噪声暴露与高血压

噪声暴露对血压的影响尚无定论，本回顾了近年来噪声暴露与高血压的研究成果，并对噪声致高血压的影响因素进行了总结。同时提出了噪声对血压影响的不同结论。     

儿童医院新生儿病区医院感染目标性监测

目的：研究儿童医院新生儿重症监护病区（NICU）和普通病区不同体重组新生儿医院感染情况,分析医院感染的特点和高危因素。方法：采用前瞻性调查方法,对2020年1月-2022年1月所有入住新生儿重症监护病区和普通病区的新生儿进行目标监测。比较两个病区不同体重组新生儿的医院感染率、器械使用率和器械相关感染率等。结果：2020年1月—2022年1月两个病区共监测新生儿病例4 999例,监测住院总日数65 466天,感染例数127例,医院感染率2.54%,感染例次数137例,例次感染率2.74%。NICU医院感染率为4.55%,例次感染率为5.20%;普通病区医院感染率、例次感染率均为1.63%。NICU和普通病区感染构成比中NICU居第一位的是下呼吸道感染,占35.80%,普通病区居第一位的是胃肠道感染,占33.93%。新生儿体重越低,医院感染率越高;中心静脉使用率越高,医院感染率越高,差异均有统计学意义（P<0.000 1）。感染患者送检标本124份,检出细菌30株,检出的病原菌均来源于下呼吸道和血液系统,其中下呼吸道以肺炎克雷伯菌为主,血液系统以肺炎克雷伯菌和表皮葡萄球菌为主。结论：...     

2009年玉林市产科及新生儿病区消毒质量监测

目的了解玉林市医疗机构产科、新生儿病区的消毒质量,控制医院感染。方法按GB15982-1995《医院消毒卫生标准》和卫生部《消毒技术规范》,对全市16家医疗机构产科、新生儿病区消毒与灭菌质量采用随机抽样检测。结果总共抽检281件,合格237件,总合格率为84.34%,医疗机构产科、新生儿病区的消毒质量三级医院优于二级及以下医院,差异具有统计学意义（P〈0.05）;不同检测项目使用中消毒剂合格率最高为100%,物体表面合格率最低仅为74.44%,医护人员手、空气、灭菌物品合格率分别为79.76%、87.50%、95.00%,其差异具有统计学意义（P〈0.05）。结论玉林市产科、新生儿病区的消毒灭菌合格率不高,需要进一步提高消毒质量,保障母婴健康和生命安全。     

大中型商场噪声现状及防治对策

目的 了解大中型商场噪声污染的现状,为今后开展卫生监督和监测提供科学依据. 方法 按中华人民共和国标准GB/T17220-1998《公共场所卫生监测技术规范》和GB/T18204.22-2000《公共场所噪声测定方法》要求进行现场布点和检测,以中华人民共和国标准GB9670-1996《商场（店）、书店卫生标准》为评价标准. 结果 22家大中型商场183个检测点的噪声合格率为17.5％. 结论 加大力度开展对大中型商场噪声的卫生监督监测工作,商家配合减少和消除噪声源;同时国家在修改公共场所标准时适当放宽商场的噪声评价标准为不超过65 dB（A）.     

37个工业生产行业职业噪声暴露监测结果评价

目的对工业作业场所职业噪声暴露进行测量和评价。方法按《作业场所噪声测量规范》(WS／T69—1996)进行测点选择和测量噪声强度[dB(A)]，对噪声作业接触人员进行听力筛查，评价职业噪声暴露水平。结果平均噪声强度79[dB(A)]以下段7个行业(占18．92％)、80-84[dB(A)]段有24个行业(占64．86％)，85[dB(A)]段以上有6个行业(占16．22％)。4479个作业场所测量点声级段分布90[dB(A)]以上段占23．17％(n=1038)、85～89[dB(A)]段占25．50％(n=1142)、85[dB(A)]以下段占51．33％(n=2299)。同期接噪作业工人听力筛查4426人，听力损伤检出996人，听力损失筛查阳性检出率为22．50％。结论从危害程度和保护高危人群的角度考虑，严格执行85[dB(A)]噪声限值是适宜的，将来国家制定《工作场所职业噪声接触限值》时应对测量方法作配套规定。     

