Current status of compliance with hand hygiene among health care workers / 中国感染控制杂志

Objective To investigate the current status of compliance with hand hygiene among health care work-ers (HCWs)in a comprehensive hospital in Xi’an.Methods Status of hand hygiene among HCWs in 73 clinical de-partments was observed directly.Results 404 moments for hand hygiene of 404 HCWs were observed,255 times of hand hygiene were implemented,181 times of hand hygiene were correct,the total compliance rate was 63.12%, and correct rate was 44.80%.Compliance rate and correct rate of hand hygiene of HCWs in intensive care unit were both higher than general wards (91.89% vs 60.22%,χ2 =14.485,P <0.001;81.08% vs 41.14%,χ2 =5.671,P=0.017).Among HCWs of different occupations,compliance rate and correct rate of hand hygiene of nurses were both the highest (73.76% and 60.18% respectively),while auxiliary persons were both the lowest (40.90% and 10.20% respectively);among five moments for hand hygiene,compliance rate was highest after body fluid and blood exposure (80.00%),correct rate was highest before aseptic procedure (62.96%).Conclusion There is a high compliance rate and low correct rate of hand hygiene among HCWs in this hospital.Compliance rate and correct rate of hand hygiene among HCWs in different departments,different occupations and different hand hygiene moments are varied,compliance with hand hygiene among HCWs should be paid extensive attention.

The comparison of intranasal and intravenous dexmedetomidine on the adverse reactions of tracheal extubation during wake up of general anesthesia / 中国医师进修杂志

Objective To compare the adverse reactions of intranasal and intravenous dexmedetomidine on tracheal extubation during wake up of general anesthesia.Methods One hundred and twenty patients who ASA Ⅰ or Ⅱ grade were divided into four groups (each 30 patients) by random digits table method.The patients in intravenous group were given 0.5 μ g/kg intravenous dexmedetomidine (diluted to 10 ml by 0.9％ sodium chloride,intravenous injection slowly,≥30 s).The patients in intranasal group 1 were given 0.5 μg/kg intranasal dexmedetomidine.The patients in intranasal group 2 were given 0.8 μg/kg intranasal dexmedetomidine.The patients in control group were given intravenous 0.9％ sodium chloride.The systolic blood pressure(SBP),mean arterial blood pressure (MAP),heart rate were compared among groups.Eyes open time and extubation time,the rate of cough and the degree during extubation were compared too.Results The SBP,MAP,heart rate in intravenous group,intranasal group 1 were significantly higher than those in basal state (P ＜ 0.05).The SBP,MAP,heart rate at different time in intranasal group 2 had no significant difference (P ＞ 0.05).The SBP,MAP,heart rate before extubation and after extubation for 3 min in control group were significantly higher than those in intravenous group,intranasal group 1 and intranasal group 2 (P ＜ 0.05).Eyes open time and extubation time among four groups had no significant difference(P ＞0.05).The rate of cough,restlessness and 3 scores of degree before extubation in intravenous group,intranasal group 1 and intranasal group 2 were significandy lower than those in control group [43％ (13/30),50％(15/30),47％(14/30) vs.70％ (21/30); 17％(5/30),23％(7/30),20％(6/30) vs.43％(13/30);53％ (16/30),60％ (18/30),50％ (15/30) vs.80％ (24/30)] (P ＜ 0.05).Conclusions Either intravenous or intranasal dexmedetomidine can effectively prevent the stress reaction during extubation,decrease the degree of restlessness and cough.Intranasal dexmedetomidine(0.8 μ g/kg) is more effective and safe.

Assessment of left atrial function in subjects with excess body weight by strain and strain rate imaging / 中华超声影像学杂志

Objective To investigate the impact of overweight and obesity on left atrial (LA) function in healthy subjects with excess body weight.Methods Conventional echocardiography and tissue Doppler imaging were performed in 30 obese subjects (BMI≥28 kg/m2),30 overweight subjects (BMI,24to 28 kg/m2) and 30 age-matched normal subjects (BMI＜24kg/m2).Strain (S),peak systolic strain rate (SSR),peak early diastolic strain rate (ESR) and peak late diastolic strain rate (ASR) values were used to evaluating LA function.Results Compared with controls,mean S,SSR and ESR were decreased in obese subjects,while mean SSR,ESR and ASR were decreased in overweight subjects.Compared with overweight subjects,mean ESR was decreased in obese subjects.Conclusions An impaired LA function is found in overweight and obese subjects who has no other clinically appreciable cause of heart disease by using strain and SR imaging.

