微生物标本检验质量控制的对策分析

医学检验是疾病诊断的重要内容,检验结果的准确性直接决定了诊断的准确率。因此,加强检验质量的控制具有非常重要的意义。医学检验是一个多流程的环节,在质量控制上应对检验的全过程进行控制,从操作流程到检验人员的专业水平以及职业素养等综合提高检验质量,以为临床诊治提供依据。     

影响血标本检验结果的常见原因及对策

临床实践证实,检查前患者的准备、静脉血标本的采集及运送等环节均可影响检验结果准确性。2006年,我院门诊共采集血标本7．3万份,其中不合格标本838份（1．14％）,凝固和溶血标本796份（1．09％）。为提高临床血标本检测准确性、减少医疗纠纷发生,现将影响血标本检验结果的常见问题及对策报告如下。     

检验科标本不合格的原因及防范措施

目的了解我院检验科标本不合格的原因并提出防范措施。方法采用统计分析方法对我院2009—2012年的标本进行分析。结果血液和胸腹腔积液标本不合格率较高,其中,血液标本溶血和标本凝固为不合格的主要因素,比例达70.13%,并呈逐年下降趋势。尿液和大便标本不合格率比较,差异无统计学意义(P<0.05)。结论应加大对标本采集和处理等分析前的质量控制,以提高血液标本的合格率,达到准确的检验结果。     

脉动真空压力蒸汽灭菌器生物监测不合格原因分析及对策

目的 分析脉动真空压力蒸汽灭菌器生物监测不合格的原因,探讨其处理和预防的措施.方法 对脉动真空压力蒸汽灭菌效果进行生物监测,分析灭菌不合格的原因.结果 脉动真空压力蒸汽灭菌器故障引起的生物监测不合格.结论 加强灭菌工作中环节质量的管理,操作人员需严格遵守机器操作流程,建立完善机器维护和保养机制,才能保证灭菌器的正常运行并提供合格的灭菌物品.     

丙氨酸氨基转移酶不合格报废血液的原因分析

丙氨酸氨基转移酶(ALT)是临床评价肝功能的常用指标,也是卫生部对采供血机构颁布的《献血者健康检查标准》中规定的强制检验项目之一.随着《中华人民共和国献血法》的实施,流动采血车、献血屋采血成为血站血液来源的主要途径.由于受流动采血的设备条件和无偿献血的流动性及时间等因素的限制,本站对献血者不进行ALT初筛.根据对血液不合格项目的统计,ALT不合格的比例最高,已超出报废血液的50%.因此,通过对ALT不合格报废血液的原因分析,有针对性的采取一些措施,降低因ALT不合格的血液报废显得尤为重要[1].现将我站自2003年以来的ALT不合格的原因进行分析,并就相应措施进行探讨.     

呼吸道标本嗜血杆菌培养及其耐药性分析

为了解呼吸道感染嗜血杆菌情况及其对抗生素耐药性。2000年10月至2002年4月。我们对317例呼吸科住院患者的痰标本或咽拭子进行嗜血杆菌分离培养鉴定和药敏试验。现将结果报告如下。     

流感病毒离心壳培养及在临床标本检测中的应用

大流行期间流感病毒在健康人群具有很高的发病率 ,并引起某些人群一定的病死率 ,如老年患者、慢性阻塞性肺部疾病和慢性心血管疾病患者 ,以及免疫缺陷患者如获得性免疫缺陷综合征。流感潜伏期为 1～ 4ｄ ,以发热突然起病 ,可伴有咽喉痛、咳嗽、头痛、肌肉酸痛、畏寒和全身不适。临床上通常以上述症状作为诊断依据 ,而实际上这些症状缺乏敏感性和特异性[1] 。因此 ,快速可靠的诊断对患者的诊治及流感流行的监控是十分重要的。流感病毒的壳培养(Ｓｈｅｌｌｖｉａｌｃｕｌｔｕｒｅ ,ＳＶＣ)则是这种快速可靠的检测方法。材料和方法一、标本来源…     

输血科不合格标本的原因探析及改进

目的:探讨分析临床输血不合格标本产生的原因,保证临床用血安全。方法:选取2012年1―12月期间西安市红会医院输血科接收临床输血样本9 211例,对不合格标本进行原因分析,并指定出改进方案。结果:统计分析2012年上半年和下半年拒收例数分别为107例和24例,同比下降63.34%。样本不合格因素包括:申请单信息有误、血型填写错误、医师未签字、血样信息有误、血量不足、样本溶血、血样无标识。各指标下半年较上半年下降率分别为:28.25%、8.16%、4.58%、14.50%、2.29%、2.29%、4.01%。结论:严格执行输血前样本审核制度,保证临床输血安全有效。     

