可抛弃式便携式支气管镜的消毒方法探索

目的评估可抛弃式便携式支气管镜的消毒方法,以期获得最佳的消毒方式。方法采用随机对照方法,将4根全新的可抛弃式便携式支气管镜随机分配消毒方法:2%碱性戊二醛浸泡法、55℃环氧乙烷消毒法、低温等离子灭菌消毒法或对照组。比较消毒时间、消毒效果等。结果 2%碱性戊二醛浸泡法、55℃环氧乙烷消毒法、低温等离子灭菌消毒法3种消毒方法消毒时间依次为108 min、600 min、55 min。低温等离子灭菌消毒法对气管镜图像质量、远端弯曲度、负压吸引力均无明显影响。55℃环氧乙烷消毒法对图像质量、负压吸引力影响较大。2%碱性戊二醛浸泡法主要对图像质量影响较大。结论低温等离子灭菌消毒法消毒时间短、消毒效果较好,对图像影响最小,目前可作为可抛弃式便携式支气管镜最佳的消毒方案。     

手术室物品灭菌前后比色对照表的应用

手术中的所有物品在使用前都需经过灭菌处理,手术室灭菌物品的灭菌标识监测是控制和预防医院感染的重要环节。根据手术室灭菌物品的性质及临床要求,目前临床上常用的灭菌方式有高压蒸汽灭菌、环氧乙烷灭菌、低温等离子灭菌[1]。采取不同的灭菌方式其灭菌标识也不同,为方便区分、     

过氧化氢低温等离子灭菌与传统灭菌效果方法比较

目的 探讨硬式腔镜器械经过氧化氢低温等离子灭菌的效果及与传统灭菌效果的差异。方法 选取2017年8月~2018年6月我院供应手术的腔镜器械60套,采用随机数字表法分为两组,各30套。对照组采用传统的脉动真空压力灭菌法,观察组采用过氧化氢低温等离子体灭菌法,观察过氧化氢低温等离子体灭菌的效果监测情况,比较两种灭菌法的细菌残留率、器械损伤情况、医护人员的不良反应、消毒时间及灭菌后保存的有效时间。结果 观察组化学监测时1例不合格,合格率为96.67%,生物监测和物理监测合格率为100.00%;观察组的细菌残留率为3.33%,低于对照组的26.67%,差异具有统计学意义（P＜0.05）;观察组灭菌时间长于对照组,灭菌后保存的有效时间长于对照组,差异均有统计学意义（P＜0.05）;观察组未发生器械损伤情况和医护人员的不良反应,与对照组比较,差异有统计学意义（P＜0.05）。结论 硬式腔镜器械经过氧化氢低温等离子灭菌安全有效,与传统灭菌方法相比,灭菌后的细菌残留率更低,灭菌后的保存有效时间更长,对器械损伤情况和医护人员无不良反应,优势显著。     

左旋聚乳酸可吸收骨钉两种灭菌法效果评价

目的评价左旋聚乳酸可吸收骨钉经环氧乙烷灭菌和^60Co-γ辐照灭菌的效果。方法将左旋聚乳酸可吸收骨钉放人环氧乙烷灭菌器中灭菌,灭菌后将材料置于空气中静置5d,以清除残留的环氧乙烷;另将左旋聚乳酸可吸收骨钉采用^60Co-γ辐照灭菌装置灭菌,吸收剂量15kGy。然后对2种方法灭菌的骨钉分别进行性能表征。结果与左旋聚乳酸可吸收骨钉初始弯曲强度相比,经2种方法灭菌的骨钉弯曲强度均无明显下降（P〉0．05）;与左旋聚乳酸可吸收骨钉初始分子量相比,经^60Co-γ辐照灭菌的骨钉分子量明显减小,下降约11％,表明材料发生降解;经环氧乙烷灭菌的骨钉分子量无明显变化,下降约3％,表明材料未发生明显降解。结论左旋聚乳酸可吸收骨钉以环氧乙烷灭菌为佳。     

