规范操作培训对降低居家腹透患者腹膜炎发生率的作用

目的探讨居家腹膜透析操作者规范化操作培训对降低腹膜炎发生率的效果。方法选取2013年1—12月于复旦大学附属金山医院肾脏科行维持性腹膜透析治疗的患者50例,对其居家腹透操作者进行规范化腹膜透析操作培训,比较培训前后操作者手部细菌培养情况及患者腹膜炎发生率。结果培训前后50例腹透操作者手部菌落数比较,差异有统计学意义(χ2=27.473,P0.05)。培训前发生腹膜炎13例次/年,发生率26%;培训后发生腹膜炎5例次/年,发生率10%,较培训前下降,差异有统计学意义(χ2=4.336,P0.05)。结论护士对腹透操作者进行规范化培训,能明显减少操作者手部细菌菌落数,有效提高其规范操作的依从性,从而减少腹膜炎发生的诱因,降低患者腹膜炎发生率。     

医护人员洗手方法探讨

目的 分析临床医护人员洗手现状,探讨适合临床实际工作的洗手方法与对策.方法 将监测科室900名医护人员随机分为5组,分别按诊疗操作后、传统习惯洗手、改用推荐六步洗手法及左、右手洗手方法进行微生物检测,并比较其效果.结果 诊疗操作后手带菌平均菌落数46 cfu/cm,按传统习惯洗手平均菌落数14 cfu/cm,改用推荐六步洗手法平均菌落数 8 cfu/cm,左手洗手平均菌落数6 cfu/cm.右手洗手平均菌落数12 cfu/cm.改用新推荐方法洗手的手卫生合格率为1.67%.结论 改用推荐六步洗手法效果理想,明显优于传统的洗手方法,护士左手比右手洗的干净.     

医院护理信息系统污染调查及预防院内感染的研究

目的　对护士站键盘、鼠标细菌污染情况调查。方法　对 32台护士站计算机的键盘、鼠标采用棉拭子法分别采样 3次 ,进行细菌培养、菌落计数和菌型鉴定。结果　检测出 18种细菌 ,菌落数最高达 2 6 0cfu/cm2 ,最低为 4 .8cfu/cm2 。对消毒前后菌落数的数据作统计学处理 (P <0 .0 5 ) ,二者差异有显著性。结论　从检测结果看污染率达 10 0 % ,危害护理人员的身体健康。建议护理人员上机前洗手 ,定人定期对护士站计算机键盘、鼠标进行消毒处理。加强预防污染对策 ,避免院内感染的发生。     

居家透析者发生细菌性腹膜炎的相关因素分析

对３３ 例持续性不卧床腹膜透析（ＣＡＰＤ）者居家透析情况作了１ 年的科研调查,研究腹透相关性细菌性腹膜炎的家庭内影响因素及相应的护理干预的效果。结果①家庭腹透室操作用桌面细菌培养合格率、腹透管皮肤出口处细菌检出率、性别、腹透室空气及操作者手细菌培养合格率和腹透管皮肤出口处感染对细菌性腹膜炎的发生有重要意义。Ｌｏｇｉｓｔｉｃ 回归分析显示前３ 者是影响的主要因素;②护理干预后腹膜炎发生率显著下降。提示使居家ＣＡＰＤ 者保持个人卫生、加强家庭透析室的消毒和规范操作非常重要。     

六步洗手口诀对提高医护人员洗手依从性的作用

目的 通过六步洗手口诀来规范医护人员洗手.方法 选取200名医护人员,随机分为实验组与对照组各100名,通过了解医护人员洗手现状,分析造成医护人员未按六步洗手法规范洗手的原因.经过规范系统培训、考核医护人员,应用精细化管理理念,制定相应措施.结果 2组洗手后考核,实验组六步洗手合格率、所需时间、手部≤10cfu/cm2的人数明显高于对照组,2组差异具有显著性(p＜0.005).结论 六步洗手口诀对提高医护人员规范洗手的依从性具有积极意义.     

医院护理信息系统污染调查及预防院内感染的研究

目的对护士站键盘、鼠标细菌污染情况调查.方法对32台护士站计算机的键盘、鼠标采用棉拭子法分别采样3次,进行细菌培养、菌落计数和菌型鉴定.结果检测出18种细菌,菌落数最高达260 cfu/cm2,最低为4.8 cfu/cm2.对消毒前后菌落数的数据作统计学处理(P＜0.05),二者差异有显著性.结论从检测结果看污染率达100%,危害护理人员的身体健康.建议护理人员上机前洗手,定人定期对护士站计算机键盘、鼠标进行消毒处理.加强预防污染对策,避免院内感染的发生.     

