HIV职业暴露医务人员的心理状态调查分析

目的探讨医务人员发生HIV职业暴露后的心理状态。方法运用SCL-90症状自评量表对我院近期发生HIV职业暴露的6名医务人员进行心理健康测试，并对测试结果进行数据分析。结果测试结果显示：焦虑、抑郁、敌对心理症状在不同时间段、不同程度高于常模，差异具有统计学意义（P〈0．05）。焦虑症状在第1周最明显，抑郁症状在第6周最为明显。结论发生HIV职业暴露后的医务人员有不同程度的心理症状，主要集中表现在焦虑、抑郁、敌对3个方面，而且不同时间段的心理症状表现程度不同，应针对不同症状早期给予心理干预，促进其早日恢复心理平衡状态。     

医务人员职业暴露调查分析研究

目的为掌握大型综合性医疗机构中,职业暴露发生的原因和机率、在不同职业人群中的分布、医务人员对职业暴露的认知程度等基础信息,从而为建立一套完整的医务人员职业暴露感染的预防控制体系奠定坚实基础.方法对我院2a来发生职业暴露的医务人员进行了调查分析.结果我院共63名医务人员发生职业暴露后经过预防措施的实施,进行了6个月的临床医学观察后,未发生1例感染.结论临床医务人员在医疗护理过程中易发生职业暴露,因此应加强医务人员全面防护的相关教育与培训,采取有效合理的措施,预防伤害事件的发生,以确保职业安全.     

临床医务人员血源性职业暴露危险因素及防范对策

目的 对临床医务人员血源性职业暴露的发生经过、类型、危险程度进行分析,探讨相关危险因素及防范对策.方法 对我院11例医务人员血源性职业暴露的发生经过、类型、危险程度及暴露后的预防措施进行分析.结果11例医务人员在发生血源性职业暴露后经过预防措施的实施,进行6个月的临床医学观察后,未发现一例感染.结论 临床医务人员在工作中易发生血源性职业暴露,我们应针对危险因素进行有效的防范措施,将职业暴露风险降到最低水平.     

医务工作者职业暴露后心理应激状况的调查分析及预防措施

目的 调查分析医务工作者职业暴露后的心理应激情况,早期预防心理应激障碍的发生,并为后续必要的心理危机干预提供依据。方法 本研究为前瞻性调查研究,通过对本院2018年11月～2020年10月发生职业暴露的医务工作人员进行网络问卷调查,比较不同性别、学历、岗位、暴露方式及防护情况等人员的(PTSD-SS)评分,进而了解不同医务工作人员职业暴露后的心理应激情况。结果 全院共计发生职业暴露447例,男性177例(39.60%),女性270例(60.40%),平均年龄(28.54±7.05)岁,平均工龄(5.06±5.62)年;根据不同职业分类,其中医生286例(63.98%)、护士140例(31.32%),医院行政后勤工作人员21例(4.70%)。447例暴露者的PTSD-SS总分平均为(47.72±21.68)分,其中最高分120分,最低24分,除不同暴露方式(针刺暴露vs黏膜暴露)的暴露者间PTSD-SS评分差异有统计学意义外,其他不同性别、学历、暴露源知晓情况和标准防护与否等各亚组总分差异均无统计学意义(P>0.05)。结论 医务人员发生职业暴露后,均可能出现不同程度的心理应激障碍...     

高职实习护生血源性传染病职业暴露后心理应激反应的纵向研究

目的了解高职护生实习期间血源性传染病职业暴露后不同时期的心理应激反应状况,研究其动态变化趋势,为管理者实施干预提供理论依据。方法选用中文版压力知觉量表(CPSS)、自评焦虑量表(SAS)、自评抑郁量表(SDS)和平时版创伤后应激障碍量表(PCL-C),针对在实习期间有过明确的血源性传染病职业暴露的高职护生,分别于暴露后1天内、7天、1个月、3个月、6个月这5个时间点,对其压力感知、焦虑、抑郁水平以及创伤后应激状态进行纵向调查,探讨血源性传染病职业暴露后实习护生心理应激反应的时间效应。结果实习护生CPSS、SAS、SDS、PCL-C得分自暴露时开始升高,暴露后7天达到最高,暴露后1个月仍维持在较高水平,暴露后3个月、6个月逐渐下降。结论血源性传染病职业暴露后,实习护生于不同时段存在不同程度的心理应激反应,管理者应根据护生各时段的不同心理应激状态进行个性化、针对性的心理行为干预,帮助其积极应对,以减少心理应激反应对护生的伤害。     

