传染科护士职业暴露现状调查分析和防护对策

目的:为了了解传染科护理人员职业暴露的发生情况,分析职业暴露发生的原因,进一步探讨传染科护理人员职业暴露防范对策。方法:2007年1月-2009年12月对我院护理人员进行问卷调查,包括个人资料、发生职业暴露情况及在临床护理操作中自我防护情况等。结果:47名被调查护理人员中,41名有职业暴露经历,发生职业暴露总次数是385次,在执行护理操作前准备用物时,发生职业暴露87次,占23%;在采集标本、注射及输液治疗等最基本的护理操作时,未采取适当的防护措施,发生职业暴露150次,占39%;在执行护理操作后整理用物、丢弃废物时,工作粗心、不严格执行操作规程、分类标识处置不规范,造成职业暴露148次,占38%;发生职业暴露后向医院感染科报告有31人,占65.9%。结论:传染科护士面临职业暴露风险大,职业防护意识薄弱,职业暴露发生率高,职业防护必须引起相关管理部门重视。     

个体医疗机构护理人员职业暴露的原因分析和应对措施

目的调查、了解、分析个体医疗机构护理人员职业暴露的发生率、发生原因、环节,有关防护的概念及应对措施,以减少个体医疗机构护理人员职业暴露危害。方法对150所个体医疗机构内286名护理人员进行职业暴露、职业防护认知状况进行调查和分析。结果受访286名护理人员中近1年内发生过职业暴露情况的护理人员有146名,职业暴露发生率为51.05%。结论个体医疗机构护理人员职业防护意识淡薄,暴露发生率高。因此,加强对个体医疗机构内护理人员职业安全培训,规范操作流程,减少职业暴露的危害是当前面临的课题。     

临床护士职业暴露现状分析与防护对策研究

目的研究临床护士职业暴露现状分析与防护对策。方法使用问卷调查的方式对2017年1月至2019年1月在医院任职工作的40名护理人员进行问卷调查和相关统计分析,对护理人员的个人经历、基本资料、是否存在职业暴露情况以及自我防护意识、防护能力和护理实践操作等内容进行全面、充分的调查了解。据此研究临床护士职业暴露现状以及有效的防护对策等。结果本次调查研究中40名护理人员的职业暴露总发生例次为52次,其中占比最高的是皮肤黏膜暴露,共发生14次,占比26.92%;其次是配置液体,共发生7次,占比13.46%。其他职业暴露情况依次为:废弃物时共发生6次,占比11.54%;医疗处置时共发生6次,占比11.54%;针头分离、用物整理共发生5次,占比9.62%;拔针共发生5次,占比9.62%;血液、吐泻物污染共发生4次,占比7.69%;动脉、静脉穿刺共发生3次,占比5.77%;针头回套共发生2次,占比3.85%。护理人员在临床操作中存在较高的职业暴露风险,大多数会采取佩戴口罩、手套、双层手套以及穿隔离衣等防护措施,但是仍旧有少部分护理人员因操作方便度降低、增加医院费用、担心患者抱怨或者是认为没必要、没想到和不习惯等导致没有及时进行自我防护处理。结论临床护士在工作实践中面临着不同程度的职业暴露风险,尤其是医院的传染科护士面临的职业暴露风险最大,对护理人员的自我防护意识以及防护能力等不断增强,可以有效降低职业暴露风险,只有从根本上重视护理安全防范工作、加强对护理人员的规范性操作指导,才能够有效把控护理人员的职业风险事件。     

助产士职业暴露现状及防护对策

目的：了解助产士职业暴露的危险因素及发生情况,探讨进一步防范对策。方法：2009年6月～2010年6月对大同市五家市级医院助产士进行问卷调查,内容包括基本情况、发生职业暴露及实践操作中自我防护情况等。结果：116名被调查的助产士中,83名有职业暴露的经历,与分娩有关的职业暴露总次数168例次;助产士自我防护意识差,可能接触产妇血液、体液、羊水时戴眼罩、面罩及穿隔离衣者仅3名,占2.6%;发生职业暴露后上报医院感染管理科的6名,占5.2%。结论：助产士面临的职业暴露风险大,职业防护意识差,增强临床助产士职业防护意识,采取有效预防措施,降低助产士发生职业暴露的风险。     