直观教育对提高医护人员手卫生依从性的效果研究

目的研究监护室医护人员手卫生教育方式,提高手卫生依从性。方法采用手卫生直观教育的方法,对医护人员手卫生进行培训,并观察医护人员手卫生依从性和质量监测。结果通过手卫生直观教育,重症监护室医护人员日洗手次数由教育前的16次提高到36次;手上带菌数由平均14 cfu/cm2,降低到≤5 cfu/cm2。检测结果显示,医护人员手卫生质量合格率由教育前的18.75%,提高到93.75%。结论通过手卫生直观教育,有效提高了重症监护室医护人员洗手依从性和手卫生质量。     

殡仪职工手卫生措施的效果调查

目的了解殡仪职工手部细菌污染状况及非干预情况下洗手效果,为规范殡仪职工手的清洁消毒方法提供依据。方法采用现场采样和细菌检测方法,对北京等8省市区38个殡仪馆的231名殡仪职工进行了洗手前后细菌污染检测。结果殡仪职工洗手前手上污染细菌总数≥15 cfu/cm2者占28.14%,洗手后手上细菌总数≥15cfu/cm2者为34.20%。结论殡仪职工洗手后手上细菌总数显著高于洗手前,常规洗手方法不能有效清除手上的细菌;应当规范殡仪职工方法和采取必要的手消毒措施。     

妇产科病房护人员洗手教育的效果观察

目的 对妇产科病房陪护人员进行洗手教育,以期提高陪护人员的洗手依从性及洗手质量,从而减少院内感染的发生.方法 对50位妇产科病房陪护人员进行洗手教育,通过问卷调查、隐蔽观察、细菌培养法,对陪护人员教育前后的洗手认知水平、依从性、洗手质量进行比较.结果 洗手教育后陪护人员的平均洗手率明显高于教育前,由34.2%上升到73.2%,漏洗部位、洗手次数和时间亦有明显改进,洗手后细菌培养菌落数降低.结论 洗手教育干预能提高妇产科病房陪护人员的洗手认知水平、依从性.     

伊曲康唑治疗腹透相关性真菌性腹膜炎10例分析

腹膜透析是治疗终末期肾病的一种有效的替代治疗方法 ,其真菌性腹膜炎发生率占 3 5%～1 5% [1 ] 。我院 1 996～ 1 999年采用口服伊曲康唑治疗腹透相关性真菌性腹膜炎 1 0例 ,取得较好疗效 ,现报告如下。1　临床资料真菌性腹膜炎诊断标准[2 ] :腹膜炎症状和体征 ;腹透液混浊 ,白细胞数 >1 0 0 /ｍｍ3,中性粒细胞 >0 50 ;腹透液中找到真菌。治愈标准 :腹膜炎症状、体征消失 ,腹透液ＷＢＣ <50 /ｍｍ3,培养无真菌生长。本组 1 0例中男 6例 ,女 4例 ,年龄 1 4～ 75岁 ,平均 50 9岁。均采用维持性不卧床腹膜透析(ＣＡＰＤ)方案治疗 ,透析液为…     

儿童遗传性心律失常的诊治进展

回顾在遗传性心律失常领域最新发表的相关研究,主要关注与儿童心源性猝死关系密切的离子通道病,包括长QT综合征（LQTS）、短QT综合征（SQTS）、Brugada综合征（BrS）和儿茶酚胺敏感性多形性室性心动过速（CPVT）,总结它们在发病机制及诊治方面的进展。     

