抗生素封管治疗导管相关性脓毒症的评价

了解抗生素封管治疗中心静脉导管相关性脓毒症(CRS)的疗效及适应证。对在上海中山医院外科发生中心静脉导管相关性脓毒症的 13例病人 ,用含头孢他啶 0 .5 g的肝素等渗盐水溶液 5 ml作中心静脉导管封管 ,进行前瞻性调查研究。结果 :13例 CRS病人中 7例有效 ,6例无效。 6例封管治疗无效病人的菌群为 :金黄色葡萄球菌 3例、阴沟肠杆菌 2例、硝酸盐阴性杆菌 1例。这些菌株对头孢他啶皆耐药。结论 :抗生素封管治疗 CRS的方法有一定的疗效。其适应证为 :1家庭肠外营养的病人发生 CRS;2需较长时期 (>1个月 ) PN支持 ,且病情的稳定的住院病人…     

预充式导管冲洗器对中心静脉导管封管的效果

目的 探讨预充式导管冲洗器对中心静脉导管封管的效果。方法 选取2020年1月—2021年6月在某三级甲等医院血液净化中心采用颈静脉置管行血液透析治疗的患者,将符合入选标准的患者按照随机数字表法分为观察组和对照组。观察组患者采用预充式导管冲洗器对中心静脉导管封管,对照组患者采用肝素钠封管液封管,分析两组患者导管相关血流感染(CRBSI)发生及导管通畅情况、导管封管费用、冲管时间及封管时针刺伤发生情况。结果 共纳入患者85例,其中观察组42例,对照组43例。观察组患者CRBSI发生率(0.79‰,1/1 260)低于对照组(5.43‰,7/1 290),观察组患者导管冲管时间[(6.44±1.11)s]短于对照组[(220.04±5.98)s],两组比较差异均有统计学意义(均P<0.05)。观察组患者导管堵塞3例,对照组导管堵塞4例,两组比较差异无统计学意义(P=0.728)。观察组封管时未发生针刺伤,对照组发生针刺伤5例,两组比较差异有统计学意义(P<0.05)。观察组患者封管费用人均11.40元,对照组患者封管费用人均15.14元。结论 预充式导管冲洗器能有效降低采用颈静脉...     

庆大霉素与肝素分离封管法预防中心静脉导管相关性感染的临床观察

目的 观察庆大霉素与肝素分离封管预防中心静脉导管相关性感染的临床效果,探讨一种新的中心静脉置管封管方法.方法选择136例次临时性中心静脉置管的血液透析患者,随机分为3组,分别采用不同的方法封管;A组46例(庆大霉素与肝素分离封管组)、B组45例(庆大霉素与肝素混合封管组)和C组45例(肝素组),监测感染等情况.结果 A组导管相关感染率及导管内感染率与B组间差异无统计学意义(P＞0.05),但均比C组明显降低(6.5%、4.4%比22.2%,P＜0.05,4.3%、2.2%比17.8%,P＜0.05).结论 庆大霉素与肝素分离封管能明显降低中心静脉导管内感染的发牛率,不增加其并发症的发生率;是一种安全有效的封管方法.     

中心静脉导管感染的护理方法探讨

目的探讨留置中心静脉导管护理感染干预措施的可行方法和临床作用,为肿瘤病人提供一条无痛性治疗途径。方法导管局部感染及隧道感染的治疗主要是采取局部措施,如加强局部伤口换药护理,伤口以上静脉炎给予双柏散冷敷或理疗,血源感染时,我们先给予抽取导管内液体培养后,遵医嘱采用庆大霉素4万单位加生理盐水2mL封管,连续2～3天,每次封管前抽取管内液体3mL丢弃,3天后从中心静脉导管输液,病人无不良反应。可继续使用导管。结果局部感染35例中有一例拔管,血源感染15例只有一例拔管,其余到出院才拔管,减轻了病人有痛苦和经济负担,提高了护理工作效率。结论此方法受到病人的支持,值得临床推广。     

尿激酶联合肝素封管对血液透析长期中心静脉导管通畅性及感染率的影响

目的观察定期使用尿激酶联合肝素封管对长期血液透析患者中心静脉导管通畅性及感染率的影响。方法将使用右颈内静脉带涤纶套长期中心静脉导管进行血液透析的患者60例随机分为2组,对照组(30例)仅使用纯肝素溶液透析后封管;观察组(30例)使用尿激酶联合肝素溶液每周一次透析后封管,其余透析时间后予以纯肝素溶液封管。均观察12个月,比较两组患者在透析血流量、透析静脉压、栓塞率、导管感染率及凝血功能方面的差异。结果观察组封管处理后其透析血流量、Kt/V水平较封管前和对照组封管后均明显提高(P<0.05),导管静脉压及栓塞率水平较封管前和对照组封管后均明显降低(P<0.05);观察组感染率水平明显低于对照组(P<0.05);两组封管处理前、后凝血功能指标比较无显著性差异(P>0.05)。结论定期应用尿激酶联合肝素封管,可有效维持血液透析长期中心静脉导管良好的通畅性,并降低导管相关性感染的发生率,临床使用安全有效。     

