血液透析浓缩B液细菌污染控制方法的研究

目的：调查血液透析浓缩B液细菌数超标的原因,找出控制方法。方法：检测出入口透析液、反渗水、A液、B液、配置B液的容器及B干粉的细菌菌落数,以查出原因前的监测资料为对照组,采取措施后的监测资料为试验组。结果：查出原因前监测资料显示B液和配液桶细菌数严重超标,其余指标均不超标。对照组B液的平均含菌量（1019±388）cfu/ml,合格率17.86%;试验组（104±41）cfu/ml,合格率100%,两组资料经统计学处理P〈0.05。对照组配液桶平均含菌量（889±359）cfu/ml,合格率为0%;试验组（30±23）cfu/ml,合格率为100%,两组比较有统计学意义（P〈0.05）。结论：浓缩B液污染的主要原因为配液桶污染,容器长时间未消毒。采取措施后B液含菌量明显减少,合格率明显提高达100%。并对B液的细菌学监测标准进行了研究认为采用≤200 cfu/ml的标准比较恰当。     

血液透析液浓缩B液细菌污染原因分析及对策

目的 调查血液透析液浓缩B液细菌菌落数超标的原因,找出控制对策.方法 检测出入口透析液、透析用水、A、B液,配制B液的容器及溶质的细菌菌落数;将查出原因前的监测资料56份列为对照组,采取措施后的监测资料50份列为实验组,比较2组的污染情况.结果 B液平均含菌量(1052±122)cfu/ml,配制B液的容器含菌量(845±318)cfu/ml,严重污染.对照组和实验组B液的平均含菌量分别为(968±515)cfu/ml和(146±32)cfu/ml,合格率分别为21%和100%,差异有统计学意义.结论 浓缩B液污染的主要原因为配制容器污染,未加盖密封保存,应采取措施予以纠正.     

血液透析液配制过程中细菌污染的调查与控制

目的寻找血液透析液配制过程中细菌污染的环节，制定和实施控制标准。方法检测反渗水、A液、透析器入口液、透析器出口液、B液、B液配制容器、B液盛装容器的细菌菌落数；将采取措施前后监测的结果进行比较。结果透析器入口液平均细菌菌落数1378．57士662．41cfu／ml，B液677．86±244．2cfu／ml，B液配制容器750±218．76cfu／cm^2、B液盛装容器10750±4475．36cfu／cm^2，污染严重，其余细菌检测均合格；采取措施前后两组比较有显著性差异。结论透析液的配制过程中任何一个环节都可能发生污染，需制定和实施严格的透析液配制清洁消毒制度，定期进行细菌学监测。并对透析液的采样监测部位及监测标准进行了探讨。     

浓缩透析液B液保存时间的临床研究

目的 探讨浓缩透析液B液的有效保存时间,以预防B液污染.方法 于无菌操作下配制B液8桶,分别于配制即刻、配制后4,6,8,10,12,18,24 h 8个时点进行采样,每个时点每桶采样5次,8桶共采样40次.计算各样本的平均染菌量,统计合格率.结果 配制好的B液在放置12,18,24 h后平均染菌量均超标,大于200 cfu/ml,并且随放置时间的延长,染菌量明显增多.本组样本放置12 h后有4份不合格,合格率为90%,与放置10 h的合格率100%比较,χ2=4.21,P《0.05,差异有统计学意义;放置12 h和10 h的平均染菌量分别为(210.0±4.1)cfu/ml和(180.0±5.5)cfu/ml,二者比较,t=23.53,P《0.01,差异有统计学意义.结论 B液的放置时间不宜超过10 h.同时,配制及保存应符合要求,并建议常规监测B液细菌数.配制好的B液可以连续使用2个透析周期,达到节约及预防感染的目的 .     

