甘肃省省级医院介入放射工作人员健康状况调查

目的了解长期接触电离辐射对甘肃省省级医院介入放射工作人员健康状况的影响,保障从事介入放射工作人员的健康与安全、改进射线防护措施。方法对甘肃省省级医院放射工作人员355人(介入放射工作人员88人、普通X射线人员267人)的健康状况进行分析。结果本次检查的88名介入放射人员和267名普通X射线人员的淋巴细胞染色体畸变率分别为18.2%和4.9%,差异有统计学意义(χ2=3.93,P<0.05);淋巴细胞微核率分别为20.4‰和11.0‰,差异有统计学意义(χ2=3.90,P<0.05);白细胞降低检出率分别为12.5%和6.4%,差异有统计学意义(χ2=7.78,P<0.05);眼科检查介入放射组与普放X射线组的异常(晶状体混浊)检出率分别为13.6%和4.1%,差异有统计学意义(χ2=8.33,P<0.05)。结论甘肃省省级医院介入放射工作人员辐射敏感指标外周血淋巴细胞染色体畸变、淋巴细胞微核率、白细胞、眼晶状体等都有一定程度的辐射损伤,加强介入放射工作人员的健康监护是今后工作的重点。     

2011年甘肃省放射工作人员体检结果分析

目的探讨电离辐射对甘肃省不同职业放射工作人员身体的影响,为制定相应的预防控制措施提供科学依据。方法根据放射工作人员的职业性质,将2011年甘肃省进行职业健康体检的1 282名放射工作人员,分为医学组和工业组,分别进行统计分析。结果 1 282名放射工作人员的检出异常率第一为B超检查,工业组、医学组分别为34.0%和35.0%;B超检出异常率第一为肝脏异常,工业组、医学组分别为18.8%和20.6%;第二为胆囊异常,分别为13.7%和14.7%;白细胞减少率、胸透异常检出率工业组比医学组高,B超异常检出率、晶体混浊率医学组比工业组高。结论电离辐射对甘肃省不同工种的放射工作人员身体健康产生了不同的影响,应引起有关部门的关注。     

兰州市放射诊疗单位放射卫生管理现状分析

目的了解兰州市医疗机构放射卫生管理现状。方法通过现场检查、询问、查阅相关资料和填写调查表等方法调查数据,用Spss 18.0软件进行统计学分析。结果兰州市共有放射诊疗机构98家,放射工作人员537人,放射防护设备配备率96.94%,在岗人员参培率93.30%,持证率83.80%,不同等级医院间放射防护配备率(c2=1.57)和在岗期间培训率(c2=3.47)差异无统计学意义(均P0.05),而不同等级医院的放射卫生资质持证率差异有统计学意义(c2=9.54,P0.05);个人剂量监测515人、监测率95.90%,实际健康体检508人、体检率94.60%,不同等级医院的个人剂量监测率(c2=124.94)和健康体检率(c2=79.02)差异均有统计学意义(均P0.05),乡(镇)卫生院个人剂量监测率和在岗职业健康体检率均低于其他各类医院。结论应加强管理,严格执行放射工作人员许可证发放和审验制度,杜绝无证上岗,提高法律意识和管理水平,尤其应加强基层医疗机构的健康监护管理工作。     

某部医院放射工作人员外周血细胞参数分析

目的分析某部医院职业放射工作人员的外周血象,了解长期低剂量职业照射对人体外周血细胞的影响。方法以从事X光诊断、放射治疗、核医学工作的放射工作人员273名为接触组,215名近期未接触放射线和化学毒物的健康人员为对照组,用BC-3000全自动血细胞分析仪测定血细胞参数,比较两组统计学差异。结果接触组人员的白细胞总数(t=4.52)、淋巴细胞计数(t=5.42)、淋巴细胞百分比(t=3.99)、血小板计数(t=8.70)与对照组相比明显减少,差异有统计学意义(均P0.05);女性较男性对辐射耐受性大;放射工龄与辐照损伤无关(r=0.008,P0.05)。结论长期暴露于低剂量放射线后将引起机体外周血细胞参数发生某些变化,应进一步加强放射防护监督管理。     