中心静脉导管感染的护理方法探讨

目的探讨留置中心静脉导管护理感染干预措施的可行方法和临床作用，为肿瘤病人提供一条无痛性治疗途径。方法导管局部感染及隧道感染的治疗主要是采取局部措施，如加强局部伤口换药护理，伤口以上静脉炎给予双柏散冷敷或理疗，血源感染时，我们先给予抽取导管内液体培养后，遵医嘱采用庆大霉素4万单位加生理盐水2mL封管，连续2～3天，每次封管前抽取管内液体3mL丢弃，3天后从中心静脉导管输液，病人无不良反应。可继续使用导管。结果局部感染35例中有一例拔管，血源感染15例只有一例拔管，其余到出院才拔管，减轻了病人有痛苦和经济负担，提高了护理工作效率。结论此方法受到病人的支持，值得临床推广。     

庆大霉素和尿激酶预防中心静脉导管感染和栓塞的临床研究

目的预防血液透析患者中心静脉导管感染和栓塞,提高透析的充分性。方法回顾性总结2006～2009年239例中心静脉置管的血液透析患者的临床资料,比较三种封管方式下中心静脉导管的感染率和栓塞率。结果预防中心静脉导管感染和栓塞三种封管方式比较：尿激酶和庆大霉素混合液组优于尿激酶和肝素混合液组以及单纯肝素封管组。结论用庆大霉素和尿激酶混合液封管对预防中心静脉感染和栓塞效果显著。     

心脏术后中心静脉导管感染的原因分析及干预措施的研究

目的 分析心外科中心静脉导管感染的原因,探讨其干预措施.方法 选择100例心外科手术患者,术后均行中心静脉导管置管.结果 100例患者发生中心静脉导管感染22例,感染率为22.0％,其中包括表皮葡萄球菌感染6例、金黄色葡萄球菌感染5例、肺炎克雷伯菌感染4例、粪肠球菌感染3例,鲍氏不动杆菌、阴沟肠杆菌、白色假丝酵母菌及铜绿假单胞菌感染各1例;均根据药敏试验结果给予相应抗菌药物治疗,感染症状消失;中心静脉压感染年龄≤50岁者感染率为12.5％、＞50岁者感染率为26.5％,二者比较差异有统计学意义(P＜0.05);无并发症者感染率为9.1％、有并发症者感染率为28.3％,二者比较差异有统计学意义(P＜0.05);锁骨下静脉穿刺者感染率为17.8％、颈内静脉刺激、穿刺者感染率为21.8％,二者比较差异无统计学意义;导管接头和封管液优化者感染率为17.6％、常规者感染率为37.5％,二者比较差异有统计学意义(P＜0.05);导管种类为双腔者感染率为21.4％、三腔者感染率为27.3％,二者比较差异无统计学意义;置管时间:＜7 d者感染率为9.1％、7～10 d感染率者为20.0％、＞7 d者感染率为40.7％,三者比较差异有统计学意义(P＜0.05).结论 术前积极处理并发症、缩短置管时间及根据药敏试验应用抗菌药物,可防治中心静脉导管感染.     

Q—syte与PosiFlus联用在PICC封管技术的临床应用及效果观察

目的：探讨分隔膜无针密闭式输液接头（Q—syte）与预充式导管冲洗器（Posinush）在经外周静脉置入中心静脉导管（PICC）冲管、封管中的应用效果。方法：将324例行PICC置管术需要化疗的肿瘤住院患者,随机分为对照组和观察组各162例,对照组采用肝素帽连接PICC导管,采用肝素液封管护理,观察组采用分隔膜无针密闭式输液接头连接PICC导管,采用预充式导管冲洗器封管护理,比较两组导管相关性感染率、导管堵管发生率、操作时间、针刺伤次数。结果：观察组导管相关性感染率、导管堵管发生率、操作时间、针刺伤次数均显著低于对照组（P〈0．05）。结论：使用分隔膜无针密闭式输液接头和预充式导管冲洗器联用对PICC进行冲封管效果好,减少导管相关性感染率、堵管率,减少PICC导管并发症。     

锁骨下静脉置管后第一次封管用不同封管液的比较

有人提出应用三向瓣膜式外周中心静脉导管,输液后不用肝素封管,只用0．99／6氯化钠注射液20ml正压脉冲式封管即可。笔者自2003年4月～2004年10月,对锁骨下静脉置管后第一次封管用不同封管液作了比较。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.