瑞得林在透析器复用灭菌中临床应用效果的探讨

目的 探讨慢性肾功能不全终末期行维持性血透患者透析器复用的主要危险因素及其有效的灭菌方法。方法 对血液透析患者热原反应发生率与透析器出、入口的细菌培养结果进行比较，并对30例透析患者使用3．5％瑞得林（Renalin）连接瑞得冲（Renatron）复用机与0．3％过氧乙酸手工复用透析器，比较两者尿素氮、肌肝的清除率。结果 使用3．5％瑞得林灭菌复用透析器时，细菌培养种类明显比0．3％过氧乙酸和1％甲醛少（P＜0．001）；3．5％瑞得林机器消毒透析器10次与用0．3％过氧乙酸手工5次复用的透析器肌酐清除结果相同，尿素清除明显优于手工（P＜0．001）。结论 3．5％瑞得林消毒液具有高效灭菌作用，在清洗透析器的同时，保护了透析膜的生物相容怀和毒素清除率，与瑞得冲合用可以增加透析器的使用次数，减少透析费用。     

透析器重复使用的临床评价

目的探讨透析器重复使用对患者的治疗费用、潜在风险及复用成本的影响。方法将178例血液透析患者按透析器使用次数分为单次使用组(n=94)和复用组(n=84),观察两组患者治疗费用、不良事件及透析器复用所需成本。结果单次使用组接受低通量血液透析(LFHD)8750例次和高通量血液透析(HFHD)653例次,费用分别为(565.46±4.82)元/次和(809.12±10.39)元/次,透析器复用组接受LFHD3840例次和HFHD4660例次,费用为(475.74±3.61)元/次和(529.57±10.55)元/次,两组均未见热原反应、透析器破膜和灭菌剂残余反应发生,未发现新增感染肝炎病例。采用全自动和半自动复用方式进行透析器复用,其复用时间和灭菌剂成本分别为(9.03±0.67)、(23.97±1.18)分钟/支和(9.20±0.14)、(2.01±0.23)元/支。结论复用组HFHD治疗费用明显低于单次使用组LFHD;而按规范进行透析器复用可有效避免风险发生。     

人工复用透析器及血路管的消毒方法探讨

透析器及透析管道的复用在临床上较为普遍,不但可以节省费用,而且透析器复用可以降低首次使用综合症,改善透析膜的生物相容性,目前多用过氧乙酸(PAA)作为透析管路的消毒剂.但也可因复用不当而引起不良反应,如热原反应等.我们监测了PAA消毒后透析器160个,管道160付,观察其消毒效果.     

密闭循环系统加热预冲复用透析器的应用观察

目的探讨密闭循环系统加热预冲复用透析器的应用效果。方法随机将200个复用透析器分为观察组和对照组（每组100套）。观察组采用密闭循环系统加热预冲法，对照组采用半开放式预冲法。结果两组灭菌剂残留检测均阴性，均未见热原反应发生；但观察组在生理盐水用量及护士工作量与对照组相比有统计学意义（P〈0．05）；两组灭菌剂排放途径不同。结论采用密闭循环系统加热预冲法可以降低透析成本，减少护士于作量及避免职业害。     

室内微小气候变化与装修后甲醛浓度的关系

[目的]了解室内微小气候变化与甲醛污染程度的关系。[方法]根据室内温度的不同分较冷、适宜、较热3组;按不同的湿度又分为湿度较小、舒适和湿度较大3种类型。分别对装修半年内的居室,不同温度和湿度下与甲醛浓度的相关性进行分析。[结果]3种温度下甲醛浓度的超标率由19.36%上升到65.18%和100%,差异有显著性(χ~2 =93.26;P<0.01)。随着室内湿度的增加,较冷组甲醛浓度超标率分别由4.35%上升到23.53%和31.82%,差异有显著性(χ~2=5.69,P<0.05);适宜组甲醛浓度超标率分别由42.86%上升到52.5%和90.91%,差异有显著性(χ~2=16.76,P<0.001);较热组甲醛浓度超标率均为100%,无差异。[结论]装修后的室内空气中甲醛的浓度与室内温度、湿度有着密切的联系。     

浅谈可复用透析器的半自动重复使用

目的减少透析器重复使用的不良反应,保证透析效果与复用的安全。方法将2008年4月～2009年4月期间复用透析器3066次及改进复用方法与之前比较。结果发热反应(凡透析1h左右患者出现畏寒发热现象)2次,发生率0.065%,与2007年4月～2008年4月相比,减少24%,破膜4次,发生率0.13%,减少66%。结论只要复用过程的每个步骤、处理方法一丝不苟地控制好,复用的不良反应是可避免的。复用对一般患者是安全的,既减轻经济负担,又达到了一定的透析效果。     