辽宁省新生儿听力筛查工作现状及对策

目的:了解辽宁省新生儿听力筛查工作现状,针对存在问题提出对策与措施。方法:根据卫生部妇幼保健与社区卫生司提供的调查表对辽宁省2006～2010年各市新生儿听力筛查工作开展情况进行调查。结果:2006～2010年辽宁省新生儿听力筛查率63.8%,初筛未通过率为9.2%,复筛接受率为65.1%,复筛未通过率为18.0%,复筛阳性转诊率为41.0%,双耳听力障碍检出率为0.20‰,干预率为71.9%。结论:应采取积极措施,全面推进新生儿听力筛查工作的深入开展,争取新生儿听力障碍得到早期干预。     

非稳态噪声工作场所噪声暴露测量与评价

[目的]测量和评价非稳态噪声工作场所的8h等效连续A声级（LAeq.8h）、1min等效连续A声级（LAeq.8h）和全天等效声级估算值（LAeq.8h）。[方法]采用个人声暴露计测量LAeq.8h,用声级计测量LAeq.8h。和每个时间段的噪声值,计算出全天的等效声级（LAeq.8h）。应用LAeq.8h和LAeq.8h、LAeq.8T分别测量某输油管道加工厂和某家用电器制造厂239名工人的个体噪声（接触）和相应作业场所噪声（暴露）水平。[结果]两家工厂LAeq.8h均值分别为（89．7±3.8）dB（A）和（90．5±5．7）dB（A）,分别高于LAeqT的（88．0±2．4）dB（A）和（89．2±3．6）dB（A）（P〈O．05或P〈0．01）。与LAeq.8h相比,LAeq.1min采样时间点存在抽样误差。绝大多数工作岗位的LAeq.1min与LAeq.8h均值差大于3dB（A）,所有工作岗位的LAeq.8T均值与LAeq.8h均值差均小于3．0dB（A）。[结论]LAeq.8h能反映在非稳态噪声工作场所工人实际接触噪声暴露水平,LAeq.T比较符合作业工人实际噪声接触水平LAeq.1min。会低估或高估工人噪声暴露水平。     

新生儿病区医院感染管理的薄弱环节及护理对策

对新生儿病区医院感染管理的薄弱环节及对策进行探讨.新生儿免疫功能低下,侵入性操作多,易引起院内感染.诊疗过程中存在消毒及诊疗措施不当等薄弱环节.控制新生儿病区医院感染既要有针对性,又要采取综合措施,完善制度,严格执行相应的法律法规,才能避免暴发性院内感染事件的发生.     

新生儿病区病原菌调查分析及预防感染对策

目的了解新生儿病区的病原菌分布及其耐药性,为有效预防和控制新生儿医院感染提供依据。方法对新生儿病区2009年4月-2011年3月,临床标本分离培养的细菌及耐药情况进行调查分析。结果共检出病原菌290株,其中革兰阳性菌174株占60.00%,革兰阴性菌106株占36.55%,真菌10株占3.45%,产ESBLs的肺炎克雷伯菌和大肠埃希菌分别为62.96%、38.89%,MRSA检出率为50.00%。结论通过病原学监测,了解细菌分布及其耐药趋势,对合理选择抗菌药物,控制耐药菌株产生,有效预防新生儿感染有重要意义。     

水力发电工人职业性噪声聋与累积噪声暴露剂量的关系

目的 分析职业性噪声聋的发生、发展规律及与累积噪声暴露剂量(CNE)的关系.方法 对调查对象进行纯音听阈测定,对作业环境噪声进行监测;计算CNE并进行相关指标分析.结果 当CNE由(97.5±5.4)dB(A)年提高到(102.4±2.9)dB(A)年时,语频损伤及高频损失的发生率分别由4.6%和11.5%上升到10....     

