基层医院消毒供应室规范化管理的探索

本院依据卫生部关于消毒供应室有关建筑要求和硬件设施标准,对原供应室于2007年底进行改建,优化工作流程,并采取集中供应的管理方式.运行2年多来,在保证无菌物品质量方面,取得良好效果.现介绍如下.     

胸腺切除治疗重症肌无力的护理

重症肌无力（myasthenia gravis Mg）是以乙酰胆碱受体为靶子的自身免疫性疾病。胸腺异常是其特征性改变。胸腺扩大切除术是治疗MG的首选方法，其疗效可达81．8％-91．5％。我院胸外科自2004年7月至2008年1月对33例重症肌无力患者进行以胸腺切除为主的综合治疗，术后病情均有不同程度的缓解，效果满意。现将围手术期的护理体会介绍如下。     

贵州江口土家族男性葡萄糖-6-磷酸脱氢酶缺陷症的基因频率调查

目的 调查贵州省江口土家族男性葡萄糖-6-磷酸脱氢酶（G6PD）缺陷症的基因频率。方法 2002年10-11月随机选取227名江口当地土家族男性居民，采用四氮唑蓝（NBT）纸片定性法初筛G6PD缺陷症。G6PD／6PGD比值法定量确诊。结果 对贵州省江口县227名土家族男性进行筛查，共检出17例G6PD缺陷阳性。其基因频率为0．0749。结论 通过对贵州土家族G6PD缺乏症基因频率的调查和分析，初步了解了贵州省土家族G6PD缺乏症的分布特征。为该地区预防该疾病、指导临床、提高少数民族的素质及研究该民族起源提供了一定的依据。     

超声引导下经皮肺穿刺活检术诊断矽肺周围型病变的应用价值初探北大核心CSCD

目的探讨超声引导下经皮肺穿刺活检术诊断矽肺周围型病变的应用价值。方法对36只健康西兰兔采用非暴露法气管注入石英粉尘制备兔矽肺模型,观察染尘2个月后肺部影像学改变。对照CT结果,对肺内周围型病变行经皮超声引导下穿刺活检术。计算取材成功率、穿刺活检与解剖病理结果的诊断符合率及并发症发生率,并以成功取材、穿刺活检与解剖病理结果相符且无并发症为严格意义上的穿刺成功。比较穿刺成功组与失败组体重、心率、呼吸、体温、病变大小、与胸壁距离及尘肺期别等指标的差异。经耳缘静脉注入10000U肝素抗凝处理后,用10％氯化钾5ml处死矽肺兔,留取肺组织标本行HE染色,观察矽肺兔肺部病理改变。结果36只矽肺兔模型中,30只肺内出现周围型病变。对30只矽肺合并周围型病变模型兔进行穿刺活检,总的穿刺成功率70％（21／30）。其中,取材成功率93％（28／30）,诊断符合率86％（24／28）,并发症发生率10％（3／30）。与穿刺失败组比较,穿刺成功组病变较大,距离胸壁较近,呼吸频率低,差异均有统计学意义（P〈0．05）。两组矽肺兔体重、心率、体温、尘肺期别差异均无统计学意义（P〉0．05）。穿刺活检及解剖病理显示周围型病变内见典型的矽结节,并可见肺小动脉肌化,内膜增厚,管腔闭塞等血管重构表现。结论超声引导下经皮对矽肺周围型病变穿刺活检安全可行,可作为监测矽肺周围型病变进展过程的重要技术手段,为矽肺病的临床诊断提供参考价值;通过肺穿刺活检观察矽肺结节内细小血管改变,有助于临床进行针对性的干预治疗。     

利用吸氧面罩自制冰敷眼罩在重睑手术中的护理效果观察

目的利用吸氧面罩自制冰敷用眼罩,并比较其在重睑术后与其他冰敷方法的不同,观察其护理效果。方法将本院2016年1月~2017年1月46例行切开法重睑手术的患者分成观察组与对照组各23例。观察组于术后24 h内使用吸氧面罩制备的冰敷眼罩,对照组使用普通冰袋进行眼部冰敷。分别于术后第3、6天对两组伤口及其周围组织的创伤反应、伤口恢复情况、患者依从性等进行对比。结果观察组周围组织创伤反应较对照组明显降低(P0.05),伤口愈合无明显差异,患者依从性明显高于对照组。结论重睑术后利用吸氧面罩自制的冰敷眼罩进行眼部冰敷,患者依从性较高,舒适度提高,同时可减轻伤口局部充血或出血,降低周围组织的创伤反应,减轻水肿,促进伤口早期愈合。     

Donabedian模型在护理质量评价中的应用研究进展

综述了Donabedian模型的基本内涵、Donabedian模型在护理质量评价中的应用情况,并结合我国的实际情况,对今后护理质量的持续改进如何进一步研究给出建议,为建立更加科学严谨的护理质量持续改进策略提供参考依据。     

乳腺癌患者术后早期功能锻炼的研究进展

正乳腺癌是女性最常见的恶性肿瘤之一。乳房根治术或改良根治术自19世纪末一直是乳腺癌主要的治疗方法~([1])。手术会破坏患肢正常的血液循环、淋巴循环和肌肉,导致不同程度的上肢功能障碍,肩部僵硬,肌肉萎缩和肢体水肿,导致日常活动能力的降低~([2-3])。术后早期合理的功能锻炼在恢复患肢功能、防止废用性肌肉萎缩以及关节强直中发挥着重要作用~([4])。目前,临床关于早期功能锻炼的定义、时间、内容、评价等     

