静配置中心护理人员职业暴露现况及自我防护知识-态度-行为(KAP)调查分析

目的 探讨静配置中心护理人员职业暴露现况及自我防护情况。方法 以我院静配置中心2019年1月～2020年1月发生职业暴露的55名护理人员为研究对象,分析其职业暴露现况、职业暴露影响因素、自我防护知识-态度-行为(KAP)。结果 55名静配置中心护理人员《医务人员职业暴露情况调查问卷》平均得分为(105.45±7.36)分,处于中上水平；自我防护KAP总分为(65.35±8.97)分,处于中等水平；文化水平、工龄、职称、自我防护教育经历、暴露次数不同的护理人员《医务人员职业暴露情况调查问卷》评分存在显著差异(P＜0.05)；锐器伤暴露风险最高,人际关系暴露风险最低；护理人员脱手套后及时洗手的自我防护行为最到位,有接触体液血液风险时戴手套、口罩、护目镜的自我防护行为最薄弱。结论 静配置中心护理人员职业暴露现象较为普遍,物理、化学、生物、心理等多种因素均可诱发职业暴露风险,但护理人员自我防护KAP较为薄弱,因此,医院应加强护理人员的自我防护教育工作,规范医疗操作流程,以有效降低职业暴露风险。     

助产士职业暴露现状与对策

目的:探讨助产士职业暴露的现状及对策.方法:对26名助产士进行问卷调查,了解、分析其职业暴露时间、种类、方式、部位、暴露后的处理、职业防护及培训等.结果:接受调查的26名助产士均有不同程度的职业暴露.但绝大多数未上报,也未进行规范的处理;46.15%的助产士相关知识欠缺;接触产妇戴手套或操作前后都洗手的助产士人数为0.结论:大多数助产士自身防护意识淡薄,需加强培训,规范工作流程,正确使用防护用具.建立健全的登记上报制度及职业暴露应急预案并实施,以确保助产人员的身心健康,减少职业风险的发生.     

急诊科护士职业暴露防护能力调查

目的 调查急诊科护理人员职业防护的现状,探讨有效的干预措施,减少职业暴露,保障急诊科护士身心健康.方法 对急诊科53名护士进行问卷调查,内容包括一般资料、护理操作中是否戴手套、针刺伤情况、职业暴露防护知识知晓率等.结果 急诊室护士职业暴露知识知晓率相对较低,尤其是年青护士防护意识差,针刺伤发生率高,针刺伤后血液检测率又相当较低.结论 应加强对急诊科护士的职业安全教育,增强其防护意识,提高职业防护能力.     

手术室护士职业防护现状调查及应对措施

目的:了解医院手术室护士职业防护现状,并提出针对性对策.方法:按工龄不同将130名护士分为A、B两组.A组工作1～9年,共65名,B组工作≥10年,共65名.对她们进行问卷调查:①巡回护士为病人进行护理操作时戴手套;②配抗癌药物时戴手套;③注射器使用后复帽时采用单手复帽法;④艾滋病病毒职业暴露时登记并报告当地疾病控制部门;⑤乙肝表面抗原阴性时接种乙肝疫苗;⑥护理操作脱手套后不洗手.结果:A、B两组在①②⑤项防护措施上有差异有统计学意义(P＜0.01,P＜0.05).结论:高年资护士的职业防护意识强于低年资护士,应加强低年资护理人员的职业防护培训和教育.     

不同级别医院护理人员血源性职业暴露自我防护能力调查及分析

目的了解不同级别医院护理人员血源性职业暴露发生情况及自我防护措施执行现状和影响因素,探讨有效干预措施。方法采用自制职业暴露自我防护相关调查表对全市37所不同级别医院的2000名护理人员进行问卷调查。结果主要暴露途径以玻璃割伤、针刺伤、刀片割伤为主,损伤率分别为80．21％、64．55％、14．44％。自我防护措施执行率：抽血戴手套为27．33％,输液戴手套为19．47％,手皮肤有破损时戴手套操作为38．40％,有可能被体液、血液溅到眼部戴护目镜为3．64％。不使用防护用品的主要原因：工作太忙、觉得太麻烦、用品提供不足、认为没必要,发生率分别为76．58％、46．79％、33．48％、14．81％。级别越低的医院锐器损伤发生率越高、自我防护措施执行率越低（P〈0．05）。结论通过行政干预,加强防护知识培训,做好标准预防,是减少职业暴露危害的重要措施。     

临床护士职业防护分析

目的 了解临床护士职业伤害现状和防护情况,完善护士职业防护教育,减少其职业伤害的发生.方法 对2009~2010年5所医院300名不同层次的临床护士进行问卷调查.结果 护士最常见的职业伤害是锐器损伤,护士最易忽视的基本防护措施依次为洗手、戴手套和戴口罩.结论 继续加强临床护士职业防护的教育和指导,并完善职业伤害的防护机制,养成良好的自我防护习惯,降低职业伤害的发生.     

