等离子体空气消毒器用于非洁净手术室空气消毒效果的观察

摘要 目的 观察等离子体空气消毒器用于非洁净手术室空气的消毒效果。方法将该等离子体空气消毒器分别安装于6间非洁净手术间,采用平板自然沉降法和激光颗粒计算器,观察6间非洁净手术间空气消毒效果。结果启动该等离子体空气消毒器运行不同时间后,均可使6间非洁净手术间空气中0.5 μm颗粒洁净度达到10 000级。6间非洁净手术间在该等离子体空气消毒器运行不同时间后空气中的沉降菌均可达到医院Ⅱ类环境卫生标准。结论应用该等离子体空气消毒器对非洁净手术室消毒效果显著。     

中国精神卫生立法进程回顾

本文围绕中国新出台的精神卫生法究竟是有所创新还是因循守旧的问题,通过分三阶段回顾立法的曲折历史,概括分析了这部法律立法思想和有关制度设计的形成过程,并对其中一些规定背后的观点交锋以及法律实施后可能带来的影响作了简要介绍,旨在为精神卫生相关立法研究和法律在实施中的进一步完善提供参考.     

Surgical incision in complete video-assisted mitral valve replacement

Background Prosthetic mitral valve replacement is a common surgical treatment of mitral valve disease.Complete video-assisted mitral valve replacement represents the contemporary minimally invasive cardiac surgery in valve disease surgical therapy. In the field of minimally invasive cardiac surgery, the success of the operation is largely depending on surgical incision, it also reflects the surgeon's technique level. Method From February 2010 to February 2013, 80 cases of cardiac patients with mitral valve pathological changes in our department who had received surgical treatment of complete video-assisted mitral valve replacement were recruited, they were divided into two groups according to the surgical incision: midclavicular group(M group,n = 50) and parasternal group(P group, n = 30). The clinical data were recorded including: cardiopulmonary bypass time, aortic clamping time, volume of thoracic drainage after operation, ICU tracheal intubation time,postoperative days of hospital stay and time for observing the postoperative complications. The comparison between two groups was performed using t-test analysis. Result Both M Group and P Group had favorable surgical view, there were no emergency situation of redo median sternotomy during initial operative period or intraoperative death, no pericardial tamponade, no infection, and no other serious postoperative complications.Whereas, there were 2 cases of redo operation for stanch bleeding in M Group and 1 case of perivalvular leakage in P Group. Nevertheless, 3 months later, the result of reexamine showed that the perivalvular leakage had vanished. The clinical data was shown as follow(M Group vs. P Group): cardiopulmonary bypass time(90.2 ± 28.7 vs. 87.3 ± 24.5 min, P 0.05), aortic clamping time(65.2 ± 17.4 vs. 68.6 ± 21.9 min, P 0.05),1st day volume of thoracic drainage after operation 1(75.8 ± 35.6 vs. 53.2 ± 25.6 mL, P 0.05), ICU tracheal intubation time(9.6 ± 3.4 vs. 8.4 ± 4.5 hours, P 0.05), postoperative days of hospital stay(7.3 ± 2.2 vs. 6.9± 3.2 days, P 0.05). T-test analysis of the data of each groups showed that there were no significant statistically difference. Conclusions Appropriate surgical incisions guarantee a favorable surgical view and the success of the whole process during intraoperative period. In both midclavicular and parasternal approaches, the complete video-assisted mitral valve replacement is able to be accomplished safely and successfully. Due to the current development level of thoracoscopic instruments and equipment, the surgical incision and approach for video-assisted mitral valve replacement are diversified. As a result, diversified surgical incisions can be customized according to the variegated pathological changes of cardiac patients.     

中医药在脊髓损伤神经源性肠道功能障碍的研究进展

脊髓损伤(spinal cordin jury,SCI)后神经源性肠功能障碍对患者身心健康和生活质量的严重影响,目前越来越受到国际关注.但国内对此尚未普遍开展.中医理论在SCI及SCI后出现的排便异常尚未作相关总结.现有研究中医药对肠道自主神经系统已经成熟,其有效性获得国内外普遍承认,并较药物更易接受.为SCI肠功能障碍的研究打下基础.但目前国内对SCI后排便异常缺乏专业认识、项目资助和人员管理,临床研究欠规范,中医理论有待完善.现主要针对SCI神经源性肠功能障碍出现的排便异常,在中医病名、病机、主要方法、有效性、优势及存在问题作一综述.     

