戊二醛临床有效时限的考证

考证了２％戊二醛消毒液临床使用的有效时限，监测了５周内消毒液的含量变化及微生物污染情况，结果表明：在室温１５±１℃时，戊二醛消毒液中醛残存率为９３．１６％；浸泡器械后５个科室的醛残存率为８６．４２±２．９９％（８２．６３％～８９．４７％）；消毒液中无细菌生长；浸泡器械数量、重量、体表面积及使用频率对消毒液的灭菌效果无显著影响；２％戊二醛消毒液的有效时限可由２～４周延长至５周，从而大大降低本品的应用成本。     

两种醛类消毒剂杀灭龟分枝杆菌效果的比较及影响因素

目的比较复方邻苯二甲醛与戊二醛对龟分枝杆菌的杀灭效果及其影响因素。方法采用悬液定量杀菌试验进行了实验室观察。结果在常温条件下,含邻苯二甲醛500mg/L的复方邻苯二甲醛或含20g/L戊二醛的消毒液,分别作用5min,对悬液内龟分枝杆菌脓肿亚种的杀灭对数值均大于5.00。菌悬液内含体积分数25%以上的小牛血清对含量500mg/L的复方邻苯二甲醛杀灭龟分枝杆菌脓肿亚种的效果有明显影响,而对20g/L戊二醛消毒液杀灭龟分枝杆菌脓肿亚种效果无明显影响。结论复方邻苯二甲醛可有效杀灭龟分枝杆菌脓肿亚种,其有效杀菌浓度明显低于戊二醛,但其杀菌效果受有机物影响较大。     

乙醇用于体温计持续浸泡消毒时效的观察

[目的 ]观察 75 %乙醇持续浸泡体温计的消毒效果及有效时限。[方法 ]监测 5周内 75 %乙醇消毒液的乙醇含量变化及微生物污染情况。 [结果 ]在常温下 ,75 %乙醇消毒液乙醇含量随着使用时间的延长、消毒体温计频率的增加而逐渐降低 ,5周内乙醇含量比原液降低了 4.9% ,但仍在有效范围内 ;染菌量 <10cfu/mL ,均未检出致病菌。[结论 ] 75 %乙醇消毒液可以用于体温计的持续浸泡消毒 ,采用“一人一支一瓶”消毒法 ,消毒效果良好 ,有效时限可达 5周。     

临床使用中戊二醛消毒液杀菌效果观察

为了观察临床使用中戊二醛消毒液杀菌效果,采用载体定量杀菌试验方法对其杀灭标准菌株和临床分离菌株的效果进行了试验检测。结果,以含20 g/L戊二醛消毒液对金属载体上大肠杆菌、铜绿假单孢菌和白色念珠菌浸泡作用5 m in,平均杀灭率达到99.8%以上。以含20 g/L戊二醛消毒液对金属载体上耐甲氧西林金黄色葡萄球菌和肠球菌浸泡作用5 m in,平均杀灭率为99.90%;对肺炎克雷伯菌作用5 m in,平均杀灭率为99.60%。以含20g/L戊二醛消毒液对上述6种菌浸泡作用10 m in,杀灭率均达到100%。以含20 g/L戊二醛消毒液对胃镜镜头上污染的耐甲氧西林金黄色葡萄菌浸泡作用10 m in,杀灭率均为100%。结论,临床消毒使用的戊二醛消毒液对细菌繁殖体和真菌标准株及临床分离的耐药菌株均有较强杀灭作用。     

一种戊二醛消毒液的消毒性能观察

目的观察一种戊二醛消毒液的杀菌效果及稳定性。方法采用载体浸泡杀菌试验和理化分析方法,对该戊二醛消毒液进行了实验室检测。结果该戊二醛消毒液浓度为22 g/L,内含2.5 g/L脂肪醇聚氧乙烯醚。以该消毒剂原液对载体上枯草杆菌黑色变种芽孢作用60 min,杀灭对数值>3.0;作用4 h以上,可达到完全杀灭。该戊二醛消毒液连续浸泡医疗器械14 d,其杀菌效果不下降;模拟现场试验对医疗器械浸泡60 min,对污染在器械上的枯草杆菌黑色变种芽孢杀灭对数值≥5.0,浸泡5 h可达到完全杀灭。该消毒液密封存放于37℃90 d,戊二醛含量下降率<10%。结论该戊二醛消毒液能在规范时间内有效杀灭细菌芽孢,加速试验性能稳定。     

