胃镜送气送水喷嘴堵塞的预防及排除

胃镜是消化内科常规的诊疗仪器，它可直观地观察胃结构的病变，并可开展介入治疗。胃镜中有多个管道（如图１所示），其中有一个送气／水管道，该管道在胃镜先端部有一个送气／水喷嘴。该喷嘴在使用中较容易发生堵塞现象，这时气和水都不易送出来，有时甚至不能从胃镜中送出来，影响胃镜的正常使用。本文详细讨论了送气／水喷嘴堵塞产生的原因以及排除和预防的方法，希望对胃镜使用和维修人员有所帮助。送气／水喷嘴发生堵塞的原因：胃镜在使用中，胃镜先端部的送气／水喷嘴会碰到胃中的血和胃分泌物，这些污物会附着在该喷嘴上，有时甚至流…     

奥林巴斯150胃镜送水送气故障及维修

送水送气故障主要有喷嘴堵塞、水气管堵塞和送水送气不畅。1喷嘴、水气管堵塞1.1堵塞原因(1)先端部不小心与硬物碰撞导致喷嘴变形;(2)使用内镜后没有立即清洗;(3)脏物凝固在喷嘴里和水气管道里;(4)消毒前没有用洗涤剂彻底洗净内镜;(5)消毒液使蛋白质凝固阻塞喷嘴和水气管;     

国产XW-2型纤维胃镜几种故障的检查和修理

一、水气不畅水气不畅是XW-2型纤维胃镜的常见故障,其检修步骤如下: (一)首先检查头端部水气孔是否被堵,如堵塞,可用φ0.4～0.5mm的钢丝疏通。 (二)检查水瓶瓶盖是否严密,其输出接头与注水接口的密封圈有否破损、老化,金属接头有无卷口。 (三)无上述故障时,可拆开镜身罩壳进行检查,拆壳动作切忌过猛,注意保护传象束和导光束。 1.取下金属三通管水气共用端塑料管作注水试验,如该管通畅,原水气不畅系塑料管与三通管的接口密封不良,或塑料管接头老化破损所致,可将破损处剪去后接上三     

不同方法预清洗胃镜的对比研究

目的 探讨一种高效、实用、安全的胃镜预清洗方法,以保证清洗质量.方法 将完成胃镜检查的600条胃镜随机等量分为A、B、C 3组,A组胃镜使用后立即送洗消间清洗消毒；B组使用后在床侧立即用湿纱布擦去胃镜表面的污物,并在清水中反复送气与送水及持续吸引≥10 s;C组使用后在床侧立即用多酶液纱布擦去胃镜表面的污物,并在多酶液中反复送气送水及持续吸引≥10 s,B、C组经过上述床侧处理后送洗消间清洗消毒；记录胃镜再使用时送气送水管道的通畅情况；并从各组中随机抽取消毒后的胃镜30条,进行生物学检测.结果 A、B、C 3组中分别有18、8、1条胃镜在操作时出现送气/送水管道完全及不全堵塞,堵塞率分别为9.0％、4.0％、0.5％,差异有统计学意义(P＜0.05)；3组中生物学抽检合格率均为100.0％.结论 胃镜检查完后应立即行预清洗,使用多酶液处理既能保障胃镜的可操作性,又能提高清洗消毒效果.     

饱餐服毒病人两种洗胃方法比较的统计分析

洗胃是抢救服毒病人的第一步 ,能否快速、安全、彻底、有效地洗胃 ,又是抢救成功与否的关键。饱餐服毒病人极为普遍 ,但目前尚没有哪种洗胃机或洗胃方法能有效解决饱餐服毒病人洗胃时因胃内容物堵塞胃管 ,造成毒物在胃内停留时间延长、毒物吸收增加 ,因为饱餐服毒病人洗胃过程中存在以下难题 :(1)由于负压的吸引胃内容物阻塞胃管前端开口 ,形成无效洗胃 ;(2 )洗胃机在“出胃”状态时 ,胃内容物被吸引 阻挡 返回胃内 ,并如此重复 ;(3)饱餐服毒病人胃内压力增高 ,使每次进出胃的液量均减少。自 1997年 12月至 1999年 12月三年间 ,我们分别用…     

