目的 探讨风险评估在医院感染管理的应用与成效.方法 某市三甲医院调查2012年医院感染情况进行回顾分析,2013至2017年采用头脑风暴对全院进行医院感染风险的识别,运用失效模式与效果分析(FMEA)法进行风险评估,明确医院感染的高风险部门、高风险因素,提出改进措施并落实,构建一个可重复、易操作的风险评估模式和评估的指标体系,2013至2015各年在医院层面评估,2016、2017年在全院各个科室推广该模式进行本科室的医院感染风险评估,并自行对评估出的本科室感染高风险因素进行管理.结果 (1)根据风险评估的风险优先系数(RPN)、按照百分位数的不同进行风险等级划分,该院医院感染极高风险科室为重症医学科、神经外科、新生儿病房;医院感染的高风险因素为手卫生依从率低、多药耐药菌隔离措施落实不到位、呼吸机相关性肺炎.(2)2012年～2017年医院感染率从2.77％下降至1.50％、多重耐药菌医院感染发生率从0.26％下降至0.20％、呼吸机相关性肺炎发生率从18.72％下降至6.23％,手卫生依从率从35.88％上升至97.84％、风险评估实施前(2012年)、实施后(2017年)上述指标相比较差异均有统计学意义.结论 医院感染风险评估能有效降低医院感染率、呼吸机相关性肺炎、多重耐药菌感染率,大幅度提高手卫生依从率;持续进行科室和全院的动态风险评估是提高医院感染管理效能的有效手段.

近年来,由于对围生医学的的研究和发展以及社会因素、医源因素的影响,剖宫产率随之急剧上升,准剖宫产产妇在手术室术前发生的紧急阴道分娩几率也上升,引起了护理工作者的重视.因而分析相关的原因并探讨相应的护理对策,确保母婴平安是提高产科护理质量的关键.

Objective:To analyze twenty patients with sexual abnormality by cytogenetics and molecular genetics to provide information for clinical diagnosis and study the mechanism of sexual abnormality.Methods:Karyotype analysis and SRY gene in twenty patients were analyzed by the technique of chromosomal G band and polymerase chain reaction(PCR).Results:All seven cases of Turner syndrome were SRY(-),including one′s karyotype presented 45,X/46,XY.One case presented 45,X /47,XYY/46,XY and SRY(-),showing the female sex reversal syndrome of mosaic type.Among the cases presented 46,XY and SRY(+),one was testicular feminization syndrome,one was XY pure gonadal dysgenesis,and six were virilizing male pseudohermaphroditism.Four cases presented 46,XX and SRY(-) were congenital adrenal hyperplasia.Conclusion:The analysis of chromosome karyotype and detection of SRY gene not only benefit studying the genetic mechanism of sexual abnormality,but also have scientific meaning for the diagnosis and treatment.

This study was aimed to investigate the prevalence and genotype distribution of heterozygotes in beta-thalassemia combining deletional alpha-thalassemia by using molecular detection and haematological methods. Three common deletions of alpha-thalassemia were detected by using gap-PCR. The mutations of beta-thalassemia were identified by using PCR with reverse dot blot hybridization. The routine analysis of blood cells was carried out. The results indicated that 15 cases from the 81 beta-thalassemia traits were found to be the compound heterozygosity for beta-thalassemia and alpha-thalassemia with 9 different types of gene defects with 18.52% detection rate. There were 6 cases (7.41%) of beta-thalassemia heterozygote combining alpha-thalassemia-1 gene (--(SEA)/alphaalpha), 8 cases (9.88%) combining with alpha-thalassemia-2 gene including 6 (7.41%) right ward deletion (-alpha(3.7)/alphaalpha) and 2 (2.47%) left ward deletion (-alpha(4.2)/alphaalpha), and 1 case (1.23%) combining deletional HbH gene (--(SEA)/-alpha(3.7)). No significant differences were found between beta-thalassemia heterozygotes combining deletional alpha-thalassemia and pure beta-thalassemia in all RBC parameters. It is concluded that the incidence of beta-thalassemia heterozygotes combining with deletional alpha-thalassemia is frequent in Wuzhou city. The hematological analysis can not give specificity for diagnosing these dual heterozygotes. Gap-PCR as a routine method for thalassemia screening has the advantages in reducing the possibility of failing to detect the combining heterozygosity for beta-thalassemia and alpha-thalassemia. It is more useful for genetic counselling and prenatal diagnosis of this disease.