肩关节软组织低温等离子射频消融电极的材料改进

低温等离子射频治疗为肩关节疾病常用的微创治疗方法。在临床中,低温等离子射频消融电极常发生电极片脱落故障。为了提高消融电极的安全性和使用性能,本研究针对一款用于肩关节软组织低温等离子消融电极电极片进行材料改进,并对改进后的钨材料电极片的金相组织、粘附组织成分、尺寸变化、力学性能进行分析。结果表明,高熔点的钨材料在该电极中的使用性能优于钛,且有效降低手术中电极片脱落的风险,为临床使用和企业生产提供了有力参考。     

手术室内镜器械的清洗和灭菌方法及效果分析

目的：探讨常用手术室内镜器械的清洗灭菌方法及临床效果,以寻找最为合理有效的清洗灭菌方法。方法以我院2013年1月~2014年1月完成内镜手术后需要清洗并灭菌的180件内镜器械为研究对象,根据清洗方式不同随机平均分为两组,而依据消毒方式的差异性随机平均分为三组,比较不同清洗消毒方式的合格率。结果比较两组清洗方法的洁净程度,使用人工清洗的A组其合格率为95.56%,自动清洗的B组则为70.00%,差异显著,具有统计学意义(P<0.05)；比较三组灭菌效果,a组合格率为85.00%,b组为60.00%,c组为100.00%,c组与a、b两组灭菌合格率比较差异,具有统计学意义(P<0.05)。结论人工清洗法清洗合格率高,等离子灭菌机灭菌效果佳,值得临床推广应用。     

低温等离子射频消融术与喉部分切开术治疗50例早期声门型喉癌患者的对比观察

目的研究低温等离子射频消融术与喉部分切开术治疗早期声门型喉癌患者的临床效果。方法选取我院2015年1月至2017年2月收治的100例早期声门型喉癌患者,按随机数字表法分为切开组(n=50)、等离子组(n=50)。切开组采用喉部分切开术治疗,等离子组采取低温等离子射频消融术。比较两组手术情况(手术时长、失血量)、黏膜恢复情况、住院天数、并发症发生情况,并随访1年,比较两组复发率。结果等离子组手术时长短于切开组,失血量少于切开组,住院天数短于切开组,黏膜恢复评分高于切开组,差异有统计学意义(P0.05);等离子组并发症发生率2.00%,低于切开组24.00%,差异有统计学意义(P0.05);随访1年,等离子组复发率4.00%(2/50),与切开组10.00%(5/50)无明显差异(P0.05)。结论早期声门型喉癌患者采取低温等离子射频消融术治疗,可优化手术情况,减少并发症,缩短住院时间,而喉部分切开术可促进术后黏膜恢复,两种术式复发率相当,临床可根据患者实际病情及需求选择合理术式。     

小鼠颈部异位心脏移植三种术式的比较

目的对三种小鼠颈部异位心脏移植术式进行比较,寻找建立小鼠颈部异位心脏移植模型的可靠方法。方法分别采用端侧吻合、端端吻合、套管法进行小鼠颈部异位心脏移植,对三种术式进行比较。结果应用三种方法各完成小鼠颈部异位心脏移植30例,端侧吻合法手术成功率为63.3%,手术时间为(112±16)min,端端吻合法手术成功率为76.7%,手术时间为(95±13)min,套管法手术成功率为93.3%,手术时间为(69±8)min。结论在三种术式中套管法手术时间最短,成功率最高,能够建立稳定可靠的小鼠颈部异位心脏移植模型。     

Ebstein畸形合并预激综合征的射频消融治疗

目的探讨对Ebstein畸形合并预激综合征采用射频消融治疗的临床效果。方法我院2009年1月至2019年11月收治Ebstein畸形患者101例,将其中9例合并预激综合征并进行了射频消融治疗的患者作为Ebstein组,另外选择同期行射频消融的25例心脏结构正常的B型预激综合征患者作为对照组。比较2组患者的手术时间、消融时间、放电次数、放电功率及临床疗效。结果Ebstein组9例患者的10条旁路被成功消融,其中有3例患者选用Swartz鞘辅助使消融电极贴靠稳定而完成手术;对照组25例患者均顺利完成消融,效果满意。Ebstein组患者手术时间、消融时间、放电次数和放电功率均大于对照组,差异有统计学意义(P<0.05)。Ebstein组患者平均随访(64.44±34.85)个月,对照组患者平均随访(53.12±13.83)个月,2组均无手术并发症发生,均无复发病例。结论与心脏结构正常的预激综合征患者相比,Ebstein畸形合并预激综合征患者行射频消融治疗可取得同样的临床效果,但手术时间、消融时间、放电次数和放电功率会增加。     

