上海市66所医院手卫生依从性现状调查

目的 了解上海市二级甲等综合以上医院医务人员手卫生依从性.方法 根据2009年WHO颁布的手卫生指南中“5个手卫生时机”,2011年11月21日-2012年3月23日采取直接观察法,对上海市66所医院医务人员临床操作过程中的手卫生依从性进行现场观察并记录.结果 手卫生依从性由高到低依次为护士62.3％、医师50.5％、实习/进修人员45.9％、辅助人员43.7％、营养师等其他人员25.0％、医技人员16.8％;5个时机的手卫生依从性分别为:接触患者前42.0％,进行清洁/无菌操作前59.5％,接触患者体液暴露风险后74.6％,接触患者后63.2％,接触患者周围环境物品后41.0％;共计34 908次操作中34.4％未采取任何手卫生措施,30.2％选择速干手消毒剂擦手作为手卫生方式,23.4％选择流动水洗手,12.0％为戴手套且未采取手卫生措施.结论 上海市医务人员手卫生依从性有待进一步提高.     

北京某二级甲等综合医院医务人员手卫生现状分析及对策

目的 了解临床医务人员手卫生状况,探讨提高医务人员手卫生依从性和洗手正确性的管理方法.方法 强化手卫生管理前后,采用随机抽查的方法,对医务人员手卫生依从性和洗手正确性进行调查.结果 强化手卫生管理后,医务人员手卫生依从性由43.23％提高至68.32％,洗手正确性由25.00％提高至38.61％;医务人员手卫生依从性和洗手正确性整体较低,护士高于医师.结论 采取相应的干预措施可以提高医务人员手卫生的依从性和正确性,但需要管理者持之以恒的严格管理.     

Effect of mouth washing on the

BACKGROUND: Mouth washing is often mentioned as a possible method to eliminate the interference of urease activity in the oral cavity before the [13C]-urea breath test (UBT). However, the effectiveness of mouth washing prior to testing has not been demonstrated clearly in the literature. Thus, the present study was designed to examine the consistency of the [13C]-UBT and the effects of mouth washing on it. METHODS: A total of 101 healthy volunteers underwent the [13C]-UBT three times. The first and second tests used a standard protocol and collected samples at 5, 10, 15 and 30 min. In the third test, the procedure was the same except that mouth washing was omitted. RESULTS: We used 5 permil (/1000) as the cut-off value and there were 21 (20.8%) positive cases. The kappa values for the samples collected at 5, 10, 15 and 30 min between the first and second tests were 0.68, 0.97, 1 and 1, respectively, and all showed good consistency, except for the sample collected at 5 min. Judging from the mean value of the [13C] enrichment of the first and second tests (with mouth washing) and the third test (without mouth washing), 50 (63.3%), 15 (18.8%), 0 and 0 cases at 5, 10, 15 and 30 min, respectively, changed from negative to positive. There were 14 (17.5%) and six (7.5%) cases at 15 and 30 min, respectively, whose [13C] enrichment changed from less than 3 (negative) to between 3 and 5 (border zone). CONCLUSIONS: These results indicate that mouth washing had an important effect on samples obtained at 5 and 10 min, while this influence decreased at 15 min and was lowest at 30 min.     

闭式冲洗留置负压引流口腔颌面部间隙感染的临床研究

目的探讨对口腔颌面部间隙感染患者实施闭式冲洗留置负压引流的临床方法。方法选取颌面部间隙感染患者120例,随机分为两组,其中对照组57例,观察组63例,使其有可比性。对照组患者在全身应用抗生素的基础上常规每天换药冲洗;观察组患者在全身应用抗生素的同时行闭式冲洗留置负压引流。对两组患者治疗效果进行评价,并对两组患者治疗前后疼痛情况和脓肿大小进行测量。结果观察组患者临床显效率、总有效率分别为93.65%和100.00%,对照组分别为78.95%和82.46%,观察组患者明显高于对照组;经过治疗,观察组患者疼痛和脓肿直径分别为(0.41±0.37)和(0.52±0.39)cm,对照组分别为(1.37±0.92)和(1.28±0.83)cm,观察组患者疼痛和脓肿直径下降率分别为(94.71±10.20)%和(92.63±9.87)%,对照组患者分别为(81.35±13.25)%和(81.78±10.29)%。两组患者疼痛及脓肿大小较治疗前均有明显下降,且观察组患者下降更为明显。上述比较差异明显,有统计学意义(P<0.05)。结论对口腔颌面部间隙感染患者实施闭式冲洗留置负压引流是一种有效、简便的治疗方法,将其应用于临床可以有效提高治疗效果并减少患者的痛苦。     

