环氧乙烷的危害及医院消毒工作中的安全防护

本文从环氧乙烷（EO）的理化特点、毒性、工作场所空气EO浓度限量和医院消毒的EO暴露风险与防范等方面论述了EO的危害与防护。提出正确安装EO灭菌器，合理布局消毒室，加强个人防护是防止意外和中毒发生的有效措施。     

环氧乙烷灭菌方法的改进

随着医学科学的不断发展,环氧乙烷(Epoxy Ethane,EO)因其广谱而高效的杀菌性能,被广泛应用于不耐高温及精密仪器的灭菌.然而,美国国家毒理学计划和国际癌症研究机构指出,EO是一种致癌化学物,它与人体接触可引起细胞畸变和癌变,对人体有较强损伤[1].     

环氧乙烷灭菌方法的改进

随着医学科学的不断发展。环氧乙烷（Epoxy Ethane,EO）因其广谱而高效的杀菌性能,被广泛应用于不耐高温及精密仪器的灭菌。然而,美国国家毒理学计划和国际癌症研究机构指出,EO是一种致癌化学物．它与人体接触可引起细胞畸变和癌变,对人体有较强损伤[J]。因此,加强EO灭菌过程中的安全管理已引起人们的高度重视。我科对EO灭菌操作方法进行改进,大大提高其安全性能,介绍如下。     

慢性腰痛患者行8周腰椎稳定训练前后腹壁超声变化及其与临床预后的关系

目的 对慢性腰痛(chronic low back pain,CLBP)患者行8周腰椎稳定训练,并于训练前后进行腹壁超声测量,分析超声变化与患者临床预后的相关性.方法 选择2018年1月～2020年1月在本院就诊的74例CLBP患者,采用随机数字表法分为对照组和观察组各37例.对照组给予针刺和传统康复运动干预,观察组在对照组的基础上给予腰椎稳定训练,两组均干预8周.观察两组患者干预前后的VAS评分、Oswestry功能障碍指数(Oswestry disability index,ODI)变化,比较两组患者干预前后腹外斜肌(external oblique abdominal muscle,EO)、腹内斜肌(internal oblique muscle of abdomen,IO)和腹横肌(Transverse ab-dominal muscle,TrA)等收缩时厚度.以VAS变化差值中位数为分界点,比较观察组疼痛不同改善程度患者的EO、IO、TrA差值.结果 干预后,观察组患者的EO、IO、TrA值均较干预前显著升高(P<0.05),且高于同期对照组(P<0.05).干预后,两组患者VAS评分和ODI指数均较干预前显著降低(P<0.05),且观察组显著低于对照组(P<0.05).观察组VAS差值>3.5分患者的EO、IO和TrA差值均高于VAS差值≤3.4分患者,差异均有统计学意义(P<0.05).结论 8周腰椎稳定训练可改善CLBP患者的临床症状,减少腰部功能障碍,通过超声监测腹部肌肉变化可能是观察疗效的重要途径.     

骨伤科医院手术室护士X线防护情况调查与对策

目的了解骨伤科医院手术室护士对X线辐射防护意识、防护知识的了解情况和自身的防护行为,探讨合理应用X线、减少不必要辐射的措施.方法 对60名手术室在岗护士采用自行设计的X线辐射防护认知和行为问卷进行评估.结果 98.3%护士担心工作中受到辐射,但仅23.3%护士接触X线时经常穿戴防护装备.接受过防护知识培训的护士其防护知识及防护行为得分显著高于未培训者(P<0.05,P<0.01).结论 手术室护士防护意识较好,防护知识与防护行为有待于加强.手术室应完善有关制度,提供充分的防护设备和加强手术室护士职业防护培训教育.     

结直肠癌中临床数据与解剖学位置和疾病阶段的关联

肯尼亚国家医院的Saidi HS, Karuri D, Nyaim EO将253例结直肠肿瘤分为右结肠(RCC)、左结肠(LCC)和直肠(RC)3组,以研究肿瘤的临床数据与其解剖学位置和疾病阶段的关系.     

血液透析耗材消毒与血液透析室复用间空气污染关系的对照研究

目的 探讨优化血液透析器、血路管消毒方法和血液透析室复用间防护措施,降低消毒液微粒对空气污染及人体健康的影响.方法 采用过氧乙酸化学消毒液行透析器和血路管3种消毒措施.试验组为自动消毒方法与有防护设施;对照 A 组为传统手工消毒方法与无防护设施;对照B组为传统手工消毒方法与有防护设施.消毒时在实验室内5个高度、140 ...     

连续硬膜外阻滞联合臭氧治疗颈源性头痛的疗效分析

目的探讨连续硬膜外腔阻滞联合臭氧硬膜外腔注射治疗颈源性头痛的临床疗效。方法诊断为颈源性头痛的患者40例,随机分为连续硬膜外腔阻滞组(E组)和连续硬膜外腔阻滞联合臭氧注射组(EO组)。两组患者接受持续硬膜外注射治疗3周,EO组每48小时给予硬膜外腔臭氧注射,每次10ml(30μg/ml),记录两组治疗前及治疗后1和2周及1、3、6个月的治疗效果,采用VAS评分及其改良Macnab疗效评定标准评价各时点的治疗优良率。结果与治疗前比较,治疗后两组VAS评分明显降低(P0.05);EO组在治疗后1、3和6个月时VAS评分均明显低于E组(P0.05)。治疗后1、3和6个月时EO组的治疗优良率明显高于E组(P0.05)。结论连续硬膜外腔阻滞联合臭氧治疗颈源性头痛,远期效果优于单纯连续硬膜外腔阻滞,值得临床选用。     

新疆维吾尔族护生实习前职业防护意识调查

目的 了解新疆地区维吾尔族(下称维族)护生实习前职业防护意识的现状.方法 对68名维族大专护生实习前的职业防护意识进行问卷调查,并与60名汉族护生进行比较.结果 维、汉族护生职业防护知识和行为比较,差异有显著性意叉(均P＜0.05).结论 维族护生的职业防护意识不容乐观,建议实习前应针对维族护生特点,加强其职业防护知识与行为的培训,提高职业防护意识,减少职业伤害.     