聚维酮碘消毒液开瓶后持续杀菌效果观察

目的观察聚维酮碘消毒液开瓶后杀菌效果持续时间。方法采用悬液定量杀菌试验方法,对该聚维酮碘产品包装开瓶后杀菌效果持续时间进行了实验室观察。结果含有效碘5 000 mg/L的聚维酮碘消毒液原液打开包装后,在2周内可保持对含菌量107 cfu/ml菌悬液的大肠埃希菌临床株和标准株、金黄色葡萄球菌临床株和标准株等4种试验菌达到完全杀灭。含有效碘1 000 mg/L聚维酮碘消毒液原液开启包装后,能在2周内完全杀灭上述4种试验菌。结论两种浓度聚维酮碘消毒剂原液开启后可在2周内保持完全杀灭细菌繁殖体的效果不变。     

医院消毒液微生物污染检测及其杀菌效果比较

为检测医院应用中消毒液微生物污染情况及聚维酮碘和碘酊的杀菌效果 ,采用随机抽检和载体定量杀菌试验进行了观察。结果 ,使用中消毒液细菌总数超标率为 1.7%～ 14 .17% ,消毒液中污染菌以洋葱假单胞菌和微球菌为主。含有效碘 5 0 0 0mg/L的聚维酮碘和 2 0g/L有效碘的碘酊作用 10min ,对大肠杆菌和金黄色葡萄球菌杀灭率为 10 0 %。二者杀菌效果无显著性差异。结果显示 ,临床科室应用的消毒液存在污染情况 ,临床使用的聚维酮碘和碘酊杀菌效果基本相同     

醛醇复方消毒液杀菌性能试验研究

醛醇复方消毒液由戊二醛、异丙醇等成分组成的液体制剂,为了研究其杀菌能力,对其进行了载体定量杀菌试验与消毒相关性能观察。结果,以含20 g/L戊二醛与体积分数20%~40%异丙醇复方消毒液在碱性条件下,对载体上枯草杆菌黑色变种芽孢作用40 m in,平均杀灭率为99.9%以上;作用至120 m in,杀灭率达到100%。该醛醇复方消毒液在碱性条件下杀菌效果较好,随pH值降低杀菌效果下降。该复方消毒液稳定性较差,不宜长期储存。结论,醛醇复方消毒液对载体上枯草杆菌黑色变种芽孢杀灭效果较好,但稳定性较差。     

唐山市消毒剂经营使用状况调查报告

为加强消毒剂的管理,对消毒剂经营使用单位的管理情况进行了调查。结果, 80%以上的生产和使用单位能够按照法规对消毒剂严格管理,消毒剂有效含量合格率在 67. 6% ~94. 4%之间;在所调查的消毒剂中以戊二醛含量合格率最高为 93. 5%,过氧乙酸含量合格率最低为 38. 5%。使用中消毒液污染监测合格率为 94. 9%,区级医院和厂企医院消毒液污染较为严重。仍然存在经营使用无证和超期产品、消毒剂含量不合格及污染严重问题,监督部门应加大监管力度。     

复方强化戊二醛消毒液对细菌芽孢的杀菌效果观察

为了解复方强化戊二醛消毒液对细菌芽孢杀灭效果,采用载体定量和定性杀菌试验进行了实验室观察和现场试验。结果,以含22.4 g/L戊二醛的复方强化戊二醛消毒液对载体上枯草杆菌黑色变种芽孢作用1 h,杀灭率>99.9%;作用3 h达到完全杀灭。能量试验对大肠杆菌最低有效浓度为1000 mg/L戊二醛。经模拟现场试验用含22.4 g/L戊二醛消毒液对污染在止血钳上的枯草杆菌黑色变种芽孢作用3 h达到完全杀灭。连续使用稳定性杀菌试验,14 d后达到完全杀灭细菌芽孢的效果需要作用5 h。结论,复方强化戊二醛消毒液对细菌芽孢杀灭效果较好,性能稳定。     

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.