敌腐特灵洗消剂对氨水灼伤大鼠皮肤的应急洗消效果

目的 评价敌腐特灵对受氨水喷溅的大鼠皮肤的洗消效果。 方法 将不同剂量敌腐特灵皮肤洗消剂与1.0 mL的1 mol/L氨水混合,利用pH计测定氨水溶液的pH值以观察中和作用;大鼠皮肤以25.0%氨水各灼伤1 min、2 min、5 min后,分别用250 mL生理盐水、敌腐特灵、硼酸溶液进行洗消,观察不同洗消剂洗消后24 h皮肤损伤情况,每组大鼠均随机分为10只。 结果 敌腐特灵皮肤洗消剂对氨水具有快速高效的中和作用。氨水滞留皮肤1 min后进行洗消,各洗消剂均具有较好洗消效果,皮肤平均损伤反应分值在各组间比较,差异无统计学意义(F=0.462,P > 0.05);氨水滞留皮肤2 min时进行洗消,敌腐特灵较硼酸溶液、生理盐水具有更好的减轻皮肤损伤作用,组织病理学观察敌腐特灵洗消后皮肤损伤明显减轻。三组溶液洗消后皮肤平均损伤反应分值分别为0.48 ±0.44、1.22 ±0.97、4.78 ±0.67,皮肤经敌腐特灵洗消后的分值与其他两组相比,差异有统计学意义(q=-3.130,P < 0.05;q=17.441,P < 0.01);氨水滞留皮肤5 min后进行洗消,皮肤平均损伤反应分值在各组间比较,差异无统计学意义(F=0.412,P > 0.05)。 结论 敌腐特灵皮肤洗消剂对氨水具有快速、高效的中和作用,早期迅速应用能明显减轻皮肤损伤。     

化学灼伤现场创面冲洗方法探讨

化学灼伤后现场所采用的急救方法对伤员预后非常重要。目前国内外已开发使用专门针对化学灼伤的洗消液, 其使用的原理同以往化学灼伤后立即用水冲洗不同。以国内外使用较多的敌腐特灵和六氟灵洗消液的使用为例, 结合临床病例对化学灼伤后洗消液的使用效果进行分析。认为敌腐特灵、六氟灵等洗消液作用明显优于用水冲洗受伤部位, 在灼伤后1 min内使用效果为佳; 如只能用水冲洗时, 须注意冲洗的一些误区, 并尽快就诊。     

酸性氧化电位水对铜绿假单胞菌感染的深Ⅱ度烧伤创面的效果

目的探讨酸性氧化电位水(EOW)用于冲洗铜绿假单胞菌感染的深Ⅱ度烧伤创面的临床效果,为医护人员合理选择液体进行创面冲洗与消毒提供依据。方法实验用SD雄性大鼠54只,在SD大鼠背部建立两个一致的铜绿假单胞菌感染的深Ⅱ度烧伤创面,随机分为3组,A组采用醋酸氯己定溶液冲洗、B组采用酸性氧化电位水冲洗、C组采用生理盐水冲洗擦干后,3组均用斯丽凯纳米银抗菌凝胶进行换药,记录换药后创面组织细菌含量的降低值和创面愈合过程中的创面收缩率、上皮化率和创面愈合时间,数据采用SPSS19.0统计软件进行处理。结果换药前后3组创面的细菌定量的差值差异明显,B组创面换药前后差值最大为(1.21±0.51)×108CFU/g,抑菌率为(52.41±6.42)%,差异有统计学意义(P<0.05);烫伤后早期两组创面的收缩率无明显差异,随着换药次数的增加,两组之间的差异逐渐增大;在烫伤第16天B组创面的上皮化率(89.79±5.43)%明显快于A组(62.35±9.65)%和C组(72.92±5.73)%,差异有统计学意义(P<0.05);B组创面愈合时间最短为(17.75±1.49)d,C组次之(22.00±2.20)d,A组时间最长(24.25±2.12)d,3组愈合时间比较差异有统计学意义(P<0.05)。结论 EOW的杀菌能力和促进创面愈合能力明显优于醋酸氯己定溶液和生理盐水,是治疗深Ⅱ度烧伤创面的重要手段之一。     