传染病医院护士职业防护现状调查

目的 了解传染病医院护士在护理工作中的防护行为、自我防护意识及知识掌握情况,以提高其自我安全防护意识.方法 采用调查问卷对157名护士自我防护知识、自我防护行为及因工作感染疾病状况和原因进行调查.结果 在暴露性护理操作中每次和经常进行防护者分别为7.0%～87.9%、7.0%～47.0%;防护知识掌握率为32.5%～70.7%,需要防护知识培训者87.9%,需要定期体检和预防接种者100%;因工作而感染疾病者23.6%,主要原因为未采取防护措施.结论 需加强护士职业防护知识的教育和培训,提高其安全防护意识,避免职业暴露感染疾病.     

Perioperative and long-term morbidity and mortality after above-knee and below-knee amputations in diabetics and nondiabetics

We performed a retrospective review of a vascular surgery quality assurance database to evaluate the perioperative and long-term morbidity and mortality of above-knee amputations (AKA, n = 234) and below-knee amputations (BKA, n = 720) and to examine the effect of diabetes mellitus (DM) (181 of AKA and 606 of BKA patients). All patients in the database who had AKA or BKA from 1990 to May 2001 were included in the study. Perioperative 30-day cardiac morbidity and mortality and 3-yr and 10-yr mortality after AKA or BKA were assessed. The effect of DM on 30-day cardiac outcome was assessed by multivariate logistic regression and the effect on long-term survival was assessed by Cox regression analysis. The perioperative cardiac event rate (cardiac death or nonfatal myocardial infarction) was at least 6.8% after AKA and at most 3.6% after BKA. Median survival was significantly less after AKA (20 mo) than BKA (52 mo) (P < 0.001). DM was not a significant predictor of perioperative 30-day mortality (odds ratio, 0.76 [0.39-1.49]; P = 0.43) or 3-yr survival (Hazard ratio, 1.03 [0.86-1.24]; P = 0.72) but predicted 10-yr mortality (Hazard ratio, 1.34 [1.04-1.73]; P = 0.026). Significant predictors of the 30-day perioperative mortality were the site of amputation (odds ratio, 4.35 [2.56-7.14]; P < 0.001) and history of renal insufficiency (odds ratio, 2.15 [1.13-4.08]; P = 0.019). AKA should be triaged as a high-risk surgery while BKA is an intermediate-risk surgery. Long-term survival after AKA or BKA is poor, regardless of the presence of DM.     

Body composition assessment and methodology in nonathletic and athletic adolescent and adult males and females

The purpose of this review is to outline methodology for assessing body composition utilizing anthropometric and densitometric techniques. The objective of body composition assessment is to measure body fat and lean body mass. The quantity of these components varies due to growth, physical activity, dietary regimens, and aging. Anthropometric techniques incorporate selected skinfolds, circumferences, skeletal widths, or other variables to estimate body composition within k2.0-4.0%. These techniques are adequate for field testing of groups or individuals, but are population specific. Densitometry measures body volume irrespective of physique, sex, or age. This laboratory technique estimates body composition within 1.0-2.0%, is more difficult to administer, but is not population specific. Some limitation exists with any present technique due to biological variability and incomplete research of reference body composition in children, females, and the aged. J Orthop Sports Phys Ther 1984;5(6):336-347.     

Postoperative nausea and vomiting and opioid-induced nausea and vomiting: guidelines for prevention and treatment

Postoperative nausea and vomiting (PONV) causes patient discomfort, lowers patient satisfaction, and increases care requirements. Opioid-induced nausea and vomiting (OINV) may also occur if opioids are used to treat postoperative pain. These guidelines aim to provide recommendations for the prevention and treatment of both problems. A working group was established in accordance with the charter of the Sociedad Espa?ola de Anestesiología y Reanimación. The group undertook the critical appraisal of articles relevant to the management of PONV and OINV in adults and children early and late in the perioperative period. Discussions led to recommendations, summarized as follows: 1) Risk for PONV should be assessed in all patients undergoing surgery; 2 easy-to-use scales are useful for risk assessment: the Apfel scale for adults and the Eberhart scale for children. 2) Measures to reduce baseline risk should be used for adults at moderate or high risk and all children. 3) Pharmacologic prophylaxis with 1 drug is useful for patients at low risk (Apfel or Eberhart 1) who are to receive general anesthesia; patients with higher levels of risk should receive prophylaxis with 2 or more drugs and baseline risk should be reduced (multimodal approach). 4) Dexamethasone, droperidol, and ondansetron (or other setrons) have similar levels of efficacy; drug choice should be made based on individual patient factors. 5) The drug prescribed for treating PONV should preferably be different from the one used for prophylaxis; ondansetron is the most effective drug for treating PONV. 6) Risk for PONV should be assessed before discharge after outpatient surgery or on the ward for hospitalized patients; there is no evidence that late preventive strategies are effective. 7) The drug of choice for preventing OINV is droperidol.