新疆部分医疗机构放射诊疗设备防护设施调查

目的了解新疆医疗卫生机构医用辐射防护资源情况,为科学实施医疗机构放射诊疗辐射防护监督管理提供科学依据。方法在全疆6个地区(州、市)抽取51家医疗机构的放射诊疗项目进行调查,分析比较各级医疗机构放射诊疗项目配置情况和辐射防护措施落实情况。结果共调查4类放射诊疗项目214台放射诊疗设备,其中调查放射诊断设备174台、占81.0%,介入放射学设备21台、占10.0%,放射治疗设备13台、占6.0%,核医学设备6台、占3.0%,其中放射诊断学和介入放射学两类设备占调查设备总数的91.0%;固定特殊受检者体位的设备和性腺屏蔽用品配置比例最低、分别占3.4%和5.3%,而铅橡胶围裙配置比例最高为39.0%,放射治疗剂量扫描装置(二维或三维水箱)配置率66.7%;2015年职业健康检查放射工作人员1 781人,正常1 703人、占95.7%,异常78人、占4.3%,未发生职业性放射性疾病确诊病例;放射诊断学、介入放射学、放射治疗学和核医学4类工种放射工作人员职业健康检查异常率,差异无统计学意义(χ2=7.20,P0.05)。结论全疆放射诊疗机构共开展4种放射诊疗项目、10种检查项目,各级放射诊疗机构的辐射防护用品配置情况总体情况较好,放射工作人员中全年未发生职业性放射性疾病确诊病例;应继续加强放射诊疗设备日常稳定性的检测监督力度。     

乌鲁木齐市医用放射工作人员防护意识调查与分析

目的了解新疆乌鲁木齐市医用放射工作人员防护意识及行为,为制订放射工作人员放射卫生监测和健康监护管理提供依据。方法采用白行设计的《医用放射工作人员防护意识调查表》,现场自填问卷的方法,对乌鲁木齐市医用放射工作人员进行调查。结果放射工作人员放射防护知识的掌握与文化程度、累积放射工龄密切相关（Х^2=8．63,P〈0．01;Х^2=11．75,P〈0．01）,参加过放射培训的工作人员答题正确率高于未参加人员（Х^2=5．97,P〈0．05）;部分放射工作人员自身防护意识不足,对受检者及陪护人员防护不到位。结论针对新参加工作及低学历放射工作人员的放射防护培训是今后培训的重点,同时在日常工作中应重点加强对受检者及陪护人员防护。     

甘肃省某医院新建医用电子直线加速器机房建设项目职业病危害因素控制卫生学评价

目的对甘肃省某医院新建医用电子直线加速器机房项目进行职业病危害因素控制卫生学评价,以确保该项目正式投入使用后放射防护设施和措施符合国家有关法律、法规和标准的要求,保护工作人员、患者和公众的安全与健康。方法依据国家相关的法律、法规、标准,对新建医用电子直线加速器机房周围辐射环境进行监测,核查放射防护措施、规章制度的落实情况,评估该加速器正常运行时的电离辐射危害因素对周围放射工作人员及公众的影响。结果该医用加速器工作场所正常工作时的泄漏电离辐射,检测值均低于国家《电子加速器放射治疗放射防护要求》(GBZ 126-2011)的标准限值;放射防护措施、规章制度基本得到落实。结论该医用加速器在正常运行时不会对放射工作人员和周围公众的健康造成影响。     

甘肃省某医院ECT中心工作场所辐射水平检测与评价

目的检测甘肃省某医院核医学科ECT中心工作场所的辐射水平,并评价检测结果和放射防护设施与措施是否符合国家有关法律、法规和标准,确保职业病危害因素得到有效控制,保障工作人员、患者和公众的安全与健康。方法依据国家相关标准对ECT中心放射性表面污染及机房周围泄漏辐射进行检测,对医院设置的放射防护措施、建立的规章制度及其落实情况进行现场核查,评估ECT中心在正常运行状态下对工作人员及公众的影响。结果 ECT中心放射性表面污染水平最高值为0.42 Bq/cm2,机房周围各检测点泄漏辐射值均小于0.1μSv/h;该ECT中心正常工作状态下的放射性表面污染水平及泄漏电离辐射符合国家标准的要求,医院设立的放射防护措施有效,制定的规章制度基本得到落实。结论该ECT中心在正常运行的情况下不会对工作人员和周围公众的健康造成有害影响。     