新生儿重症监护室医院感染监测

目的 探讨新生儿重症监护室(NICU)的医院感染率及危险因素。方法 采用目标性监测的方法对某院2002年1～12月NICU所有住院患儿进行主动(前瞻)监测。结果 共出院新生儿1790人，其中130例发生医院感染，医院感染率为7．26％；感染部位构成比排序为：下呼吸道29．23％，皮肤26．92％，上呼吸道25.38％，胃肠道12．31％，口腔4．62％，其他1．54％。结论 NICU医院感染率高；各种侵袭性操作、败血症、早产儿活力不足、低体重出生、住院时间长、抗感染药物应用不合理等是NICU医院感染的危险因素。     

多维度新生儿营养风险筛查量表在新生儿病房住院患儿中的应用

目的 通过不同营养量表的对比,讨论最新的多维度营养风险筛查量表在新生儿病房住院患儿的应用价值。方法 选取2017年7月-2018年5月于西安交通大学第二附属医院新生儿病房治疗的患儿86例,分为早产儿和足月儿两组;所有入组患儿再次分为内科组与外科组。应用多维度新生儿营养风险筛查量表、Strongkids自出生开始每周分别对患儿进行评估至28 d。结果 通过多维度新生儿风险筛查量表得出发生营养不良风险患儿占70.9%,早产儿与足月儿相比存在更高的营养不良风险(χ²=6.542,P=0.010);多维度新生儿风险筛查量表提示外科疾病患儿与内科疾病患儿相比存在更高的营养不良风险(χ²=15.816,P<0.001);对于外科疾病新生儿,新生儿营养风险筛查量表敏感度较Strongkids高(χ²＝10.400,P＝0.001)。结论 多维度新生儿营养不良风险筛查量表对于新生儿营养不良风险筛查效果较好,特别针对于患有外科疾病的新生儿中较传统的筛查方式有着更高的敏感性,可用于临床推广。     

消毒湿巾对新生儿病房环境物体表面消毒的效果

目的比较消毒湿巾与含氯消毒剂的消毒效果,为改进医院感染防控措施提供依据。方法按消毒方法分为伽玛卫生湿巾组、洁力佳表面消毒巾组和84消毒剂组,分别对新生儿病房床单位进行清洁消毒,在消毒前及消毒后5、10、30、60 min五个时间点对新生儿病房床单位表面采样,每组每个时间点分别采集标本30份,比较组间细菌菌落数、杀灭率和消毒合格率,同时筛查物体表面耐甲氧西林金黄色葡萄球菌(MRSA)检出情况。结果消毒后5、10、30 min,床单位物体表面三组间细菌菌落数及杀灭率比较,差异无统计学意义(P0.05)。消毒后60 min,细菌菌落数伽玛卫生湿巾组[(2.61±0.41)CFU/cm~2]、洁力佳表面消毒巾组[(2.71±0.42)CFU/cm~2]低于84消毒剂组[(4.08±0.33)CFU/cm~2],差异有统计学意义(P0.05);细菌杀灭率伽玛卫生湿巾组[(72.36±3.90)%]、洁力佳表面消毒巾组[(71.49±4.77)%]优于84消毒剂组[(55.92±3.22)%],差异有统计学意义(P0.05)。床单位物体表面消毒合格率伽玛卫生湿巾组(86.67%)优于84消毒剂组(63.33%),差异有统计学意义(P0.05)。三种消毒方法均能有效清除物体表面MRSA。结论消毒湿巾消毒效果可靠,且能有效杀灭新生儿病房床单位物体表面多重耐药菌,适用于新生儿等高风险环境。     

Noise exposure assessment among groundskeepers in a university setting: A pilot study

