医院物体表面清洁与消毒方法灭菌效果的比较

目的观察医院物体表面采用清洁与消毒方法后,物体表面细菌总数变化,为医院减少消毒剂使用提供依据。方法选择医院Ⅲ类环境物体表面如普通病房、治疗室等,随机分成试验组和对照组,试验组用自来水擦拭地面、桌椅及墙面。对照组常规采用含500mg/L有效氯消毒液擦拭消毒。监测清洁消毒前、清洁消毒后0.5,1.0,2.0,4.0h2组地面、桌面、墙面细菌菌落总数变化。结果2组清洁消毒前及清洁消毒后不同时间段物体表面细菌培养合格率比较差异无统计学意义(P>0.05)。结论除非有血液或体液污染,医院Ⅲ类环境物体表面,一般可用自来水作清洁处理而无需每日常规使用消毒液进行消毒处理。     

空气消毒净化机消毒灭菌效果观察

目的检验空气消毒净化机在治疗室和病房的消毒灭菌效果。方法选择我院治疗室、普通病房,随机分成观察组和对照组,观察组用自来水清洁擦拭地面、桌椅及墙面,干燥后用空气消毒净化机消毒灭菌2 h;对照组常规采用含500 mg/L有效氯消毒液擦拭消毒。监测两组消毒灭菌前、消毒灭菌后1 h、2 h地面、桌面、墙面细菌菌落总数变化。结果两组消毒灭菌前及消毒灭菌后不同时间段物体表面细菌培养合格率比较差异无统计学意义(P>0.05)。结论医院的治疗室、普通病房每日可用空气消毒净化机消毒灭菌。     

改良清洁法在洁净手术室物体表面清洁中的应用

[目的]观察不同的清洁方法对洁净手术室物体表面清洁程度的影响。[方法]选择洁净手术室万级层流洁净手术间8间,随机分为试验组和对照组各4间。试验组用一次性纸巾擦拭未被血液及体液污染的桌面和墙面,用清水拖地;对照组常规采用500 mg/L有效氯消毒液擦拭消毒,比较两组细菌培养合格率。[结果]两组物体表面细菌培养合格率比较,差异无统计学意义(P >0.05)。[结论]清水一次性纸巾擦拭洁净手术室未被有机物污染的物体表面有效可行。     

酸性氧化电位水在综合ICU的应用

目的：通过应用酸性氧化电位水对综合ICU病床、床头桌、地面、墙面等物体表面擦拭及呼吸机螺纹管清洗消毒,了解酸性氧化电位水杀菌的消毒效果。方法：分为试验组及对照组,按照《消毒技术规范》对物体表面及环境地面样本采集进行观察。结果：酸性氧化电位水对综合ICU的物体表面、环境地面擦拭接触3min,呼吸机管路各部件浸泡作用3min,平均杀灭对数值大于1,消毒合格。应用酸性氧化电位水对环境物体表面及诊疗护理用具进行清洁和消毒可以达到理想效果,能有效预防医源性感染。     

酒精擦拭消毒物体表面的效果观察

医院普遍采用含氯消毒液对物体表面进行擦拭消毒,效果比较可靠,但我们在实际工作中发现,含氯消毒液消毒法存在腐蚀性强、刺激性大等缺点,经常造成无菌柜金属框架的锈斑,擦拭后使人感到很大的刺激性。为此,我们改用75%酒精对无菌间的物体表面进行擦拭消毒,并对擦拭后的物体表面进行监测。1方法随机选择无菌间的物体表面,如无菌柜台面、柜门把手等,以75%酒精液浸湿无菌巾,每天2次物体表面,再用紫外线照射消毒1h。消毒后用无菌棉拭沾湿采样液对表面作涂抹采样,将采样棉拭投入5m l采样液试管内进行细菌总数检测。2结果结果表明,用75%酒精消毒物…     

酸性氧化电位水消毒效果及安全性分析

目的研究酸性氧化电位水（EOW）对物体表面擦拭消毒的效果。方法对物体表面分别用酸性氧化电位水、75％酒精、84消毒液擦拭消毒前后,细菌采样培养,比较3种消毒液消毒效果,观察对皮肤及环境的影响。结果3种消毒液消毒率分别是81．8％、76．5％、84．8％,物品擦拭消毒前后对细菌的消毒效果差异有统计学意义（P〈0．01）,3种消毒液的消毒效果比较差异无统计学意义（P〉0．05）。酸性氧化电位水对皮肤和环境无影响。结论酸性氧化电位水使用安全、有效、环保,擦拭消毒可起到有效的杀菌作用。     

