婴儿培养箱及其质量控制

介绍了婴儿培养箱的工作原理,分析了其使用风险和操作注意事项,强调了对婴儿培养箱进行质控和预防性维护的重要性,并结合案例给出了具体方法。     

Thermal balance in term and preterm newborn infants nursed in an incubator equipped with a radiant heat source

A radiant hood warmer, a device that heats the incubator roof independently of the incubator's main heat source, was used to study the thermal balance of 11 full term and 13 preterm (gestational age 25–34 weeks) infants exposed to an isolated elevation of incubator roof temperature at stable ambient air temperature and humidity. After initial measurements without active heating of the incubator roof, the hood warmer was set to 33°C, 36°C and finally (preterm infants only) to 39°C. At least 18 min of measurements with the infant asleep were made at each hood warmer setting. In the term infants an increase in roof temperature from 30.5°C to 35.6°C resulted in an increase in skin temperature from 35.4 to 35.9°C, and a decrease in radiative heat loss from 32.8 to 20.7 W/m² exposed skin. In the preterm infants an increase in roof temperature from 31.0 to 38.4°C led to an increase in skin temperature from 35.7 to 36.3°C and a decrease in radiative heat loss from 34.1 to 13.0 W/m² exposed skin. The increased inner roof surface temperature did not affect evaporative or convective heat loss, skin blood flow, respiratory water loss, oxygen consumption or transepidermal water loss in either group. Thus, at stable ambient air temperature and humidity, the increase in incubator roof temperature resulted in an increase in skin temperature and a decrease in radiative heat loss in both term and preterm infants.     

新生儿重症监护病房暖箱集束化管理效果探讨

目的 探讨新生儿重症监护病房暖箱集束化管理的效果。方法 对我院新生儿重症监护病房50台宁波戴维YP-920型暖箱进行集束化管理,以2011年的消毒管理方法作为对照组,2012年更新后的消毒管理方法作为实验组,两年的监测结果进行合格率的比较。结果 实验组552次培养中不合格次数为6次,不合格率1.1%,而对照组546次培养中不合格次数75次,不合格率13.7%,差别具有统计学意义。结论 采用集束化的管理措施可以有效控制暖箱内病原体的定植。从而控制病原体经暖箱进行的传播。     

给氧方式对暖箱内氧浓度和温湿度影响的研究

目的观察不同给氧方式和暖箱密闭状态对早产儿暖箱内氧浓度、温度和相对湿度的影响.方法选择4台不同型号的早产儿暖箱,测定不同氧流量下,暖箱进风口给氧及暖箱内头罩给氧时,模型患儿鼻部的氧浓度、温度和湿度的变化.结果氧流量在2L/min及10L/min时,采用暖箱进风口给氧可使模型患儿鼻部的氧浓度分别达到(24.36±1.75)%和(39.52±11.95)%,而采用暖箱内头罩给氧则可使模型患儿鼻部的氧浓度高达(38.91±1.37)%和(61.76±7.62)%(P<0.01);开放头部仓门暖箱内氧浓度下降1.08%～4.06%,变化不大(P>0.05);环境温度在25.5℃～26.5℃时,给氧方式、氧流量和暖箱密闭状态对暖箱内温度无明显影响;暖箱内相对湿度受环境相对湿度、氧流量和暖臬密闭状态影响.结论暖箱内头罩给较大流量的纯氧将导致氧浓度过高,不宜常规使用;适当提高环境相对湿度和氧气充分湿化对维持暖箱内相对湿度有益.     

