肺叶切除术后呼吸训练法的应用研究

目的：通过对肺叶切除术后患者进行呼吸训练的研究，寻求一种简单、安全、有效的呼吸训练方法。方法：对120例肺叶切除患者。随机分为A、B两组，分别用深呼吸训练法和吹气球呼吸训练法进行术后呼吸训练，观察患者肺活量的变化、血气分析结果、肺复张情况及其并发症、自觉症状等。结果：A、B两组各项观察指标比较行显著差异，B组优于A组。结论：吹气球呼吸训练法对改善肺叶切除术后患者的呼吸功能、促进肺复张、减少并发症、提高生活质量等方面效果显著。     

imCIM检测B类碳青霉烯酶的效果评价

目的评价抑制剂增强改良碳青霉烯失活法(im CIM)在B类碳青霉烯酶检测中的应用价值,并与EDTA纸片增效试验(EDPT)进行比较分析。方法收集碳青霉烯类抗生素不敏感菌株181株,其中肺炎克雷伯菌44株、大肠埃希菌44株、鲍曼不动杆菌43株、铜绿假单胞菌50株;碳青霉烯类抗生素敏感菌株83株,其中肺炎克雷伯菌25株、大肠埃希菌16株、鲍曼不动杆菌25株、铜绿假单胞菌17株。采用im CIM和EDPT对上述264株菌株进行B类碳青霉烯酶的筛查,以PCR结果作为金标准。应用一致性检验、Wilcoxon符号秩和检验、独立样本Kruskal-Wallis H检验及ROC曲线进行统计学分析。结果 181株碳青霉烯类抗生素不敏感菌株中144株PCR扩增耐药基因阳性,A、B、D类碳青霉烯酶分别为39株、77株、28株;im CIM检测70株阳性,111株阴性,其中166株与PCR结果一致;EDPT检测72株阳性,109株阴性,其中134株与PCR结果一致。碳青霉烯类抗生素敏感菌株83株,PCR扩增耐药基因、im CIM及EDPT检测结果均为阴性。im CIM敏感性和特异性分别为85.71%(66/77)和97.86%(183/187),与PCR结果一致性Kappa值为0.859;EDPT敏感性和特异性分别为66.23%(51/77)和88.77%(166/187),Kappa值为0.561。im CIM抑菌圈差值(Δdim CIM)与EDPT抑菌圈差值(ΔdEDPT)有差别,差异有统计学意义(Z=-6.941,P0.05)。采用im CIM检测B类碳青霉烯酶的Δdim CIM水平与A、D类酶Δdim CIM总体分布位置不同,差异有统计学意义(χ2=108.887,P0.05)。im CIM与EDPT的ROC曲线下面积分别为0.988(95%CI:0.977~0.999)和0.936(95%CI:0.909~0.963)。结论 im CIM是一种准确、高效、便捷的碳青霉烯酶表型筛选方法,敏感性、特异性较高,适合用于流行病学监测。     

多层螺旋CT门静脉造影术准直与螺距匹配及重建方法优化选择

目的探讨多层螺旋CT门静脉造影术(MSCTP)准直与螺距匹配及重建方法的优化选择.方法150例疑肝脏疾病患者,按不同螺距及准直随机分为4组行MSCTP检查,对比分析不同组间及不同重建方法(MIP、VR、SSD)间的图像质量.结果不同准直间、不同螺距间CTP图像质量存在明显差异.一定扫描时间内,2.5 mm准直、0.875螺距组CTP图像质量优于1 mm、1.75螺距组.不同重建方法间存在明显差异,以VR图像质量最好.结论相同螺距、相同扫描条件下,准直越薄,三维图像质量越好.三种重建方法以VR显示门静脉图像质量最佳;SSD在显示立体结构空间定位准确性方面最佳.     

Buck's direct repair of lumbar spondylolysis restores disc stresses at the involved and adjacent levels

BACKGROUND: Lumbar spondylolysis was reported to cause disc degeneration at both caudal and cranial adjacent level. However, basic disc biomechanics in the spondylolytic spine is not fully understood. Purpose of this study was to analyze the disc stresses at cranial and caudal adjacent level of lumbar spondylolysis. Also, the biomechanical effects of Buck's technique on disc stresses at these two segments were evaluated. METHODS: An experimentally validated three-dimensional non-linear finite element model of the intact ligamentous L3-S1 segment was used. Bilateral lumbar spondylolysis was simulated by creating bilateral pars defects with 1.0 mm gap at L5. Buck's direct repair model was simulated with 4.0 mm cannulated Titanium screws, placed bilaterally across the defect. Von Mises stresses in the annulus fibrosus and nucleus pulposus at L4/5 (cranial adjacent) and L5/S (caudal adjacent) disc levels were analyzed in flexion, extension, lateral bending and axial rotation in response to 400 N of axial compression and 10.6 Nm moment. The highest values were compared among the three models, intact, spondylolysis and Buck's technique. FINDINGS: After spondylolysis occurred at L5, annulus fibrosus and nucleus pulposus stresses at L4/5 increased to 111% and 120%, respectively. After the Buck's technique it recovered to 102% and 105%, correspondingly. On the other hand, at L5/S, annulus fibrosus stress increased to 168%, and nucleus pulposus, 155%, which was much higher when compared to the stresses at L4/5. After the Buck's technique the stresses were decreased to 125% and 120%, correspondingly. During rotation motion, especially, the operation normalized the disc stress completely. INTERPRETATION: Spondylolysis increases disc stresses at the affected as well as cranial adjacent level, and it may lead to disc degeneration at both levels. However, the increase in stresses is higher at the affected caudal level, when compared to the cranial level. Buck's technique may restore the disc stresses back to normal at both disc levels. Thus, this technique may be beneficial from a biomechanical perspective as well.     