探讨皮肤炭疽护理流程临床应用效果

目的:探讨利用药物冲洗、湿敷在皮肤炭疽皮疹护理效果,总结皮肤炭疽护理常规和皮肤护理流程。方法:先利用2%双氧水、9g/L氯化钠注射液、0.5g/L高锰酸钾溶液冲洗,再用康复新液对14例皮肤炭疽患者局部皮肤进行湿敷30分钟,每日进行2次,恶性水肿型每日可进行4次,康复新液能显著促进肉芽组织生长,加速坏死组织脱落,迅速修复创面的作用。结果:14例患者均有新生肉芽组织生长,焦痂脱落,皮肤愈合出院,1例病例留有瘢痕。结论:利用药物冲洗、湿敷的方法总结的皮肤护理流程针对皮肤炭疽破损皮肤创面效果显著,特别针对恶性硬性水肿型皮肤皮损均能促进愈合。     

化学性皮肤灼伤早期创面处理综述

早期创面处理是化学性皮肤灼伤现场急救极为重要的环节，直接关系到救治的效果和预后。通过复习相关文献，并结合实际经验，对化学性皮肤灼伤后现场救治应遵循的程序、洗消液的选择、早期创面的洗消方法、创面的早期外科处理等方面的临床实践进行总结，以期为化学性皮肤灼伤的现场急救提供借鉴，提高现场救治和院内诊疗水平。     

角蛋白19在Ⅲ度烧伤创面修复过程中的表达及意义

目的 通过对Ⅲ度烧伤创面原位再生修复过程中不同活组织角蛋白19(K19)表达特征的研究，探索Ⅲ度烧伤创面原位再生修复的可能机制。方法 选择有Ⅲ度烧伤创面的青年患者10例，在原位再生修复过程中的不同时期分别切取活组织，应用过氧化酶标记的链霉卵白素(SP)免疫组化法，以K19单抗检测表皮干细胞的分布和形态特征；同时取供皮区的正常皮肤以及慢性溃疡组织作对照。结果 (1)正常皮肤组织只有表皮基底细胞层和附属器的部分细胞表达K19；(2)伤后3—6d，10例患者的痴下活组织均未发现K19表达阳性细胞；(3)肉芽样组织有部分细胞表达K19；(4)早期再生组织检测结果示：在再生表皮的中部，即位于基底膜与颗粒层之间有大量的K19表达阳性细胞，且分布广泛而有规律；(5)晚期再生组织检测结果显示：与正常皮肤类似；(6)入院前慢性皮肤溃疡组织中无K19表达阳性细胞。结论 Ⅲ度烧伤创面经烧伤湿性医疗技术加rhEGF治疗后K19表达阳性细胞可以从无到有产生并不断增加，以实现Ⅲ度烧伤创面的原住再生修复。     

硝酸银溶液治疗烧烫伤

我院自1980年10月至1985年3月采用硝酸银溶液治疗小面积烧烫伤158例,收到快速治愈的明显效果。现介绍如下: 治疗方法病人入院后,对烧伤创面进行常规清创处理。以蒸馏水冲洗创面2～5分钟,清除创面脱落皮肤及污物;再以生理盐水反复冲洗5分钟;以0.5％硝酸银溶液对烧烫伤部位进行密封湿敷治疗。同时根据病情(烧伤面积和程度等)可给予:①黄连解毒汤加减或三黄石膏汤加减;②应用抗生素;③补充液体和电解质。在我们治疗的158例中,小面积烧伤病人中男性95例,女性63例;年龄最大55岁最小2岁;烧烫伤种类:水烫伤82例,沸油烫伤29例、火焰     

烧伤病人的饮食治疗

烧伤病人的饮食治疗兰景轩烧伤是指热力引起的皮肤或其它组织的损害。烧伤病人，特别是大面积烧伤者，易发生营养障碍。一方面因代谢率增高，分解旺盛，创面渗出以及切皮、植皮、感染、手术出血等原因，致使全身消耗增多；另方面则由于烧伤病人消化功能紊乱，食欲锐减，致...     

