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加强附属医院“双肩挑”干部管理的若干思考

摘要：围绕“双肩挑”的讨论以对“双肩挑”现象的利弊分析、对策建议和管理干部职业化思考方面居多。本文基于“双肩挑”现象将长期存在并发挥不可替代的作用这一现实，主要讨论加强“双肩挑”干部管理的认识和思考。

以重症肺炎收入的 H5N1 型高致病性禽流感患者医院感染防控措施与体会一例

医务人员艾滋病职业防护及医院感染知识与行为调查干预

目的　了解医务人员艾滋病职业防护和医院感染知识及行为的现状。 方法　2011年7月采用问卷调查法，分别对干预前299名、干预后254名医务人员进行艾滋病职业防护及医院感染预防知识、态度、行为调查。 结果　医务人员对艾滋病的基本知识知晓率较高（＞85.0%），但对较深层的问题缺乏认识，“窗口期”知晓率18.7%，“蚊虫叮咬”知晓率15.1%，消毒知识知晓率10.7%，干预前后比较差异有统计学意义（P＜0.01）。 结论　应加强艾滋病职业暴露防护和预防医院感染知识的教育与培训，提高职业防护能力，以保障医务人员职业安全，预防艾滋病医院感染。

The Relationship between Nosocomial Infection and Nursing Management in Operating Room for General Surgery Patients

目的　探讨普通外科手术患者发生院内感染与手术室护理管理的相关性，为有效控制院内感染提供理论依据。 方法　收集普通外科2008年4月－2009年6月接受手术治疗的150例患者为对照组，2009年7月－2011年9月接受手术治疗的150例患者作为干预组，分析可能影响院内感染的手术室护理因素。 结果　出院后随访6个月，对照组感染率为20.67%，高于干预组的8.00%（P＜0.05）；普通外科手术医院感染与手术时间、术前抗生素应用、有无参观人员等手术室因素密切相关。 结论　在手术室护理工作中，要采取一系列手术室护理干预措施，以提高护理管理质量，降低普通外科手术的院内感染发生。

Emergent Percutaneous Transluminal Coronary Angioplasty in 41 Patients with Acute Myocardial Infarction in Elementary Hospital

摘要:目的:探讨基层医院开展急诊经皮冠状动脉支架植入术(PCI)治疗急性心肌梗死(AMI)的可行性、安全性。方法:回顾分析2002年11月~2009年4月我院41例AMI患者的急诊PCI资料。结果:41例AMI患者,急诊开通梗死相关动脉(IRA)39例(即时成功率95.1%),开通IRA者中术后死亡2例(死亡率4.9%),总成功率90.2％。结论:在有条件的基层医院开展急诊PCI安全有效。Abstract: Objective: To explore the feasibility and safety of primary percutaneous coronary intervention in patients with acute myocardial infarction in elementary hospital. Methods: The clinical data of 41 AMI patients who underwent emergent PCI from November 2002 to April 2009 were retrospectively analyzed. Results: Among the 41 AMI patients referred to PCI, infarctrelated arteries were recanalized in 39 cases. The immediate success rate was 95.1%. 2 cases of them died. The total success rate was 90.2%.Conclusion: Emergent PCI is safe and effective in the hospitals which could carry out PCI.

传染病医院保洁人员感染知识知晓程度调查与分析

目的了解保洁员对感染知识的掌握情况。 方法2012年3月－5月结合《医院感染管理办法》和《消毒技术规范》的部分章节及相关参考文献，采用自行设计的调查表，对52名保洁员的职业防护知识进行不记名问卷调查。 结果保洁员对感染知识缺乏，六步洗手法的知晓率仅为30.7%；摘手套后洗手的执行率为21.1%；工作中坚持戴口罩者仅占28.9%。 结论保洁员在日常工作中存在较为严重的医院感染隐患，应采取适合的培训方法，加大对保洁员的培训力度，加强对其工作过程的监督与管理，提高工作质量，有效控制医院感染。

