged change of pH, PCO2 and PO2 were not significantly different from zero. The data demonstrate that ventricular defibrillation threshold is a stable physiological parameter that may be measured with reasonable precision.     

Design and evaluation of an ultrasound-based bladder volume monitor

Ultrasonic bladder volume monitors have successfully been used in the diagnosis and treatment of various urological disorders. Ultrasonic bladder monitors have been developed but they have either been too bulky or too simple and inaccurate. A new, wearable ultrasonic bladder volume monitor has been designed for urological patients. The instrument consists of seven phased-array ultrasonic transducers ergonomically arranged in a circular pattern to optimise detection of the bladder walls perpendicular to the abdominal wall. A Bluetooth radio link was used to transmit data to a laptop computer, where the main signal processing was performed. After detection of bladder surface points, a three-dimensional convex hull representing the bladder was generated, and the volume was estimated. Accuracy, precision, drift over time, temperature dependency and dynamic performance were evaluated using ultrasound phantoms. Furthermore, the system was tested on one volunteer using magnetic resonance imaging (MRI) as reference. The apparatus showed no significant drift, systematic error or temperature effects. Percentage error during static volume measurements had a 95% central prediction interval of ±7.5% and mean absolute percentage error of 2.9%. The dynamic performance analysis showed linearity in the analysed volume interval. The in vivo study showed a high degree of correlation (R²=0.99) between the volume measured using MRI and that measured with the apparatus.     

Effects of defibrillation shock energy and timing on 3-D computer model of heart

We present computer simulations of electrical defibrillation in a three-dimensional model of the ventricles of the heart. In this model, calledHeartSim, the ventricles are represented by 1473 cubic elements with 3 mm sides. The action potential is described by five discrete states; absolutely refractory, three relatively refractory, and repolarized. Activation is propagated to an element's six orthogonal neighbors with the conduction velocity dependent on the refractory state of the neighbor. Delivery of several extra-stimuli with decrementing coupling intervals results in ventricular fibrillation. Following the onset of ventricular fibrillation, we simulate defibrillation using various electrode configurations, shock energies, and timings. The current density distributions in the heart model resulting from the defibrillation shocks are determined from finite element analysis of the electric fields produced by the delivery of high energy shocks. The simulations suggest that successful defibrillation shocks produce a short period of low activation followed by a complete cessation of activation for a duration of 387±162 ms. In contrast, unsuccessful shocks produce a significantly shorter period of low activation (70±12 ms) after which ventricular fibrillation resumes.HeartSim mimics the experimentally reported, highly variable response to near-threshold shocks — the energy for successful defibrillation varies widely (20.8±20.7 J). In addition, the success rate vs. energy curve has a sigmoidal shape that is consistent with experiments. We demonstrate that this variability in the energy requirement results from dynamic variability in the number of elements made refractory by the shock and the relative distribution of the activation pattern at the time of the shock. Further, we show that it may be possible to lower the defibrillation energy requirements by delivery of two successive low energy pulses. The most efficient timing for the second pulse corresponds to the repolarization of the elements that were excited by the first pulse. Thus, when the interval between the two pulses was 85±18 ms, the defibrillation threshold energy (DFE) is reduced by 30.7±10% with pulses of 10 ms duration, and 62.6±7.9% with pulses of 5 ms duration. Our simulations also show that there is a delicate balance of energy between the two pulses that must be reached in order to achieve energy reduction with double pulse defibrillation. In conclusion,HeartSim serves as a tool for studying the underlying mechanisms of the effects of DF shocks on ventricular arrhythmias, and assists in evaluation of improved strategies for shock delivery.     

Real world teleradiology

Digital mammography can potentially improve mammography image and interpretation quality. On-line interpretation from a workstation may improve interpretation logistics and increase availability of comparison images. Interpretation of eight 4k- × 5k-pixel mammograms on two to four 2k- × 2.5k-pixel monitors is problematic because of the time spent in choosing which images to display on which monitors, and zooming and roaming on individual images that are too large to display completely at full resolution. The authors used an eyetracker to measure radiologists viewing behavior during mammography interpretation with film on a viewbox. It was observed that a significant portion of the mammographers' time is spent viewing “comparison pairs” (typically two or more comparisons per case), such as the left mediolateral and craniocaudal images or old and new images. From the eyetracker measurements, we estimated that the number of images display, roam, and zoom operations decreases from an average of 64 for one monitor to 31 for four monitors, with the largest change going from one to two monitors. We also show that fewer monitors with a faster response time is superior to more monitors with a slower response time. Finally, the authors demonstrate the applicatity of time-motion analysis to mammographic workstation design.     

