无菌台上医疗废物的规范化管理

目的规范手术间无菌台上医疗废物管理,防止污染扩散和传播感染性疾病,并提高手术室工作效率和护理质量。方法按照《医疗废物管理条例》及有关规定在我院手术室12个手术间无菌台上实行医疗废物分类收集,进一步规范手术间医疗废物的管理。结果①实验组手术伤口感染率、外科医院感染率以及锐器伤发生率分别为16.5%、8.9%、7%。②手术医生、麻醉医生、保洁员的满意度分别为:95%、98%、100%。结论无菌台上医疗废物的规范化管理是手术间医疗废物的管理的重要环节,不仅保证了手术间的干净整洁,减少了医疗废物在手术间的二次污染,防止了污染扩散,避免了手术台上产生医疗垃圾的混放,减少了医务人员的锐器伤率,防止了感染性疾病的传播。优化了手术间的保洁流程,提高了手术团队人员的工作效率和手术间的利用率。     

Factores asociados a la extubación temprana en pacientes con cirugía correctora de tetralogía de Fallot

ObjectiveTo assess surgical management and postoperative results associated with early extubation in patients undergoing tetralogy of Fallot corrective surgery at a public hospital in Argentina.MethodsA retrospective review was made from clinical records from patients who underwent corrective surgery for tetralogy of Fallot. A total of 38 clinical records that met the inclusion criteria for the retrospective review were included in the analysis.Results16% were extubated early. Milrinone was the only drug that showed differences in patients who were extubated early (p=0.01). Extracorporeal circulation time, aortic clamping time, transfusion with cryoprecipitates, saturation of oxygen pressure, and haematocrit at the end of the surgical procedure showed no differences (p>.05). In the postoperative period, the ICU stay was shorter for the patients who were extubated early (p=0.0007), but there were no differences in the total hospital stay (p=0.26).ConclusionsEarly extubation in the institution, although found to be low frequency, has proved as a safe and effective alternative to shorten these patients’ stay in ICU.     

经胸壁穿刺持续负压吸引法解决胸腔镜手术烟雾问题的效果

 目的 探讨经胸壁穿刺持续负压吸引法解决胸腔镜手术烟雾问题的效果。方法 选择2021年3－6月北京世纪坛医院接受单孔胸腔镜肺叶切除术的患者103例,根据患者意愿分为两组,其中A组48例,B组55例。术中应用经胸壁穿刺持续吸引法的患者归为A组,未使用该方法的归为B组。比较两组患者的年龄、性别、体质指数、肿瘤部位、肿瘤直径、TNM分期、手术时间、术中出血量、术中镜头擦拭次数、术后住院时间以及术中手术室PM 2.5。结果 A组手术时间为(105.14±35.27)min,短于B组[(130.15±38.36)min] (P＜0.001);A组术中镜头擦拭次数为 2.43±2.55,明显少于B组(7.33±4.12) (P＜0.001);A组术中出血量为(85.58±33.45)ml, 少于B组[(106.43±34.23)ml] (P＜0.001)。在手术室空气质量改善方面,A组术中PM2.5 浓度为(55.43± 25.12)μg/m³,远小于B组的(654.34±108.76)μg/m³ (P＜0.001);关胸10 min后两组手术的手术室PM 2.5仍然表现出明显的差异 (P＜0.001)。而两组患者的性别、年龄、体质指数、TNM分期以及术后住院时间无统计学差异。结论 经胸壁穿刺持续吸引法操作简单,效果良好,可减少镜头模糊、缩短手术时间、减少术中出血量、减少手术烟雾造成的手术室环境污染。     

一种上层空间紫外线杀菌系统的照射效能评价

目的评价一种上层空间紫外线杀菌系统的照射效能。方法在装有“思诺恒时TM室内空气杀菌系统”的模拟病房或诊室里，用紫外线辐射强度测量仪在杀菌系统正前方1．0m处及左右各0．5、1.0、1．5m及对面墙壁4．8m处，以及上述每个点的上下5cm和10cm处测量紫外线辐射强度，并在约1．7m的人面部高度测量该系统的辐射强度和剂量。紫外线照射强度〉10uW／cm2为有效杀菌强度；辐射剂量〈0．2uW／cm2为安全剂量。结果距离“思诺恒时TM室内空气杀菌系统”正前方1．0Fn处的辐射强度为427uW／cm2，其左右两侧（1．5m）接近墙壁的位置辐射强度分别56uW／cm2和58uW／cm2，在正前方1．5、2．0m和对面墙体即4．8m处的辐射强度分别为179uW／cm2、111uW／cm2和70uW／cm2。结论上层空间紫外线杀菌系统是一种安全、高效的消毒工具，适用于呼吸系统传染病，特别是结核病感染控制。     