从事~(131)I放射诊疗医务人员个人剂量监测结果分析

在诊断和治疗地方性甲状腺肿等甲状腺疾病中,利用放射性核素131I在衰变过程中产生的γ射线和β射线,对甲状腺疾病进行诊断和治疗技术已广泛应用于临床医学。从事131I放射诊疗工作的医务人员如果在分装、注射及洗刷器皿等操作过程缺少必要防护,势必会引起放射损伤;另外正常人体经呼吸道等途径摄入131I时,也会引起内照射损伤,危害身体健康。根据《中华人民共和国职业病防治法》、《放射性同位素和射线装置放射防护条例》和《放射工作人员健康管理规定》等法律、法规,用人单位对放射工作场所和放射同位素的运输、贮存必须依法配置防护设备和…     

甘肃省介入放射工作人员职业健康状况调查

目的了解介入放射工作人员的职业健康状况,加强职业健康管理,为制定辐射防护措施提供理论依据。方法2015─2016年对甘肃省省级及部分市级医疗机构825名放射工作人员进行职业健康体检(介入组289人、普放组536人),检查项目按照《放射工作人员职业健康管理办法》要求,包括既往患病史、内科、皮肤科、眼科、B超(肝、胆、脾、胰、肾)、X线胸片、心电图、尿常规、外周血象、血糖、肝功能、肌酐、尿素氮和外周血淋巴细胞遗传学等指标。结果放射工作人员自觉症状异常检出率为3.00%,主要表现为头晕、乏力、睡眠障碍和记忆力减退等神经衰弱症候群表现;B超检查,介入组异常检出率为39.79%、普放组31.53%,差异有统计学意义(χ2=5.678,P0.05);两组白细胞(WBC)异常检出率分别为12.46%和7.46%,差异有统计学意义(χ2=5.599,P0.05),淋巴细胞微核检出率分别为31.49%和24.63%,差异亦有统计学意义(χ2=4.481,P0.05);血压(χ2=1.627)、心电图(χ2=0.231)、尿常规(χ2=1.176)、X胸片(χ2=0.499)、空腹血糖(GLU,χ2=0.000)、肝功(ALT,χ2=0.049;TBIL,χ2=0.438;DBIL,χ2=0.816;IBIL,χ2=0.770)和肾功(Cr,χ2=0.540;BUN,χ2=1.081)等各项指标,两组差异无统计学意义(均P0.05);介入组人员的眼科(χ2=1.786)、血小板(PLT,χ2=0.288)、红细胞(RBC,χ2=0.055)、血红蛋白(HGB,χ2=0.706)和染色体畸变(χ2=1.287)等各项指标两组间比较差异无统计学意义(均P0.05),但异常检出率明显高于普放组。结论射线对介入放射工作人员健康有一定损伤;建议临床医师操作时佩戴双剂量计,同时加强放射防护相关知识培训,改进防护措施,将射线对人体的损害降到最低程度。     

北京大兴长子营地区老年糖尿病流行病学调查研究

目的 了解北京大兴农村地区老年糖尿病（DM）和空腹血糖受损（IFG）发生的情况和特点.方法 纳入大兴长子营地区60岁以上人群3036例,通过问卷调查统计糖尿病知晓以及治疗情况、吸烟情况、检查身高和体重,计算体重指数（BMI=体重/身高2）;水银血压计测量血压;酶法检测空腹血糖、总胆固醇（TC）、甘油三酯（TG）、血尿酸（UA）;直接法检测高密度脂蛋白胆固醇（HDL-C）和低密度脂蛋白胆固醇（LDL-C）、改良苦味酸法检测血肌酐（Cr）;全自动血液分析仪测定白细胞总数（WBC）和血小板总数（PLT）.结果纳入人群中IFG患者358例、DM患者712例,DM的知晓率、治疗率和控制率分别为64.10%、61.10%和19.94%.DM患者、IFG患者与血糖正常人群的BMI、血压、TC水平均无差异;与血糖正常的人群相比,IFG和DM患者吸烟指数更高,TG、LDL-C、UA、WBC、PLT水平升高（P＜0.05）,DM患者TG高于IFG患者,HDL-C水平低于正常血糖人群.结论 ①大兴长子营地区老年T2DM知晓率和治疗率较高,但控制率较低;②老年T2DM患者较正常血糖人群心血管危险因素更多;③IFG期心血管危险因素与T2DM接近.     