不可缺少的家族成员——纤维胃镜

纤维胃镜的类型很多,总体结构相同,按先端部的形式和物镜的部位,分为直视、侧视和斜视三种类型。但目前由于胃镜先端部分角度改进,在临床上以直视镜应用最广。直视式纤维胃镜能满意地观察全部食管,也可以检查胃、十二指肠球部及降部上段,对食管及胃大弯观察较侧式镜清楚。 侧视式纤维胃镜在胃内操作灵活、观察胃窦、胃角和胃体小弯侧病更清楚,也可以观察十二指肠球部和降段上部的病变。活检调节较灵活且准确。但观察食管中段以上病变     

内镜感染的危险因素及对策

笔者对内镜室的工作进行全面质量管理,分析内镜存在感染的危险因素及对策. 1危险因素 1.1 多酶清洗液使用不规范 内镜清洗人员消毒意识淡薄,未认识到内镜交叉感染的重要性,未做到一镜一更换.多酶清洗液价格较贵,一镜一酶工作量大,在工作中存在酶液重复使用的现象,从而增加了医院感染发生的风险.1.2喷嘴阻塞 (1)异物阻塞:清洗用水水质不良或水中有异物,灌流时,杂质或异物沿内镜腔道阻塞喷嘴.(2)分泌物或血块阻塞:检查时,当患者恶心、屏气时,胃内压力骤增,分泌物常反流进入喷嘴内.(3)操作不当:在操作、清洗或转运时,如内镜前端与硬物相碰,可致喷嘴变形而发生阻塞;当镜面模糊用纱布擦拭时,如擦拭方向不对,可使异物嵌入喷嘴致阻塞.     

负压封闭引流术后管道堵塞的原因及护理对策

目的探讨负压封闭引流(VSD)术后管道堵塞的原因及护理对策。方法选取2016年6月至2019年6月于医院行VSD治疗的74例患者作为研究对象,统计VSD术后管道堵塞情况,分析原因及护理对策。结果VSD术后管道堵塞12例(16.22%),其中创面感染5例(6.76%),创面大、需使用多块材料3例(4.05%),引流时间长4例(5.41%),经处理后10例恢复正常。结论VSD术后管道堵塞原因有创面感染、需使用多块材料、引流时间长等,需从多个方面给出护理对策及方法。     

麻醉应用于胃镜检查及治疗的护理体会

<正> 胃镜诊治是目前上消化道诊断治疗的最常用方法,由于胃镜诊治在插管过程中因镜身对胃肠管壁的刺激引起患者产生不同程度的恶心、呃逆等不适感。使部分患者产生了畏惧及抗拒心理,不能很好的配合,给胃镜诊治带来了一定的困难,同时也可能给患者留下不良的记忆,甚至夸大其痛苦程度影响其他患者对胃镜的诊疗。为了解决这一问题,我院     

饱餐服毒病人洗胃方法的改进

洗胃是抢救服毒病人的第一步能否快速、安全、彻底、有效地洗胃又是抢救成功与否的关键。饱餐服毒极为普通目前尚没有哪种洗胃机或洗胃方法能有效解决饱餐服毒病人洗胃时因胃内容物堵塞胃管造成毒物在胃内停留时间延长这一难题因为饱餐服毒病人洗胃过程中存在以下困难：由于负压吸引胃内容物阻塞胃管前端开口形成无效洗胃，洗胃机在“出胃”状态时，胃内容物被吸引阻挡返回胃内，并如此重复，饱餐服毒病人胃内压力增高，使每次进出胃液量均减少。自１９９７年１月我们对该类病人洗胃方法进行了改进。方法是：改良胃管前端，通过…     