血透患者透析器及导管重复使用医院感染评价

本文报告血液透析患者一次性使用的透析器及导管（血管路），通过清洁和２％甲醛及２％次氯酸钠溶液消毒，取出用生理盐水冲尽残余的甲醛。但是透析器及导管消毒后重复使用，是直接与患者血液循环系统相连接，易导致血液循环发生热原反应或医院感染。本组，空心纤维透析器复用１２４７例次，其中抽样调查５４３例次，经统计学处理，医院感染８例，感染例次发生率为１．４８％，与文献报告相近。     

两种手术室内镜灭菌方法比较

目的 探讨方便、合格、能延长内镜寿命的灭菌方法.方法 对过氧化氢等离子低温灭菌法和2%戊二醛溶液浸泡灭菌法消毒内镜进行比较.结果 两种灭菌方法均达到灭菌要求;内镜采用戊二醛浸泡法灭菌每次需要10 h,过氧化氢等离子低温灭菌法灭菌每次需要55 min;灭菌相关器械损耗率分别为戊二醛浸泡法0.17%,过氧化氢等离子低温灭菌法为0,差异有统计学意义(P<0.01);灭菌剂毒性反应发生率分别为戊二醛浸泡法3.23%,过氧化氢等离子低温灭菌法为0,差异有统计学意义(P<0.05).结论 使用过氧化氢等离子低温灭菌器消毒内镜,灭菌周期短,质量可靠,对内镜损伤小,对人和环境无害,是内镜首选的灭菌方法.     

手术室腔镜器械清洗消毒灭菌方法的对比研究

目的:探讨医院手术室腔镜器械的优效的清洗消毒灭菌方法.方法:改进医院手术室腔镜器械清洗消毒灭菌制度和流程,重点针对腔镜器械灭菌环节分别采用以下二种方法进行比较.A组60例采用过氧化氢等离子灭菌器STERRAD100S进行灭菌,时间1h,灭菌后有效时间90d,B组60例使用2%戊二醛溶液浸泡消毒灭菌10h,灭菌后有效时间1d.结果:2组比较P<0.01.灭菌所需时间A组比B组明显缩短,而灭菌后有效时间A组比B组明显延长.经统计学处理差异有显著性,结论:A组灭菌方法不仅快速,而且灭菌有效时间长,便于储存,值得推广.是提高灭菌质量的重要手段.     

胎膜早破时间与绒毛膜羊膜炎的相关性研究

目的?对胎膜早破时间与绒毛膜羊膜炎的相关性进行研究.方法?抽取2010年9月—2011年9月期间出现胎膜早破的患者63例,其中不同破膜时间段的患者各有21例,分别为A组、B组以及C组.对三组患者绒毛膜羊膜炎发生率以及其严重程度进行了解,并且进行比较分析.结果?A组的绒毛膜羊膜炎的发生率为38.09%;而B组中绒毛膜羊膜炎的发生率为66.67%;而C组的绒毛膜羊膜炎的发生率为85.71%.即相对于A组,B组、C组中患者的绒毛膜羊膜炎的发病率较高,P<0.05;而相对于B组,C组中患者的绒毛膜羊膜炎的发病率较高,P<0.05,差异有统计学意义.结论?破膜时间的延长一定程度上会导致患者绒毛膜羊膜炎的发生率提高以及疾病情况的加重,应进行相应的防治措施.     

长春新碱过量引起严重毒副反应1例的护理体会

报道1例霍奇金淋巴瘤患者因误用长春新碱（VCR）10mg一次性静脉推注后治疗护理情况。其出现间断性神志恍惚、眼睑闭合不全、言语不清、口腔黏膜糜烂、全身疼痛、麻痹性肠梗阻、尿潴留、手足麻木等症状,经积极解救,禁食,持续胃肠减压、胃管内注入麻油、开塞露、生理盐水灌肠,合理应用肠外营养,注重疼痛、心理护理,做好口腔、肛周护理,预防感染加重,患者病情得到控制好转出院。     

Correlates of stages of change of smoking among inhabitants of deprived neighbourhoods