Assessment of preventive measures for accidental blood exposure in operating theaters: a survey of 20 hospitals in Northern France

BACKGROUND: Accidental exposures to blood of body fluids (ABE) expose health care workers (HCW) to the risk of occupational infection. OBJECTIVES: Our aim was to assess the prevention equipment available in the operating theater (OT) with reference to guidelines or recommendations and its use by the staff in that OT on that day and past history of ABE. METHODS: Correspondents of the Centre de Coordination de la Lutte contre les Infections Nosocomiales (CCLIN) Paris-Nord ABE Surveillance Taskforce carried out an observational multicenter survey in 20 volunteer French hospitals. RESULTS: In total, 260 operating staff (including 151 surgeons) were investigated. Forty-nine of the 260 (18.8%) staff said they double-gloved for all patients and procedures, changing gloves hourly. Blunt-tipped suture needles were available in 49.1% of OT; 42 of 76 (55.3%) of the surgeons in these OT said they never used them. Overall, 60% and 64% of surgeons had never self-tested for HIV and hepatitis C virus (HCV), respectively. Fifty-five surgeons said they had sustained a total of 96 needlestick injuries during the month preceding the survey. Ten of these surgeons had notified of 1 needlestick injury each to the occupational health department of their hospital (notification rate, 10.4%). CONCLUSION: The occurrence of needlestick injury remained high in operating personnel in France in 2000. Although hospitals may improve access to protective devices, operating staff mindful of safety in the OT should increase their use of available devices, their knowledge of their own serostatus, and their ABE notification rate to guide well-targeted prevention efforts.     

Performance evaluation of BC-3200 hematology analyzer in a university hospital

The BC-3200 automated hematology analyzer was evaluated and compared with the Beckman-Coulter AcT (Ac.T diff 2) 3-part differential hematology analyzer. The BC-3200 was evaluated according to guidelines published by the International Committee for Standardization in Hematology (ICSH), Clinical and Laboratory Standards Institute (CLSI), and Department of Food and Drug Administration (FDA). The results demonstrated no background, minimal carryover (<0.5%), and excellent linearity for hemoglobin (Hb) level, white blood cell (WBC), red blood cell (RBC), and platelet (PLT) counts (>0.998). Precision was generally acceptable for all complete blood count (CBC) parameters; coefficients of variation (CVs) were within the manufacturer's claims and CVs of CBC parameters, including WBC, RBC and PLT counts, Hb and mean corpuscular volume, were <6%. Correlation between the BC-3200 and Ac.T diff 2 was excellent (r > 0.98) for all major CBC parameters (WBC, RBC, and PLT counts and Hb). We conclude that the overall performance of the BC-3200 is excellent and compares well with that of the Coulter Ac.T diff 2.     

北京郊区医务人员艾滋病职业暴露与防护现况

目的了解北京郊区医务人员艾滋病职业暴露及防护情况。方法采取现况调查的方法,按多阶整群抽样的原则,于2005年12月-2006年1月抽取北京郊区的医务人员进行问卷调查。结果2 021名医务人员中有21.8%参与过艾滋病诊疗服务,5.6%一年内接触过HIV阳性病人,38.9%一年内曾被医疗器械(皿)刺破皮肤,52.0%一年内经常接触引起血液、体液飞溅的操作;职业暴露防护不规范率为12.3%~62.1%;职业暴露后局部处理、预防性用药知识知晓率分别为4.6%、15.3%。结论北京郊区医务人员普遍存在艾滋病职业暴露危险,防护相关行为有待进一步培训、规范,推广普遍性防护原则势在必行。     

Occupational exposure to blood and risk of bloodborne virus infection among health care workers in rural north Indian health care settings