手术复苏室患者睡眠障碍的原因分析及护理对策

我院于2008年11月2日建立了手术后复苏室，所有接受麻醉的手术病人术后均需进入复苏室进行持续监护和治疗，大部分手术患者当天就可以转回病房，部分老年、危重、大手术患者以及合并症较多的患者需在复苏室中观察治疗24h甚至更长时间，直至患者病情稳定转回病房。术后留夜患者普遍存在睡眠障碍，不利于顺利渡过术后危险期，不利于早日康复。我科2009年10-11月共收治留夜患者435例，其中220例术后出现睡眠障碍，我们针对性地进行护理干预，现分析总结如下。     

The impact of a supervised injecting facility on ambulance call‐outs in Sydney,Australia

Aims Supervised injecting facilities (SIFs) are effective in reducing the harms associated with injecting drug use among their clientele, but do SIFs ease the burden on ambulance services of attending to overdoses in the community? This study addresses this question, which is yet to be answered, in the growing body of international evidence supporting SIFs efficacy. Design Ecological study of patterns in ambulance attendances at opioid‐related overdoses, before and after the opening of a SIF in Sydney, Australia. Setting A SIF opened as a pilot in Sydney's ‘red light’ district with the aim of accommodating a high throughput of injecting drug users (IDUs) for supervised injecting episodes, recovery and the management of overdoses. Measurements A total of 20 409 ambulance attendances at opioid‐related overdoses before and after the opening of the Sydney SIF. Average monthly ambulance attendances at suspected opioid‐related overdoses, before (36 months) and after (60 months) the opening of the Sydney Medically Supervised Injecting Centre (MSIC), in the vicinity of the centre and in the rest of New South Wales (NSW). Results The burden on ambulance services of attending to opioid‐related overdoses declined significantly in the vicinity of the Sydney SIF after it opened, compared to the rest of NSW. This effect was greatest during operating hours and in the immediate MSIC area, suggesting that SIFs may be most effective in reducing the impact of opioid‐related overdose in their immediate vicinity. Conclusions By providing environments in which IDUs receive supervised injection and overdose management and education SIF can reduce the demand for ambulance services, thereby freeing them to attend other medical emergencies within the community.     

Work in operating rooms and pregnancy outcome among nurses

The aim of this study was to analyse the relationship between work in an operating room and pregnancy outcome, as described by the rates of spontaneous abortion and of birth defects. The population comprised the female nurses of 17 hospitals in Paris, interviewed in 1987–1989. An exposed group included all operating room nurses, and a control group was composed of female nurses in other departments matched by hospital, age and duration of service. Each woman described all prior pregnancies. In total, 776 pregnancies were described by 418 nurses who were first pregnant in 1970 or thereafter; ectopic pregnancies, those terminated by voluntary induced abortion and those leading to multiple births were excluded. The rate of spontaneous abortion was significantly higher for pregnancies during which women worked in an operating room than for the other pregnancies. Birth defects were not significantly related to work in an operating room during pregnancy. These results are in agreement with others showing a significant relationship between occupational exposure to operating rooms and spontaneous abortion, although identification of the responsible factor remains difficult. They suggest that effective ventilating systems should be installed in all operating rooms and that special preventive measures must be taken for women of childbearing age.     

参观手术室环境对患者术前恐惧程度的影响

目的 探讨参观手术室环境对患者术前恐惧程度的影响.方法 选取入院后恐惧视觉模拟评分≥4分、首次行择期手术、活动无障碍、非糖尿病患者160例,年龄16～64岁,随机分为2组(n=80):对照组和试验组.对照组麻醉前行常规访视和告知,试验组在常规访视和告知后带患者参观手术室环境和有关医疗设备.于入院后第2天清晨(T1)、访视后当晚入睡前(T2)、人手术室后麻醉前(T3)记录恐惧视觉模拟评分、MAP和HR,于T1,3时测定血糖.结果 与对照组相比,试验组T2,3时MAP、HR、中度和重度恐惧发生率及T3时血糖明显降低(P<0.01).结论 参观手术室环境有助于减轻患者术前的恐惧程度.