The acoustic characteristics of the skull

Many investigators have stated that the difficulties of imaging with acoustical energy through the skull result from the marked attenuation of the energy by the skull. In the literature measurements of total attenuation have been confused with those for absorption.Measurements made by us show that absorption by compact bone varies between 2–3 dB cm^?1 MHz^?1 and, in the low megaHertz region appears to be directly proportional to frequency.It has also between shown that the convoluted inner surface of the ivory bone of the inner table of the skull may degrade the collimation and directionality of the beam by refraction.Cancellous bone, such as is present in the dipole of the skull, greatly attenuates the energy. It is postulated that this largely results from scattering. It is also postulated that the energy propagates through cancellous bone as two components, one in the soft tissues and the other partly in the bony spicules. Observations suggest that attenuation due to scattering much more markedly affects the latter of these components and scatters more greatly the higher frequencies in a pulse of broad bandwidth.The energy in each component has varying propagation paths so that the later cycles in the pulse of each component are subject to increasing interference as a result of the variations in propagation times. The two components moreover may have different propagation times so that interference may occur between the pulses of each component as well.All of these phenomena degrade the collimation, coherence, directionality, beam width, pulse length, frequency and other properties of the ultrasonic energy upon which imaging through the skull depends.The interference effects described above are least for the first cycle in the pulse which usually is not the cycle of highest amplitude. Since, in the free field, most of the energy is concentrated around the beam axis, most of the energy in the field which is deflected from its normal propagation path is deflected away from the beam axis. Thus the directionality of the beam is least degraded in the beam axis. The effects of the skull in degrading the properties of the ultrasonic pulse would therefore be lessened if the amplitude of the first cycle of the pulse and the directionality of its energy could be used for imaging.     

家族性噬血细胞性淋巴组织细胞增生症1例并文献复习

目的加强对家族性噬血细胞性淋巴组织细胞增生症（familially hemophagocytic lymphohistiocytosis,FHL）的认识。方法报道确诊为FHL的新病例1例,结合国内外报道的FHL的病例,对该病的临床特点进行汇总分析。结果FHL2常与PRF1基因突变相关,约20%~40%的患者存在穿孔素基因突变。结论对于有阳性家族史,基因诊断明确,应尽早行化疗或者造血干细胞移植。若无家族史,未发现与继发性HLH相关的原发病因,可考虑行基因筛查以明确是否存在FHL的可能。     

甲状旁腺功能减退性心肌病的系统综述

目的 甲状旁腺功能减退（甲旁减）性心肌病是一种罕见的心脏疾病,为扩张型心肌病中少数可逆转的一种,常被误诊为不明原因或难治性心力衰竭。本文旨在探寻甲旁减性心肌病的规律性特征。方法 检索Pubmed、SinoMed、万方数据库中符合标准的甲旁减性心肌病病例,采用统计分组法对纳入研究的文献进行分析,依据系统综述和meta分析优先报告条目（PRISMA声明）进行报告。结果 在我们筛查出的41例患者中,女性居多（68.29%）,平均年龄为45.5岁,各年龄段均有发病。甲旁减性心肌病最常见的病因为特发性甲旁减（78.05%）,颈部手术导致的甲旁减性心肌病次之（17.07%）。患者均以心力衰竭就诊,伴不同程度的低钙血症。51%的患者有神经肌肉兴奋性增加的病史,90%的患者左心室射血分数降低。该病误诊漏诊率较高,仅36%的患者于入院后即明确诊断为甲旁减性心肌病。低血钙的纠正是治疗的关键,90%的患者心脏功能在血钙浓度正常化后恢复至正常。结论 对所有不明原因或难治性心力衰竭患者都应警惕甲旁减性心肌病的可能。     

动态心电图临床操作标准化方法

动态心电图,又称Holter或Holter检查,是一种评价各种心脏病患者心电图异常的简便、高效、准确、安全的无创检查,广泛用于心律失常的相关症状评价,心肌缺血的诊断,心脏病患者的预后和日常生活能力评估,药物疗效评价,起搏器等埋藏式心脏电治疗装置监测等领域。目前动态心电图已广泛用于于临床各级医疗机构,为了更好地发挥其作用,有必要对该项技术进行规范化培训。本文参考相关指南、共识及专家建议,结合作者经验,撰写动态心电图临床操作标准化方法供临床使用时参考。     

Burkitt's lymphoma of maxillary gingiva: A case report

Burkitt's lymphoma(BL) is an aggressive form of nonHodgkin's B-cell lymphoma with three variants namely endemic, sporadic, and immunodeficiency-associated types. It is endemic in Africa and sporadic in other parts of the world. While the endemic form is widely reported to occur in early childhood and commonly involves the jaw bones, the sporadic form typically presents as an abdominal mass. This presentation reports a rare case of sporadic form of BL clinically manifesting as a generalized gingival enlargement in an immunocompetent adult male which demonstrated an aggressive behavior. The patient reported with a prominent anterior gingival swelling of 6 mo duration which slowly enlarged in size and associated with multiple lymph node involvement. Microscopic examination of the lesion using H, E and immunohistochemical diagnosis confirmed the diagnosis as BL. The patient succumbed to the disease before any therapy could be instituted. Since a wide array of causes can be attributed to gingival enlargements, it is necessary to consider malignancies as one of the important differential diagnosis so as to facilitate the need for appropriate diagnosis and prompt treatment.     

