目的 探讨压力蒸汽灭菌时超标外来器械发生水热分离对湿包的影响及其物理机制，为临床操作提供参考。方法 2023年6-12月，采用便利抽样法选取某院行膝关节置换手术所用的120套膝关节器械为研究对象，按随机数字表法将其分为对照组、实验组1和实验组2；3组中包内电钻和电锯的摆放方式分别为紧贴篮筐底部吸水纸、架空、包裹吸水纸后架空，观察每组器械包灭菌后湿包情况。采用便利抽样法选取规格型号相同的硬质容器盒90个，按随机数字表法将其分为对照组（普通干燥程序）和实验组（脉动干燥程序），每组平均分为3份，分别盛放高为9 mm的热水、常温水和冰水。每份各取1个为1个小组，放在同一灭菌舱完成灭菌。观察同干燥程序下不同温度水及不同程序下同温度水水位差及灭菌后水温变化。结果 电钻、电锯架空摆放时全部湿包；紧贴底部吸水纸或包裹吸水纸后架空摆放时均未湿包。脉动干燥程序下及普通干燥程序下热水水位下降程度均高于其他两组（均 P ＜0.05）。灭菌后水温热水与其他两组比较均有差异（ P ＜0.05）。结论 冷凝水与冷凝过程中产生的热量分离是导致湿包的主要原因；在实际操作中，应确保二者位置尽可能接近。

Objective To explore the effect of water-heat separation on wet packs and its physical mechanism during pressure steam sterilization of non-conforming loaner instruments during sterilization,and to provide reference for clinical practice.Methods The convenience sampling method was used to select 120 sets of knee joint instrument packages used inknee replacement surgery in a hospital as the research objects from June to December 2023.They were divided into control group,experimental group 1 and experimental group 2 by random number table method.In the three groups,the electric drills and saws were placed:contacting absorbent paper at basket bottom（control),suspended（group 1),or suspended after being wrapped with absorbent paper（group 2).A total of 90 identical rigid containers were selected and randomly divided into control group（standard drying procedure) and experimental group（pulsating drying procedure).Each group was divided into 3 portions on average,each containing 9mm water columns at hot/room-temperature/ice temperatures.For each group,one portion was taken to form a new group and placed in the same sterilization chamber for simultaneous processing.We observed and compared:(1) water level differences and post-sterilization temperature changes among different temperature groups under the same drying program and among different drying programs for the same water temperature.Results All suspended instruments（group 1) developed wet packs,while other groups remained dry.The decrease of hot water level under pulsating drying procedure and under the standard drying procedure were greater than that of the other two groups and there was a difference（all P ＜0.05）.There was a difference in the water temperature between the hot water and the other two groups（ P ＜0.05).Conclusions The separation of condensed water and heat generated during the condensation process is the primary cause of wet packs.During operation,it should be ensured that the two positions are as close as possible.

R472.1