洁力康用于伤口及创面冲洗的临床效果

目的 比较临床上使用抗菌剂的抗菌效果。方法用洁力康进行普外、妇产、小儿外科、泌尿、烧伤、骨科、心胸外科、耳鼻喉及口腔科的17206例手术患者创口冲洗。结果手术切口及创面均为甲级愈合，洁力康对创口及皮肤黏膜细菌的即时杀灭率均为100％，在术后24h换药时切口部位亦未检出细菌。结论采用具有持续杀菌作用的洁力康进行手术创口及各类创面的冲洗，对控制术后及医院交叉感染有积极意义。     

人类全厚皮片移植裸鼠模型烧伤后MMP-1、TIMP-1表达的动态变化

目的 研究NMP-1、TIMP-1在烧伤创面愈合至HS形成的过程中的表达、关系和作用。方法 将人类正常全厚皮肤移植于裸鼠，待其完全存活后造成深Ⅱ度烧伤创面；然后用免疫组织化学染色的方法，观察NMP-1、TIMP-1在烧伤创面愈合至瘢痕形成全过程中的表达变化。结果 NMP-1于烧伤后第2d出现，第3d～15d表达较强，第28d已下降到基底值。它在具有不同流动性组织的界面明显。TIMP-1于烧伤后第2d出现，很快就表现为类似于NMP-1的接触界面的表达模式，并且一直持续到烧伤后5月瘢痕的形成；它的表达模式没有NMP-1那么规则，但在血管周围有明显的分布。结论 在伤口愈合的炎症期和增生期，NMP-1和TIMP-1两种力量处于动态平衡；在重塑期，TIMP-1通过抑制MMP-1的表达，减少胶原降解，从而诱导HS形成；并且它们可能在具有不同流动性组织的界面起着特殊的作用。     

Prevention of irritant contact dermatitis among health care workers by using evidence-based hand hygiene practices: a review

Irritant contact dermatitis is often found on the hands of healthcare workers and is generally caused by frequent hand washing, gloves, aggressive disinfectants or detergents. Alcohols have only a marginal irritation potential, although they may cause a burning sensation on pre-irritated skin. A burning sensation when using alcohols therefore, suggests that the skin barrier is already damaged. Two options for hand hygiene are generally available in clinical practice: (1) hand washing with some type of soap and water or (2) hand disinfection with alcohol-based hand rubs. Most clinical situations require the use of an alcohol-based hand rub for decontamination, which is especially useful for reducing the nosocomial transmission of various infectious agents. Washing one's hands should be the exception, to be performed only when they are visibly soiled or contaminated with proteinaceous material, or visibly soiled with blood or other body fluids. The overall compliance rate in hand hygiene is around 50%, which is far too low. In addition, healthcare workers quite often wash their hands with soap and water, when they should use an alcohol-based hand rub. This not only adds to the degree of skin irritation, but is also potentially dangerous for patients, due to the low efficacy of hand washing when compared to hand disinfection with alcohol rubs. Adhering to evidence-based hand hygiene protocols and following international guidelines on hand hygiene practices therefore, can help prevent irritant contact dermatitis among healthcare workers.     

Effectiveness of hand washing on the removal of iron oxide nanoparticles from human skin ex vivo

In this study, the effectiveness of washing with soap and water in removing nanoparticles from exposed skin was investigated. Dry, nanoscale hematite (α-Fe₂O₃) or maghemite (γ-Fe₂O₃) powder, with primary particle diameters between 20–30 nm, were applied to two samples each of fresh and frozen ex vivo human skin in two independent experiments. The permeation of nanoparticles through skin, and the removal of nanoparticles after washing with soap and water were investigated. Bare iron oxide nanoparticles remained primarily on the surface of the skin, without penetrating beyond the stratum corneum. Skin exposed to iron oxide nanoparticles for 1 and 20 hr resulted in removal of 85% and 90%, respectively, of the original dose after washing. In the event of dermal exposure to chemicals, removal is essential to avoid potential local irritation or permeation across skin. Although manufactured at an industrial scale and used extensively in laboratory experiments, limited data are available on the removal of engineered nanoparticles after skin contact. Our finding raises questions about the potential consequences of nanoparticles remaining on the skin and whether alternative washing methods should be proposed. Further studies on skin decontamination beyond use of soap and water are needed to improve the understanding of the potential health consequences of dermal exposure to nanoparticles.     

