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Standards and quality control points of alginate-based medical devices

ObjectiveTo analyze standards of alginate-based medical devices at home and abroad, and to emphasize key issues of quality control that should be concerned about.MethodsBased on investigation of alginate application in medical devices and alginate-related medical standards, alginate-related technical indicators and quality control points were comprehensively analyzed.ResultsWith the rapid development of alginate-based medical materials and medical devices, the relevant standards at home and abroad have been elaborated on the basic technical indicators and detection methods. In addition to Chinese Pharmacopoeia, China has issued one alginate standard for tissue engineering and three alginate related product standards.ConclusionConsidering the special physical and chemical properties of alginate, researchers also need to focus on the sterilization method, expiry date, molecular weight, and ratio of α-L-guluronic acid to β-D-mannuronic acid of alginate, and impurity content.

血液透析患者動靜脈內瘺并發癥的護理對策

目的:總結分析維持性血液透析患者動靜脈內瘺使用過程中的主要并發癥,探討積極有效的護理對策,延長內瘺的使用壽命。方法:回顧156例維持性血液透析患者資料,分析其動靜脈內瘺使用過程中的主要并發癥及其相應的護理對策。結果:瘺并發癥按發生率高低依次為出血、血流量不足、假性動脈瘤和血栓形成,無一例感染。結論:出血及血流量不足是動靜脈內瘺的主要并發癥,及時有效的護理措施可預防減少并發癥的發生,延長內瘺的使用壽命。

Observation and Nursing of Renal Hypertension

目的：慢性腎臟疾病中腎性高血壓常見，危害大且不易控制，本文就臨床護理實踐進行總結。方法：腎性高血壓患者男性82例，女性74例，予限水鹽攝入,飲食療法,休息與心理護理,以及合理的降壓藥治療，加強觀察等。結論：腎性高血壓控制不佳者，在降壓藥使用基礎上注意休息，控制水鈉入量，并加強其心理治療，解除心理負擔，有利于控制血壓。

Application of Continuous Quality Improvement Measures in Prevention of Peritoneal Dialysis Related Peritonitis

ObjectiveTo investigate whether continuous quality improvement (CQI) measures can reduce the episodes of peritonitis. MethodsWe analyzed the data of 114 cases of peritoneal dialysis related peritonitis from January to December 2011 before applying CQI measures and 72 cases from January and December 2012 after applying CQI measures in West China Hospital. Then we studied the episodes, cause and pathogenic bacteria species of peritonitis in peritoneal dialysis patients. We implemented the process of reducing the episodes of peritonitis by applying PDCA four-step design: plan-do-check-act. ResultsThe episodes of peritonitis were reduced from per 60.8 patient-months (0.197/patient-years) to per 66.6 patient-months (0.180/patient-years) after applying CQI measures. The positive rate of pathogenic bacteria culture was both 50.0% before and after applying CQI measures, in which 66.7% were gram-positive cocci. The curing rate of peritonitis was increased from 57 case/times (76.3%) to 87 case/times (79.2%). Switching to hemodialysis rate was reduced from 17 cases/times (14.9%) to 10 cases/times (13.9%). Death cases was reduced from 9 cases/times (7.9%) to 5 cases/times (6.9%). ConclusionThese results show that the incidence of peritoneal dialysis related peritonitis decreases and the curing rate increases through CQI measures.

腹膜透析液加藥小技巧

保赫曼妙貼預防腹透導管出口處感染效果觀察

【摘要】　目的　觀察腹膜透析患者使用保赫曼妙貼覆蓋腹透導管出口處其感染預防的臨床效果。　方法　選擇2008年10月-2009年3月首次行腹膜透析置管手術患者60例，按行腹膜透析置管手術單雙日分為兩組，觀察組:腹透導管出口處使用保赫曼妙貼（8 cm×10 cm）；對照組:使用傳統敷料（6 cm×7 cm 的12層無菌紗布），并用紙膠布固定。觀察兩組患者術后腹透導管出口處敷料固定情況及感染發生率。　結果　術后7 d，觀察組腹透導管出口處敷料固定良好，優于對照組（Plt;0.05）；術后6周內，觀察組腹透導管出口處感染率低于對照組（Plt;0.05），差異有統計學意義。　結論　保赫曼妙貼能有效預防腹透導管出口處感染，使用簡便，值得推廣。

Comparison between the Effects of Two Different Care Methods for the Exit of Peritoneal Dialysis Catheter