治咳枇杷露的质量标准研究

目的：对治咳枇杷露的质量标准进行研究,提高质量控制水平。方法采用薄层色谱法对枇杷叶、薄荷脑、桔梗进行鉴别,采用气相色谱法测定薄荷脑的含量。结果枇杷叶、薄荷脑、桔梗的薄层色谱斑点清晰,分离度好,专属性强,阴性无干扰;薄荷脑的线性范围为0．4008～2．4050μg（r＝0．9999）,平均加样回收率为99．4％（n＝6）,RSD＝0．19％。结论优化后的质量标准方法易行、准确可靠,可用于治咳枇杷露的质量控制。     

贵州省地方性氟中毒地区人群GSTP1基因Ile105Val位点多态性分析

Objective To investigate plasma glutathione S-transferase(GSTs) activity and GSTP1 gene Ile105Val polymorphism in Bijie City, Guizhou Province, a coal-burning fluorosis endemic area. Methods One hundred and sixty villagers from Yachi Twon using non-improved cooking stoves were selected as the non-intervened group in Bijie City, Guizhou Province where coal-burning fluorosis was prevailing; 153 villagers as the intervented group were chosen from Changchun Twon, where cooking stoves were improved; 151 villagers were served as the control group from Baiyunshan Twon, Changshun County without endemic fluorosis. The activity of GSTs was tested by colorimetric analysis with spectrophotometer. The genotype of the GSTP1 gene Ile105Val polymorphism, presenting as either homozygous wild-type (AA), or heterozygous mutation type (AG), or homozygous mutation type (GG), was detected through the PCR-RFLP procedure. Results The activity of GSTs in plasma of non-intervened group [(12.44±4.97) kU/L]was significantly lower than that of intervened group (P < 0.05), and that of intervened group[(20.78±6.20)kU/L]was significantly lower than that of control group[(24.30±6.27)kU/L, P< 0.05]. The difference of the enzyme activity of three groups were statistically significant (F = 51.71, P < 0.05), but this enzyme activity did not vary significantly in each sex of each grnup(P > 0.05). Compared intervened group [AA:67.3%(103/153), AG:29.4%(45/153),GG:3.3%(5/153)]and non-intervened group[AA:66.9%(107/160), AG:30%(48/160), GG:3.1%(5/160)]with control group[AA:74.8%(113/151), AG:25.2%(38/151), GG:0 (0/151)], the Ile105Val polymorphism site of GSTP1 gene had significant difference(χ2= 6.04,6.07, both P< 0.05), but not significant between intervened and non-intervened groups(χ2 = 0.02, P>0.05). Conclusions Fluorosis can decrease the activity of GSTs and introduce the GSTP1 gene Ile105Val polymorphism, intervention with the fluorine intake will improve the effect of fluoride on the body.     

贵州省地方性氟中毒地区人群GSTP1基因Ile105Val位点多态性分析

Objective To investigate plasma glutathione S-transferase(GSTs) activity and GSTP1 gene Ile105Val polymorphism in Bijie City, Guizhou Province, a coal-burning fluorosis endemic area. Methods One hundred and sixty villagers from Yachi Twon using non-improved cooking stoves were selected as the non-intervened group in Bijie City, Guizhou Province where coal-burning fluorosis was prevailing; 153 villagers as the intervented group were chosen from Changchun Twon, where cooking stoves were improved; 151 villagers were served as the control group from Baiyunshan Twon, Changshun County without endemic fluorosis. The activity of GSTs was tested by colorimetric analysis with spectrophotometer. The genotype of the GSTP1 gene Ile105Val polymorphism, presenting as either homozygous wild-type (AA), or heterozygous mutation type (AG), or homozygous mutation type (GG), was detected through the PCR-RFLP procedure. Results The activity of GSTs in plasma of non-intervened group [(12.44±4.97) kU/L]was significantly lower than that of intervened group (P < 0.05), and that of intervened group[(20.78±6.20)kU/L]was significantly lower than that of control group[(24.30±6.27)kU/L, P< 0.05]. The difference of the enzyme activity of three groups were statistically significant (F = 51.71, P < 0.05), but this enzyme activity did not vary significantly in each sex of each grnup(P > 0.05). Compared intervened group [AA:67.3%(103/153), AG:29.4%(45/153),GG:3.3%(5/153)]and non-intervened group[AA:66.9%(107/160), AG:30%(48/160), GG:3.1%(5/160)]with control group[AA:74.8%(113/151), AG:25.2%(38/151), GG:0 (0/151)], the Ile105Val polymorphism site of GSTP1 gene had significant difference(χ2= 6.04,6.07, both P< 0.05), but not significant between intervened and non-intervened groups(χ2 = 0.02, P>0.05). Conclusions Fluorosis can decrease the activity of GSTs and introduce the GSTP1 gene Ile105Val polymorphism, intervention with the fluorine intake will improve the effect of fluoride on the body.