Effects of intravenous anesthetic agents on middle cerebral artery blood flow velocity during induction of general anesthesia

Objective. Our objective was to quantify the effects of intravenous anesthetics on values measured by or derived from transcranial Doppler sonography (TCD) during induction of general anesthesia.Methods. We recorded blood flow velocity in the middle cerebral artery (V-MCA) before, during, and after induction of general anesthesia in six groups of young patients without intracranial pathology (n=10 each) using TCD. Patients were randomized to receive either 2 mg/kg propofol, 1.5 mg/kg methohexital, 5 mg/kg thiopental, 0.3 mg/kg etomidate, 2 µg/kg fentanyl and 0.15 mg/kg midazolam, or 1.5 mg/kg ketamine and 0.15 mg/kg midazolam intravenously. At 2 min after injection, each patient was intubated and given isoflurane 0.8% and nitrous oxide 66% in oxygen. Ventilation was set to achieve an end-tidalPco ₂ of 40 mm Hg. V-MCA, arterial blood pressure, heart rate, hematocrit, andPco ₂ (venous samples) were measured before and 1, 3, 5, 10, and 30 min after induction of anesthesia.Results. The preinduction data were not different between groups. At 1 min after injection, propofol, thiopental, methohexital, and etomidate significantly decreased V-MCA. TCD values were only slightly affected following fentanyl/midazolam. Ketamine/midazolam induced a modest rise in V-MCA. After endotracheal intubation, V-MCA increased in all groups, and slowly declined thereafter.Conclusions. Under the circumstances of our study, values derived from TCD measurements responded differently to the agents used to induce general anesthesia in nonneurosurgical patients.     

达芬奇机器人和传统胸腔镜手术治疗肺部疾病的疗效

目的 评价达芬奇机器人手术（robot assisted thoracic surgery, RATS）和胸腔镜手术（video assisted thoracic surgery, VATS）治疗肺部疾病的疗效。方法 对收治的218例行达芬奇机器人和传统胸腔镜手术诊治肺部疾病的临床资料进行回顾性分析。患者自愿选择手术方式,其中RATS组98例,VATS组120例。结果 RATS组手术时间较VATS组长（P<0.01）,手术费用（P<0.05)和住院总花费（P<0.01）较VATS组多。RATS组术中失血量更少（P<0.01）,术后住院时间更短（P<0.05）。两组在中转开胸手术、总引流量、术后引流时间差异均无统计学意义（P>0.05）。肺癌患者中RATS组术后住院时间更短（P<0.01）,住院总花费更高（P<0.01）。非肺癌患者RATS组手术时间更长（P<0.01）,住院总花费更高（P<0.01）;RATS组术中失血量更少（P<0.05）,术后住院时间更短（P<0.05）。结论 达芬奇机器人辅助胸腔镜手术是安全有效的,其在术中出血量和术后住院时间具有明显的优势,而其他指标在机器人手术中无明显优势。     

吗啡、氯胺酮联合用于术后镇痛临床观察

目的 :比较吗啡、氯胺酮联合与吗啡单独使用用于术后镇痛的临床效果。方法 :30例ASAⅠ～Ⅱ的腹部手术全麻病人随机分为两组 ,术后使用吗啡静脉自控镇痛并分别加氯胺酮静脉输注 (氯胺酮组 )和生理盐水静脉输注(生理盐水组 )。观察两组的视觉模拟评分 (VAS) ,吗啡消耗量和发生的     

经颅黑质超声诊断帕金森病的临床评价

目的 通过对帕金森病患者及正常对照组进行经颅超声(transcranial sonography,TCS)检查,结合帕金森病患者的Hoehn Yahr（H Y）分级及帕金森病统一评分量表评分结果,了解我国大陆地区帕金森病患者有无黑质(substantia nigra, SN)回声增强表现。方法 对入选对象进行TCS检查,并对检查结果进行评价。结果 帕金森病患者 SN阳性率明显高于正常对照者（P＜0.05）。帕金森病SN异常组 H Y 分期明显高于帕金森病SN正常组(P＜0.05),表明帕金森病患者SN高回声面积与H Y分期相关。TCS检查对帕金森病的敏感性为80.5%,特异性为79.9%。结论 我国帕金森病患者SN强回声检出率显著高于对照组,说明我国帕金森病患者也存在SN回声增强这一现象,与国内外报道相一致。TCS检查对帕金森病的诊断具有一定的意义,敏感性及特异性较高。