血源性职业暴露与风险防范

目的分析45名血源性职业暴露危险因素,降低职业暴露风险。方法分析我院2010—2012年45名在职医务人员发生血源性职业暴露,对其暴露源、暴露类型、职业、就诊情况、用药情况、随访情况进行分析,并对在职医务人员进行职业暴露培训,使医务人员能及时报告,填写相关资料。结果血源性职业暴露主要是锐器伤造成,锐器类型以各类针头占首位,致锐器伤操作环节以输液结束拔针与回套针帽时发生率最高;危险因素为针头处理不正确,标准预防措施落实不到位。结论加强医务人员职业暴露防护教育的培训及防范管理,改善医疗操作环境,规范操作流程,实施标准预防,最大限度地减少职业暴露风险,降低职业暴露发生率。     

医务人员职业暴露分析及防控对策

目的：探讨医务人员发生职业暴露的主要因素，及有效的干预措施。方法对我院2012年7月-2013年9月医务人员发生职业暴露的情况进行汇总分析。结果医务人员职业暴露以锐器伤为主，占94.45%；科室分布中手术科室占52.27%，重症监护室占27.27%；发生人员护士多于医生，所占比例分别为72.73%和27.27%；受伤部位以手部刺伤或划伤为主，占95.45%；发生率最高的时机为手术中缝合、传递器械，占29.55%，其次为处理锐器、整理用物，分别占27.27%和20.45%；暴露源中血源性暴露占36.36%。结论针对职业暴露发生的影响因素，医务人员需采取积极有效的防控措施，做好自身防护，减少职业暴露的发生，降低职业危害，保障医务人员安全。     

某三甲综合医院医务人员血源性职业暴露调查分析

目的 了解某三甲综合医院医务人员血源性职业暴露现状、防护知识和防护行为,为血源性职业暴露的防控工作提供数据支撑。方法 采用问卷调查法对2021年1月某三甲综合医院医务人员开展现况调查。结果 1 905名医务人员血源性职业暴露发生率为53.49%,护士职业暴露发生率为72.03%,发生职业暴露的地点主要在普通病房,占比为67.62%;发生职业暴露的班次主要是白班,占比为88.42%;发生职业暴露时所做的操作主要为注射/拔针,占比为43.08%。上报职业暴露的医务人员人数为413名,上报率为40.53%。结论 针对血源性职业暴露的特点,应对医务人员加强教育培训、配备安全型器具、优化上报流程、规范操作规程,以降低其血源性职业暴露发生率。     

教学医院医务人员锐器伤现状调查及干预对策

目的:了解医务人员在工作中发生锐器伤情况,探讨预防锐器伤的有效措施。方法:通过现场调查,对我院2014年546名医务人员进行了锐器伤及职业暴露防护调查。结果:546名医务人员中发生锐器伤300名,发生率为55%;锐器伤发生时机以临床治疗期间为主。在发生锐器伤的人员中,护士占82%,保洁员占59%,工作年限以1年≤工作年限<5年者为主,占锐器伤总数的48.67%。一次性注射器针头刺伤占46%,输液器针头刺伤占25%。结论:医务人员在诊疗工作中锐器伤发生率较高,必须加强医务人员职业暴露自我防护意识。     

某院工作人员血源性职业暴露基线调查及分析

目的了解该院工作人员血源性职业暴露状况,建立医务人员血源性职业暴露报告流程和监测管理系统,为制定职业暴露防护对策提供科学依据。方法监测出2011年8月该院163例工作人员发生了血源性职业暴露,对其高危因素、职业、工龄、致锐器伤操作环节、暴露后的风险评估以及预防用药等进行分析。结果血源性职业暴露护士发生率最高(79.14%),其次是医师(15.95%);血源性职业暴露类型主要是锐器伤。结论加强医务人员培训教育、规范操作流程、实施标准预防、建立监测系统、完善报告流程及暴露后正确有效处理和干预是降低职业暴露风险的关键。     