消毒措施对控制学校室内空气中微生物效果观察

为了观察三氯异氰尿酸对室内空气微生物的杀灭效果 ,采用平板沉降法进行了检测。结果 ,消毒前不同地点室内空气中细菌总数平均为 4 0 0 0cfu/m3 。用有效氯含量 10 0 0mg/L的三氯异氰尿酸水溶液喷雾消毒 ,4 5min后室内空气中细菌总数明显减少 ,平均控制在 2 0 0 0cfu/m3 以内。对空气中细菌平均消除率为 5 8.33% ,其中使放线菌下降 5 1.5 9% ,真菌下降 33.6 0 %。结果显示 ,三氯异氰尿酸喷雾消毒对空气中细菌有一定杀灭作用     

中专护生临床实习兴趣调查研究

目的：了解临床实习中专护生感兴趣学习的具体实习项目及教学形式,方法：设计护生实习兴趣调查表,采用此表对122名临床毕业实习中专 护生进行调查。结果：护生最感兴趣的实习项目是“手术器械护士”,最不感兴趣的项目是“排泄的护理”,最感兴趣的教学形式为“老师操作,学生跟着学习”,最少人喜欢“学生操作,老师指导”,结论：护生偏重“纯技术”操作,轻“生活护理”,同时伴交际与操作方面的自信心不足。     

Magnetocardiographic Pacemapping for Nonfluoroscopic Localization of Intracardiac Electrophysiology Catheters

The purpose of the study was to validate, in patients, the accuracy of magnetocardiography (MCG) for three-dimensional localization of an amagnetic catheter (AC) for multiple monophasic action potential (MAP) with a spatial resolution of 4 mm2. The AC was inserted in five patients after routine electrophysiological study. Four MAPs were simultaneously recorded to monitor the stability of endocardial contact of the AC during the MCG localization. MAP signals were band-pass filtered DC-500 Hz and digitized at 2 KHz. The position of the AC was also imaged by biplane fluoroscopy (XR), along with lead markers. MCG studies were performed with a multichannel SQUID system in the Helsinki BioMag shielded room. Current dipoles (5mm; 10mA), activated at the tip of the AC, were localized using the equivalent current dipole (ECD) model in patient-specific boundary element torso. The accuracy of the MCG localizations was evaluated by: (1) anatomic location of ECD in the MRI, (2) mismatch with XR. The AC was correctly localized in the right ventricle of all patients using MRI. The mean three-dimensional mismatch between XR and MCG localizations was 6 ± 2 mm (beat-to-beat analysis). The coefficient of variation of three-dimensional localization of the AC was 1.37% and the coefficient of reproducibility was 2.6 mm. In patients, in the absence of arrhythmias, average local variation coefficients of right ventricular MAP duration at 50% and 90% ofrepolarization, were 7.4% and 3.1%, respectively. This study demonstrates that with adequate signal-to-noise ratio, MCG three-dimensional localizations are accurate and reproducible enough to provide nonfluoroscopy dependant multimodal imaging for high resolution endocardial mapping of monophasic action potentials.     

消毒剂杀灭淋球菌的试验方法研究

淋球菌对营养要求特殊,普通培养基上生长较慢。为科学评价化学消毒剂对淋球菌的杀灭效果,采用平板浸润接种法对不同培养基进行比较,以评价杀菌效果的差异。结果,淋球菌在普通营养琼脂和酵母浸膏琼脂上生长的菌落均小于2 mm;在酵母浸膏血琼脂和巧克力琼脂上生长的菌落为2~3 mm,计数回收率高出26%。而平板涂布法的回收菌数低于平板浸润法,其标准差大于平板浸润法。进行悬液定量杀菌试验时,采用酵母浸膏血平板浸润接种方法。观察临床分离的淋球菌和标准菌株对化学消毒剂的抗力,选择抗力较高的标准菌株作有机干扰物试验。用大白兔作为淋球菌感染部位和感染量的试验动物。结果表明,用酵母浸膏血琼脂替代巧克力琼脂培养淋球菌无统计学差异,淋球菌用平板浸润法接种比平板涂布法好。临床分离菌株对化学消毒剂的抗力略低于标准菌株。在30 g/L牛血清白蛋白的存在下,达到消毒要求的消毒剂浓度是PBS菌悬液的消毒剂浓度的5~6倍。淋球菌可通过皮肤、角膜感染大白兔的泌尿系统,可感染角膜菌量为80 cfu。故建议在30 g/L牛血清白蛋白的条件下,淋球菌经消毒剂处理后,下降5个对数值,作为消毒合格标准较可靠。     

手术室护士压力源分析与对策

针对手术室护士所面临的主要心理压力源及心理压力程度,提出相应的对策。对本市三所三甲医院54名手术室护理人员进行调查。护理人员压力源主要集中在护理专业及工作方面、社会方面和继续教育与职业需求方面。护理管理者和护士在实际工作中应该注意这些压力源并设法消除其影响因素。积极应对工作压力,提高工作效率。