介入手术室医院感染的预防及管理

目的探讨介入手术室医院感染管理存在的主要问题,加强介入手术室医院感染管理。方法结合新颁布的《医院感染管理办法》,对介入手术室医院感染的危险因素进行总结分析,提出介入手术室在预防医院感染、卫生学标准、布局设计及工作流程等方面存在和应改进的问题。结果介入手术室感染管理存在的主要问题是医务人员对医院感染认识不足、预防感染的意识薄弱、消毒隔离制度执行不严格、手术室建筑布局不符合要求等;针对存在的问题,加强重点环节、重点流程、关键人、物的管理,有效地预防和控制了介入手术室医院感染的发生。结论强化各级人员预防医院感染的意识,工作人员按标准要求严格执行无菌技术操作,建立有效的介入手术室感染控制制度及措施,实施手术室合理布局是介入手术室控制医院感染的重要环节。     

医院感染在基层医院手术室的隐患因素及管理对策

目的 为了加强手术室对医院感染工作重要性的认识,预防和控制基层医院手术室感染.方法 调查分析基层医院手术室感染隐患,制订预防与控制医院感染管理对策.结果 医院手术室感染管理不规范.存在管理制度不完善,建筑布局不合理与工作环境不理想,工作人员感染防范意识差、违反操作规程、各项监测不到位等隐患;加强医院手术室感染管理力度,有效地预防与控制了医院感染.结论 只有加深对医院感染工作重要性的认识,更新理念,完善管理,才能提高手术室感染管理水平,有效地预防与控制基层医院手术室感染.     

手术室医院感染的预防与控制

总结了手术室医院感染的危险因素及管理流程。手术室感染来源包括环境布局、人员、室内物品、一次性医疗物品、手术器械等方面。手术室感染控制的措施包括：加强院感管理,完善工作流程;强化院感培训,及时掌握院感标准;严格人员管理,提高医务人员院感控制自觉性;手术室物品、设备的管理;医疗废物管理。认为对手术室采取多环节、全方位院感控制方案,如组织管理、制度健全、措施完善、人员培训、环境监控、物流管理等,是预防手术室医院感染的有效措施。     

心血管介入诊疗的医院感染危险因素及预防对策

本文分析了心血管介入诊疗的医院感染相关危险因素。包括：穿刺部位的皮肤情况、介入室的隔离条件、预防性抗感染药物的应用、设备再使用前的清洁、导管留置时间、手术穿刺部位的选择等,并提出相关的预防对策,包括：建立合理的布局和工作流程、工作人员卫生要求、卫生管理制度的落实、对病人实施有效护理以及不提倡预防性应用抗菌药物等。加强重点环节、重点流程的管理,提高医院感染防范意识就能有效地预防控制心脏介入手术医院感染的发生。     

整形美容门诊手术室医院感染存在问题及对策

目的探讨整形美容门诊手术室医院感染管理中存在问题与控制对策。方法分析美容门诊手术室感染的危险因素,严格规范和布局感染预防工作流程和监测等环节的管理。结果通过贯彻所制定的防控措施,规范了整形美容门诊手术室病人通道和物流通道,降低了医院感染率。结论整形美容门诊手术室医院感染管理存在问题,经过整改加强了管理措施,使之得到规范。     

加强消毒供应室管理以预防和控制医院感染

目的加强消毒供应室管理,预防和控制医院感染。方法按照《医院消毒供应室验收标准》,设计规范的建筑布局及科学合理的工作流程;强化全员预防医院感染的意识,培养良好的职业素质;严格执行操作流程,严把消毒灭菌质量关;严格落实灭菌效果监测及一次性医疗用品管理制度。结果提高了全室人员预防医院感染的意识,医院感染得到有效预防和控制。结论规范的布局与科学的管理是提高消毒供应质量,预防和控制医院感染的重要保证。     

加强消毒供应室管理以预防和控制医院感染

目的加强消毒供应室管理,预防和控制医院感染。方法按照《医院消毒供应室验收标准》,设计规范的建筑布局及科学合理的工作流程;强化全员预防医院感染的意识,培养良好的职业素质;严格执行操作流程,严把消毒灭菌质量关;严格落实灭菌效果监测及一次性医疗用品管理制度。结果提高了全室人员预防医院感染的意识,医院感染得到有效预防和控制。结论规范的布局与科学的管理是提高消毒供应质量,预防和控制医院感染的重要保证。     

手术室医院感染控制规范的实施效果

目的:探讨手术室践行医院感染控制规范的效果。方法:通过认真解读规范,对照标准查找不足,完善制度流程,关注重点环节,严格执行规范要求等,加强手术室医院感染管理工作。结果:手术室院感管理取得较好效果,2013年Ⅰ类手术切口感染率0.2%。结论:严格执行手术部(室)医院感染控制规范,使手术室医院感染管理工作更加科学、规范,有效保障了医疗质量和医疗安全。     

整形美容科门诊手术室医院感染隐患与防控对策

目的:探讨整形美容门诊手术室医院感染的安全隐患与控制措施。方法:分析发生感染的危险因素,采取相应的感染预防与控制措施,严格遵守感染预防原则,做好布局、流程、监测等环节的管理。结果:通过预防措施,规范了整形美容患者进入门诊手术室手术的流程,降低了医院感染率,提高了医疗护理质量,避免了医疗纠纷。结论:通过分析整形美容门诊手术室医院感染的安全隐患,加强整形美容门诊手术室医院感染的管理,增加了医院的社会及经济效益。     

基层医院感染管理存在的问题及对策

目的加强基层医院感染管理。方法通过分析基层医院感染管理存在的主要问题,探讨医院感染预防控制措施。结果医院感染管理存在的问题(1)行政机构重视不足;(2)专职人员配置不当;(3)医务人员意识淡薄;(4)重点科室布局不合理;(5)医院感染监测避重就轻;(6)抗生素滥用现象较普遍。改进措施(1)规范相关机构组织职责;(2)开展医院感染知识全员培训;(3)规范重点部门工作流程;(4)开展医院感染目标性监测;(5)加强抗生素的应用管理。结论做好院内感染控制工作,不仅关系到医疗质量,更关系到患者的生命安全和医务人员的职业健康。     

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.