Can we use incubators with atmospheric oxygen tension in the first phase of in vitro fertilization? A retrospective analysis

PurposeAim of the present study was to compare two culture strategies used in our routine in vitro fertilization program.MethodsThis is a retrospective analysis. Two culture systems were used in parallel and analysed retrospectively: 1) Use of atmospheric oxygen tension (~20 %) until insemination followed by use of low (~5 %) oxygen concentration; 2) Exclusive use of low oxygen concentration. Main outcome was the utilization rate defined as the number of transferred + vitrified embryos per inseminated oocytes. Secondary outcomes were clinical pregnancy and live birth rates.ResultsA total of 402 in vitro fertilization cycles were analyzed. Demographic and clinical data of patients belonging to the two culture systems were not significantly different. Utilization rate, cumulative clinical pregnancy rate and cumulative live birth rate per cycle was similar using two different oxygen concentration compared to exclusive use of low oxygen tension (37 % versus 39 %; 30 % versus 30 %; 23 % versus 28 %, respectively).ConclusionsThe use of a culture system with atmospheric oxygen tension from recovery of oocytes until insemination followed by culture in low oxygen gives results similar to exclusive use of low oxygen concentration.     

保温毯对手术患者体温的影响观察

目的观察使用保温毯对手术患者体温的影响。方法将60例患者随机分为观察组和对照组,观察组使用保温毯,对照组为室温下,观察两组体温变化。结果两组手术患者的体温分别在手术开始后20 m in、40 m in、60 m in、手术完毕体温差异有统计学意义(P<0.01)。结论保温毯能有效地保持手术患者恒定的体温,能有效地降低围手术期低体温发生,减少手术并发症,促进患者早日康复。     

Variations in incubator temperature and humidity management: a survey of current practice

Aim: To describe and assess routine procedures and practices for incubator temperature and humidity management in France in 2009. Methods: A questionnaire was sent to all the 186 neonatal care units in France. Results: The questionnaire return rate was 86%. Seventy‐five per cent of the units preferred skin servo‐control to air temperature control in routine practice. Air temperature control was mainly used for infants with a gestational age of more than 28 weeks and aged over 7 days of life. In general, thermal management decisions did not depend on the infant’s age but were based on a protocol applied specifically by each unit. All units humidified the incubator air, but there was a large difference between the lowest and highest reported humidity values (45% and 100% assumed to be a maximal value, respectively). More than 65% of the units used a fixed humidity value, rather than a variable, protocol‐derived value. Conclusion: We observed large variations in incubator temperature and humidity management approaches from one neonatal care unit to another. There is a need for more evidence to better inform practice. A task force should be formed to guide clinical practice.     

婴儿暖箱终末消毒效果及有效期的临床研究

目的探讨暖箱终末消毒效果及有效期,监测暖箱表面菌落数的变化。方法 2018年7-10月将患儿出院或使用7 d更换的暖箱12台进行常规终末消毒,于消毒后的第2天、第7天、第14~24天分别对暖箱的箱体内表面、床垫外表面、床板内表面、水槽内表面采样进行细菌培养,观察终末消毒后暖箱4个部位的菌落数。结果暖箱终末消毒后20 d内各部位均未培养出细菌,从第21天开始各部位检测出细菌,且以水槽内表面细菌数量最多且繁殖速度最快。结论暖箱终末消毒达到了灭菌效果,建议暖箱终末消毒后的放置时间≤20 d。     

MEBT/MEBO治疗新生儿烫伤体会

目的 湿润烧伤膏（MEBO）是目前治疗各种类型烧伤创面的主要药物,但用其治疗新生儿烫伤创面的论文并不甚多,本文旨在总结MEBO治疗新生儿烫伤创面的临床疗效.方法 自2005年至2010年,我院采用MEBO治疗新生儿烫伤11例,将患儿安放在暖箱内,各种不同深度的创面均采用MEBO油纱覆盖半暴露疗法治疗或湿润暴露疗法治疗.半暴露疗法初始,每6h更换药纱1次,湿润暴露疗法每4h换药1次,而后根据创面情况可延长换药间隔时间;同时接受抗感染、抗休克、加强母乳喂养等措施治疗.结果 浅Ⅱ度创面治疗8d～10 d愈合,深Ⅱ度创面治疗3w愈合,浅Ⅲ度创面愈合时间最长为25 d,治疗过程中未出现全身或局部严重感染、高热、营养不良等病症,随访3～6个月,均未见显性瘢痕增生.结论 湿润烧伤膏治疗新生儿烫伤临床疗效显著,宜在保温箱内接受治疗.