护士职业暴露后的心理状况及应对策略

目的了解护士在临床工作中职业暴露后的心理状况。方法采用症状自评量表（SCL-90）进行评定。结果 54名临床护士职业暴露后,躯体症状、抑郁、焦虑、恐怖等因子得分均高于国内常模（P〈0.01）。结论职业暴露发生后,对护士身心健康造成不同程度影响。提示暴露发生后护士应积极应对现实;医院管理者在重视预防及减少职业暴露的同时,更应关注护士职业暴露后的心理变化,及时提供心理支持和医疗帮助。     

医务人员血源性职业暴露调查分析

目的:探讨医务人员发生血源性职业暴露的危险因素与预防措施.方法:收集泸州医学院附属医院4年共191份血源性职业暴露登记表进行分析总结.结果:191名血源性职业暴露者中,医师、护士发生血源性职业暴露的次数最多(91.10％);暴露方式以锐器伤为主(60.73％),其中针头刺伤最多(43.98％);明确的污染源以HIV最多(38.73％),HBV其次(22.55％);暴露后采取正确的处理措施的占多数(80.63％).结论:应加强医务人员岗前培训,增强职业暴露防护意识,按照操作常规进行规范安全的操作,有效减少职业暴露的发生.     

某传染病医院2010-2014年医务人员HIV职业暴露资料分析

目的分析某传染病医院医务人员发生HIV职业暴露情况,探讨HIV职业暴露的影响因素及防范对策。方法对某收治艾滋病患者定点医院2010-2014年发生的HIV职业暴露情况进行分析。结果某传染病医院发生职业暴露的医务人员累计报告67例,其中护士占70.15%;针刺伤43例,黏膜、破损皮肤暴露24例;来源于确诊艾滋病的66例,不详1例;暴露级别1级(轻度)17例,2级(中度)38例,3级(重度)12例;暴露后均做了紧急处理、及时预防服药并定期检测,无一例发生HIV感染。结论重视职业暴露安全防护培训,树立预防观念,HIV职业暴露后及时正确处置,进行暴露后预防和给予心理、社会支持,减轻职业暴露者的心理压力,使暴露后感染降到最低限度。     

76例医务人员职业暴露及防护措施现状调查

目的:了解医务人员职业暴露的发生原因,及时处理职业暴露,制订并落实有效的防范措施。方法:建立医务人员职业暴露监测报告系统,制订医务人员职业暴露报告、处理程序,填写医务人员职业暴露报告表和职业暴露调查登记表,调查登记医务人员在临床工作中发生职业暴露的情况。结果:职业暴露的职业分布,护士(含实习护士)52名,最高,占68.42%,其次是医生12名,占15.79%;以职业暴露的类型分布,锐器伤73例,占96.05%,是最常见的职业暴露类型;以工龄分布,工龄≤3年最多37例,占48.68%;以暴露源血源性传播疾病分布,乙型肝炎居首位;发生职业暴露后均及时进行局部紧急处置,并进行临床医学观察,未发生血源性传播疾病的感染。结论:加强职业安全防护培训,规范操作行为,预防和减少职业暴露的发生,暴露后及时采取有效合理的干预措施以降低被感染的危险。     

安徽省医务人员血源性职业暴露上报情况及影响因素分析

目的 了解安徽省医务人员发生血源性职业暴露后的上报情况,分析上报的影响因素,为提高医务人员职业暴露正确处置率提供参考依据.方法 2019年4月1日至30日以安徽省医疗机构医务人员作为调查对象,采用问卷调查的方法,收集一般人口学特征、暴露发生的经历以及相关影响因素等信息,以是否上报为因变量进行多因素logistic回归分析.结果 共发放调查问卷33185份,回收有效问卷33156份.锐器伤和血/体液暴露后的上报率分别为27.41％和24.43％.单因素分析结果显示,不同年龄、医院级别、文化程度、职称水平、职业、是否遵循标准预防、操作前查看患者免疫十项报告、培训次数职业暴露上报率比较,差异有统计学意义(P<0.05).多因素logistic回归分析显示,职业暴露后影响上报率的因素为职业、医院级别、文化程度、是否遵循标准预防、操作前查看患者免疫十项报告及培训次数(P<0.05).结论 安徽省医务人员职业暴露发生后上报率较低.应加强对医务人员职业暴露正确处置知识专项培训,提高医务人员职业暴露预防和上报意识.     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.