足球比分网

歡迎光臨廣州錫海凈化科技有限公司!廣州凈化工程公司,無塵車間裝修,實驗室家具,實驗室工程,空氣過濾器廠家

凈化工程公司

SHIYANSHIYUKONGQIJINGHUAGONGCHENG

15813334961

江西贛州醫院潔凈手術室環境中控制顆粒防護工程

19-05-08

足球比分网 JIEJINGSHOUSHUHUANJINGZHONGKONGZHIKELIWURANWUDEBIYAOXINGYI《YIYUANJIEJINGSHOUSHUBUJIANZHUJISHUGUIFAN)XIUDINGZUYANTAOXILIEKETIZHI

JIANGXIGANZHOUYIYUANJIEJINGSHOUSHUSHIFANGHUGONGCHENG

CHUANTONGDESHOUSHUWURANKONGZHIGUANDIANRENWEI,SHOUSHUGUOCHENGZHONGZHIBINGWEISHENGWUTONGGUORENDEJIECHU、WUPINHEKONGQICHUANBODENGTUJINGWURANBINGHUANDESHOUSHUQIEKOU,SHIYINFASHOUSHUQIEKOUGANRAN(Surgical Site Ifeetion, SSI) HEGELEIBINGFAZHENGDEZHUYAOYUANYIN。XIANGYINGDI,SHOUSHUSHIHUANJINGJIANCEYIKONGQI、WUTIBIAOMIANJIYIHURENYUANSHOUBUDENGDEXIJUNXUEZHIBIAOWEIZHU[1,2]。ZAIYIYUANSHOUSHUBUDERICHANGHUANJINGKONGZHIJIANCEZHONG,HUANJINGWEISHENGXUEZHIBIAOWANGWANGZUOWEIGUANJIANDE、SHENZHIWEIYIDEPINGJIAZHIBIAO。ERYOUCIDAILAIDEYIWENSHI,ZUOWEIJIEJINGSHOUKONGHUANJINGDECHUANTONGKONGZHIZHIBIAO-KELIWURANWU,SHIFOUDUISHOUSHUCAOZUODEANQUANXINGJICHENGGONGLVCUNZAIYINGXIANG?KELIWURANWUDEJIANCEDUIYUJIEJINGSHOUSHUBUHUANJINGSHIFOUYOUYIYI?

JIANGXIGANZHOUYIYUANJIEJINGSHOUSHUSHIFANGHUGONGCHENG

《YIYUANJIEJINGSHOUSHUBUJIANZHUJISHUGUIFAN》GB 50333- 2002[3]JI QIJIJIANGBANBUDEXIUDINGBANZHONG,JUNJIANGXUANFUKELIWUNONGDU(JIEJINGDU)ZUOWEISHOUSHUBUGONGCHENGXIANGMUYANSHOUJIEDUANDEZHONGYAOJIANCEZHIBIAO,GUANGZHOUXIHAISHOUSHUSHIJINGHUAGONGCHENGZHEYANGZUODEYUANYINZHUYAOYOU:

 (1)從感染控制角度來看,絕大多數的空氣懸浮微生物都以灰塵顆粒物作為載體和媒介,因此,可以通過對顆粒物的控制實現對微生物的控制[4]。
      (2)即使是不攜帶微生物的顆粒物(無菌顆粒),也對術后并發癥有負面影響,因此,控制空氣中懸浮顆粒物的濃度是必需的。
      (3)手術受控環境的分級及相應環境指標控制范圍與傳統的潔凈受控環境- - 致。
      (4)相比于細菌學監測,潔凈度的監測(包括末端過濾裝置的現場檢漏測試)可以實時快速地反映凈化空調通風系統的有效性,并可以對潛在的缺陷準確定位,便于修復并消除隱患。
      顆粒污染物對手術后并發癥的負面影響,國內尚少 見相應的研究與報道,筆者曾就這一問題與德國手術部建設標準DIN1946-4的編制工作組主席Hans Martin Seipp教授進行了交流與探討,并在他的建議下,收集了國外對于此問題的研究論文等信息。現將這些信息整理成文,與國內同行、專家共同研討。