BACKGROUND: This study examines the prevalence and correlates of stages of change of smoking, in terms of psychosocial, structural and sociodemographic factors, among inhabitants of deprived neighbourhoods. METHODS: Cross-sectional data were obtained from a survey on health related behaviour. Subjects were 2009 current and former smokers, aged 20-46, living in deprived neighbourhoods in Rotterdam, the second largest city in the Netherlands. Three groups of smokers were formed according to the stages of change-definitions of the Transtheoretical Model: smokers not planning to quit (precontemplators), smokers planning to quit (contemplators/preparators) and former smokers (actors/maintainers). Smokers planning to quit and smokers not planning to quit were compared regarding psychosocial factors (attitude, social norm, self-efficacy), structural factors (neighbourhood problems, material deprivation, financial problems, employment status) and sociodemographic factors (age, gender, marital status, cultural background, educational level). Former smokers were compared with smokers planning to quit regarding structural and sociodemographic factors. Logistic regression was used to assess correlates of stages of change. RESULTS: Smokers planning to quit (prevalence = 19%) reported a more positive attitude, stronger social norms and higher self-efficacy expectations in quitting smoking than smokers not planning to quit (prevalence = 57%). Smokers planning to quit less often were Dutch-born, more often had attended higher vocational schooling or university and more often reported experiencing two or more neighbourhood problems compared to smokers not planning to quit. Former smokers (prevalence = 24%) were older, more often Dutch-born, married, employed and higher educated, compared to smokers planning to quit. Furthermore, former smokers less often reported material deprivation and financial problems than smokers planning to quit. CONCLUSION: Among people living in deprived neighbourhoods, different factors correlate with different stages of change of smoking. Implications for health promotion are discussed.     

Choice of measures of vaccination and estimates of risk of pediatric pertussis

BackgroundVaccination uptake at the individual level can be assessed in a variety of ways, including traditional measures of being up-to-date (UTD), measures of UTD that consider dose timing, like age-appropriate vaccination, and risk reduction from individual doses. This analysis compared methods of operationalizing vaccination uptake and corresponding risk of pertussis infection.MethodsCity-wide case-control study of children in Philadelphia aged 3 months through 6 years, between 2001 and 2013. Multiple logistic regression was used to isolate the independent effects of each measure of vaccination uptake and the corresponding relative odds of pertussis.ResultsBeing UTD on vaccinations was associated with a 52% reduction in risk of pertussis (OR 0.48, 95% CI: 0.34, 0.69). Evaluation of delayed receipt of vaccine versus on-time UTD yielded similar results. There was a decrease in risk of pertussis for each additional dose received with the greatest reduction in pertussis infection observed from the first (OR 0.48, 95% CI: 0.28, 0.83) and second dose (OR 0.17, 95% CI: 0.08, 0.34). Additional doses conferred minimal additional protection in this age group.ConclusionExamining vaccination status by individual doses may offer improved predictive capacity for identifying children at risk for pertussis infection compared to the traditional UTD measure.     

上海市某医院骨科平均住院日影响因素分析

对上海市某医院2003年-2007年骨科出院病人的住院日描述性分析．2003年-2007年骨科的床位利用指数与平均住院日相关性分析．2003年-2007年骨科床位与医护比例分析．2007年骨科前10大病种平均住院目影响因素分别进行单因素相关性分析和多因素逐步回归分析（STATA软件）。通过对骨科10大病种住院日影响因素分析,术前等待天数、手术类型、是否输血分别对10个、9个和8个病种的住院目有影响。输血因素和手术类型是医院不可控、由病人的病情决定的,术前等待天数是管理因素,是最值得医院重视的影响因素。     

两种不同肌瘤剔除术治疗子宫肌瘤的临床疗效比较

目的:比较腹腔镜子宫肌瘤剔除术与腹式子宫肌瘤剔除术的临床疗效。方法:回顾分析63例腹腔镜子宫肌瘤剔除术与61例腹式子宫肌瘤剔除术的临床资料,比较2种手术方式的手术时间、术中出血量、肛门排气时间、使用抗生素时间、术后感染率、体温恢复正常时间、住院时间等情况。结果:两组患者接受子宫肌瘤剔除术顺利完成,腹腔镜组手术时间长于开腹组(P0.05),腹腔镜组术中出血量及剔除肌瘤个数均少于开腹组(P0.05),术后腹腔镜组体温恢复正常时间、肛门排气时间、抗生素使用及住院时间均短于开腹组,两组患者最多随访6个月,腹腔镜组平均康复时间较开腹组短(P0.05),两组随访B超均未发现明显肌瘤结节。结论:腹腔镜子宫肌瘤剔除术损伤小,恢复快,住院时间短,是值得推广的微创手术。     

