洁净手术部动态微生物学监测与控制

目的 探讨洁净手术部在动态下(手术过程中)各时段空气中的微生物变化规律.方法 在医护人员正常工作的情况下,对百级、万级、10万级洁净手术间进行手术不同阶段的细菌菌落数监测及手术区与周边区的尘埃粒子数监测.结果 动态实测值均高于静态标准值,同级别不同阶段菌落数比较,差异有显著性意义(均P＜0.01);各级别手术间手术区尘埃粒子数显著高于周边区(均P＜0.01).结论 动态监测能反映手术过程中微生物的变化,根据具体监测结果和现代手术控制感染的思路,必须树立术中全过程控制的理念.     

中草药注射液与溶媒配伍后不溶性微粒观察

目的 探讨洁净手术室共用净化空调对手术间空气环境的影响。方法 根据洁净手术室分级标准，选择20例外科手术在共用净化空调手术间其中一间施行手术，分别在施行手术的手术间和未施行手术的手术间分时段采样做空气细菌培养。结果 施行手术手术间皮肤切开前15min和术毕整理手术间时菌落数显著高于术前空调运行30min（均P〈0．01），且显著高于未施行手术手术间同时段（均P〈0．01）；未施行手术间各时段菌落数比较．差异无显著性意义（均P〉0．05）。结论 共用净化空调不会对洁净手术间空气环境造成影响。     

棉织布与无纺布尘埃粒子数及抗渗液性能比较研究

目的比较棉织布与无纺布制作的手术衣和手术洞巾等在手术铺巾时空气中的尘埃粒子数及术中抗渗液性能，为有效控制外科切口感染和预防医患交叉感染提供参考。方法将棉织布与无纺布制作的手术布类各备15包，包内内容均相同，经灭菌处理。应用尘埃粒子计数仪测定两组铺巾时、铺巾后及收巾时空气中的尘埃粒子数，同时在手术过程中观察其抗渗液性能。结果无纺布组在铺巾时、铺巾后及收巾时产生的尘埃粒子数显著少于棉织布组（P〈0．05，P〈0．01）；其抗渗液率为100％，而棉织布组为0。结论无纺布抗渗液性能优，可减少手术环境中的尘埃粒子数，从而控制外科切口感染；其阻隔防护效能对患者和医护人员具有双重保护作用。     

多用途胶粘型除尘器清洁床单效果观察

目的观察多用途胶粘型除尘器（下称除尘器）对患者床单洁净作用及对病房空气的影响。方法分别用除尘器（观察组29例）和湿毛巾（对照组28例）对床单进行清扫，于清洁前5min和清洁后5min、30min于床单表面、病房空气采样行细菌培养。结果两纽扫床后床单细菌菌落数均显著降低并达标（均P〈0．01），其中观察组显著优于对照组（P〈0．01）。病房空气中菌落数观察组扫床前、后差异无显著性意义（P〉0．05），对照组扫床后显著高于扫床前和观察组扫床后（均P〈0．01）。结论2种扫床方法均能有效洁净床单，其中观察组效果更佳，对病房空气影响更小。     

综合管理对骨科洁净手术间空气含菌量的影响

目的 通过监测手术间的空气菌落数,分析干预策略对骨科洁净手术室洁净度的影响.方法 选择Ⅰ、Ⅱ和Ⅲ级骨科的洁净手术间,将其每天的第一台手术随机纳入相应级别的干预组和常规组.干预组采用严格控制手术间开门次数、尽量避免人员进出手术间、改善患者入室前的卫生状况等干预策略,常规组按照平常的工作模式完成手术.用撞击法监测患者入手术室前(T1)、手术切皮前(T2)、手术开始30 min(T3)和缝合皮肤前(T4)4个时点手术间中央区的浮游细菌浓度,同时用沉降法监测T1、T2、T3时室内周边区的细菌浓度.结果 各级手术间干预组开门次数显著低于常规组(均P＜0.01);患者进入手术间后,室内空气中的悬浮细菌随着时间的延长明显增多(P＜0.05);组间比较,干预主效应差异有统计学意义(均P＜0.05).结论 采用综合干预可以有效降低骨科手术间的浮游细菌浓度.     