Effect of remifentanil on mean arterial pressure, heart rate and QTc interval during tracheal intubation of general anesthesia patients / 中国医师进修杂志

Objective To evaluate the effect of remifentanil on mean arterial pressure (MAP), heart rate (HR) and QTc interval during tracheal intubation of general anesthesia patients. Methods Seventy-five ASA Ⅰ -Ⅱ grade patients were selected and allocated to receive either saline (group C), remifentanil 0.50 μg/kg (group R1) or remifentanil 0.75 μg/kg(group R2) by random digits table with 25 cases in each, they were administrated as a bolus intravenous, followed by a continuous infusion at 0.10 μg/ (kg·min), 1 min before laryngoscopy. All patients received fentanyl 3 μg/kg,propofol 1.0 - 1.5 mg/kg and vecuronium 0.1 mg/kg. The ECG.MAP and HR were recorded prior to induction of anesthesia (T0), 2 min following the start of drug intravenous of fentanyl and propofol with vecuronium (T1), 1 min following remifentanil or saline (T2), before laryngoscopy(T3), 30 s (T4), 2 min (T5) and 4 min (T6) after intubation. Results The QTc interval was significantly prolonged immediately following intubation in group C and group R1, but it remained stable in group R2, compared with the QTc interval just before laryngoscopy. In group R2, QTc interval was significantly shorter at T4-T6 compared to group C(P＜ 0.05 or ＜ 0.01). QTc interval significantly increased from baseline at T4 in group R1 and T4-T6 in group C (P＜ 0.05 or ＜ 0.01). The number of patients with QTc interval ＞ 440 ms were significantly greater immediately following tracheal intubation in group C than that in group R2 [44% (11/25) vs. 12% (3/25)] (P ＜ 0.05). Conclusions QTc interval increases following tracheal intubation during induction of anesthesia using fentanyl and propofol. Intravenous of remifentanil attenuates the QTc interval prolongation associated with tracheal intubation. In addition, remifentanil decreases the hemodynamic responses to tracheal intubation.

Effect of epidural saline washout on regression of sensory and motor block after epidural anesthesia in elderly patients / 中国医师进修杂志

Objective To evaluate the effectiveness of epidural saline washout on regression of sensory and motor block after epidural anesthesia in elderly patients.Methods A total of 70 males with ASA Ⅰ or Ⅱ who were subjected lumbar epidural anesthesia with 10 ml of 1.73% bicarbonate-lidocaine and fentanyl 50 μg (1 ml).At the end of transurethral surgery,the washout group (35 cases) received an epidural bolus of 20 ml saline while the control group(35 cases) did not,extracted the epidural catheter after 10 minutes.Results Mean times of 3-dermatomal sensory regression for pinpric, 1-grade of motor block, and the rate of 1 h motor block were significantly shorter in the washout group than those in the control group [(24.6 ± 15.9) min vs(32.8 ± 16.7) min, (32.7 ± 13.4) min vs(47.9 ± 22.6) min,5 cases (14.3%) vs 14 cases (40.0%)](P < 0.05 or < 0.01 ).There was no difference in pain-killer utilization, postoperative pain scores no more than 3 scores and side effects between the two groups (P > 0.05).Conclusion It suggests that epidural washout facihtates regression of both sensory and motor block following epidural anesthesia without reducing the postoperative analgesic benefit.

Assessment of left ventricular synchronicity in patients with metabolic syndrome by tissue Doppler imaging / 中华超声影像学杂志

Objective To assess left ventricular synchronicity in patients with metabolic syndrome(MS)by tissue Doppler imaging.Methods Twenty-two patients with MS and left ventricular hypertrophy(LVH)(MS-LVH group),69 patients with MS and non-LVH(MS-NLVH group)and 33 healthy subjects(control group) were included.Left ventricular(LV)systolic and diastolic synchronicity were determined by measuring the maximal difference in time to peak myocardial systolic contraction(Ts-diff)and time to peak myocardial early diastolic relaxation(Te-diff),and the standard deviation of time to peak myocardial systolic contraction(Ts-SD)and early diastolic relaxation(Te-SD)with 6 basal and 6 middle LV segments.Results Compared with control group,patients with MS in MS-NLVH and MS-LVH group showed significantly prolonged Ts-diff,Ts-SD,Te-diff and Te-SD.Furthermore,Te-diff and Te-SD were much more prolonged in MS-LVH group than in MS-NLVH group.Conclusions Patients with MS have impaired L V systolic and diastolic synchronicity.LVH impacts the LV diastolic synchronicity much more obviously than systolic synchronicity in the patients with MS and LVH.