内镜下等离子射频联合尼龙圈套扎治疗消化道广基息肉的临床研究

目的研究内镜下等离子射频联合尼龙圈套扎治疗消化道广基息肉的临床疗效。方法临床入选2008年3月至2010年9月期间在我科诊疗的下消化道广基息肉患者104例,按照随机数字方法分成2组,每组52例,对照组患者在内镜下单纯予以内镜下等离子射频治疗,而研究组患者予以内镜下等离子射频联合尼龙圈套扎治疗。对两组患者的相关临床资料进行分析比较。结果两组患者在一次性治疗成功率方面具有统计学差异（P〈0.05）,均出现了并发症,主要有穿孔、出血、电凝综合征等,其中对照组其并发症发生率为34.62%,研究组的并发症发生率为7.69%,两组相比较具有统计学差异（P〈0.05）。两组患者在单颗息肉内镜治疗时间、住院时间及愈合时间方面均没有统计学差异（P〉0.05）。结论内镜下等离子射频联合尼龙圈套扎治疗消化道广基扁平息肉与内镜下单纯等离子射频治疗相比较,不仅疗效显著,而且并发症的发生率明显降低。     

Effect of gamma,ethylene oxide,electron beam,and plasma sterilization on the behaviour of SR-PLLA fibres in vitro

- The aim of this study was to evaluate the effect of various sterilization processes on the physical and mechanical properties of self-reinforced bioabsorbable fibres made out of polylactide (PLLA). The samples were sterilized using plasma, ethylene oxide (one and two cycles), gamma (25 kGy at room temperature, 25 kGy in dry ice, and 2 × 25 kGy at room temperature), and electron beam (15, 25, and 55 kGy) sterilization. The intrinsic viscosity, crystallinity, and mechanical properties (modulus of elasticity, yield strength, and ultimate tensile strength) were tested before and immediately after each sterilization treatment, as well as up to 30 weeks in vitro. Compared with unsterilized fibres, the intrinsic viscosity was markedly decreased after radiation sterilization (gamma and electron beam) and the loss in mechanical properties was accelerated during in vitro degradation. Plasma and ethylene oxide (one and two cycles) did not markedly alter the properties of the samples after sterilization or during in vitrodegradation. These data are important for determining the effect of various sterilization processes on the physical and mechanical properties of polylactidebased materials and can be used to predict how fast degradation of the mechanical properties of the self-reinforced PLLA will occur. They can also be used to tailor the degradation kinetics to optimize implant design.     

血浆对臭氧在水介质中杀菌效果影响的研究

目的探索血浆对臭氧在水介质中杀菌作用的干扰效应,为医用臭氧对腹水等体液中细菌杀灭作用研究摸索臭氧作用的浓度及时间参数。方法在含不同浓度血浆的生理盐水中加入大肠埃希菌（ATCC25922）和金黄色葡萄球菌（ATCC25923）,悬液定量法计算高浓度臭氧（90μg／mL）对其杀菌率;臭氧作用于含10．0％血浆的生理盐水．摸索臭氧有效杀菌的浓度和作用时间参数。结果臭氧杀菌效果随生理盐水中血浆浓度的提高而降低,血浆含量大于10．0％后杀菌效果显著降低（P〈0．05）,90μg／mL臭氧作用20min（流速12ml／min）对含10．0％血浆的生理盐水中大肠埃希菌、金黄色葡萄球菌杀菌率可分别达到100％、99．05％。不同浓度组（40μg／mL、60μg／mL、90μg／mL）的臭氧杀菌效果有显著性差异（P〈0．05）,臭氧作用不同时间（5min、10min、20min）杀菌效果亦有显著性差异（P〈0．05）,以浓度为90μg／mL臭氧作用20min杀菌效果最好。结论血浆可干扰臭氧在生理盐水中的杀菌作用．血浆含量在10．0％以下时影响作用较小,提高臭氧浓度、延长作用时间可提高杀菌率。     