Decontamination of clothing and building materials associated with the clandestine production of methamphetamine

This study was designed to determine how easily methamphetamine can be removed from clothing and building materials, utilizing different cleaning materials and methods. The study also addressed the penetration of methamphetamine into drywall and the ability of paints to encapsulate the methamphetamine on drywall. Clothing and building materials were contaminated in a stainless steel chamber by aerosolizing methamphetamine in a beaker heater. The amount of methamphetamine surface contamination was determined by sampling a grid pattern on the material prior to attempting to clean the materials. After cleaning, the materials were again sampled, and the degree of decontamination noted. We found that household clothing and response gear worn by first responders was easily decontaminated using a household detergent in a household washing machine. A single wash removed over 95% of the methamphetamine from these materials. The study also indicated that methamphetamine-contaminated, smooth non-porous surfaces can be easily cleaned to below detectable levels using only mild cleaners. More porous surfaces such as plywood and drywall were unlikely to be decontaminated to below regulatory levels even with three washes using a mild cleaner. This may be due to methamphetamine penetration into the paint on these surfaces. Evaluation of methamphetamine contamination on drywall indicated that approximately 40% of the methamphetamine was removed using a wipe, while another 60% remained in the paint layer. Stronger cleaners such as those with active ingredients including sodium hypochlorite or quaternary ammonia and commercial decontamination agents were more effective than mild detergent-based cleaners and may reduce methamphetamine contamination to below regulatory levels. Results from the encapsulation studies indicate that sprayed on oil-based paint will encapsulate methamphetamine on drywall and plywood surfaces up to 4.5 months, while latex paints were less effective.     

清除蔬菜甲胺磷污染的方法研究

自１９８７年底开始，由于进食含有高浓度甲胺磷的蔬菜而中毒的事件在香港时有发生。除了采取不同的行政措施，以防止受农药污染的蔬菜进入香港之外，教育市民利用各种有效方法，在进食前清除蔬菜上可能含有的甲胺磷，亦是防止食物中毒的一种有效措施。这份研究报告评估了各种处理方法的效果，例如用清水冲洗蔬菜，加入洁净剂清洗蔬菜，沸水浸泡或炒煮。结果显示在室温下用水冲洗蔬菜，藉以除去蔬菜上的甲胺磷，过程缓慢，将蔬菜在清水中冲洗１小时亦只能除去６５％的甲胺磷，纵使再继续冲洗过程，情况亦不会有大改善。加入各种洁净剂，包括洗洁精、高锰酸钾、过氧化氢、碳酸氢钠及醋于清水中，亦对于清除蔬菜上的甲胺磷没有显著的改善作用。比较各种处理方法，以在沸水中浸泡最为有效，在浸泡１分钟后，蔬菜上残留的甲胺磷减少已超过九成。     

In vitro test of nicotine's permeability through human skin. Risk evaluation and safety aspects.

Permeability tests with Franz' diffusion cells and an in vitro test model were made to evaluate the importance of dermal absorption of nicotine as a pathway for intoxication. Studies were carried out to ensure that safety procedures, when spilling nicotine on skin, are sufficient to prevent poisoning. Pure nicotine and nicotine in various concentrations in water or ethanol were applied on human skin or gloves in Franz' cells. Washing was simulated by removing nicotine from skin after 3 or 5 min. Permeation rate (flux) and lag time were calculated and estimated for human skin. Different glove materials were tested for their nicotine breakthrough time. Flux depended on concentration in a non-linear way when nicotine-water solutions were tested. Highest flux was found in 50% w/w nicotine dissolved in water. Solutions with low concentration of nicotine (1% w/w) dissolved in water had a similar permeation rate to 100% nicotine. Flux was found to be low when using ethanol as a vehicle; flux was also pH-dependent. The nicotine-water solution containing acetic acid had the lowest flux. The tests where nicotine was washed away revealed that skin served as a possible nicotine depot, because nicotine concentration in the receptor compartment continued to increase after removing the nicotine from the surface. The length of contact time affected the amount of substance passing the skin, resulting in great difference between 3 and 5 min contact time, 5 min giving higher nicotine concentration and 3 min lower. This emphasizes the importance of washing away nicotine spilled on skin rapidly. Two glove types were tested and they were found to be appropriate in their use with nicotine if changed regularly.     