排列图法对老年患者痰培养标本质量影响因素分析

目的 应用排列图法分析住院老年患者痰培养标本不合格的原因并制定防范措施。方法 利用排列图法对我科2019年5月至11月住院老年患者留取痰培养标本不合格包括未留取标本共91例进行原因分析,筛选出主要因素、次要因素和一般因素。结果 在原因分析中主要因素有老年患者配合度差、留取方法不正确、护士对痰标本留取不重视,次要因素有患者无痰,一般因素有容器错误、未及时送检、护士宣教不够。结论 应用排列图法可科学地筛查出住院老年患者痰培养标本不合格原因的主要因素和次要因素,为临床护理人员提供科学的工作指导,制定针对性防范措施,有效提高老年患者痰培养标本的质量和合格率。     

复苏因子促进临床标本结核分枝杆菌生长的作用分析

目的探讨结核杆菌复苏因子在分枝杆菌快速培养中的实用性。方法收集41份抗酸杆菌涂片阳性的患者痰标本;经过NALC-NaOH法处理;接种到Bact/Alert mp快速培养瓶中;放入Bact/Alert 3d快速培养仪中;记录培养物阳性时间,统计分析。结果实验组阳性率均为90.2%,对照组阳性率为87.8%;实验组平均培养时间为14.8 d,对照组平均培养时间为14.9 d,两组比较有差异,但不明显(P>0.05);实验组有4份标本未生长,对照组有5份标本未生长且4份未生长标本与实验组相同,实验组有17份标本早于对照组生长,最多的提前2.67 d,20份标本晚于对照组生长,最多晚了2.61 d。结论结核分枝杆菌复苏因子对肺结核患者痰标本中结核分枝杆菌的生长有一定促进作用,但没有明显差异。     

Failure of thrombolysis: experience with a policy of early angiography and rescue angioplasty for electrocardiographic evidence of failed thrombolysis

OBJECTIVE—To assess the outcome of a policy of emergency coronary angiography with or without rescue angioplasty in patients with acute myocardial infarction and ECG evidence of failed reperfusion after thrombolysis.
DESIGN—A cohort study.
SETTING—Regional cardiothoracic unit.
PATIENTS—197 patients with acute myocardial infarction fulfilling a simple ECG criterion of failed reperfusion.
INTERVENTIONS—Emergency coronary angiography proceeding to rescue angioplasty for inadequate antegrade flow.
MAIN OUTCOME MEASURES—Hospital mortality for all 197 patients; incidence of successful and failed rescue angioplasty; need for additional revascularisation in those receiving rescue angioplasty compared with those not treated in this way.
RESULTS—197 patients had emergency angiography for ECG evidence of failed reperfusion; 156 patients received immediate rescue angioplasty. Overall hospital mortality for those undergoing rescue angioplasty was 11.5%. Rescue angioplasty achieved TIMI 2 (11) or TIMI 3 (124) in 135 patients, who had a hospital mortality of 5.9%. Failure to achieve at least TIMI 2 flow following rescue angioplasty occurred in 21 patients, with a hospital mortality of 48%. In the 41 patients in whom immediate rescue angioplasty was not performed, reinfarction or requirement for revascularisation occurred in 37%. Reinfarction occurred in three patients (1.9%) who had immediate rescue angioplasty. Hospital mortality for the whole cohort was 10.7%.
CONCLUSIONS—A policy of emergency coronary angiography proceeding to rescue angioplasty where appropriate reduces mortality in a high risk group to a level less than expected for patients with acute myocardial infarction and ECG evidence of failed reperfusion. Unsuccessful rescue angioplasty is associated with a high mortality.


Keywords: acute myocardial infarction; rescue angioplasty; failed reperfusion     

Rapid count of microbial cells in dialysate

An apparatus for the non-culture method (NCM) of microbial cell count was formerly developed and named a bioplorer. The bioplorer NCM is based on the double staining of cells with 4', 6-diamidino-2-phenylindole (DAPI) and propidium iodide (PI) and the automatic analysis of their fluorescent microscopic images. Viable cells can be stained with DAPI, while dead cells can be stained with DAPI and PI. In this study, the bioplorer NCM has been applied to the dialysate. The viable and dead cells in dialysate could be counted within 20 min. The detection limit expressed by log(10)[cells/100 mL] was 2.0. When cell-spiked dialysate samples containing prescribed number of Bacillus subtilis cells were assayed, the numbers of cells determined by the bioplorer NCM (N(VIA)(NCM)) and a conventional culture method (CM) on R2A medium (N(VIA)(R2A-CM)) were similar in the range of 2.6-4.6 within the 95% confidence interval (NCM-CM equivalent range). When test solutions sampled from a practical facility in a hospital were assayed, N(VIA)(NCM) was greater than, but comparable to, N(VIA)(R2A-CM). The endotoxin (ET) in the test samples were assayed as well using a test kit for limulus amoebocyte lysate assay. The results of microbial cells and ET concentration indicated that the dialysate supplying line was clean and well maintained. The bioplorer NCM can determine if the microbial contamination of dialysate supplying facilities is greater than 2.6 (398 cells/100 mL).     