医务人员血源性病原体职业暴露的调查分析

目的探讨医务人员血源性病原体职业暴露的危险因素和预防措施。方法对2011年65名发生血源性病原体职业暴露的医务人员填写的"血源性病原体职业接触登记表"进行统计分析。结果 65名医务人员中护士职业暴露发生率最高,占41.5%;职业暴露发生在外科的比例最高,占47.7%;被空心针头扎伤的比例最高,占63.1%;引起职业暴露最常见的原因是诊疗过程中操作或处理不慎,占26.2%。结论加强职业安全教育,严格执行标准预防措施,是预防医务人员职业暴露的关键。     

医务人员血源性职业暴露基线调查与分析

目的了解青岛市胶州中心医院医务人员血源性职业暴露的真实情况,为制定职业防护对策提供科学依据。方法采用统一的问卷调查2013年8月1-31日期间医务人员血源性职业暴露发生情况。结果血源性职业暴露护士发生最多,为80人（60.61%）;其次为医生,共30人（22.73%）。工龄5年以下人员发生频率最高,共63人（47.73%）;锐器伤的器物以注射器针头和玻璃制品最多。操作环节为掰安瓿和注射或输液结束时最多。结论加强医务人员职业防护培训,规范操作规程,完善职业暴露报告流程和监测管理,提高职业防护意识,从而保障职业安全。     

医务人员血源性职业暴露监测分析与防护对策

目的 了解血源性职业暴露状况,建立医务人员血源性职业暴露报告流程和检测管理系统,为制定职业暴露防护对策提供科学依据.方法 监测2009年1～12月94名血源性职业暴露的医务人员,对其职业、高危因素、致锐器伤操作环节、暴露后的风险评估以及预防用药等进行分析.结果 血源性职业暴露护士发生率最高(77.66%),其次是医师(18.09%);2名HIV职业暴露者给予预防用药,无1名因职业暴露而发生血源性病原体感染.结论 加强医务人员培训教育、规范操作流程、实施标准预防、完善报告流程及暴露后正确有效处理和干预是降低职业暴露风险的关键.     

传染病院医务人员锐器伤调查分析

目的：探讨医务人员锐器伤发生原因,提高医务人员自我防护意识,减少职业暴露的发生。方法：对2011年1月至2013年12月25例医务人员锐器伤资料进行统计分析。结果：25例锐器伤中护士占84.0%,医生占12.0%,其中工作年限〈5年护士占72.0%,发生锐器伤主要场所病区占88.0%,手术室占12.0%。其中职业暴露占56.0%,暴露源主要为HBV占57.1%、HIV占35.7%。结论：低年限医务人员锐器伤最多见;加强低年限医务人员职业防护知识培训,减少职业暴露的发生。     

精神病专科医院医务人员血源性职业暴露现状分析与防护策略

目的：分析精神病专科医院血源性职业暴露现状及特点,以制定正确有效防护措施。方法：根据2008年1月至2012年1月各科室上报登记的“医务人员意外职业暴露卡”,对职业暴露人员的职业、工龄、操作环节、暴露源分布等项目进行统计分析。结果：（1）发生血源性职业暴露人员主要是护士,占85．42％;（2）发生职业暴露工作年龄以1～5年所占比例大;（3）发生血源性职业暴露主要以HbsAg为主;（4）发生职业暴露的48例医务人员中有25例针刺伤,占52．08％,18例抓咬伤,占37．50％,黏膜接触5例,占10．42％。结论：针刺伤和抓咬伤是精神病医院发生血源性职业暴露的重要原因。制定内部安全防护管理制度,严格执行标准预防措施,加强新上岗职工职业防护培训,特别是护理人员,另外根据专科医院特点加强职业安全培训、规范操作行为、加强职业暴露后的监控管理等,是减少医务人员血源性职业暴露的关键,也是有效预防血源性暴露后感染发生的有力措施。     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.