Assessment of balanced biphasic defibrillation waveforms in transthoracic atrial cardioversion.

Various electrical pulses have been used for defibrillation. The monophasic damped sinusoid waveform, initiated in 60 s, was adopted in virtually all defibrillators. Biphasic pulses were introduced recently, achieving success with less energy. A biphasic exponential waveform was modelled with 4 ms duration per phase with a balanced 3:1 ratio of the first to second phase peak voltages and implemented in a defibrillator. A version obtained by chopping the pulses with a 5 kHz frequency was also used. It was hypothesized that the modelled transmembrane voltage decay time is a parameter that could be associated with successful defibrillation. The results of cardioversion for two groups of patients with the 'classic' monophasic waveform and with the biphasic pulses were compared. The mean efficient energy with the damped sinusoid was 205 +/- 85 J, versus 88 +/- 43 J with the biphasic pulses, yielding a ratio of 2.32 (1.92 to 3.2 for fibrillation and flutter, respectively). An acceptable agreement between model data and clinical results was found. The transmembrane voltage decay time ratios for monophasic versus biphasic pulses was in the approximate range of 2.5 to 3.5.     

Effects of cardiac configuration,paddle placement and paddle size on defibrillation current distribution: a finite-element model

The present rationale for clinical defibrillation is empirically based, and the technique is the same for different paddle locations and anatomical configurations. Using a two-dimensional finite element model, we studied the effects of such variations on the distribution of myocardial current during defibrillation, and developed a method to quantitatively assess the potential for a defibrillating shock to cause myocardial damage. We used this method to compare five paddle placements, two paddle sizes and three variations of thoracic anatomy. Anatomical variations did not affect current distributions during electrical defibrillation, whereas paddle position had a marked effect. Paddle positions close to the heart with interposed bony structures between the heart and electrode produced focal regions of much higher than average myocardial current magnitudes. Myocytes in the highest current intensity regions dissipated 49 times the energy dissipated by cells exposed to threshold current magnitudes, potentially causing focal myocardial damage. An alternative paddle position was identified which significantly improved the myocardial current distribution. Maximum energy dissipation was only 4·8 times threshold energy, while defibrillation efficiency was reduced by <7 per cent, minimising the risk of myocardial damage. These results suggest that paddle position plays a dominant role in determining myocardial current distributions and defibrillation-induced damage.     

An energy-time analysis of ventricular fibrillation and defibrillation thresholds with internal electrodes

The paper describes experimentation with the intracardiac production and termination of ventricular fibrillation, the ultimate goal being the design of an automatic implantable defibrillation device. Fibrillation and defibrillation thresholds were identified by means of increasing electrical-shock energies on dogs via internal electrodes. A maximum energy, called VF type I (VF₁), has been demonstrated and is defined as the highest electrical-shock energy which can evoke a resolvable and non-lesional fibrillation. Energies of a much higher order of magnitude produced a lesional and therefore unresolvable type of ventricular fibrillation (VF₁₁). The optimal defibrillation threshold is identified as the smallest shock energy which terminated VF₁ on all attempts. The high defibrillation energies (i.e 16–40 J) reported here and elsewhere are due, in part, to the relatively low resistivity of the blood compartment, which tends to short-circuit the electrical shock. In conclusion, a VF₁ window is mapped-out on an energy-time diagram, and a myocardial synchronous response threshold is proposed as being equivalent to both the maximum VF₁ energy and the optimal defibrillation threshold.     

Possibilities for predictive measurement of the transthoracic impedance in defibrillation

Transthoracic electrical defibrillation is administered by high voltages and currents applied through large size electrodes. Therefore, the defibrillator load impedance becomes an essential factor for the efficacy of the procedure. Attempts at prediction of transthoracic impedance by pre-shock measurement with lowamplitude high-frequency current have yielded apparently promising results. A reassessment was undertaken of the comparison between transthoracic impedance measured over a wide frequency range (bioimpedance spectroscopy) and measured during the shock. An estimation of the possibilities for pre-shock 'prediction' of the impedance was performed, to allow adequate selection of the defibrillation energy or current with the intention of increasing the possibility for positive results with the first shock. Data were obtained from experimental fibrillation/defibrillation cycles on dogs and from cardioversion of atrial fibrillation or flutter in patients. The final results suggest that high-frequency low-amplitude impedance measurements cannot predict the corresponding value during the shock with very high accuracy, as differences up to 15-17% were found using biphasic pulses in patients. However, the method can be used for approximate assessments.