浅析临床输血易引发医疗纠纷的原因及防范对策

医疗纠纷是医疗机构工作人员在诊疗护理过程中所存在的失误和过错。临床输血医疗纠纷时有发生,大部分是可避免的。而发生的原因是多方面的。本文将从多方面对临床输血中发生的医疗纠纷进行分析,提出应对措施,旨在加强临床输血工作管理,提高输血安全,减少或规避临床输血医疗纠纷的发生。     

无偿献血者ALT升高原因分析及应对策略

<正>血清丙氨基转移酶(ALT)是目前采供血机构筛选献血者的必检项目之一,其单项不合格也已成为当前血液报废的主要原因。但ALT活性升高除了某些病理因素外,如生理状态下(剧烈运动、体育锻炼、月经期)、饮食结构及生活方式的改变,都可能引起ALT一过性升高〔1〕。为了减少单项ALT升高献血者的流失和不必要的血液报废,巩固固定无偿献血者队伍,我们对本地区2009-2012年ALT升高无偿献血者性别、年龄、季节变化及再次     

2000～2001年新疆地区细菌培养及药敏分析

目的 通过分析我院院内感染的细菌分布以及对抗生素的敏感情况，以指导临床合理应用抗生素。方法 主要使用法国生物梅里埃公司的VITEK全自动微生物分析仪。结果(1)各种标本的合计阳性率为32．79％(424／1293)，其中G^ 球菌以金黄色葡萄球菌最多(36株)，其次是表皮葡萄球菌(31株)。肠球菌共18株，C杆菌246株，其中最多为大肠杆菌(60株)，其次是不动杆菌(40株，鲍曼钙不动杆菌25株)；假单胞菌35株(铜绿假单胞26株)。其他杆菌41株。(2)葡萄球菌产生β—内酰胺酶为93％～100％，耐甲氧西林的金黄色葡萄球菌(MRSA)和耐甲氧西林的表皮葡萄球菌(MRSE)分别为60％和92％。肠球菌1例为VIE。大肠杆菌产生ESBLs最多，为10株(24．4％)，其次为肺炎克雷伯菌2株(19％)，铜绿假单胞菌为1株(4．2％)。铜绿假单胞菌对头抱他啶敏感率(87％)比亚安培南(78％)高，大肠杆菌除对亚安培南敏感外(100％)，对其他抗生素敏感率在70％以下。肺炎克雷伯菌对大多数抗生素敏感。结论 在新疆地区夏季细菌培养种类中球菌以葡萄球菌为主，其中以耐药表皮葡萄球菌为主，革兰氏阴性杆菌种类与全国情况相似，但产生ESBLS以大肠埃希氏菌最多，铜绿假单胞菌对头抱他唉的敏感率比亚安培南高，其他所有革兰氏阴性杆菌对亚安培南均有很高的敏感率。     

A clinical tool to predict failed response to therapy in children with severe pneumonia

Severe pneumonia in children under 5 years of age continues to be an important clinical entity with treatment failure rates as high as 20%. Where severe pneumonias are common, predictive tools for treatment failure like chest radiography and pulse oximetry are not available or affordable. Thus, there is a need for development of simple, accurate and inexpensive clinical tools for prediction of treatment failure. Using clinical, chest radiographic and pulse oximetry data from 1702 children recruited in the Amoxicillin Penicillin Pneumonia International Study (APPIS) trial we developed and validated a simple clinical tool. For development, a randomly derived development sample (n = 889) was used. The tool which was based on the results of multivariate logistic regression models was validated on a separate sample of 813 children. The derived clinical tool in its final form contained three clinical predictors: age of child, excess age‐specific respiratory rate at baseline and at 24 hr of hospitalization. This tool had a 70% and 66% predictive accuracy in the development and validation samples, respectively. The tool is presented as an easy‐to‐use nomogram. It is possible to predict the likelihood of treatment failure in children with severe pneumonia based on clinical features that are simple and inexpensive to measure. Pediatr Pulmonol. 2009; 44:379–386. © 2009 Wiley‐Liss, Inc.     

微生态制剂对非酒精性脂肪性肝炎大鼠肝脏自然杀伤T淋巴细胞功能的影响

本研究旨在探讨肝脏自然杀伤T淋巴细胞(natural killer T cells,NKT细胞)细胞免疫功能异常在非酒精性脂肪性肝炎(non-alcoholic steatohepatitis,NASH)组织病理学变化中的作用及对微生态制剂的影响,以期为了解NASH的发病机制及寻找有效的治疗药物提供依据.     

结直肠肿瘤经自然腔道取标本手术陷阱与对策

外科技术发展日新月异,NOSES理论框架也日趋完善,随着NOSES的开展越来越多,不可避免的会出现各种各样的问题,比如技术操作不成熟,手术团队成员不固定,手术适应证把握不准确等,只有对现有的技术理念不断的进行总结完善,才能实现NOSES的可持续发展,使其更具生命力.笔者结合自己多年的临床经验将NOSES手术中可能遇到的...