Effect of surface roughness and sterilization on bacterial adherence to ultra-high molecular weight polyethylene

Sterilization with ethylene oxide (EO) and gas plasma (GP) are well-known methods applied to ultra-high molecular weight polyethylene (UHMWPE) surfaces in the belief that they prevent major material changes caused by gamma irradiation. However, the influence of these surface sterilization methods on bacterial adherence to UHMWPE is unknown. UHMWPE samples with various degrees of roughness (0.3, 0.8 and 2.0 µm) were sterilized with either GP or EO. The variations in hydrophobicity, surface free energy and surface functional groups were investigated before and after sterilization. Sterilized samples were incubated with either Staphylococcus aureus or Staphylococcus epidermidis in order to study bacterial adherence to these materials. Fewer bacteria adhered to UHMWPE after sterilization with EO than after sterilization with GP, especially to the smoothest surfaces. No changes in chemical composition of the UHMWPE surface due to sterilization were observed using X-ray photoemission spectroscopy analysis. The decreased bacterial adherence to UHMWPE found at the smoothest surfaces after sterilization with EO was not directly related to changes in chemical composition. Increased bacterial adherence to rougher surfaces was associated with increased polar surface energy of EO-sterilized surfaces.     

新型射频组织焊接电极的设计、仿真与实验研究

目的 设计一种新型射频组织焊接电极,提高吻合口生物力学强度的同时减少组织热损伤。 方法 设计表面存在镂空结构的新型电极(梅花形电极),以环形电极作为对照组,在射频能量作用下完成肠道组织焊接,通过撕脱力和爆破压测试研究焊接吻合口的生物力学特性,采用有限元电-热-力多场耦合仿真分析和热电偶探针研究焊 接过程中的组织热损伤,并对微观组织结构进行检查。 结果 当焊接功率 120 W、焊接时间 8 s、压合压强 20 kPa时,肠道吻合口呈现最优的生物力学特性。 与环形电极对照组相比,梅花形电极组吻合口生物力学强度更高,撕脱力和爆破压分别从(8. 62±1. 22) N、(81. 7±3. 36) mmHg 增加到 (9. 54±1. 24) N、(89. 4±4. 15) mmHg,且组织热损伤显著减少,组织微观结构连接更为紧密。 结论 该新型电极在提高吻合口生物力学强度的同时可减少组织热损伤,进而实现更好的吻合效果。 研究结果可为实现人体管腔组织的无缝连接提供参考。     

心房钠尿肽对脂多糖所致大鼠急性肺损伤的影响

目的:探讨心房钠尿肽(ANP)对脂多糖(LPS)血症大鼠急性肺损伤的作用和机制。方法: 大鼠静脉给予LPS(2 mg·kg^－1)后立即静脉给予ANP(2 μg·kg^－1),记录动物平均动脉血压(MAP)、检测血浆一氧化氮(NO)和内皮素(ET)浓度、测定肺水含量并做肺组织病理学检查。结果: 给予LPS的大鼠,MAP持续下降,至4 h MAP(8.1±2.6)kPa;血浆NO和ET浓度均显著升高(P<0.01 vs control);4 h肺湿干比(5.15±0.43),显著高于对照组(P<0.05);大鼠肺组织病理学检查呈现肺间质水肿。LPS＋ANP组大鼠MAP在给药初期的短暂下降后逐步回升,至4h MAP(13.4±2.9)kPa(P<0.05 vs LPS);4 h血浆NO水平和ET浓度均显著下降(P<0.05 vs LPS),但仍明显高于对照组(P<0.01 vs control);肺湿干比(4.57±0.35)与对照组没有显著差异;肺组织病理学改变较LPS组明显减轻。结论: ANP对LPS引起的急性肺损伤有治疗作用,能调节LPS引起的动脉血压的持续下降,上述作用可能与ANP拮抗ET的产生、降低NO的分泌有关。     