医疗服务操作分类与编码的设计与应用简

医疗服务操作分类与编码是医学信息标准化的重要组成部分,是临床数据提取、分析和应用的基础。世界卫生组织及世界多国一直致力于开发、更新和维护此分类与编码。我国此前一直沿袭美国准备在2014年停止使用的ICD-9-CM-3（卷3）,中国需要结合国际主流设计思路,根据国情开发出适宜的多轴、一体化的医疗服务操作分类与编码体系。     

环境中双酚A的污染及降解去除的研究进展

近10年来随着科学与社会的发展,环境雌激素污染日益引起人们的关注。双酚A是环境雌激素的一种,用途广泛,但具有多方面的毒性。对其毒理、污染及降解去除的研究已经成为国际上的研究热点。该文拟对上述几方面的研究进展情况作一简要介绍。     

黄体功能不健的调控机理

主要就引起卵巢黄体功能不健的因素 ,分别从激素调节、细胞因子 (VEGF、TNF α、BFGF、IFN γ、IGF)、C myc、Fas、SGP 2基因调控以及细胞连接、细胞粘附分子、NO等对卵巢功能的调节及对黄体细胞的凋亡影响进行阐述 ,认为卵泡发育不良、颗粒细胞、黄体细胞的凋亡与黄体功能不足有密切的关系。且多种细胞因子、基因表达产物参与此过程的调控。深入的研究这一调控机制 ,对于进一步了解卵巢卵泡生长发育、卵泡闭锁及黄体细胞凋亡的内在机制有重要意义     

HIS与PACS软件融合方案的设计与实现

目的：实现PACS与HIS的系统集成。方法：使用Powerbuilder设计电子申请系统，利用Oracle存储过程实现不同系统间的数据同步。结果：完成了第四军医大学西京医院的PACS／HIS软件融合，经临床应用，反应良好。结论：系统集成应根据医院需求，由信息科牵头，多方论证，遵循高可用性、低耦合度的原则，在保证软件实用、流程合理的前提下，应最大限度地压缩新旧流程的共存时间。     

Intake of dietary phytoestrogen and indices of antioxidant and bone metabolism of pre- and post-menopausal Korean women

A group of 101 women, aged 40-65 years consisted of 48 premenopausal subjects and 53 postmenopausal ones living in Daegu and Gyeongbuk area in Korea were evaluated with their general characteristics, lifestyle factors, nutrient and phytoestrogen intakes, blood and urinary indices concerning antioxidant status and bone metabolism. Body mass index (BMI), waist hip ratio (WHR) and systolic blood pressure (SBP) of the postmenopausal women were significantly higher (23.8, 0.86, and 126.9 mmHg, respectively) than those of the premenopausal women (22.6, 0.82, and 115.9 mmHg; respectively). Nutrient intakes of the postmenopausal and premenopausal groups were not different except lower fat intake and higher dietary fiber and iron intakes in the postmenopausal group. Daily total phytoestrogen intake was significantly higher in the postmenopausal group (48.54 mg) than the premenopausal (31.41 mg) and was resulted mostly from higher intakes of daidzein and genistein from soy and soy products (45.42 mg vs 28.91 mg). Serum genistein level and excretion of enterolactone, major lignan metabolite, were not very different between the two groups. Serum retinal and α- tocopherol levels were higher in the postmenopausal group but TBARS levels were not different between the two groups. Serum osteocalcin (7.18 ng/mL) and urinary deoxypyridinoline (7.15 nmol/mmol creatinine), in the postmenopausal group were significantly higher than those in the premenopausal group (4.80 ng/mL, 5.95 nmol/mmol creatinine). Urinary excretion of enterolactone was positively correlated with serum osetocalcin in premenopausal women and serum genistein negatively correlated with the urinary DPD in postmenopausal women. Dietary phytoestrogen intake was negatively correlated with serum level of TBARS in all subjects. It is concluded that the effect of total phytoestrogen intake is beneficial on body antioxidant status in all middle-aged women regardless of menopause but the effect on bone metabolism appears different by the type of the phytoestrogen and the menopausal state.     