目的 探讨淋巴细胞免疫治疗原因不明性反复自然流产的效果.方法 对20例封闭抗体阴性的原因不明性反复自然流产患者进行淋巴细胞免疫治疗.结果 接受治疗的20例患者中有13例已分娩正常活婴,2例妊娠晚期(1例失访),3例妊娠中期(1例失访),2例失败,治疗成功率为88.89%(16/18).结论 淋巴细胞免疫治疗原因不明性反复自然流产安全、有效,值得推广.

Objective: To investigate the aberration types and clinical manifestations of individual cell chromosomal aberration in peripheral blood.Methods: Peripheral blood cells were cultured for 72 hours with routine method and slide performed with G banding,and then the slide was read and mode analysis was carried out.The diagnostic standard of individual cell chromosomal aberration was that one abnormal karyotype was found in every 30 to100 mitotic phases.Results: The aberration types of 13 cases of individual cell chromosomal aberration in peripheral blood were balanced translocation,inversion,deletion,duplication,and monosomic X.The main clinical manifestations included abnormal sex development,abortion or dead fetus,and limb deformity.Conclusion: It is an important clinical significance of individual cell chromosomal aberration in genetic counseling.Prenatal diagnosis is necessary for people with such chromosomal aberration in their reproductive actions.

Objective: To investigate the genotypes distribution on thalassemia for reproductive people in Wuzhou city of Guangxi.Methods: At first,355 blood samples were detected with hematological methods and gap-PCR used to characterize three common deletions of α-thalassemia(α-thal),then the subjects with HbA_2≥3.5% and/or HbF≥2.0% were confirmed the mutations of β-thalassemia(β-thal) by reverse dot blot hybridization.Results: Of 355 samples,121(34.1%) were defined to be the gene carriers of α-thal.Three types of α-thal alleles were detected wiuh gene contributions of 78.1%(——~(SEA)),16.4%(-α~(3.7)) and 5.5%(-α~(4.2)).74(20.8%) of β-thal heterozygotes with 8 different types of mutations were found.The commonly seen 5 mutations,CD41-42,-28,IVS-II-654,CD17 and CD71-72 were accounted for 90.6% of the β-thal alleles in this area.Of 74 β-thal subjects,13(17.6%) were found to compound with α-thal.Conclusion: The thal trait and the incidence of the compound heterozygosity for β-thal and α-thal are relatively frequent in Wuzhou city.Gap-PCR as a routine method for thal screening has the advantages in finding out the silent carriers of α-thal,and reducing the possibility of failing to detect β-thal heterozygotes compound α-thal.It is more useful for genetic counselling and prenatal diagnosis of this disease.

患者女,7个月,因怀疑两性畸形就诊.查体:大阴唇肥大、褶皱较多,阴蒂稍长,腹股沟、大阴唇处未触及肿块.B超显示:盆腔实性肿块,考虑为子宫回声;双侧阴唇及腹股沟未见肿块回声.内分泌检查:促黄体生成素1.33 mIU/mL(正常参考值男2～12 mIU/mL,女1～105 mIU/mL),卵泡成熟素4.40 mIU/mL(正常参考值男1～8 mIU/mL,女2～138 mIU/mL),垂体泌乳素22.64 ng/mL(正常参考值男1.6～18.8 ng/mL,女1.4～24.2 ng/mL),雌二醇18.00 pg/mL(正常参考值男0～77 pg/mL,女38～500 ng/mL),睾酮0.35 ng/mL(正常参考值男1.95～11.38 ng/mL,女0.05～0.73 ng/mL),孕酮0.18 ng/mL(正常参考值男0～1.20 ng/mL,女0.2～38.63 ng/mL).

患者女,33岁,未婚.因继发闭经就诊.查体:身高135 cm,体重38.5 kg,无蹼颈,智力正常.月经初潮时间不详,自诉月经周期紊乱,曾到外院治疗,服药后来月经1次,之后未继续服药,亦未见月经来潮.

羊膜位于胎儿绒毛膜的表面,为光滑、无血管、无神经、无淋巴的透明薄膜,厚约0.02 ～0.50 mm,由羊膜上皮、基底膜及基质组成.我们用改良方法制成戊二醛保存的羊膜敷料,并应用于烧伤创面覆盖,效果良好.现将羊膜敷料的制作方法报告如下,并讨论其在临床应用中的优点.

我国糖尿病病人90%～95%属于Ⅱ型糖尿病,伴有高脂血症者更为多见.患者血浆纤维蛋白原(Fg)水平升高可造成动脉粥样硬化,引起心血管病发生率.本课题测定了Ⅱ型糖尿病合并高脂血症患者血糖、Fg及血清总胆固醇(TC)、三酰甘油(TG)水平的变化,并观察了益气复胰汤对其的影响.