      1.江西贛州醫院潔凈手術室工程環境中顆粒污染物的危害

      國外相關研究資料表明,顆粒污染物導致手術并發癥的報道可追溯至20世紀40年代[5,6],-一般而言,顆粒污染物引起的手術并發癥主要包括:腹部疼痛、粘連、肉芽腫、植人關節周邊骨質溶解、植入組織松動甚至失效等。

      其中,較為常見的報道就是手術后粘連。一般認為,粘連的產生源于腹膜對手術創傷、組織缺血、炎癥以及異物侵人等所進行的自身修復反應。手術后在患處纖維蛋白原滲出形成纖維蛋白凝塊(fibrinclot),- 般情況下, 纖維蛋白凝塊會被機體內的溶纖維蛋白系統吸收、溶解,但在有些情況下,成纖維細胞(fibroblast) 會進人纖維蛋白凝塊,形成膠原蛋白(collagen) ,進而導致疤痕和粘連的產生[7。

      粘連在術后并發癥中占有非常高的比重。據報道,術后粘連往往于手術后數小時內開始形成,并一直具有較高的并發癥發病率(-0。與直接細菌感染導致的術中感染不同的是術后粘連往往可導致多種術后并發癥,例如腹腔疼痛(發病率可達20%~50%)、小腸硬阻(發病率可達49%~74%)、輸卵管梅陽及其他子官并發癥導致的不孕不育癥(可達15%~ -20%)[1]。相關并發癥的治療也導致了大量醫療資源的占用及高額的醫療經費支出[7]。

足球比分网 ZAIYIXUEJIE,CHUANTONGGUANDIANRENWEISHOUSHUGUOCHENGDUIFUMOJIJITIZUZHIDESUNSHANG(operativetrauma)、 QUEXUEYIJIYIWUWEILI(foreign microbody)SHIDAOZHISHUHOUZHANLIANXINGCHENGDESANGEZHUYAOYINSU[10,12]。WEIJIANSHAOSHOUSHUCHUANGSHANG,YIQIANGJINGSHOUSHUWEIDAIBIAODEWEICHUANGJIERENZHILIAOZAIJIN20NIANNEIDEDAOLEFEISUFAZHAN。JINGUANDALIANGYANJIUZHENGMING,XIANGBIYUPOUFUSHOUSHU,FUQIANGJINGSHOUSHUKEYOUXIAOJIANSHAOZUZHISUNSHANGJIZHANLIANXINGCHENG[7,13];DANYEYOUYANJIUZHICHUFUQIANGJINGJIERENZHILIAOZAIJIANSHAOZHANLIANXINGCHENGJIHUANJIEBINGHUANBUSHIDENGFANGMIANDEZUOYONGBINGWEIHUODEYIZHIXINGDEGAISHANPINGJIA[8.14.15]。ERDONGWUSHIYANBIAOMING,POUFUSHOUSHUZHONG,YIWUDAOZHIFUMOZHANLIANDEKENENGXINGYAOBIZUZHISHIXUE、CHANGDAOCAOZUODENGDOUYAOGAO[16]

LINGYIFANGMIAN,DALIANGDEZHENGJUBIAOMING,SHOUSHUGUOCHENGZHONGYINSHOUSHUHUODONGJINRENBINGHUANFUQIANGDEXIWEIYIWUKELIYUSHUHOUFUQIANGNEIROUYAZHONGJIFUMOJIEJIEDESHENGCHENGYOUMIQIELIANXI。TinkerDENGRENCENGLIYONGDONGWUSHIYANJIAOWEIXIANGXIDIMIAOSHULESDDASHUZAIFUQIANGNEIYINRENXIWEIYIWUKELIHOUROUYAZHONGDEXINGCHENGGUOCHENG:YIWUKELIZHIREN24 hHOU,  PINWEIJIANCEJIUFAXIANSUOZHIRENYIWUKELIPIAOFUYUSHUIZHONGYEZHONGBINGBANSUIDUOHEBAIXIBAOCHUXIAN:  5dHOU,DALIANGDEXIANWEIDANBAIJIDUOHEBAIXIBAOCHUXIAN,BINGBEIKELIZUZHISUOWEIRAO; 9dHOU,JUXIBAOCHUXIAN,TUNSHIYIWUKELIHOUDEROU YAZHONGFEIQIANLAOHUABINGZAO(noncaseating granulomas)XINGCHENG; 13 dHOU.  JIANZHIXINGXIANWEIHUACHUXIAN[17]。  RENJIAN  MIAOTEDANDAXUEFUSHUYIXINZHUmmes...

