骨科术中外来器械与手术室器械污染监测对比分析

目的监测骨科术中外来器械和手术室器械污染情况,为外来器械管理提供参考.方法在骨科手术进行至2.5 h、3.5 h时由手术护士配合采集未使用的术中器械样本,其中外来器械98个,手术室器械75个.样本均置于37℃恒温箱中培养72 h后观察记录,肉汤混浊、变色、有生物膜生成视为阳性,肉汤透明清亮视为阴性.结果外来器械总体样本阳性率、3.5 h样本阳性率高于手术室器械,差异有统计学意义(P<0.05);外来器械组内比较,2.5 h和3.5 h间差异有统计学意义(P<0.05);手术室器械组内比较,2.5 h和3.5 h间差异无统计学意义(P>0.05).骨科手术中所用全部器械污染率2.5 h和3.5 h时比较差异有统计学意义(P<0.05).结论骨科术中外来器械污染率高于手术室器械,手术开始3.5 h时污染率明显高于手术室器械,外来器械的污染率随手术时间延长而升高;骨科手术器械整体采样阳性率偏高,且随手术时间延长呈升高趋势.     

规范外来骨科器械接收环节质量管理的效果分析

目的规范外来骨科器械的接收环节,提高消毒灭菌处理效果和服务质量。方法制定完整的外来骨科器械接收处理记录表,采取3联单完整记录接收器械的来源信息、器械的使用信息与器械消毒灭菌处理信息3个部分,同时在电脑的信息记录追溯系统中进行录入。落实接收岗位组长对器械的清点、拆卸、新器械和复杂器械的学习和科内洗涤、包装的培训指导责任,以及与包装人员、与手术室医生护士和与器械配送人员的沟通责任。每日评价外来骨科器械的接收信息记录质量、器械洗涤质量、外来骨科器械的沟通与交接情况。结果规范外来骨科器械接收环节质量管理3年后,信息记录完整性、器械洗涤质量、针对外来骨科器械的沟通质量明显提高,差异有统计学意义(P0.05)。结论规范并落实外来骨科器械的接收环节质量管理,能有效提高信息记录质量与可追溯性,提高器械的洗涤包装质量及服务质量。     

骨科术中外来器械与手术室器械污染监测对比分析

目的:探讨骨科手术室外来器械与手术室器械污染监测方法。方法:对2011年1月~2012年1月我院骨科手术器械进行样本采集并监测,分别于手术开始后2 h和4 h进行抽样采集并经恒温培养后,比较外来器械与手术器械的污染情况。结果:手术室器械2 h与4 h阳性率无统计学差异(P0.05),外来器械2 h与4 h的阳性率存在统计学差异(P0.05)。结论:骨科手术中外来器械的污染率远远高于手术室器械,且随着手术时间的延长,其污染几率显著增加。加强手术器械的人员及消毒管理,注重手术器械的污染监测,严格控制手术室的无菌环境,是降低手术室器械阳性率的关键措施,值得推广应用。     

骨科手术外来器械与手术室器械污染情况对比分析

[目的]比较骨科手术外来器械和手术室器械污染情况。[方法]在骨科手术术前、术中和术后由手术室护士配合采集未使用的外来器械和手术室器械样本并放于37℃,5%二氧化碳(CO2)细胞培养箱中培养96h后,观察细胞培养液的变化。[结果]外来手术器械在术中和术后的污染率明显高于手术室器械,而且随着手术时间的延长,污染率增加。[结论]为了进一步减少手术感染的发生,应加强对外来器械的管理,尽可能缩短手术时间。     

探讨手术室外来器械的管理

手术室外来器械多见于外来骨科器械和外请教授自备器械。外来骨科器械主要指由外单位（厂家）带来在医院临时使用的手术器械,如各种骨科植入物、手术内固定用工具等。我院2009年4月-2010年4月涉及外来器械的手术820例。手术中心接收的外来器械包括腰椎、     

手术室外来器械管理存在的问题及对策

目的 探讨我院手术室外来器械管理中存在的问题及对策.方法 通过对手术室外来器械使用情况的跟踪及了解,发现外来器械对手术室的医疗安全管理具有较大的影响,并制订了有效对策.结果 通过针对外来器械存在的问题实施有效对策后,外来器械的清洗、消毒及灭菌质量得到了保证,完善了外来手术器械的清点、登记等管理措施,加强了术前、术中及术后对外来器械的管理,外来器械公司业务人员加强了对医院感染相关知识的掌握.结论 加强对外来器械及业务人员的管理,是降低手术室医疗安全隐患、确保患者手术安全的保障.     

外来医疗器械及植入物在手术中的安全应用

总结了完善和具体化手术室外来器械及植入物的管理体会。主要包括建立外来器械准入制度,加强外来器械的管理,加强器械清洗、包装、灭菌管理,严格质量控制,保障安全使用,进行有效的追溯管理,器械公司人员管理,器械的术中使用与管理和术后管理,完善和具体化外来手术器械的各个环节,优化工作流程等方面。认为手术室外来器械的管理是一个不断完善的过程,科学的管理手段是提高护理质量、确保患者手术安全、消除医疗安全隐患的重要保证。     

外来骨科器械在手术室无菌质量的管理

目的 探讨有效的外来骨科器械在手术室无菌质量管理方法.方法 2010年1月至2011年12月为研究组,共处理外来骨科器械2 300例,2008年1月至2009年12月为对照组,共处理外来骨科器械2812例.分别统计和记录两组外来器械应用过程中器械包破损、丢失损坏、术前准备污染、手术过程中污染的发生率.结果 研究组不良事件发生率明显多于对照组,数据经统计学比较具有显著差异(P＜0.05).结论 新标准化手术室外来骨科器械无菌质量管理流程有利于减少不良事件的发生,提高无菌管理效率,应从台账管理、相关人员培训管理、术前器械准备、术中使用规范和术后处理要求等方面入手管理.     

现代物流理念在手术室骨科植入物管理中的应用

为了解决手术室在骨科植入物和外来进口器械管理中存在的问题,利用现代物流管理中精益管理方法,将骨科内植入物假体在手术室备货储存及进口骨科器械进行存放备用的方法,通过设定科学的初始化库存量,良好的目视管理化,有效的计算机条码跟踪管理,加之及时把握拉动和响应时机等一系列措施,通过不断的循环改进,使手术室内植入物流通最优化,保持了最低库存量、最小占地空间,减少不必要的搬运,降低物品过度储备,减少了医院有限的资金和人力的浪费.     

多部门合作信息追溯模块在医院外来器械管理中的应用

总结医院多部门合作构建外来器械信息追溯模块的使用效果.由医工信息部、消毒供应中心、手术室、临床骨科病房多部门协作,联合信息系统对医院各部门信息模块进行改进,完善医院外来器械的管理流程,加强对医院外来医疗器械的管理,保证外来器械在院内的医疗安全.多部门合作信息追溯模块构建并实施后,外来器械及植入物的接收登记合格率从88.97％提高到100.00％,外来器械使用后清洗消毒执行率从81.97％提高到97.55％,差异有统计学意义(P＜0.001).     

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.     

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.     

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.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.