医院透析液污染状况调查

目的了解医院血液净化室透析液污染状况,找出污染原因,以便改进透析液质量。方法通过现场采样和微生物检验方法,对透析环节和透析用水进行了监测。结果透析液入口液平均细菌总数280 cfu/ml,出口液120 cfu/ml;透析液A液平均菌数为1 cfu/ml,B液平均细菌总数为680 cfu/ml。反渗水中平均细菌数为3 cfu/ml,透析液干粉B粉中细菌总数为210 cfu/g,盛装透析液B液的桶内表面细菌总数为14000 cfu/cm2。结论大连地区部分医院透析液配制过程中,每个环节都存在污染,盛装B液桶内表面污染特别严重,透析液干粉B粉中含菌量高与B液桶内污染为主要原因。     

血液透析浓缩液容器两种消毒方法的比较

目的探讨合理的透析浓缩B液容器使用和消毒方法。方法将1～10号透析机使用的容器分为实验组和对照组,对照组采用传统处理方法,实验组采用改良方法。分别对浓缩B液、入口透析液、B液桶内表面进行细菌学培养,并进行比较。结果两组B液、入口透析液细菌含量均符合医院感染管理要求,B液桶内表面平均含菌量实验组为21.05±19.73cfu/ml,对照组为32.34±27.78cfu/ml,实验组明显低于对照组,有显著性差异（P〈0.01）。结论改良后的方法更加安全、经济、环保。     

血液透析液细菌污染的调查与分析

目的探讨血液透析液细菌污染的情况,分析原因并提出对策。方法检测透析器出、入口透析液,透析A、B液,反渗水的细菌菌落数。结果透析液入口液平均细菌菌落数392cfu/ml;出口液平均细菌数为196cfu/ml;A液平均细菌数为0cfu/ml;B液平均细菌数为2012cfu/ml;反渗水平均细菌数为2cfu/ml。结论入口处透析液在配制过程中有多个环节可能造成污染,B液污染特别严重,应加强透析液监测。     

医院口腔综合治疗台诊疗用水污染状况调查

目的了解医院口腔综合治疗台诊疗用水不同部位污染状况。方法采用随机抽样和细菌检验方法,对大连地区部分综合性医院口腔综合治疗台供水系统进行了细菌污染调查。结果储存水含菌量为27000cfu/ml,全部不合格;过滤前后的水含细菌数分别为49cfu/ml和67cfu/ml,合格率分别为85.71%和85.71%;漱口水含菌量为570cfu/ml,合格率为45.83%;三用枪水和手机机头水平均染菌数分别13000cfu/ml和23000cfu/ml,合格率分别为19.23%和8.70%。结论口腔综合治疗台诊疗用水污染非常严重,手机回吸对距手机越近的管路污染越明显,储存水供水方式加重了机头水的污染程度。     

血液透析用水和透析液微生物污染原因调查

目的了解透析用水和透析液微生物污染的原因,提出预防控制措施,防止医院感染的发生。方法根据2000年版《医院感染管理规范》和2002年版《消毒技术规范》的要求和标准检测透析液细菌菌数。结果透析器入口液平均菌数586 cfu/ml,出口液平均菌数107 cfu/ml,B液平均菌数8 400 cfu/ml,反渗水平均菌数120 cfu/ml。结论透析液配制过程中,各环节均有可能造成污染,其中B液污染特别严重。应制定预防控制措施,加强各容器和管道的消毒和透析液监测,保证透析用水水质达标,防止透析液污染,有效预防和控制医院感染。     

血透制水系统的消毒处理及其监控

目的观察血透制水系统消毒处理情况及其质量监测,以提高血液透析用水质量。方法采集透析用水及透析液进行细菌检测。结果该医院血液透析水处理系统制备的透析用水细菌超标率为51%,透析出口液细菌总数部分超过2000 cfu/ml、入口液细菌总数超过200 cfu/ml,储存容器表面有枯草芽孢杆菌等细菌生长。经过整改后,检测出、入口透析液均未发现超标现象,合格率达到100%。结论该医院血透制水系统的管理不严格、消毒不彻底,透析液存在污染超标问题;经改进后使血透制水系统消毒全部达标。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.