应用ATP生物荧光法评价消毒湿巾对物体表面的清洁消毒效果

摘要 目的 应用ATP生物荧光检测法评估使用一次性医用消毒湿巾对ICU病房高频接触环境物体表面清洁消毒质量。方法 将ICU病房医护人员高频接触的环境物体表面作为研究对象，采集样本后使用手持式ATP荧光检测仪检测一次性医用消毒湿巾对物体表面的擦拭清洁消毒效果。结果 擦拭消毒前ATP值明显高于擦拭消毒后3 min、1 h、2 h的ATP值，且差异有统计学意义；擦拭消毒后3 min、1 h、2 h的ATP值之间差异均没有统计学意义。擦拭消毒前及擦拭消毒后2 h，医护人员周围环境物体表面ATP值明显高于患者周围环境物体表面ATP值，差异有统计学意义；擦拭消毒后3 min及擦拭消毒后1 h，患者周围环境物体表面ATP值与医护人员周围环境物体表面ATP值接近，差异没有统计学意义。结论 含季铵盐成分的消毒湿巾具有清洁、消毒的作用，医护人员周围环境高频接触物体表面是物体表面清洁消毒的重点。     

洁净手术室Ⅰ类切口手术后不同物体表面擦拭方法效果观察

目的：探讨洁净手术室I类切口手术后不同物体表面的清洁方法及其效果。方法：在保障洁净设备完好、管理措施完善、监测技术规范的情况下,于每天第1台I类切口手术结束后,分别对没有被有机物污染和被有机物污染的无影灯、手术床垫、托手、麻醉工作台表面采用清水和含氯消毒剂擦拭,各取30例样本,检测物体表面菌落数,比较两种擦拭方法的清洁消毒效果。结果：没有被血液、体液等有机物污染的物体表面分别用清水和消毒液擦拭后,菌落数比较差异无统计学意义（P〉0.05）;被有机物污染的物体表面分别用清水和消毒液擦拭后,菌落数比较差异有统计学意义（P〈0.01）。结论：I类手术后未受有机物污染的物体表面选择清水擦拭有效可行,既达到环境质量要求又能减少消毒液对环境和物体表面的破坏,而有机物污染或疑受污染的物体表面必须使用消毒液擦拭。     

洁净手术室回风口清洁效果观察

目的:观察洁净手术室回风口物体表面采用清水、消毒剂两种方法清洁的除菌效果,以利于做好手术室的卫生清洁工作。方法:选择百级层流洁净手术间和万级手术间共6间,第一种方法用清水擦洗地面、墙面、治疗台、回风口;第二种方法除了用清水擦洗用,回风品表面再加用75%酒精擦拭。30min后对物体表面进行采样,观察菌落计数。结果:第一种方法除回风口物体表面细菌培养不合格外,其他均合格。第二种方法物体表面细菌培养合格率均符合中华人民共和国卫生部消毒技术规范里的标准。两组清洁后回风口物体表面细菌培养合格率比较,差异有统计学意义(P0.05)。结论:洁净手术室回风口的物体表面除了用清水擦拭外,还需加上消毒液擦拭才能达到行业标准。     

加强管理前后医院消毒工作质量的比较

对本院贯彻《医院感染管理规范》前（1996）、后（1997年）的消毒工作质量监测结果进行了比较。监测时,对室内空气用直径9cm普通营养琼脂平板沉降5min采样,对物体表面和人员手借助标准无菌规格板用棉拭涂抹采样,检测细菌总数。以医护人员手细菌总数≤5cfu／cm2,Ⅱ类环境室内空气细菌总数≤200cfu／m3,物体表面者≤5cfu／cm2,Ⅲ类环境室内空气细菌总数≤500cfu／m3,物体表面者≤10cfu／cm2为合格。检测表明,贯彻《医院感染管理规范》后,室内空气与物品及人员手的消毒质量均明显提高（附表）。1997年检测27间室内空气细菌总数,12间…     

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.