过氧乙酸浓度稳定性与温度关系

过氧乙酸 (peracetic acid,PAA)为广谱消毒剂 ,有效浓度为 0 .2 %～ 0 .5% ,是消毒复用透析器、透析管理想的消毒液。用过氧乙酸试纸 (peracetic- acid- reagentpotenc test)检测 PAA消毒液的有效浓度 ,试验分 A、B两组进行 ,A组置于 2 2～ 2 5℃暗处试验 ,B组置于 2～ 4℃暗处试验。结果显示 ,B组 PAA有效浓度维持日数达 1 4d。因此 ,消毒复用透析器、透析管均应放置在 2～ 4℃暗处     

不同温度下过氧乙酸消毒的复用透析器有效保存时间的观察

目的 观察过氧乙酸消毒的复用透析器及管路在室温及低温（4－10℃)下的有效保存时间。方法 随机选30套用0．35％的过氧乙酸消毒的复用透析器及管路在室温下存放，1－5天后分别作有效浓度测试；随机选30套用0．35％的过氧乙酸消毒的复用透析器及管路在低温（4－10℃）下存放，1－8天后分别作过氧乙酸有效浓度测试。结果 经0．35％过氧乙酸消毒灭菌的透析器及管路在室温及低温下存放，其有效浓度的持续时间有较大的差异。结论 因过氧乙酸在低温下分解较慢，随着温度的升高，其氧化分解速度加快，灭菌性能随之下降，因此，经过氧乙酸消毒灭菌的复用透析器及管路应低温保存，以延长其消毒灭菌的有效期。     

血液透析患者出现热原反应原因调查

为探寻血液透析患者出现热原反应的原因,进行了微生物污染与消毒剂浓度调查。结果,消毒透析器所用过氧乙酸浓度低至０．０５％～０．１６％,贮罐中自来水、反渗水及透析器入口处透析液的细菌总数分别高达 １１ ２００ｃｆｕ／ｍｌ、 １５８０ｃｆｕ／ｍｌ与 １２５０ｃｆｕ／ｍｌ,透析液、反渗水细菌内毒素阳性率均为 １００％（ ２０／ ２０）。经确保过氧乙酸浓度≥０．３％,缩短消毒周期,改善液体过滤除菌设备,液体微生物检测均达标,未再出现热原反应。     

“84”消毒液电动喷雾用于接台手术空气消毒的效果观察

目的 为寻找快捷简便,对人体无毒性且适合于急用手术间的空气消毒方法。方法 随机选择术后经清洁处理的普通手术间作为消毒场所,采用不同浓度的“８４”消毒液进行气溶胶喷雾,其消毒效果经生物８学检测,与１％的过氧乙酸喷雾相对照,并进行统计学分析,结果 １％的“８４”消毒液喷雾后细菌减少率为７５．３％,０．５％的“８４”消毒液喷雾后细菌减少率为７２．８％,号使用１％的过氧乙酸喷雾相比较,无显性差异（Ｐ〉０     

门诊各窗口细菌污染调查及对策

目的：对消毒前后的门诊挂号、收费及取药窗口进行细菌学监测,比较０．２％过氧乙酸、２％来苏及０．１５％碘伏３种消毒液的效果。方法：于门诊挂号、收费、取药窗口采样,分别用３种消毒液擦拭窗台。结果：消毒前后细菌检出率差异有显性（Ｐ〈０．０５）,３种消毒液的结果差异无显性（Ｐ〉０．０５）,但碘伏消毒效果优于过氧乙酸与来苏。结论：加强对门诊挂号、疏费及取药窗台的消毒对防止医院内感染有重要意义,推荐使用碘     

门诊窗口细菌污染情况调查

通过对门诊挂号、收费、取药窗口消毒前及采用０．２％过氧乙酸、２％来苏儿、０．０１５％碘伏３种消毒液擦拭后细菌３种消毒液控拭后细菌学监测。结果发现，消毒前窗口污染严重细菌增减阳性率高达９７．５％，且多为致病菌和条件致病菌，分别用３式后，阳性率明显降低与控拭前比较有明显差异（Ｐ〈０．００１）。建议有关部门应注重门诊各听清洁消毒工作。     

氧气湿化瓶消毒方法的探讨

１９９４年２月～１９９５年１０月，作者对医院临床内科氧气湿化瓶污染情况进行了调查。结果提示：湿化瓶的液体中存在大量的细菌生长，检出率为７８．９％，以革兰氏阴性菌为主。选用三种消毒液浸泡湿化瓶消毒，（０．２％过氧乙酸，１：１００＂８４＂消毒液与０．１％的新洁尔灭）消毒效果相比较，Ｐ＜０．０１具有显著性。消毒后病人使用湿化瓶和干燥备用湿化瓶分别于第４天和第７天有细菌生长。消毒后湿化瓶，病人使用应每周消毒２次，干燥备用湿化瓶超过１周应重新消毒。     

静脉穿刺前后操作者手的细菌学监测与洗手消毒液的选择

作者通过对４０４例病人静脉穿枣前后，操作者常规洗手与消毒液洗手前后手部皮肤细菌学的监测，以及四种不同消毒液消毒效果的比较，其结果的表明护士为病人进行静脉穿刺后，手部皮肤带菌率为１００％；当用肥皂及流水洗手后，带菌量明显减少，但仍有大量细菌当选用不同的消毒液洗手后，手部细菌受到不同程度的清除，尤其是０．２％－０．５％过氧乙酸及８４消毒液效果最佳。     

不同温度下过氧乙酸消毒的复用透析器有效保存时间的观察

目的观察过氧乙酸消毒的复用透析器及管路在室温及低温(4～10℃)下的有效保存时间.方法随机选30套用0.35%的过氧乙酸消毒的复用透析器及管路在室温下存放,1～5天后分别作有效浓度测试;随机选30套用0.35%的过氧乙酸消毒的复用透析器及管路在低温(4～10℃)下存放,1～8天后分别作过氧乙酸有效浓度测试.结果经0.35%过氧乙酸消毒灭菌的透析器及管路在室温及低温下存放,其有效浓度的持续时间有较大的差异.结论因过氧乙酸在低温下分解较慢,随着温度的升高,其氧化分解速度加快,灭菌性能随之下降,因此,经过氧乙酸消毒灭菌的复用透析器及管路应低温保存,以延长其消毒灭菌的有效期.     

过氧乙酸和次氯酸钠消毒透析器的研究

复用透析器不仅可以降低治疗费用、节约物品,还能提高膜生物相容性,减少透析反应。因此,透析器的复用不仅在第三世界国家得到发展,而且在经济发达的欧美国家也得到提倡。但如果处理不当,也会出现不少问题,尤其是复用透析器的消毒方法和消毒剂的选用及其安全性问题,引起了广泛的关注。为此,我们应用０５％的过氧乙酸（ＰＡＡ）和１％的次氯酸钠（ＮａＯＣｌ）进行透析器复用消毒,并对不同的消毒方法和消毒时间与透析器破膜、发热反应的关系以及对透析器毒素清除效果的影响进行了研究,现分析报告如下。１　材料和方法１１　实验…     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.