10所医院手术部位感染横断面调查

目的 调查分析成都市医院手术部位感染的流行病学特征,为进一步研究手术部位感染相关危险因素及干预措施提供依据.方法 对成都市10所二甲及以上医院术后住院患者进行24 h现患率调查,分析手术部位感染的危险因素与分布,明确主要病原菌和围手术期用药情况.结果 共调查1088例外科术后患者,手术1107例次,发生手术部位感染25例、26例次,手术部位感染率2.3%、例次感染率2.35%;26例次手术部位感染中,表浅切口感染占76.92%,深部切口感染占19.23%,器官/腔隙感染占3.85%;手术部位感染与切口、手术类型、术前感染情况密切相关(P<0.01);手术部位感染主要集中在泌尿外科、烧伤科、骨科和普外科,肠杆菌科是主要病原菌,围手术期抗菌药物使用不规范,Ⅰ类切口手术前使用率为58.50%,术后使用率>99.34%.结论 初步揭示了该地区手术部位感染发生的一般规律和存在的问题,为预防和控制手术部位感染提供了参考依据.     

研究生自杀意念与人格特质及应对方式相关性研究

目的探讨在校研究生自杀意念与人格特质及应对方式的相关性,为制定有效干预措施提供理论依据。方法对武汉市某高校600名在校硕士研究生采用Beck自杀意念量表、简易应对方式问卷和艾森克人格问卷进行调查。结果回收有效问卷568份。1w内自杀意念发生率11．8％,最消沉时自杀意念发生率45．1％。艾森克人格问卷-外倾性维度分与自杀意念呈显著负相关（P〈0．01）,精神质和神经质维度分与自杀意念呈显著正相关（P〈0．01）,应对方式与自杀意念存在相关,与外倾性维度呈显著正相关（R=0．258）。多元回归分析显示,人格维度中的精神质、神经质、外倾性维度与最近1w自杀意念及最消沉最抑郁时自杀意念均显著相关。结论在校研究生自杀意念的产生与多种因素有关,其中应对方式及人格特质与自杀意念存在显著相关,对在校研究生积极开展有效的心理健康教育及心理干预,不断提高积极应对方式,可有效降低自杀意念的发生。     

Surgical site infection following elective orthopaedic surgeries in geriatric patients: Incidence and associated risk factors

The purposes of this study were to investigate the incidence of surgical site infection (SSI) following geriatric elective orthopaedic surgeries and identify the associated risk factors This was a retrospective two‐institution study. Between January 2014 and September 2017, patients aged 60 years or older undergoing elective orthopaedic surgeries were included for data collection and analysis. SSI was identified through the review of patients' medical records for the index surgery and through the readmission diagnosis of SSI. Patients' demographics, characteristics of disease, surgery‐related variables, and laboratory examination indexes were inquired and documented. Univariate and multivariate logistic analyses were performed to determine independent risk factors for SSI. There were 4818 patients undergoing elective orthopaedic surgeries, and within postoperative 1 year, 74 patients were identified to develop SSIs; therefore, the overall incidence of SSI was 3.64%, with 0.4% for deep and 1.1% for superficial infection. Staphylococcus aureus (25/47, 53.2%) and coagulase‐negative staphylococci (11/47, 23.4%) were the most common causative pathogens; half of S. aureus SSIs were caused by Methicillin‐resistant Staphylococcus aureus (MRSA) (12/25, 48.0%). Five risk factors were identified to be independently associated with SSI, including diabetes mellitus (odds ratio [OR], 3.7; 95% confidence interval [95% CI], 1.7‐5.6), morbid obesity (OR, 2.6; 95% CI, 1.3‐3.9), tobacco smoking (OR, 4.2; 95% CI, 2.1‐6.4), surgical duration>75th percentile (OR, 1.9; 95% CI, 1.0‐2.9), and ALB < 35.0 g/L (OR, 2.3; 95% CI, 1.3‐3.4). We recommend the optimisation of modifiable risk factors such as morbid obesity, tobacco smoking, and lower serum albumin level prior to surgeries to reduce the risk of SSI.     

液相色谱质谱联用(LC-MS/MS)在天然化学成分分析中的应用Ⅰ.音喷离子化(SSI)与大气压化学离子化(APCI)对利血平的比较分析

报道应用 L C- MS/ MS,采用音喷离子化 (SSI)与大气压化学离子化 (APCI)对利血平的比较分析 ,应用这两种离子化方法比较所得的利血平的标准质谱 (MS)和二级质谱 (MS2 ) ,实验证明两种离子化方法所得结果完全一致     

Surgical attire,practices and their perception in the prevention of surgical site infection

IntroductionClean surgical scrubs, surgical gowns and headgear are worn by operative teams to decrease bacterial contamination and lower surgical site infection (SSI) rates.MethodsA detailed review was undertaken of peer-reviewed publications and other sources of material in the English language over the last 50 years included.ResultsSurgical scrubs should be clean and made of tightly woven material. Studies investigating single-use gowns and drapes versus reusable gowns report conflicting evidence. Double gloving may reduce SSI rates in procedures where no antibiotic prophylaxis was administered. Bacterial contamination of the operative field has been shown to be decreased by the wearing of surgical headgear by the operating team.ConclusionsFurther consideration and better trials are required to determine the impact of different theatre clothing on SSI rates.     

Prophylactic antibiotics given within 24 hours of surgery, compared with antibiotics given for 72 hours perioperatively, increased the rate of methicillin-resistant Staphylococcus aureus isolated from surgical site infections

The purpose of this research was to find which method better prevented MRSA isolation from postoperative infection sites: the administration of postoperative infection control agents within 72 h of surgery, including the day of surgery, or the administration of these agents within 24 h of surgery. More than 3000 patients who underwent elective surgery of the digestive system were studied. Cefazolin or cefotiam was used as the prophylactic antibiotic. The number of patients, sex, age, clinical stage, incidence of surgical site infection (SSI), isolated bacteria, distal pancreatectomy with or without gastrectomy, the rate of laparoscopic surgery, and the rate of abdominoperineal resection (APR) were examined in a prospective controlled study over three time periods. There were no significant differences in the demographics of patients in the three periods. The duration of antibiotic administration was 96.1 ± 11.2 h in period A, 18.2 ± 2.7 h in period B, and 66.9 ± 11.1 hours in period C (P < 0.05). There was no significant difference in the incidence of SSI in the three periods. Methicillin-resistant Staphylococcus aureus (MRSA) was isolated from the infectious site in 0.47% of patients in period A, and from 2.1% and 0.34% of patients in periods B and C, respectively, and the incidence of MRSA was significantly higher in period B as compared with periods A and C (P < 0.01). The isolation rates of MRSA and methicillin-sensitive S. aureus (MSSA) were both significantly higher in period B patients (P < 0.005). We concluded that the administration of prophylactic antibiotics within 24 h of surgery increased the rate of isolation of MRSA.