Optimizing the sterilization of PLGA scaffolds for use in tissue engineering

There are few suitable techniques available to sterilize biodegradable polyester three-dimensional tissue engineering scaffolds because they are susceptible to degradation and/or morphological degeneration by high temperature and pressure. We used a novel polyllactide-co-glycolide) scaffold (Osteofoam) to determine the optimal sterilization procedure--i.e. a sterile product with minimal degradation and deformation. Initial studies, found that an argon plasma created at 100W for 4min was optimal for sterilizing Osteofoam scaffolds without affecting their morphology. The RFGD plasma sterilization method was compared to two well-established techniques--ethylene oxide (ETO) and gamma-irradiation (gamma)--which were in turn compared to disinfection in 70% ethanol. Disinfection in 70% ethanol serves as a useful control because it affects neither the morphology nor the molecular weight of the polymer: yet, ethanol is unsuitable as a sterilization method because it does not adequately eliminate hydrophilic viruses and bacterial spores. The three sterilization techniques, ETO, gamma and RFGD plasma, were compared in terms of their immediate and long-term effects on the dimensions, morphology, molecular weight and degradation profile of the scaffolds. Scaffolds shrank to 60% of their initial volume after ETO sterilization whereas their molecular weight (Mw) decreased by approximately 50% after gamma-irradiation. Thus, both ETO and gamma-irradiation posed immediate problems as sterilization techniques for 3-D biodegradable polyester scaffolds. During the in vitro degradation study, all sterilized samples showed advanced morphological and volume changes over time relative to ethanol (EtOH) disinfected samples, with the greatest changes observed for gamma-irradiated samples. ETO, RFGD plasma sterilized and EtOH disinfected samples showed similar changes in Mw and mass over the 8-week time frame. Overall, of the three sterilization techniques studied, RFGD plasma was the best.     

Quantifying the effect of resin type and sterilization method on the degradation of ultrahigh molecular weight polyethylene after 4 years of real-time shelf aging

Alternative sterilization methods including ethylene oxide, gas plasma, and gamma-radiation in an inert environment were implemented in the late 1990s, to limit oxidative degradation of ultrahigh molecular weight polyethylene (PE). There was also a simultaneous transition to PE resins that did not contain calcium stearate. Shelf storage duration of PE inserts following gamma-irradiation in air has been correlated to poor clinical performance and increased wear. This study aimed to determine how sterilization method and resin type influenced degradation of PE after 4 years of real-time shelf aging. It was hypothesized that gamma-irradiation and stearate containing resins would incur significantly more degradation than nonradiated, stearate-free resins. Gamma-irradiated PE samples in air and nitrogen had a significantly increased density and oxidation index, compared to nonirradiated PE after 4 years of shelf aging. Alternative sterilization methods such as ethylene oxide and gas plasma appeared to have significantly less oxidation regardless of PE resin type. A partial correlation demonstrated that density and oxidation index were not correlated (r(2) = 0.079) when examining the influence of sterilization method. The data supported that after 4 years of real-time shelf aging, the type of sterilization method had a larger influence on PE degradation than resin type.     

The effect of solvent extraction and sterilization procedure on the tissue response to Dacron velour

The effects of solvent extraction and sterilization procedure on tissue response to Dacron velour were studied in a canine model, using histomorphometrical techniques. The solvents used for extraction of low molecular weight moieties were either ethanol or water: the sterilization techniques examined were ethylene oxide (ETO) treatment, steam sterilization, and radiofrequency glow discharge (RFGD) treatment. The effect of the sterilization procedure was most marked in the outermost regions (velour) of the implant; no sterilization effects were determined in the capsule or the knitted regions. Velour in the steam sterilized implants had the smallest blood vessel dimensions compared with those that were treated with ETO or RFGD. The effects of different extraction methodologies appeared to be more significant than sterilization effects and were detected further into the implant. That is, not only were extraction effects detected in the capsule and velour, they were also detected in the outer knitted region. Extraction with water resulted in histological responses considered more biologically desirable (thinner capsule, lower giant cell presence, and larger blood vessel diameters) than responses to extraction with ethanol. Neither extraction nor sterilization effects were detected in the inner layers of the knitted region, which were adjacent to the adhesive.