儿童紫癜性肾炎血清、尿液巨噬细胞移动抑制因子水平及临床意义

目的：探讨过敏性紫癜肾炎（HSPN）患儿血、尿巨噬细胞移动抑制因子（MIF）的水平及临床意义。方法：采用酶联免疫吸附（ELISA）法检测33例HSPN、21例HSP患儿以及20例健康对照组儿童血清和尿液MIF水平，进行比较并分析其与24h尿蛋白（TUP）、尿红细胞的关系。其中11例HSPN患儿进行肾穿刺活检术获得肾组织标本，比较不同病理程度血、尿MIF水平的变化。结果：HSPN组尿液MIF水平显著高于HSP组及对照组（P〈0．05，P〈0．01）；3组血MIF水平比较差异无统计学意义（P〉0．05）。HSPN患儿中尿MIF水平随蛋白尿水平增加而逐渐增加，TUP≥1．0g组显著高于0．15g≤TUP〈1．0g组和TUP≤0．15g组（P均〈0．01）；3组之间血MIF水平差异无统计学意义（P〉0．05）。肉眼血尿组尿液MIF水平高于镜下血尿组，差异有统计学意义（P〈0．01），两组血MIF水平比较差异无统计学意义（P〉0．05）。HSPN病理Ⅲ～Ⅳ级组的尿MIF水平显著高于I～Ⅱ级组及对照组（P〈0．05，P〈0．01），病理I～Ⅱ级组的尿MIF水平显著高于对照组（P〈0．01）；病理Ⅲ～Ⅳ级组的血MIF水平高于正常对照组（P〈0．05），但与I～Ⅱ级组相比差异无统计学意义（P〉0．05）。结论：MIF表达上调可能是HSPN肾损害的重要机制之一，尿MIF水平能反映肾病理损伤程度，动态监测其变化可作为判断HSPN病情的一个非侵入性指标。     

共用净化空调对手术室空气环境的影响

目的探讨洁净手术室共用净化空调对手术间空气环境的影响.方法根据洁净手术室分级标准,选择20例外科手术在共用净化空调手术间其中一间施行手术,分别在施行手术的手术间和未施行手术的手术间分时段采样做空气细菌培养.结果施行手术手术间皮肤切开前15 min和术毕整理手术间时菌落数显著高于术前空调运行30 min(均P＜0.01),且显著高于未施行手术手术间同时段(均P＜0.01);未施行手术间各时段菌落数比较,差异无显著性意义(均P＞0.05).结论共用净化空调不会对洁净手术间空气环境造成影响.     

高容量血液稀释对骨科手术患者红细胞免疫粘附功能的影响

目的观察高容量血液稀释（HVH）对手术患者红细胞免疫粘附功能的影响。方法选择ASAⅠ～Ⅱ级择期骨科手术患者40例，随机均分为两组：HVH组（H组）和常规容量输液组（N组）。H组用20ml／kg的6％羟乙基淀粉实施HVH，N组输入常规生理维持量。监测入室后即刻、术前禁食体液丧失量输注后、血液稀释后即刻、切皮后1h、术后1、3、5d红细胞压积（Het）、红细胞酵母菌花环率（RYRR）、肿瘤细胞红细胞花环率（TRRR）。结果H组血液稀释后Hct明显下降（P〈0．01），术后H组HCt高于N组（P〈0．05）；与入室后即刻相比，H组血液稀释后RYRR和TRRR明显增加（P〈0．05或P〈0．01），术后1d则下降（P〈0．05）。N组切皮后1h、术后1、3dRYRR和TRRR明显下降（P〈0．05或P〈0．01）；与血液稀释后即刻相比，两组在切皮后1h、术后1、3d均有明显下降（P〈O．05或P〈0．01）；血液稀释后即刻、切皮后1h、术后1、3d组间差异有统计学意义（P〈0．05或P〈0．01）。结论HVH可明显减少围手术期的血液丧失，减少手术、麻醉应激对红细胞免疫粘附功能的抑制，促进术后红细胞免疫粘附功能的早期恢复。     

不同类型肝硬化患者心理状态调查分析

目的了解不同类型肝硬化患者的心理状态，为采取针对性的护理干预措施提供依据。方法采用症状自评量表（SCL-90）分别对60例病毒性肝炎肝硬化患者（肝炎组）、60例酒精性肝硬化患者（酒精组）进行问卷调查。结果肝炎组SCL-90总分及抑郁、焦虑、偏执因子分显著高于常模（P〈0．05，P〈0．01）；酒精组焦虑、敌对、偏执因子分显著高于常模（P〈0．05，P〈0．01）。两组焦虑、敌对、偏执因子分比较，差异有显著性意义（均P〈0．01）。肝炎组B／C级与A级在抑郁、精神病性、饮食睡眠方面差异有显著性意义（P〈0．05，P〈0．01），而酒精组除饮食睡眠外，其它各项差异有显著性意义（均P〈0．01）。结论不同类型肝硬化患者心理健康状况均较差，应采取针对性的护理措施进行干预。     

