2018—2020年杨浦区医疗机构职业性外照射个人剂量监测结果分析

目的 了解2018—2020年杨浦区医疗机构放射工作人员外照射个人剂量水平和分布情况,为预防职业性放射性疾病提供基础数据。方法 依据职业性外照射个人监测规范,采用热释光剂量测量系统对放射工作人员进行个人剂量监测,对数据进行汇总和分析。结果 2018—2020年共监测2082人,人均年有效剂量为0.20 mSv·a^-1;2020年人均年有效剂量低于2018年和2019年,差异有统计学意义（P < 0.05）;有4名放射工作人员人均年有效剂量超过5 mSv·a^-1;诊断放射学人均年有效剂量0.20 mSv·a^-1,高于牙科放射学、医学应用其他,差异有统计学意义（P < 0.05）;核医学人均年有效剂量0.34 mSv·a^-1,高于其他工种,差异有统计学意义（P < 0.05）;未定级医疗机构人均年有效剂量0.14 mSv·a^-1,低于三级医院和二级医院,差异有统计学意义（P < 0.05）。结论 杨浦区医疗机构放射工作人员人均年有效剂量总体保持在较低的水平,应加强核医学及二、三级医院放射工作人员的放射防护,将职业性外照射剂量降到尽可能低的水平。     

内镜诊疗中心管理及清洗消毒现状分析

目的：通过汇总和分析2006年—2019年发表的关于内镜中心管理和清洗消毒质量的调研报告,了解我国目前内镜中心的发展情况和存在的问题。方法：通过数据库检索2006年—2019年关于内镜中心清洗消毒和感染管理调研的文献,并对文献中的数据进行汇总和分析。对管理要求、布局及设施、设备要求、清洗消毒操作规程、监测与记录、培训和职业安全防护、抽检合格率等方面数据进行分析。结果：共收集2006年—2019年发表的相关文献50篇,涉及2 981所医疗机构。管理要求方面,81.4%的医疗机构已建立内镜管理的各项规章制度。布局和设施方面,77.3%医院设置了独立清洗消毒室。清洗消毒流程方面,74.1%的医院清洗流程符合规范,74.7%的医院消毒/灭菌流程符合规范。监测与记录方面,83.3%医院每季度开展内镜消毒质量监测。培训和职业安全防护方面,74.0%消毒员接受过专业培训,69.6%消毒员佩戴适合的个人防护用品。抽检合格率方面,78.7%的消毒内镜内腔染菌量检测合格。结论：我国内镜中心虽已建立基本的管理制度和清洗消毒流程,但在许多细节上仍存在不足。应通过精细化的管理进一步提高内镜中心感染管理质量,以保证患者诊疗安全。     

双柱定性气相色谱电子捕获检测器测定上海市饮用水中微量碘化物

Objective To modify and optimize gas chromatographic conditions, qualitative and quantitative method on the base of the actual national standard detection method for drinking water on testing iodide with gas chromatography, and detect iodide in drinking water of Shanghai.Methods Iodobutanone derivative was identified by gas chromatography/mass spectrometry, then two capillary columns coupled to electron capture detector were made by qualitative and quantitative analysis.Finally, 100 ml water samples were collected respectively from raw water and finished water of three plants in which water sources were Yangtse river, Huangpu river, and inner river respectively and detected by this developed method.Results The results of mass spectrometry showed that iodide would form iodobutanone which could generate 1-iodo-2-butanone and 3-iodo-2-butanone isomers by derivatization.The data of qualitative analysis by two capillary columns revealed that iodobutanone was separated completely and the total time of chromatogram separation was 19.33 min.3-iodo-2-butanone with the high response value was selected to quantitatively analyse.The linear range was 1 - 100 μg/L,and the coefficient of determination (r2) was 0.9997.The limit of detection was 13 ng/L.Recoveries were between 97.68% and 104.37% ,and relative standard deviations were between 2.14% and 4.41%.The results of iodide detected by this method in raw water and finished water in three plants in Shanghai showed that the ranking of iodide's concentration in raw water was Huangpu river (15.14 μg/L) ＞ inner river (6.97 μg/L) ＞ Yangtse river (3.55 μg/L).The level of iodide in finished water of plant 1 (3.55 μg/L and 5.92 μg/L for raw and finished water respectively) and 3 ( 6.97 μg/L and 9.62 μg/L for raw and finished water respectively) increased slightly except for plant 2( 15.14 μg/L and 1.81 μg/L for raw and finished water respectively).The relative standard deviations of all water samples measured in duplicate were less than 9.73%.Conclusion The improved method possesses higher degree of sensitivity and accuracy of qualitative and quantitative analysis than actual national standard detection method, and it is fit for trace analysis of iodide in water.     

上海市杨浦区中学生自行车伤害知识信念行为调查

目的了解上海市杨浦区中学生预防自行车伤害的相关知识、信念和行为,为中学生自行车伤害的防治提供依据。方法采用分层整群抽样方法 ,采用自行设计的问卷对上海市杨浦区7所中学的4250名学生进行回顾性调查。结果中学生交通法律法规和自行车交通安全知识平均得分为62.5分,女生略高于男生;高中生高于初中生,差异有统计学意义(t=-10.057,P=0.000)。83.29%的学生愿意了解道路交通法律法规及交通安全知识,但只有19.38%的学生接受过培训和教育。18.41%的学生认为自行车伤害不会给家庭、个人、社会带来负担。在调查前1个月内,经常违法违章的学生占8.51%,至少有1种违法违章的占81.42%;学生过去1a中自行车伤害发生率为7.12%。结论杨浦区中学生预防和控制自行车伤害的知识、信念和行为均存在一定的不足。应对中学生加强道路交通法律法规和自行车交通安全知识宣传教育活动。     