抗肿瘤坏死因子α抗体对体外循环肺损伤的保护作用

Objective To study the protective effect and its mechanism of anti-tumor necrosis factor-alpha antibody (TNF-α Ab) on lung injury after cardiopulmonary bypass(CPB). Methods Twenty patients who underwent cardiac valve replacement were randomly divided into two groups (each group 10 cases).TNF-α Ab group: human TNF-α Ab (1.2μg/kg) was twice dropped into the intracheal tube before operation and just after releasing the aortic clamp. Control group: only received CPB. Lung dynamic compliance, oxygenation index, endotracheal intubation time, blood neutrophils count, TNF-α, and malondialdehyde (MDA) from the right and left atrium in both groups were determined perioperatively. Results Lung dynamic compliance and oxygenationindex in TNF-α Ab group after CPB were higher than those in control group(Plt;0.01). The endotracheal intubation time in TNF-α Ab group was much shorter than that in control group(Plt;0.01). Compared with control group, TNF-α Ab can significantly restrain leukocyte accumu lation, reduce releasing of TNF-α and MDA in the lung. Conclusion Intratracheal TNF-α Ab has markedly protective effect on lung injury after CPB.

Impact of Nursing Interventions on Reducing the Hospital Infection Rates in Children with Extremely Low Birth Weight

ObjectiveTo investigate the effects of nursing interventions on reducing the hospital infection rates in children with extremely low birth weight. MethodsA total of 158 children with extremely low birth weight were treated in our hospital from January 2012 to June 2013. Based on the routine care, we took a series of other nursing interventions, such as strengthening environmental management, strict materials management and disinfection, active prevention of ventilator-associated pneumonia and catheter-related bloodstream infections, close monitoring of a series of isolated neonatal care interventions, to reduce the nosocomial infections in these children. ResultsThe hospital infection rate of this group of children was 9.49%, and the rate of infection cases was 10.76%. The infection sites included blood system, respiratory tract, digestive tract, mouth and eye. The patients were improved or cured after anti-infection and symptomatic treatment and caring measures. ConclusionScientific nursing interventions can reduce the incidence of nosocomial infection in children with extremely low birth weight.

新生儿感染聚集性病例调查及流程改进实践

目的通过新生儿疑似医院感染聚集发病后控制过程回顾，探索有效的控制措施。 方法2013年3月22日-4月1日，通过对一起新生儿疑似医院感染聚集发病事件的现场调查及病原学检测，了解探讨病因线索，提出有效控制措施，包括鼓励报告，不一味责备，管理部门介入，病例调查，环境采样，分组隔离，奶具由消毒供应中心处理，强化手卫生，强化环境消毒，改用小包装无菌棉签，病例讨论等。 结果该新生儿室在短时间内连续发生4例口腔真菌感染患儿，其中2例口腔分泌物涂片见真菌孢子，临床判断为疑似医院感染聚集性病例。经及时采取干预措施，疫情得到了有效改善，未造成不良后果。 结论在临床中，医院感染聚集病例受同源性检测设备昂贵、时间长的限制，常不能及时确诊，该起疑似医院感染聚集病例的调查及处理对类似案例的处置可供借鉴。

普外科医护人员对患者术后疼痛认识现状的调查分析

目的:了解普外科医护人员对疼痛知识的掌握情况,探讨提高普外科医护人员掌握疼痛知识的方法。方法:采用 Margo McCaffery的“疼痛知识与态度调查表”,对91名普外科医护人员进行了有效调查。结果:15题总答对率仅为39.63%, 护士平均答对率36.83%,医生平均答对率为42.04%。其中,普通护士平均答对率33.78%,护师及以上平均答对率44.44%,住院医师平均答对率38.96%;主治医师及以上平均答对率47.84%。不同学历、职称、工龄的医护人员对疼痛知识的掌握情况,差异无统计学意义(Pgt;0.05)。结论:大部分普外科医护人员对疼痛知识缺乏,医院应当采取多种途径加强对医护人员进行疼痛知识的培训,以提高医护人员对疼痛的认识和处理疼痛的临床技能水平,以提高患者生活质量。