熵在全身麻醉深度监测中的应用

目的评价熵在全身麻醉深度监测中的临床意义。方法30例AsAl或Ⅱ级择期全麻手术病人随机均分为熵指导组（Ⅰ组）和对照组（Ⅱ组）。Ⅰ组根据反应熵（RE，维持在40～50）调控用药，Ⅱ组根据临床经验用药。记录静息态和全麻诱导、维持及苏醒期的MAP和HR。结果两组芬太尼和维库溴铵及丙泊酚用量比较差异无统计学意义。与Ⅱ组比较，Ⅰ组异氟醚用量明显减少（P〈0．05），平均MAC低（P〈0．01），拔管时间、睁眼时间均明显缩短（P〈0．01）；在关腹时Ⅱ组RE比Ⅰ组低（P〈0．01），HR比Ⅰ组慢（P〈0．01）；两组术后均否认有术中知晓。结论熵监测麻醉深度有一定临床意义，有助于维持合适的麻醉深度，减少麻醉药的用量，苏醒快、拨管快。     

Bacteriological Evaluation of the Cardiac Surgery Environment Accompanying Hospital Relocation

Purpose Airborne bacteria in the environment are thought to be a cause of postoperative infection. With the relocation of our hospital, the operating room we had used for 35 years was replaced, changing the surgical environment for cardiac operation completely. We conducted this study to evaluate the bacteriological change in the surgical environment between the new and old operating rooms. Methods Airborne contaminants in the operating rooms were collected on blood agar plates, and samples of intraoperative salvaged blood from cardiac surgery were drawn from salvaged bags produced by Cell Saver 5 (Haemonetics, Braintree, MA, USA) in both the old (group O) and the new operating rooms (group N). These samples were cultured and evaluated bacteriologically. Results We collected nine samples of airborne contaminants from both group O and group N. The mean number of isolated bacteria colonies was 5.0 ± 1.2 in group O, and 2.0 ± 0.94 in group N (P < 0.001). Bacterial growth was detected in 85% of the salvaged blood samples from group O (n = 20) versus 60% from group N (n = 15) (P = 0.09). The mean bacteria count was 1.9 ± 2.7 colony-forming units (cfu)/ml in group O versus 0.4 ± 0.5 cfu/ml in group N (P = 0.032). Conclusion Hospital relocation resulted in an improved operating room environment with less bacterial contamination of intraoperative salvaged blood.     

臭氧消毒机对连台手术间空气消毒的湿度及时间研究

为了探讨臭氧消毒机对连台手术间空气消毒的最佳湿度和时间 ,在 8间面积均为 70 m2、朝向一致的手术间 ,用臭氧消毒机于首台手术前后及不同湿度 (6 5 %、70 %、75 %、80 %、85 % )、不同时间 (10、15 m in)下行空气消毒。结果首台手术前、后 (未消毒时 )细菌阳性手术间数比较 ,差异有极显著性意义 (P<0 .0 1) ;首台手术后消毒 15min,5种湿度条件下的细菌阳性手术间数比较 ,差异有显著性意义 (P<0 .0 5 ) ,其中 6 5 %、70 %、75 %湿度之间细菌阳性手术间数比较 ,差异无显著性意义 (P>0 .0 5 ) ,其分别与 80 %、85 %湿度的细菌阳性手术间数比较 ,差异有极显著意义 (均 P<0 .0 1) ;在 80 %～ 85 %的相对湿度下消毒 10、15 min,均达国家标准 (细菌数≤ 6 9.3cfu/m3) ,两种消毒时间比较 ,差异无显著性意义 (P>0 .0 5 )。提示连台手术之间必须行空气消毒 ;最佳消毒相对湿度为 80 %～85 % ,时间为 10～ 15 min。     

Microbiologic environment of the conventional operating room.

Areas of potential contamination of the surgical wound in the conventional operating rooms include the back table, the unsterile suction receptacle, and the lack of a positive pressure relationship between the operating room and adjacent areas. Use of an impermeable hood with a large mask diminished contamination of the instrument table and the the wound from fallout of bacteria from the surgical team. The level of airborne bacterial comtamination in the operating room can be reduced by limiting the traffic and controlling the activity and the number of operating room personnel. Higher rates of postoperatively wound sepsis were noted in older operating rooms, particularly with difficult procedures and those performed later in the day. Conventional operating rooms should be categorized by the level of room air exchange per hour and the level of airborne bacterial contamination.     

