降低急诊输液室空气中菌落数的方法探讨

目的探讨降低急诊输液室空气菌落数的有效方法。方法对输液室进行过氧乙酸喷雾和紫外线照射及自然通风处理,然后采样。结果过氧乙酸喷雾和紫外线照射对空气消毒有效,但不能持久,消毒后2h室内菌落数开始超标;自然通风有效降低室内空气菌落数,每天通风2h以上,每次30min,室内菌落数持续<500CFU/m3。结论自然通风是降低急诊输液室室内空气菌落数的有效措施,方法简单、易行和实用。     

急诊输液室空气消毒方法的探讨

目的探讨急诊输液室空气消毒最佳时机,以确保其室内空气质量达标。方法准备面积一样,通风条件相似的输液室两间分别为实验组和对照组,在正常输液时间内随机安排输液患者,实验组采用动态空气消毒机对输液室进行空气消毒,对照组采用通风的方式,3h为一时间段,时间段内,患者数达到5～9人、10～15人、16～30人时分别采样。结果试验组空气能够达标,对照组当患者数在3h内超过15～30人时,空气中菌落数开始增加。结论输液室的空气消毒应随着患者数的改变而改变,不能机械地执行每日消毒两次,并且如果采取通风和臭氧联合消毒的方法效果会更好。     

门诊采血室3种空气消毒方法的消毒效果观察

摘要 目的 观察紫外线、三氧消毒机和循环风空气消毒机对门诊采血室空气消毒的效果。方法应用紫外线、三氧消毒机和循环风空气消毒机分别对医院门诊采血室内空气进行消毒,采用自然沉降法在消毒前、消毒后及工作中进行空气采样,评价3种消毒方法的效果。结果消毒后可明显降低采血室内空气菌落数,与消毒前比较差异均有统计学意义;循环风空气消毒机在人员工作状态下持续消毒4 h,空气平均菌落数始终＜4.0 cfu/平皿,紫外线和三氧消毒机在人员工作状态下,空气平均菌落数迅速升高。结论循环风空气消毒机对门诊采血室工作状态下空气消毒均能达到Ⅲ类环境卫生标准,消毒后空气中细菌总数回升缓慢,适于门诊采血室空气消毒。     

培养皿采样置放架的研制及应用

紫外线照射是临床普遍采用的空气消毒方法。为了监测消毒效果,通常采用平皿沉降法进行空气采样行细菌培养。《消毒技术规范》对采样时间、采样高度以及布点原则进行了严格的规定,但临床工作中由于缺乏专门的辅助工具而无法准确按照规范执行操作,往往导致收集到的信息资料缺乏可信度。为了解决这个问题,我们研制了一种专门用于平皿沉降法行空气采样的置放架,应用于临床,取得了良好的效果,现介绍如下。     

介绍一种用于空气采样培养皿置放架的制作

紫外线照射是临床普遍采用的空气消毒方法.为了监测消毒效果,通常采用平皿沉降法进行空气采样行细菌培养.<消毒技术规范>对采样时间、采样高度以及布点原则进行了严格的规定,但临床工作中由于缺乏专门的辅助工具而无法准确按照规范执行操作,往往导致收集到的信息资料缺乏可信度.为了解决这个问题,我们研制了一种专门用于平皿沉降法空气采样的培养皿置放架,应用于临床,取得了良好的效果,现介绍如下.     

急诊换药室感染控制路径对急诊换药室空气消毒效果的影响

目的:探讨急诊换药室感染控制路径对急诊换药室空气消毒效果的影响。方法:2012年1月~2013年1月换药室作为观察组,采用急诊换药室感染控制路径,2011年1月~2011年12月换药室作为对照组,两组换药室都进行了45次清创缝合手术与换药术,分别于8:00、11:00、14:00、16:00时做标准采样,比较两组消毒效果,对患者进行随访并作对比。结果:8:00、11:00、14:00、16:00,观察组急诊换药室细菌数均显著低于对照组急诊换药室(P0.05)。观察组术后体温升高、术后3 d血常规WBC10.0×109例数显著低于对照组(P0.05),术后抗生素使用时间、术后拆线时间均显著短于对照组(P0.05)。结论:对急诊换药室采用感染控制路径管理方法能提高手术室空气的洁净程度,显著降低术后患者感染率,降低并发症,值得临床推广使用。     

通风对提高门诊输液室空气质量的观察

目的探讨通风对门诊输液室空气质量的影响。方法在紫外线消毒前、紫外线消毒后室内未经通风、通风30min后、通风1h后进行空气采样分析。结果通风30min后、通风1h后，输液室空气菌落数可以达到卫生部制订的医院消毒技术规范标准。结论通风是保证输液室室内空气质量的简便而有效的措施。     

医院检验科环境卫生与消毒效果评价

了解检验科环境卫生状况,对消毒效果进行评价,探讨检验科院感防控工作的重点。监测检验科清洁区值班室、办公室和学习室,污染区生化室、临检室和微生物室物体表面细菌数、空气细菌数,评价检验科环境卫生状况,评估消毒方法和院感防控工作的有效性。检验科清洁区和污染区空气监测平均菌落数,平皿暴露5min的空气菌落数≤3CFU/皿,平皿暴露15min的空气菌落数均≤4CFU/皿,暴露30min的空气菌落数≤6CFU/皿,清洁区与污染区无明显区别,差异无统计学意义(P0.05)。物体表面菌落数均≤5CFU/cm~2,清洁区与污染区无明显区别,差异无统计学意义(P0.05)。检验科环境卫生达到Ⅱ类环境要求,实施的消毒方法和医院感染管理措施是有效的,检验科医院感染管理工作的重点应该放在防止标本、试剂泄漏等意外的发生,加强标本等污染源的管理和消毒工作上。     

DF医用型空气消毒机在空气中的杀菌效果评价

目的:探讨医院环境空气消毒的新方法.方法:用平皿沉降法进行采样分析,监测DF医用型空气消毒机的消毒效果,并与紫外线照射消毒进行比较.结果:在该院不同病房和诊室中,空气消毒机的杀菌效果优于紫外线.结论:空气消毒机杀菌率高,在有人情况下可进行动态消毒,在一定程度上克服了紫外线的缺陷,是防止空气中细菌传播的重要消毒器材.     

空气采样平皿送检时间对监测结果的影响

空气消毒效果监测是评价医院环境空气质量的重要依据,是院内感染管理工作的重要内容之一.我院感染管理检查时发现,空气采样平皿送检时间存在较大差异.为了解不同送检时间对空气采样卫生学检测结果的影响,我们进行了实验观察.     

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.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

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.