BACKGROUND: Approximately 3 million health care workers (HCWs) experience percutaneous exposure to bloodborne viruses (BBVs) each year. This results in an estimated 16,000 hepatitis C, 66,000 hepatitis B, and 200 to 5000 human immunodeficiency virus (HIV) infections annually. More than 90% of these infections are occurring in low-income countries, and most are preventable. Several studies report the risks of occupational BBV infection for HCWs in high-income countries where a range of preventive interventions have been implemented. In contrast, the situation for HCWs in low-income countries is not well documented, and their health and safety remains a neglected issue. OBJECTIVE: To describe the extent of occupational exposure to blood and the risk of BBV infection among a group of HCWs in rural north India. METHODS: A cross-sectional survey of HCWs from 7 rural health settings gathered data pertaining to occupational exposure to blood and a range of other relevant variables (eg, demographic information, compliance with Universal Precautions, perception of risk, knowledge of BBVs). A mass action model was used to estimate the risk of occupational BBV infection for these HCWs over a 10-year period. RESULTS: A total of 266 HCWs returned questionnaires (response rate, 87%). Sixty-three percent reported at least 1 percutaneous injury (PI) in the last year (mean no. = 2.3) and 73% over their working lifetime (mean no. = 4.2). Predictors of PI during the last year were hospital site, job category, perception of risk, and compliance with Universal Precautions. CONCLUSION: The high level of occupational exposure to blood found among this group of rural north Indian HCWs highlights the urgent need for interventions to enhance their occupational safety to prevent unnecessary nosocomial transmission of BBVs.     

强化培训对塞拉利昂军队医护人员传染病职业防护的干预效果

目的探讨强化培训在塞拉利昂医院及其基层医疗点医护人员传染病职业暴露防护认知与技能的干预效果。方法选择塞拉利昂某大型综合医院——A医院及基层2个医疗点的医护人员,通过问卷调查,了解传染病职业暴露防护认知与技能的情况;通过预分析反馈的问题,开展针对性的理论授课,实际操作演练等强化培训,然后再次针对该人群进行问卷调查,比较干预前后的效果。结果医护人员培训干预后职业风险认知和实践技能总体评分明显高于自身干预前的水平(P均0.05)。但无论干预前还是干预后,基层医院医护人员职业风险认知和实践技能总体评分均低于A医院。结论对医护人员进行强化培训干预,整体提高了当地医护人员传染病职业防护认知与技能水平,但基层医疗点条件差、人员素质偏低,实际操作技能还须进一步强化和督导。     

Value of platelet count in the early diagnosis of nosocomial invasive fungal infections in premature infants

The aim of this study was to investigate the value of a platelet count (PLT) in the early diagnosis of nosocomial invasive fungal infections in premature infants. Based on clinical diagnosis combined with blood culture results, 72 premature infants of 5354 pediatric patients who were hospitalized in the neonatal ward of our hospital between September 2009 and February 2013 were diagnosed with nosocomial invasive fungal infections (fungal infection group). There were 58 premature infants diagnosed with bacterial infections during the same period (bacterial infection group). The control group included 74 premature infants without nosocomial infections who were hospitalized during the same period. Receiver operating characteristic (ROC) curves were used to analyze the sensitivity, specificity, and diagnostic efficacy of the PLT and white blood cell (WBC) counts and C-reactive protein (CRP) level in the diagnosis of fungal infections in premature infants. The risk factors for invasive fungal infections included birth weight < 2000 g, gestational age < 32 weeks, peripherally inserted central catheter (PICC), oxygen inhalation therapy, intravenous nutrition, and administration of antibiotics (p < 0.05). Compared with the control group, the WBC and PLT counts in the fungal infection group decreased in the early and acute stages of infection (p < 0.01), while the CRP level increased (p < 0.01). The PLT count in the bacterial infection group decreased in the early and acute stages of infection (p < 0.01) and the CRP level increased (p < 0.05). Moreover, the decrease in the PLT count in the fungal infection group was more significant than the bacterial infection group (p < 0.01) and the CRP level increased more in the fungal infection group in the early stage of infection (p < 0.01); however, there were no significant differences in the PLT count and CRP level between the fungal and bacterial infection groups in the acute stage of infection (p > 0.05). ROC curve analysis of the WBC and PLT counts and the CRP level in the early diagnosis of fungal infections showed that the area under the curve of the PLT count was 0.912 (95% confidence interval:0.863–0.961), thus indicating a high accuracy with a cutoff PLT count of 157.0 × 10⁹/L. The corresponding sensitivity and specificity were 77.8% and 94.6%, respectively. We conclude that the PLT count is a convenient, economical, and effective predictor of invasive fungal infections in premature infants and has potential in the early diagnosis of fungal infections.     