1991~1993NIANJIAN,LUTEDANDAXUEFUSHUYIYUANDENGSISUOOUZHOUYIYUANCENGDUIZHONGFUJIESHOUFUBUSHOUSHUDECHAOGUO400LIBINGHUANJINXINGLINCHUANGDIAOYAN。JIEGUOBIAOMING,YUE25%DEBINGHUANZAISHOUSHUFENGHECHUFAXIANLEROUYAZHONG,ERSHANGCIFUBUSHOUSHUSHISHOUSHURENYUANCAIYONGYOUFENSHOUTAODE309LIBINGHUANZHONG,YUE5%ZAIFUQIANGNEIFAXIANLEDIANFENROUYAZHONG。XIANGGUANYILIAOJILUXIANSHI,FENGHECHUFAXIANROUYAZHONGDEBINGHUANBUDEBUZAICIJIESHOUSHOUSHUZHILIAODEZHONGWEISHIJIANJIANGEWEI13GEYUE;ERDUIYUQITABINGHUAN,QIBUDEBUZAICIJIESHOUSHOUSHUZHILIAODEZHONGWEISHIJIANJIANGEZECHAOGUO30GEYUE[18]。TONGSHI,DALIANGDEDONGWUSHIYANYEZHENGSHILEFUQIANGNEIYIWUKELIDECUNZAIKEDAOZHISHOUSHUHOUROUYAZHONGJIZHANLIANFABINGLVDEXIANZHUTIGAO[18,19] ZAIDAXINGGUKESHOUSHURUQUANKUANGUANJIEZHIHUANSHUZHONG,SUIRANSUIZHUZHIRENJIATIDECAIZHIJIBIAOMIANCHULIGONGYIDEGAIJIN,SHUHOUGUANJIESONGDONGDEFASHENGGAILVDAFUJIANGDI,DANRENGYOUGAODA13%DEBINGHUANZAISHUHOUCHUXIANLEZHIRUJIATIZHOUWEIGUZHIRONGJIE,ERYOUDAYUE10% ~ 30%DEBINGHUANZAISHUHOU10NIANXUZHONGXINJINXINGSHOUSHUYIJIEJUEYINGUZHIRONGJIESUODAOZHIDEZHIRENJIATISONGDONG。TONGGUODUISONGDONGJIATIJILIANGHAOGUDINGDEZHIRENGUANJIEZHOUWEIXIANWEIZUZHIJINXINGZUZHIFENXIHOUFAXIAN,QIANZHECHENGXIANCHUYIWUKELISUODAOZHIDEROUYAZHONGTEZHENGBINGYOUCHONGMANYIWUKELIDEJUXIBAO。JINYIBUDEXIANWEIFENXIXIANSHI,YINFASHANGSHUFANYINGDEYIWUKELICHICUNZUIXIAOKEDAO0. 1μmYIXIA[20]。XIANGGUANSHENGHUAYANJIUYEBIAOMING,CONGQIANZHEZUZHIZHONGFENLICHULAIDEXIBAOHUIXIANGZHOUBIANJIEZHISHIFANGDALIANGDEE2QIANLIEXIANSU(prosta-glandinE2)JIJIAOYUANMEI(collagenase), ERZHELIANGZHONGWUZHIDOUHUIDAOZHIGUZUZHIRONGJIE(20]。.

分享至:
重庆彩票 重庆彩票 重庆彩票 上海时时乐 上海时时乐 专业玩彩 专业玩彩 专业玩彩