56例护士职业暴露的原因分析及对策

目的 探讨护理人员职业暴露发生的原因,并提出切实有效的防护对策,减少其发生.方法 对我院100名临床护士采用自拟答卷进行调查,并进行回顾性分析.结果 发现护理人员职业暴露发生比例较高,标准预防与现实执行偏差较大.结论 只有加强职业安全防护教育,规范护理人员操作行为,增强自我防护意识,是减少职业暴露的有力措施.     

56例护士职业暴露的原因分析及对策

目的 探讨护理人员职业暴露发生的原因,并提出切实有效的防护对策,减少其发生.方法 对我院100名临床护士采用自拟答卷进行调查,并进行回顾性分析.结果 发现护理人员职业暴露发生比例较高,标准预防与现实执行偏差较大.结论 只有加强职业安全防护教育,规范护理人员操作行为,增强自我防护意识,是减少职业暴露的有力措施.     

基层医院护理人员锐器伤职业暴露风险分析与对策

目的：探讨基层医院护理人员锐器伤职业暴露原因分析与防护措施。方法：对12家基层医院护理人员职业暴露发生的风险因素分析,并采取一系列防护措施。结果：98名职业暴露人员中,工作年限≤5年的人员占63.27%;初级职称人员占68.37%;外科发生职业暴露明显高于内科;职业暴露种类以静脉针头或血管套管针为主,占48.98%;职业暴露发生环节以静脉输液时或拔针时为主,占42.86%。结论：基层医院医务人员职业暴露风险大,应提高医院领导意识,加强培训,完善流程,规范操作,改善操作环境等综合措施,才能有效避免护理人员职业暴露的发生。     

浙江省绍兴市某医院临床护士职业暴露风险与防范分析

目的：了解绍兴市某医院护士职业暴露情况,从而为制定相关防范措施提供依据。方法：采用回顾性问卷调查方法,于2010年4月对绍兴市某医院不同科室的136名临床护士进行调查,了解该医院护士职业暴露情况。结果：调查发现136人共发生职业暴露97例,发生率为71.32%。结论：医院护士发生职业暴露的原因主要为职业防护知识缺乏,个人防护意识不强等,应加强护理人员职业安全教育与培训,加强个人防护意识;应使用必备防护用具;应加强医院监管,制定并落实相关防范对策及制度等。     

助产士职业暴露的危险因素及防护措施

目的探讨助产士职业暴露的危险因素及防护措施,对存在的问题提出对策。方法通过对我科45名助产士进行调查,分析助产士职业暴露的危险因素及防护情况。结果助产士职业暴露的危险因素是多方面的,重在防护。结论助产士职业暴露发生率高,要做好职业安全教育,全面提高助产士的自身防护意识,完善必要的防护措施,确保助产士的职业安全。     

助产士职业暴露危险因素及防护措施

目的分析助产士工作中存在的职业暴露危险因素,制定相应防范措施,旨在降低职业暴露风险。方法通过对我市3家三级综合医院56名助产士2009年1月至12月间发生职业暴露情况及职业防护情况进行调查,分析助产士职业暴露的危险因素。结果56例都曾被羊水、血液污染过皮肤;被羊水、血液污染眼、鼻、口腔29例;发生针头、缝针、剪刀、安瓿等锐器伤45例;清洗器械时被污水溅到面部皮肤、眼睛36例。结论助产士职业暴露发生率高,应做好职业安全教育,全面提高助产士的自我防护意识,针对职业暴露危险因素采取相应防护措施,以求最大限度地降低助产士职业暴露风险。     

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.     

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.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.