目的　比較兩種不同方法護理腹膜透析患者導管出口處的效果。 方法　選取2008年7月－2009年12月51例患者作為試驗組，直接采用聚維酮碘溶液擦洗導管出口處，2007年1月－2008年7月45例患者作為對照組，先用生理鹽水清洗遂道口，再用聚維酮碘溶液擦洗導管出口處。比較兩組導管出口處感染的情況及操作所需時間。 結果　試驗組出口評分系統（ESS）＜2分15例，2～3分34例，≥4分7例；對照組＜2分10例，2～3分24例，≥4分16例；兩組差異有統計學意義（P＜0.05）。試驗組護士操作時間為（3.0 ± 1.0）min，患者操作時間為（5.0 ± 1.5）min；對照組護士操作時間為（8.0 ± 2.0）min，患者操作時間為（10.0 ± 2.0）min；兩組差異有統計學意義（P＜0.05）。 結論　聚維酮碘溶液直接清洗、消毒導管出口處降低了感染的發生率，減少了操作環節和所需物品，縮短了操作時間。

Cause Analysis and Nursing of Peritoneal Dialysis-related Peritonitis

目的　分析持續腹膜透析患者發生腹膜炎的情況及相關因素，降低腹膜透析患者腹膜炎發生率、退出率，提高患者的生存率、生活質量。 方法　回顧分析2011年1月－6月收治的41例在家中行持續非臥床性腹膜透析且發生腹膜炎患者的臨床資料，觀察腹膜炎的發生率及轉歸，腹膜炎癥狀出現后初始的處理，對腹膜炎的誘因進行分析。 結果　41例腹膜透析患者共發生腹膜炎43例次，痊愈35例（85.4%），轉血液透析3例（7.3%），死亡3例（7.3%）。在癥狀出現初期，3例（7.3%）患者繼續在家觀察，10例（24.4%）患者立即到當地就醫，15例（36.6%）患者采用電話咨詢，13例（31.7%）患者到腹膜透析中心就診；18例（43.9%）患者直接將腹膜透析引流液帶到醫院進行藥敏試驗。就感染誘因而言，16例（39.0%）患者未嚴格進行空氣消毒，13例（31.7%）患者未嚴格進行環境清潔，10例（24.4%）患者操作過程存在污染行為。 結論　加強對居家行腹膜透析患者的初次培訓、操作指導及監測，可避免腹膜炎的發生，提高患者生活質量。

老年腹膜透析患者相關營養指標比較及教育對策

目的　分析比較老年腹膜透析患者營養狀況，提出針對性的營養教育對策。 方法　回顧分析2010 年12月－2011年11月328例維持性腹膜透析患者的臨床及隨訪資料，并通過兩組不同年齡段患者（≥60歲和＜60歲）的血漿白蛋白（ALB）、前白蛋白（PAB）、鐵蛋白（FER）、血清鐵（FE）、總鐵結合力（TIBC）、血紅蛋白（HGB）、標準化每日蛋白質分解率（nPCR）、尿素清除指數（Kt/V）、肌酐清除率（Ccr）、24 h尿、腹透液漏出蛋白和體質量指數（BMI）、改良定量主觀整體評估（MQSGA）等指標，比較其營養狀況。 結果　老年組腹膜透析患者營養不良的發生率（72.79%）高于中青年組（28.65%）（P＜0.05）。兩組患者ALB分別為（32.64 ± 4.78） g/L和（34.99 ± 5.42） g/L（P＜0.05），PAB分別為（303.00 ± 72.47）mg/L和（372.53 ± 88.09）mg/L（P＜0.05），HGB分別為（102.58 ± 21.05）g/L和（91.63 ± 19.37）g/L（P＜0.05）；老年組ALB和PAB水平均低于中青年組，而HGB水平高于中青年組（P＜0.05）。兩組患者BMI、FE、TIBC、FER、nPCR、Kt/V、Ccr、每日蛋白漏出總量差異無統計學意義（P＞0.05）。 結論　老年腹膜透析患者比中青年患者更容易出現低蛋白血癥，導致蛋白營養不良。故而在制定腹膜透析患者的營養教育方案時，應針對老年患者的臨床特征，加強蛋白質營養方面的指導。

Summary of best evidence for prevention and management of joint dislocation after total hip arthroplasty

Objective To summarize the best evidence for prevention and management of joint dislocation after total hip arthroplasty (THA) and provide evidence-based support for reducing the occurrence of joint dislocation after THA. Methods The databases and websites related to prevention and management of joint dislocation after THA were searched, mainly including clinical decisions, guidelines, expert consensuses, evidence summaries, systematic reviews. The search period was from January 1, 2020 to April 30, 2025. Results Finally, 12 articles were included, including 2 guidelines, 4 systematic reviews, 4 clinical decisions, and 2 evidence summaries. The 5 dimensions of evaluation, preventive measures, early dislocation identification, daily activity recommendations, and health education were summarized and organized into 25 pieces of evidence. Conclusions The overall quality of the evidence related to the prevention and management of joint dislocation after THA summarized in this study is good. Medical staff should selectively apply the evidence based on clinical situations to develop safe, scientific, and personalized anti-dislocation plans for patients, in order to reduce the occurrence of joint dislocation and improve patient prognosis.