Health Care in East Africa

An experiment was conducted to determine the value of different cleaning solutions for decontaminating cotton sacks that had contained antilouse powders. All three insecticides (DDT, BHC, and malathion) tested were found to be more persistent to washing with tap water alone. When regular soap, washing soda, and caustic soda were used for washing, malathion loss was more significant than the loss of DDT and BHC. The use of detergents for decontamination of empty sacks is effective and the cost involved in time and material makes the procedure practical. Use of nonoxynol (Berol detergent) at 1%, 2%, or 5% concentration can be relied upon to be 91.85%, 93.89%, and 99.09% efficient in removing the highly contaminating DDT residues from sacks. Since minute amounts of insecticides were found after washing, advantage could be taken of the toxic effect of the remaining residue for pestproofing purposes.     

Is biofilm accumulation on endoscope tubing a contributor to the failure of cleaning and decontamination?

We predicted that biofilm would form on surfaces of endoscope tubing in contact with fluids, and may be difficult to remove by current washing procedures. Its presence may protect micro-organisms from disinfectant action and contribute to failure of decontamination prior to re-use. Tubing samples removed from 13 endoscopes that had been sent to an endoscope-servicing centre were examined for the presence of biofilm and bacteria by scanning electron microscopy. Biological deposits were present on all samples tested. Biofilm (bacteria plus exopolysaccharides matrix) was present on the suction/biopsy channels of five of 13 instruments, and was very extensive on one of these. Bacteria and microcolonies were often but not necessarily associated with surface defects on the tubing. All 12 air/water channels examined showed biofilm, and this was extensive on nine samples. Routine cleaning procedures do not remove biofilm reliably from endoscope channels, and this may explain the unexpected failure of decontamination encountered in practice despite good adherence to infection control guidelines.     

Decontamination of human skin exposed to 2,3,7,8-tetrachlorodibenzo-p-Dioxin (TCDD) in vitro.

Human post-mortem skin was exposed in vitro to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) at 32 degrees C, under controlled humidity. In one-half of the samples, damage to the surface of the skin was simulated by stripping of the stratum corneum. After incubation with TCDD for 100 min, four different decontamination protocols were performed: (1) the sample was wiped with dry, adsorbent material (cotton balls); (2) a 10-min topical treatment with mineral oil was followed by dry wiping with cotton balls; (3) a 10-min topical treatment with mineral oil was followed by wiping with acetone-soaked cotton balls; and (4) the sample was washed with water and soap. After decontamination, skin samples were incubated (up to 300 min) again at 32 degrees C. One set of both intact and stripped TCDD-exposed skin samples was incubated for 300 min--absent decontamination--and was used as a control. Mineral oil treatment and acetone wipes, or water and soap, were effective in reducing (i.e., about two-fold) the amount of TCDD in the stratum corneum of intact skin. Mineral oil plus dry wipes reduced the amount of TCDD in the stratum corneum by about one-third, whereas dry wiping alone was ineffective. All protocols, however, were similarly effective in reducing the amount of TCDD in the epidermis and upper dermis; TCDD concentrations were decreased locally by factors of up to ten. In the lower dermis, a minimal effect of the decontamination procedures was observed.(ABSTRACT TRUNCATED AT 250 WORDS)     

危重新生儿合并上消化道出血的止血效果观察及护理

目的:探讨危重新生儿合并上消化道出血的止血方法及护理。方法:把住院的90例合并上消化道出血的危重新生儿随机分为治疗组和对照组。治疗组在对照组常规治疗的基础上先用1%碳酸氢钠洗胃后,给予立止血0.5KU溶于注射用水5～10ml中经胃管注入,并给予综合性护理措施。结果:治疗组的止血有效率高于对照组(P<0.01),平均止血时间也短于对照组(P<0.01)。结论:采用碳酸氢钠联合立止血治疗新生儿上消化道出血效果显著。同时采取综合性护理措施,科学严密地观察病情是提高危重新生儿合并上消化道出血临床治愈成功率的关键。