Reliability and validity of indices of hand-grip strength and endurance

Background/aim: Grip strength is useful in clinical practice for the assessment of disease and/or rehabilitation progression. Brief maximal gripping is seldom required in everyday occupations, with repeated or sustained gripping at sub‐maximal power more commonly involved. It has been proposed that assessment of both maximal hand‐grip force and endurance is utilised. While the suitability of maximal contraction measures has been clearly established, the reliability and validity of other hand‐grip indices have not been investigated. This study examined the reliability of various hand‐grip indices and their validity in relation to distance walked during the six‐minute walk test, a standardised exercise capacity test. Methods: Subjects undertook static sub‐maximal (50%) and maximal force contraction hand‐grip testing from which various indices were derived, and six‐minute walk testing from which distance walked was determined. Testing was repeated on three separate occasions for determination of test–retest reliability. Results: Pre‐ and post‐fatigue maximal contraction measurements demonstrated excellent test–retest reliability and validity. Conversely, other hand‐grip indices were shown to be unreliable and exhibited no relationship with distance walked and hence concurrent validity could not be established. Conclusions: Based on the results of this study, it is recommended that pre‐ and post‐fatigue maximal contraction may be utilised for the assessment of client ability and progression due to their established validity and test–retest reliability. However, previously proposed measures of fatigue such as endurance (duration of sustained contraction), Strength Decrement Index and work performed (function of endurance and force of contraction) are unreliable and invalid and may have limited use in clinical practice.     

Evaluation of impact of temperature and pH alterations on the size and antigenicity of meningococcal serogroup A and X polysaccharides and conjugates

The changes in the recommended storage conditions of the glycoconjugate vaccines against Neisseria meningitidis (Men) serogroup A and serogroup X can affect its activity or potency. Elevated temperature and the change in pH may result in the physical instability leading to the size degradation of the polysaccharide (PS) and subsequent loss of PS epitopes. Moreover, high temperature may also result in protein aggregation and altered tertiary structure of the protein in the conjugate. Consequently, the construction of a potent glycoconjugate is dependent on optimal temperature and pH. The changes in both these conditions can also affect the production of a capsular polysaccharide (PS) and its conjugation to a protein carrier and may also affect the integrity of the vaccine molecule including the maintenance of the protective epitopes. In our study we have used inhibition ELISA as a tool to assess the impact of temperature and pH alterations on the antigenicity of N. meningitidis serogroup A and X, PS and conjugates and their correlation with the size distribution analysis using high pressure size exclusion chromatography. The studies on pH alterations from 5 to 9 led to minimal impact on size and antigenicity of all antigens, however, an elevated temperature adversely impacted the antigen size as well as antigenicity to varying extent. Results indicate the higher stability of MenX PS and conjugate as compared to that for MenA counterparts at elevated temperatures. Furthermore, both the MenA and MenX conjugates appears to be more stable as compared to the corresponding PSs.     

疾病预防控制机构实验室设备资产配置及缺口研究

目的明确2002～2005年疾病预防控制机构设备资产配置变化情况。方法全国系统抽样调查省市县各级疾病预防控制机构的各类设备配置种类和数量,计算设备资产,和标准比较得到缺口。结果疾病预防控制机构实验室设备资产配置明显增加,但缺口仍然很大,就A类设备缺口达到50·2亿。     

依布哂啉纯度、杂质检测及安全性实验

目的 检测合成的依布哂啉(Ebselen Ebs)的纯度、杂质并进行急性毒性实验。方法 Ebs测定采用自建立的高效液相色谱法(HPLC)，杂质(苯胺)采用比色法，急性毒性试验采用成年大鼠1次性灌胃，观察24h内死亡率。结果 Ebs纯度为99.95％～99．99％，苯胺含量为0．00017％～0．00019％，大鼠1次经口的LD50为2355．05mg／kg。结论 Ebs质量可靠，安全性高，可供开发研究。