Approximately 870,000 U.S. workers are employed as landscaping and groundskeeping workers who perform various tasks and use a variety of tools that expose them to high noise levels, increasing their risk to noise-induced hearing loss (NIHL). Several studies on noise exposure and NIHL in other job sectors have been published, but those on groundskeepers are very limited. This study aims to characterize the noise exposure of groundskeepers. Participants were monitored over their entire work shift for personal noise exposure by wearing noise dosimeters at shoulder level, 4 in from the ear. Using two different dosimeter settings (OSHA and NIOSH), the time-weighted averages (TWAs) and 1-min averages of noise exposure levels in decibels (dBA) were obtained. The participants were also asked to fill out an activity card daily to document their tasks, tools used, location and noise perception. Sound pressure levels (SPLs) produced by various groundskeeping equipment and tools were measured at full throttle near the ear of the operator using a sound level meter. These measurements were used to assess worker noise exposure profiles, particularly the contributing source of noise. The overall mean OSHA and NIOSH TWA noise exposures were 82.2±9.2 (range of 50.9–100 dBA) and 87.8±6.6 dBA (range of 67.2–102.9 dBA), respectively. Approximately 46% of the OSHA TWAs exceeded the OSHA action limit of 85 dBA. About 76% of the NIOSH TWAs exceeded 85 dBA, and 42% exceeded 90 dBA. The SPLs of equipment and tools measured ranged from 75– 106 dBA, most of which were at above 85 dBA and within the 90–100 dBA range. Hand-held power tools and ride-on equipment without enclosed cab may have contributed significantly to worker noise exposure. This study demonstrates that groundskeepers may be routinely exposed to noise levels above the OSHA and NIOSH exposure limits, and that the implementation of effective hearing conservation programs is necessary to reduce their risk to NIHL.     

Noise exposure and children's blood pressure and heart rate: the RANCH project

Background

Conclusions that can be drawn from earlier studies on noise and children''s blood pressure are limited due to inconsistent results, methodological problems, and the focus on school noise exposure.

Objectives

To investigate the effects of aircraft and road traffic noise exposure on children''s blood pressure and heart rate.

Methods

Participants were 1283 children (age 9–11 years) attending 62 primary schools around two European airports. Data were pooled and analysed using multilevel modelling. Adjustments were made for a range of socioeconomic and lifestyle factors.

Results

After pooling the data, aircraft noise exposure at school was related to a statistically non‐significant increase in blood pressure and heart rate. Aircraft noise exposure at home was related to a statistically significant increase in blood pressure. Aircraft noise exposure during the night at home was positively and significantly associated with blood pressure. The findings differed between the Dutch and British samples. Negative associations were found between road traffic noise exposure and blood pressure, which cannot be explained.

Conclusion

On the basis of this study and previous scientific literature, no unequivocal conclusions can be drawn about the relationship between community noise and children''s blood pressure.     

妊娠期糖尿病与新生儿并发症的相关因素调查

目的：探讨妊娠期糖尿病（ GDM）对新生儿早期并发症的影响。方法以孕24～28周或首诊＞28周经产科门诊确诊为GDM单胎孕妇125例及其所娩出的新生儿为研究对象（ GDM组）,以同期分娩确诊除外糖尿病的正常单胎孕妇95例及其新生儿为对照组。对两组新生儿宫内营养状况、娩出方式、新生儿窒息、低血糖及黄疸等并发症发生情况进行对比分析。结果两组新生儿宫内营养状况[GDM组出生体重指数（PI）值为2．717,对照组为2．469],新生儿窒息发生率差异均无统计学意义（均P＞0．05）;GDM组剖宫产71例,自然分娩54例,对照组分别为31例和64例,两组比较差异存在统计学意义（χ2＝12．6786,P＜0．05）;GDM组新生儿低血糖、新生儿黄疸发生率分别为18．4％、24．0％,与对照组的7．4％和12．6％比较差异均存在统计学意义（χ2值分别为4．5000、5．5777,均P＜0．05）。结论妊娠期糖尿病与新生儿低血糖、新生儿黄疸的发生存在密切的关系。     