六味玉屏风散联合洗眼法治疗过敏性结膜炎临床观察

[目的]观察六味玉屏风散联合洗眼法治疗过敏性结膜炎（al ergic conjunctivitis,AC）的临床疗效。[方法]选择2008年1月至2014年6月在我院就诊并确诊为AC的患者60例（120眼）,随机分为对照组1、对照组2、治疗组,各20例（40眼）,均局部运用2%色甘酸钠滴眼液点眼3次/d,治疗组加用六味玉屏风散内服联合中药洗眼法外用,对照组1六味玉屏风散内服,2次/d,对照组2仅外用滴眼,均治疗4～6周后,比较3组的临床疗效,并用统计学方法对3组数据进行分析比较。[结果]治疗组与对照组2总有效率比较差异有统计学意义（P＜0.01）;治疗组与对照组1总有效率比较差异有统计学意义（P＜0.05）。[结论]六味玉屏风散联合中药洗眼法治疗AC疗效肯定,值得推广。     

鼻窦灌注液冲洗对鼻息肉术后鼻黏膜细胞因子的影响

目的观察鼻窦灌注液冲洗鼻腔对鼻息肉相关的细胞因子水平的影响。方法将39例鼻息肉患者随机分为鼻窦灌注液组18例和生理盐水组21例。全部鼻息肉术后患者在接受术后综合治疗同时,分别采用鼻窦灌注液、9 g／L生理盐水冲洗鼻腔3个月。采用鼻腔鼻窦结局测试－20（SNOT－20）及Lund－Kennedy评分评估疗效,术前及术后3个月分别取鼻腔中鼻道黏膜作标本,采用酶联免疫吸附（ELISA）法检测黏膜中白细胞介素－5（IL－5）、白细胞介素－8（IL－8）、白细胞介素－10（IL－10）、干扰素－γ（IFN－γ）、粒细胞—巨噬细胞集落刺激因子（GM－CSF）、肿瘤坏死因子－α（TNF－α）的表达水平。结果（1）术后2组SNOT－20及Lund－Kennedy评分均较术前降低,差异有统计学意义（P＜0．05）,但术后2组比较,差异均无统计学意义（P＞0．05）。（2）术后3个月,2组黏膜细胞因子IL－5、 IL－8、 IL－10、 IFN－γ、 TNF－α、 GM－CSF表达水平均较术前显著降低（P＜0．05）,且鼻窦灌注液组对细胞因子IL－5、 IL－8、 IL－10、 IFN－γ表达水平的降低作用优于生理盐水组（P＜0．05）,而2组TNF－α、 GM－CSF的表达水平比较,差异无统计学意义（P＞0．05）。结论术后3个月,2组在改善患者生活质量及鼻腔形态方面疗效相当,而鼻窦灌注液对IL－5、 IL－8、 IL－10、 IFN－γ水平的调节作用优于生理盐水。     

蒸汽-冷水混合器在医药生产清洗工位的应用

介绍了蒸汽冷水混合套件(蒸汽冷水混合器/常压水枪/软管挂架)工作原理,以及在制药企业清洗工段的应用。其清洗效率高,使用安全性好,节能,环保,在国外已广泛使用。     

手术后椎间隙感染的诊断与治疗（附5例临床分析）

目的：探讨手术后椎间隙感染的病因及诊治方法。方法：对胡诊为手术后椎间隙感染的患者严格卧床制动，早期足量联合使用抗生素或行经皮穿刺切吸冲洗术。结果：经严格卧床制动，使用抗生素治疗对临床症状较轻者有效，对症状严重者行经皮穿刺切吸冲洗术疗效满意。结论：全身免疫力低下及局部抗感染力下降是手术后椎间隙感染的主要因素。经严格卧床制动，早期足量联合使用抗生素治疗或行经皮穿刺切吸冲洗术，可取得满意疗效。手术后椎间隙感染应重在预防，尽最大努力降低其发生率。     

Bladder wash flow cytometry in transitional cell carcinoma: useful or misleading?

To evaluate the practical usefulness of flow cytometry (FC) applied to bladder wash specimens for the diagnosis of transitional cell carcinoma (TCC), a study was conducted on a series of 101 cases comprising 60 patients with tumor or with past history of TCC, and a control group of 41 patients undergoing cystoscopy for causes other than TCC in which the absence of tumor was confirmed after 1 year of follow-up. When results of the 33 patients with tumor were compared with those of the control group, FC gave low specificity and positive predictive values (54% and 58%, respectively). Conventional cytologic study was superior to FC in this setting. Although the combination of both techniques increased the sensitivity for low-grade tumors, specificity remained lower than that of cytologic study alone. Otherwise, when considering only the cases with a past history of TCC, results of FC were superior to those of cytologic examination, and the combination of both techniques gave high sensitivity and negative predictive values (94% and 93%, respectively). In conclusion, the use of FC in a general diagnostic setting could be misleading, whereas in the follow-up of patients with a history of TCC it becomes a useful adjunct to cytologic study in order to obtain a high diagnostic performance that could allow cystoscopies to be spaced out in these patients.