尘肺病患者145例死因调查

目的分析汉中市尘肺病的发生、发展和死亡原因，以提高尘肺病患者的生存质量。方法对145例尘肺病患者的死因进行回顾性分析，计算其平均发病年龄、死亡年龄及患尘肺病后的存活年限。结果矽肺的平均发病年龄和死亡年龄均早于煤工尘肺和石棉肺，尘肺病的主要死因为患肺部疾患，患尘肺病后的平均存活年限为12a。结论加强职业健康体检工作，对尘肺病人做到早发现早治疗和预防并发症的发生。     

性发育异常发病机制的研究进展

正常的性腺分化可分为3个过程：原始性腺形成、性别决定和卵巢/睾丸发育。在任一环节中,基因表达或调控发生异常均有可能导致性发育异常疾病的发生。性发育异常是指染色体、性腺和解剖性别不典型。随着分子生物学技术的发展,不断地发现新的基因或信号通路参与性腺分化和发育,如SRY、SF1、WT1、Sox9等基因与睾丸发育密切相关,Wnt/Rspo1/B连环蛋白通路、Dax1、Foxl2等基因在卵巢分化中发挥着重要作用,一些非编码RNA和转化生长因子也有重要的调节功能,且睾丸和卵巢发育均为主动过程,即使在出生后因某些基因的改变两者间也可出现横向分化。这些为揭示性分化异常的发病机制提供了可能。     

西林瓶装注射用水的装量检查分析

为了检查西林瓶装注射用水的实际分装量是否符合2005年版《药典》三部要求,按照2005年版《药典》三部中“生物制品分装和冻干规程”,分装规格为0．8ml的西林瓶装注射用水10000瓶,随机在分装过程的前、中、后阶段共抽取100瓶,轧盖、目检。分别用1ml标定注射器及1ml普通无菌注射器抽取每瓶注射用水的实际体积,以t检验法对实际抽取量与标示量的差值进行统计学分析,结果显示其与2005年版《药典》三部要求分装附加量为0．1ml相比有显著性差异（P〈0．001）。     

One-year stability of the Measure of Processes of Care

BACKGROUND: The Measure of Processes of Care (MPOC) is a 56-item self-administered measure designed to examine what parents of a child with a chronic health problem think of the services they and their child receive, and to measure the extent to which these services are family-centred. Reliability and validity of the MPOC were established in prior studies. The aim of the present study was to assess the 1-year stability of the MPOC to justify its use as an evaluative tool. METHODS: Nine paediatric rehabilitation centres in the Netherlands participated in this short longitudinal survey study. Subjects were 205 parents (response rate 74.8%) of children aged 1-18 years who received care in one of the participating paediatric rehabilitation centres. All subjects filled out two MPOCs with a 1-year interval. RESULTS: All correlations between the scale scores of the MPOC at the first and second administration were relatively high and significant (range: 0.443-0.609, all P < 0.001), demonstrating high inter-individual stability. However, all mean scale scores, except for Providing General Information, significantly reduced after 1 year. CONCLUSIONS: The MPOC has a moderate 1-year stability. However, because of its tendency to score lower when repeated after 1 year, its use as an evaluative follow-up instrument to assess the effectiveness of a programme intervention is restricted.     

儿童皮质发育畸形的MRI诊断

目的探讨儿童皮质发育畸形(MCD)的MRI表现特点,为MCD的早期诊断提供依据。 方法选择2010年1月至2012年12月在四川省医学科学院·四川省人民医院放射科经MRI检查确诊为MCD的44例患儿为研究对象。回顾性分析及总结其MRI影像学特征。本研究遵循的程序符合四川省医学科学院·四川省人民医院人体试验委员会制定的伦理学标准,得到该委员会批准,征得受试对象及其监护人知情同意,并与监护人签署临床研究知情同意书。 结果本组44例经MRI确诊为MCD患儿中,巨脑回-无脑回为17例,多小脑回为14例,灰质异位为9例,脑裂畸形为4例。MCD的MRI特点中,巨脑回表现为脑回增宽、皮质增厚及白质变薄;无脑回表现为正常脑沟、脑回消失,皮质增厚及白质变薄;多小脑回表现为脑回增多、细小;灰质异位表现为皮质下及侧脑室周围深部白质区结节状、团块状或带状病灶,信号与灰质信号相同;脑裂畸形表现为从侧脑室到脑表面贯穿大脑半球的裂隙,表面覆盖灰质。 结论MRI是诊断儿童MCD的可靠影像学方法。