分娩室保洁员职业暴露危害调查与防护

目的：调查分析分娩室保洁员职业暴露的危害,并通过教育增强其自身的防护意识。方法：通过对温州地区6家综合性医院30名分娩室保洁员以访谈和问卷相结合的方法进行调查。采用自行设计的调查问卷,调查被调查人员对职业暴露危害的认知情况、防护措施进行调查,并对被调查人员采用相关知识的讲座以及相关宣传资料的发放的方式进行教育。比较分析被调查人员接受教育前后对职业暴露的认知情况和防护情况。结果：与职业暴露教育前相比,教育后被调查人员对血源性疾病的种类、血源性疾病传染、羊水的污染、防护措施的重要性以及污染锐器的处理方法的认知比率明显提高;防护意识明显增强,保洁前戴手套和保洁后认真洗手的比率明显提高,且被污染针刺伤的比率明显降低,差异均具有统计学意义（P〈0.05）。结论：了解分娩室保洁员职业暴露情况,探讨发生原因,提出合理化的建议和防护措施,通过制定严格的工作制度,对分娩室保洁员加强工作前培训,强调以预防为主,工作中指导及监督,提高她们的自我防护意识,可以有效地防止职业暴露,切断医院传播途径,有效预防医院感染。     

护生实习职业暴露状况与防护知识的调查

①目的了解护生在实习中对职业暴露及防护知识的掌握状况，加强护生职业安全教育及提高防护意识。②方法采用自行设计的调查表，对本院118例临床实习护生进行问卷调查。③结果护生在标准预防知识、6步洗手法与洗手措施指征、有潜在血液或体液接触操作中戴手套、针刺伤后感染哪些疾病及处理合格的仅分别占16．95％、32．20％、22．03％、11：86％及16．10％。④结论只有强化护生实习阶段对职业暴露防护知识的教育和带教老师的素质培养，才能有效减少、避免护生被职业暴露的伤害。     

哈尔滨市8家三级甲等医院外科护士对艾滋病相关知识知晓状况及影响因素分析

目的调查哈尔滨市8家三级甲等医院外科护士对艾滋病相关知识知晓状况并分析其影响因素,为提高外科护士防治艾滋病防护知识培训提供依据。方法采用自行设计的艾滋病相关知识调查问卷对哈尔滨市8家三级甲等医院外科护士的艾滋病相关知识知晓状况进行调查,同时对影响因素进行分析。结果 630名外科护士中,艾滋病相关知识得分≥18分为541名,总知晓率为85. 9%。基本知识知晓率为83. 2%(524/630)、传播途径知识知晓率为96. 5%(608/630)、职业防护知识知晓率为77. 5%(488/630)。不同年龄、学历、职称、职务、工作年限、接受过相关培训次数、针刺伤发生次数的外科护士艾滋病防护知识知晓率比较,差异均有统计学意义(χ~2=26. 098、37. 872、9. 067、9. 503、15. 876、22. 049、16. 585,P 0. 05),年龄越大(χ~2=26. 044,P 0. 01)、学历越高(χ~2=33. 826,P 0. 01)、职称越高(χ~2=9. 003,P 0. 05)、职务越高(χ~2=8. 889,P 0. 01)、工作年限越长(χ~2=15. 795,P 0. 01)、接受过相关培训次数越多(χ~2=21. 140,P 0. 01)、针刺伤发生次数越多(χ~2=16. 278,P 0. 01)的外科护士对艾滋病防护知识知晓率越高;年龄越大(OR=1. 812)、学历越高(OR=2. 008)、职称越高(OR=1. 516)、职务越高(OR=1. 228)、工作年限越长(OR=1. 121)、接受过相关培训次数越多(OR=2. 102)、发生职业暴露次数越多(OR=1. 948)等是影响艾滋病防护知识知晓率高的因素(P 0. 05)。结论外科护士对艾滋病基本知识、防护知识等知晓程度较低。应通过各种途径和手段进行艾滋病相关知识培训,提高外科护士对艾滋病相关知识的整体认知水平。     

手术室护理实习生HIV/AIDS知识知晓状况及影响因素

目的了解手术室护理实习生HIV/AIDS知识知晓状况并探讨其影响因素,为制定干预措施提供参考依据。方法采用自行设计的调查问卷,对轮转至手术室的208名护理实习生进行HIV/AIDS防护知识知晓状况进行问卷调查。结果以女性为主,年龄最小16岁、最大26岁,平均(21. 4±3. 2)岁;以大专学生为主;对HIV/AIDS基本知识的掌握程度较好,各条目答对率范围在80. 7%～99. 5%之间,对HIV/AIDS防护知识的掌握程度相对较差,各条目答对率范围在70. 2%～84. 1%之间;不同年龄、学历以及家中有无从事护理专业的亲属、是否喜欢护理专业、是否接受过相关培训和是否发生过职业暴露的手术室护理实习生对HIV/AIDS知识知晓率间差异有统计学意义(P 0. 05);年龄(OR=1. 846,95%CI:1. 332～2. 425)、学历(OR=2. 334,95%CI:1. 626～4. 358)、家中有无从事护理专业的亲属(OR=2. 856,95%CI:1. 828～5. 683)、是否喜欢护理专业(OR=1. 337,95%CI:1. 102～3. 125)、是否接受过相关培训(OR=1. 154,95%CI:0. 987～2. 854)和是否发生过职业暴露(OR=1. 122,95%CI:0. 969～2. 085)是影响手术室护理实习生HIV/AIDS知识知晓率的重要因素(P 0. 05)。结论年龄、学历、家中有无从护理专业的亲属、是否喜欢护理专业、是否接受过相关培训和是否发生过职业暴露是影响手术室护理实习生HIV/AIDS知识知晓的重要因素,应针对这些影响因素开展针对性的健康宣教培训。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.