血管内皮细胞生长因子对移植后骨髓造血微环境的影响及意义

目的　观察血管内皮细胞生长因子基因治疗对骨髓移植后造血微环境的调节作用。方法　重组腺病毒注射给小鼠 ,随后进行同基因骨髓移植 ;在不同时期检测骨髓微血管灌注面积和造血细胞容量以及外周血WBC、PLT计数。结果　移植后 2 0天时 ,VEGF组骨髓微血管灌注面积已恢复正常 (P >0 .0 5 ) ;移植后 3 0天时VEGF组骨髓细胞容积明显大于EGFP组和常规组 (P <0 .0 5 )。各时间点VEGF处理组外周血WBC、PLT计数均显著高于常规BMT组和EGFP组 (P <0 .0 5 )。结论　血管内皮细胞生长因子基因治疗促进了骨髓移植后造血微环境的恢复 ,并提高外周血WBC、PLT计数水平。     

Demonstration by Flow Cytometry of the Numbers of Residual White Blood Cells and Platelets in Filtered Red Blood Cell Concentrates and Plasma Preparations

Background and objectives: New-generation polyester filters provide significant depletion of white blood cells (WBC) and platelets (PLT) in filtered red blood cell concentrates (FRCC) and in filtered plasma preparations (FP). The aim of this study was to elaborate a sensitive flow cytometric method for monitoring residual WBC and PLT in FRCC and FP. Materials and methods: We determined the number of WBC in 500 μl FRCC of FP using 50 μl of a combination of monoclonal antibodies (MAB) against CD45 (FITC labeled) and CD19 (PE labeled). After lysis of red blood cells, we mixed a specific number of reference beads with the remaining WBC. The number of residual WBC related to the acquisition volume was defined by the acquired reference beads. Using this method, the detection limit (DL) was 3 WBC/μl. Alternative methods used MAB against CD45 (FITC and PerCP labeled) and CD14 (PE labeled) or lymphocyte subsets such as CD3 (FITC labeled) and CD19, CD4, CD8, CD16 and CD56 (PE labeled) in combination with CD45 (PerCP labeled). The DL values were 10 WBC/μl for the CD45/CD14 staining and 0.1 WBC/μl for the determination of both CD3+ and CD19+ lymphocytes. For residual PLT in FRCC or FP, we used an FITC-conjugated MAB against CD41, with reference beads to determine the acquisition volume. PLT were demonstrated in a green-fluorescence (FL1) single histogram after gating in the forward light scatter × 90° light scatter signal dot plot. PLT counting was as described for WBC. The DL value was about 2 PLT/μl. Results: Filtration with Pall WBF-1 filters reduces WBC by 4 log and PLT by 3–4 log, resulting in cell counts which are below the critical limit for causing adverse transfusion reactions. Conclusions: Flow cytometry techniques provide a reproducible and objective tool for counting residual WBC and PLT in blood preparations compared with the Nageotte hemocytometer. Absolute numbers of leukocyte and lymphocyte subpopulations are obtainable.     

重症肺炎患者部分血栓前凝血及纤溶系统变化检测及临床意义

目的探讨重症肺炎患者部分血栓前凝血及纤溶系统变化。方法选择本院收治的重症肺炎患者60例为研究组,同期来院健康体检者60名为对照组,两组均抽外周静脉血,检测患者血细胞(PLT、WBC)、凝血指标(PT、APTT、Fg)、纤溶指标(D-D、FDP),并进行组间比较。结果研究组PLT低于对照组,WBC、PT、APTT、Fg明显高于对照组,D-D阳性率、FDP阳性率均高于对照组,两组间比较上述指标差异均有统计学意义(P<0.05);研究组不同程度血小板减少患者PT、APTT、Fg差异显著(P<0.05),血小板水平与PT、APTT、Fg呈明显负相关(r=-0.408、-0.517、-0.452,P<0.05);研究组不同程度WBC增多患者,PT、APTT、Fg差异显著(P<0.05),WBC水平与PT、APTT、Fg呈明显正相关(r=0.392、0.533、0.497,P<0.05)。结论重症肺炎患者存在一定程度的凝血及纤溶功能失调,临床应加强对该指标监测,在抗感染治疗的同时,调整凝血系统功能,对缓解重症病情有积极意义。