The effect of Federal Public Health Service guidelines on air, surface and floor germ count in a general surgery and an orthopedic operating room]

In a prospective study the environmental contamination in an old and a new operating theatre was investigated. The old operating rooms were constructed in 1936 whereas the new rooms were built in 1986. The study was conducted in surgical and orthopedic surgical operating rooms. There was a slight increase in floor as well as in surface contamination in the new operating rooms. On the other hand there was a slight decrease in the airborne microorganisms in the orthopedic surgery and nearly identical colony counts in the general surgery operating rooms. All the differences were statistically not significant. The spectrum of microorganisms and the occurrence of Staphylococcus aureus in the old and the new operating rooms showed no difference.     

手术室保洁人员岗前培训管理

目的提高手术室保洁工作质量,有效预防医院感染。方法对42名保洁人员上岗前就公司培训项目、频率、体检防疫、自我防护、职业认识等进行问卷调查。经2周培训后进行综合考核,内容包括废弃物品的分类处理、消毒液的配制与应用等,并在其完成手术间工作后,监测物体表面菌落数,并进行质量评判。结果通过调查掌握了保洁人员岗前所获培训项目、职业技能及心理等基本情况;培训后合格率分别为:废弃物品的分类处理92.9%,感染手术间的处理流程95.2%,消毒液的配置与使用85.7%,空气消毒机的使用90.5%,利器损伤后的处理83.3%;手术间物品表面菌落数监测合格率分别为:无影灯92.9%,器械台面97.6%,手术床面90.5%。结论科学严谨的岗前培训管理是保证手术室保洁工作质量的关键。     

智能垂直仓储管理系统在手术无菌包转运中的应用

目的 探讨智能垂直仓储管理系统应用于无菌包从消毒供应中心转运至手术中心的效果。方法 将2018年10月152例首台手术用无菌包作为对照组,由工勤人员采用传统密闭车转运无菌包至手术中心;2018年11月174例首台手术无菌包作为观察组,通过智能垂直仓储管理系统转运无菌包。比较两组无菌包转运和取用时间和无菌包不良事件发生率。结果 观察组无菌包转运和取用时间显著短于对照组,无菌包在转运和取用过程中漏取包发生率显著低于对照组（均P<0.01）。结论 智能垂直仓储管理系统在无菌包的效期管理、定位查找以及出入库把控方面有着明显优势,可提升手术无菌包的质量管理,优化工作流程,满足手术需求。     

Contamination of the operative wound.

A study of the bacteriologic environment of the conventional operating rooms in the hospitals used by the Mayo Clinic orthopedic surgical section revealed several areas of potential contamination of the surgical wound. Such areas included the back table and the unsterile suction receptacle. Use of an impermeable hood with a large mask diminished contamination of the instruments and the wound originating in direct fallout from members of the surgical team. Irrigation of the operative wound with 0.1 per cent neomycin solution for brief periods was not as effective as previously thought. The level of airborne bacterial contamination in the operating room can be reduced by limiting the traffic and controlling the activity and the number of operating room personnel. Although none of these factors could be directly related to operative wound sepsis in any of our studies, their potential was obvious. They can be controlled by the methods we have described.     

Establishment of a pediatric surgery center: increasing anesthetic efficiency

STUDY OBJECTIVE: To examine whether the establishment of dedicated pediatric operating rooms (ORs) staffed exclusively by pediatric anesthesiologists has had a significant impact on anesthetic efficiency during surgery. STUDY DESIGN: Before and after design. SETTING: General and pediatric operating rooms at Yale-New Haven Hospital. MEASUREMENTS AND MAIN RESULTS: Using Operating Room Information System data (1991 to 1997), we examined whether the anesthesia-controlled time, the time it takes for induction and emergence of anesthesia of a selected surgical procedure (tonsillectomy and adenoidectomy), was affected by the change of practice from general to pediatric ORs. The average length of anesthesia induction decreased by 30% (p = 0.0007). Similarly, the average length of emergence from anesthesia decreased by 42% (p = 0.01) and anesthesia-controlled time decreased by 31% (p = 0.0008). Of particular importance is the decrease by 75% in the anesthesia-controlled time range (maximum-minimum). CONCLUSIONS: The establishment of dedicated pediatric ORs resulted in significantly shorter anesthesia induction and emergence times. Furthermore, the decreased variability of anesthesia-controlled time may allow for better scheduling of surgical cases and for better surgeon and patient satisfaction.