医院感染管理专职人员现状与思考

近年来，随着卫生事业改革的不断深入，国家政策法规的逐步完善，各级卫生行政主管部门越来越重视医院感染管理工作。2002年南京市对其所管辖的监控网医院及所有民营医院进行了2次医院感染管理专项检查。现将检查中暴露出的问题报告如下。     

双柱定性气相色谱电子捕获检测器测定上海市饮用水中微量碘化物

Objective To modify and optimize gas chromatographic conditions, qualitative and quantitative method on the base of the actual national standard detection method for drinking water on testing iodide with gas chromatography, and detect iodide in drinking water of Shanghai.Methods Iodobutanone derivative was identified by gas chromatography/mass spectrometry, then two capillary columns coupled to electron capture detector were made by qualitative and quantitative analysis.Finally, 100 ml water samples were collected respectively from raw water and finished water of three plants in which water sources were Yangtse river, Huangpu river, and inner river respectively and detected by this developed method.Results The results of mass spectrometry showed that iodide would form iodobutanone which could generate 1-iodo-2-butanone and 3-iodo-2-butanone isomers by derivatization.The data of qualitative analysis by two capillary columns revealed that iodobutanone was separated completely and the total time of chromatogram separation was 19.33 min.3-iodo-2-butanone with the high response value was selected to quantitatively analyse.The linear range was 1 - 100 μg/L,and the coefficient of determination (r2) was 0.9997.The limit of detection was 13 ng/L.Recoveries were between 97.68% and 104.37% ,and relative standard deviations were between 2.14% and 4.41%.The results of iodide detected by this method in raw water and finished water in three plants in Shanghai showed that the ranking of iodide's concentration in raw water was Huangpu river (15.14 μg/L) ＞ inner river (6.97 μg/L) ＞ Yangtse river (3.55 μg/L).The level of iodide in finished water of plant 1 (3.55 μg/L and 5.92 μg/L for raw and finished water respectively) and 3 ( 6.97 μg/L and 9.62 μg/L for raw and finished water respectively) increased slightly except for plant 2( 15.14 μg/L and 1.81 μg/L for raw and finished water respectively).The relative standard deviations of all water samples measured in duplicate were less than 9.73%.Conclusion The improved method possesses higher degree of sensitivity and accuracy of qualitative and quantitative analysis than actual national standard detection method, and it is fit for trace analysis of iodide in water.     

脑卒中后遗症患者社区康复治疗效果评估

目的评估脑卒中后遗症患者系统康复治疗效果,并探讨影响康复治疗效果的相关因素。方法随机抽取某社区卫生服务中心接受康复治疗的门诊患者和住院病人70人,经过一个疗程(6个月)的康复治疗后,测量其相关指标。结果康复治疗后,患者的上肢、手和下肢功能的Brunnstrom分级得到提升,改良Barthel指数从82.86上升到89.50。结论脑卒中后遗症患者到社区卫生服务中心接受有针对性的康复治疗,对患肢或患侧肢体的功能恢复会有效果。     

保养卵巢血养子宫次全切除手术16例临床分析

目的由于全宫切除手术病人术中需切除子宫体及宫颈组织,术后易引起医源性并发症,特别对＜50岁患者术后已保留卵巢组织,但其卵巢易出现早衰,性生活质量不满意,排尿无力,因此,对于上述病人进行全宫切除探查一种新的手术方法,以保留卵巢血养.术后不影响卵巢功能及性生活质量是当今妇科医生迫切需解决的问题.方法对患者子宫良性疾病需全宫切除的病人开展保留卵巢血养的子宫次全切除共16例,其中,子宫肌瘤15例,子宫腺肌症1例,所有病人术前均排除无子宫,宫颈恶性肿瘤存在.结果16例病人均顺利采用该新式手术,手术时间在30～40分钟完成,术中出血量80～100ml,术后平均住院时间6～7天,随访12～16个月,16例病人术后恢复好,无并发症发生.结论开展该新式手术治疗子宫良性疾患,手术效果好,安全,无医源性并发症出现,保留一个子宫体,保存盆腔"完整性",该术式值得推广.     

医院感染病原菌分布及耐药性分析

目的探讨医院感染病原菌分布及耐药情况,提出控制措施. 方法对1998～2003年收住我院所有患者医院感染常见病原菌及耐药情况,进行了回顾性和前瞻性统计分析. 结果 6年中所有医院感染病例共获得各种病原微生物28种3 039株,以革兰阴性细菌占主导共1 459株,占48.01%;革兰阳性细菌明显增多 986株,占32.44%;真菌感染18.99%;这些菌株对临床常用抗生素均有不同程度的耐药性,多重耐药呈增加趋势. 结论降低医院感染发生率,减少医院感染病原菌的增加,合理使用抗生素是今后医院感染工作的一项重要内容.     

8例脑卒中偏瘫肢体骨折患者的循证护理

目的探讨8例脑卒中偏瘫肢体骨折患者的循证护理效果。方法 2009年10月至2012年11月本科室收治8例脑卒中偏瘫肢体骨折患者,其中胫骨中下段骨折4例,胫腓中段骨折1例,尺骨鹰嘴骨折2例,桡骨中段骨折1例;均行切开复位内固定术,围术期实施循证护理。观察8例患者的手术效果、并发症、护理满意度。结果 8例患者均成功手术,术后恢复良好,无压疮、肺部感染、深静脉血栓形成等并发症。8例患者及家属对护理服务满意,满意度为100%。结论循证护理可改善脑卒中偏瘫肢体骨折患者的手术治疗效果,提高护理服务质量。