新生儿常见疾病早期血浆D-二聚体的检测及意义

目的 分析新生儿常见疾病中早期血浆D-二聚体的水平并探讨其临床意义。方法 常见新生儿疾病300例(实验组),健康新生儿50例(对照组),采集静脉血并检测D-二聚体含量。结果 新生儿轻度窒息组D-二聚体的水平(1 167.5±683.7)及重度窒息组D-二聚体的水平(5 399.5±3 123.3)与健康对照组(320.4±145.5)相比均明显升高,其中重度窒息组D-二聚体水平升高更加显著。新生儿感染性肺炎组D-二聚体的水平(2 406.8±1 559.5)与显著高于健康对照组(320.4±145.5),差异有统计学意义。新生儿呼吸窘迫综合征(NRDS)组D-二聚体的水平( 1 975.6±1 205.6)与健康对照组(320.4±145.5)相比明显升高。新生儿病理性黄疸组(401.1±229.1)与对照组(320.4±145.5)相比差异具有统计学意义,新生儿湿肺D-二聚体的水平(316.9±174.2)与对照组(320.4±145.5)相比差异无统计学意义。结论 血浆D-二聚体的检测对新生儿可能发生高凝状态和血栓性疾病的诊断及预后判断有一定实用价值。     

维生素D在新生儿呼吸窘迫综合征中的研究进展

新生儿呼吸窘迫综合征(neonatal respiratory distress syndrome,NRDS)是新生儿科常见急危重症,具有较高的病死率与致残率,临床上早产儿更易发生。维生素D在NRDS发生发展中有着重要的临床意义,且维生素D缺乏是其发生的独立危险因素。既往研究发现,新生儿普遍存在维生素D的缺乏或不足。维生素D可促进肺泡活性物质的合成与分泌,参与肺泡的成熟及肺血管的发育,减少新生儿呼吸窘迫综合征的发生风险。该文就维生素D在NRDS中的相关研究进行综述,以期临床重视维生素D的补充,进而为降低本病的发生风险提供参考。     

细节管理在新生儿病房中的应用

新生儿是指出生后28天内的婴儿,新生儿各器官功能发育不完善,对疾病易感性强,患病时症状和体征不典型,病程短,病情变化快,死亡率高。荆州医院新生儿科是一个无家属陪伴的病区,针对新生儿科服务对象的特殊性,在实践中护理工作从小处着手抓细节管理,以确保环节质量,提高终末质量。     

Noise exposure and hearing loss prevention programmes after 20 years of regulations in the United States

Objectives

To evaluate noise exposures and hearing loss prevention efforts in industries with relatively high rates of workers'' compensation claims for hearing loss.

Methods

Washington State workers'' compensation records were used to identify up to 10 companies in each of eight industries. Each company (n = 76) was evaluated by a management interview, employee personal noise dosimetry (n = 983), and employee interviews (n = 1557).

Results

Full‐shift average exposures were ⩾85 dBA for 50% of monitored employees, using Occupational Safety and Health Administration (OSHA) parameters with a 5 dB exchange rate (L_ave), but 74% were ⩾85 dBA using a 3 dB exchange rate (L_eq). Only 14% had L_ave ⩾90 dBA, but 42% had L_eq ⩾90 dBA. Most companies conducted noise measurements, but most kept no records, and consideration of noise controls was low in all industries. Hearing loss prevention programmes were commonly incomplete. Management interview scores (higher score = more complete programme) showed significant associations with percentage of employees having L_ave ⩾85 dBA and presence of a union (multiple linear regression; R² = 0.24). Overall, 62% of interviewed employees reported always using hearing protection when exposed. Protector use showed significant associations with percentage of employees specifically required to use protection, management score, and average employee time spent ⩾95 dBA (R² = 0.65).

Conclusions

The findings raise serious concerns about the adequacy of prevention, regulation, and enforcement strategies in the United States. The percentage of workers with excessive exposure was 1.5–3 times higher using a 3 dB exchange rate instead of the OSHA specified 5 dB exchange rate. Most companies gave limited or no attention to noise controls and relied primarily on hearing protection to prevent hearing loss; yet 38% of employees did not use protectors routinely. Protector use was highest when hearing loss prevention programmes were most complete, indicating that under‐use of protection was, in some substantial part, attributable to incomplete or inadequate company efforts.