Bleeding from thermistor connector indicates entrapment of pulmonary artery catheter

Several complications of insertion and use of pulmonary artery catheter (PAC), including catheter entrapment, are recognized during or after cardiac surgery. Early detection is very important. We report a case of PAC entrapment because the the catheter was accidentally sutured to the superior vena cava. Bleeding from the thermistor connector was initially detected after surgery because the needle punctured the lumen of thermistor connector. The PAC was removed through re-exploration. Therefore, bleeding from the thermistor connector could early indicate the PAC entrapment. We suggest that abnormal bleeding from the non-injectate lumen ports of PAC should be checked before sternal closure.     

下肢关节康复器在膝关节僵直术后功能锻炼中的应用

回顾性总结38例利用下肢关节康复器（CPM）辅助膝关节僵直患者术后功能锻炼的治疗观察，发现其较传统方法可提高膝关节活动度，且痛苦小，患者易于接受。同时加强术前、术后护理，均可取得满意疗效。     

手术室等离子体空气净化技术应用效果研究

摘要 目的 观察等离子体空气净化技术在手术室的应用效果。方法 2017年1月-2019年1月,对采用等离子体风机盘管空气净化消毒技术的普通手术室和采用空气洁净技术的洁净手术室进行比较,对比两种手术室的建设成本、使用维护和能耗成本、术中空气的细菌数和尘埃数、医护人员的使用满意度。结果 采用等离子体风机盘管空气净化消毒技术的普通手术室使用中空气尘埃数、细菌数与洁净手术室无明显差异,但普通手术室的建设成本、使用维护和能耗成本明显低于洁净手术室,医护人员对普通手术室的使用满意度也高于洁净手术室。结论 等离子体风机盘管空气净化消毒技术用于普通手术室建设,具有消毒效果可靠、建设和使用成本低、使用满意度高等优点,具有较好的推广价值。     

杏香兔耳风总酚酸耐药突变选择窗的体外研究

目的 测定杏香兔耳风总酚酸和对照药绿原酸对金黄色葡萄球菌ATCC26003和大肠埃希菌ATCC44102的防耐药变异浓度(MPC)。方法 采用琼脂平板二倍稀释法,测定杏香兔耳风总酚酸和绿原酸对金黄色葡萄球菌和大肠埃希菌的最小抑菌浓度(MIC)、99 %抑菌浓度(MIC99)、初测MPC(MPCpr)和MPC。结果 杏香兔耳风总酚酸、绿原酸对金黄色葡萄球菌的MIC、MPC和细菌耐药选择指数(MPC/MIC99)分别为0.4,6.0 mg·mL-1;10.8,8.4 mg·mL-1;34.0,1.6。对大肠埃希菌的MIC、MPC和MPC/MIC99分别为12.0,6.0 mg·mL-1;16.8,9.6 mg·mL-1;1.4, 1.7。结论 杏香兔耳风总酚酸限制金黄色葡萄球菌耐药突变菌株作用强于绿原酸,限制大肠埃希菌耐药突变菌株作用弱于绿原酸。     

司法精神医学鉴定结论分歧的分析

目的:通过对司法精神医学专家委员会(专委会)鉴定案例的总结来分析司法精神医学鉴定中结论分歧的类别和原因.方法:对60例专委会鉴定案例的社会人口学和各次鉴定资料,先以专委会鉴定和初次鉴定结论分歧的类别分组并对有关资料进行对照分析,然后对两次鉴定之间的一致性进行检验.结果:初览诊断为精神发育迟滞者,两次鉴定结论以基本一致居多,而器质性精神障碍与精神分裂症的两次鉴定结论以完全不一致居多, 初鉴中人格障碍多为错误论断,论断有误多导致关览单位对结论的异议.结论:司法精神医学鉴定结论出现的分歧较多(51.4%),鉴定人员应不断提高业务水平,尽量减少失误.