重症监护病房非发酵革兰阴性杆菌病原学与耐药性监测

目的分析重症监护病房(ICU)非发酵革兰阴性杆菌(NFGNB)感染的病原学分布及耐药性,为临床经验性使用抗菌药物提供依据。方法对ICU患者感染NFGNB及其对抗菌药物的敏感性进行回顾性调查。结果铜绿假单胞菌、鲍氏不动杆菌、嗜麦芽窄食单胞菌分别占NFGNB 33.91%、24.50%、12.38%。铜绿假单胞菌对亚胺培南、美罗培南、阿米卡星、庆大霉素、头孢他啶,不动杆菌对亚胺培南、美罗培南、阿米卡星、庆大霉素、哌拉西林/他唑巴坦、环丙沙星及嗜麦芽窄食单胞菌对阿米卡星、环丙沙星、耐药性较低。结论根据细菌病原学和抗菌药物敏感性资料,选择经验性抗菌药,控制感染,并减少新的耐药菌株出现。     

非发酵革兰阴性杆菌233株临床分布和耐药性分析

目的分析非发酵革兰阴性杆菌的临床分布和耐药情况,为临床合理选择抗菌药物提供依据。方法采用黑马细菌鉴定仪进行细菌鉴定,Kirby-Bauer法检测非发酵革兰阴性杆菌对12种抗菌药物的药物敏感性。结果233株菌中铜绿假单胞菌占53.2%,恶臭假单胞菌占20.6%,施氏假单胞菌占10.3%,不动杆菌占9.9%,嗜麦芽窄食单胞菌占4.7%;前5种主要非发酵革兰阴性杆菌共占98.7%。铜绿假单胞菌耐药率为17.7%～54.8%,敏感性较高的依次为亚胺培南、哌拉西林/他唑巴坦和阿米卡星;恶臭假单胞菌耐药率为16.7%～56.3%,其中对亚胺培南和哌拉西林/他唑巴坦较敏感;产碱假单胞菌耐药率为16.7%～66.7%,其中对亚胺培南、哌拉西林/他唑巴坦较敏感;不动杆菌属耐药率为13.0%～73.9%,对亚胺培南最敏感。结论铜绿假单胞菌、恶臭假单胞菌、产碱假单胞菌、不动杆菌属是引起医院感染的主要非发酵革兰阴性杆菌,其耐药率高,应根据微生物实验室所提供的细菌耐药情况合理使用抗生素。     

临床常见非发酵菌耐药性分析

目的:分析临床分离常见非发酵菌耐药状况,探讨合理使用抗生素。方法:采用API系统进行细菌鉴定,K-B法进行药敏试验。结果:共分离出非发酵菌328株,前三位分别是铜绿假单胞菌(54.3%)、鲍曼不动杆菌(20.1%)、嗜麦芽窄食单胞菌(12.8%)。亚胺培南对铜绿假单胞菌和鲍曼不动杆菌敏感性高,分别为94.4%、97.0%;嗜麦芽窄食单胞菌对复方新诺明和头孢哌酮/舒巴坦敏感性分别为93.9%和91.5%。结论:临床非发酵菌感染以铜绿假单胞菌、鲍曼不动杆菌、嗜麦芽窄食单胞菌最常见,对多种抗生素存在高耐药率,应重视非发酵菌耐药监测,依据药敏结果制定正确的抗感染方案,防止耐药菌株的产生。     

临床常见非发酵菌耐药性分析

目的:分析临床分离常见非发酵菌耐药状况,探讨合理使用抗生素。方法:采用API系统进行细菌鉴定,K-B法进行药敏试验。结果:共分离出非发酵菌328株,前三位分别是铜绿假单胞菌(54.3%)、鲍曼不动杆菌(20.1%)、嗜麦芽窄食单胞菌(12.8%)。亚胺培南对铜绿假单胞菌和鲍曼不动杆菌敏感性高,分别为94.4%、97.0%;嗜麦芽窄食单胞菌对复方新诺明和头孢哌酮/舒巴坦敏感性分别为93.9%和91.5%。结论:临床非发酵菌感染以铜绿假单胞菌、鲍曼不动杆菌、嗜麦芽窄食单胞菌最常见,对多种抗生素存在高耐药率,应重视非发酵菌耐药监测,依据药敏结果制定正确的抗感染方案,防止耐药菌株的产生。     

ICU患者呼吸机相关性肺炎耐药菌分布的现状及分析

目的 分析我院急诊重症监护病房(EICU)机械通气患者合并呼吸机相关性肺炎(ventilation-associated pneumonia,VAP)的细菌耐药的现状.方法 无菌条件下收集2010年7月~2012年3月我科呼吸机相关性肺炎患者100例下呼吸道分泌物并进行细菌培养,并测定培养所得菌株对常见16种抗菌药物的耐药率.结果 共分离到菌株240株,其中革兰氏阴性菌168株,革兰氏阴性菌中,主要为铜绿假单胞菌、鲍曼不动杆菌、肺炎克雷伯杆菌、嗜麦芽窄食假单胞菌和大肠埃希菌.结论 铜绿假单胞菌与鲍曼不动杆菌对亚胺培南、头孢吡肟、哌拉西林/三唑巴坦、环丙沙星、阿米卡星耐药率较低;嗜麦芽窄食假单胞菌主要对复方新诺明耐药率最低.亚胺培南对肠杆菌属有着较高的抗菌活性.     

下呼吸道感染患者支气管镜肺泡灌洗液病原学的临床研究

目的探讨下呼吸道感染患者支气管镜肺泡灌洗病原菌的种类及其对抗生素的敏感性情况。方法针对2011年1月-2012年8月经支气管镜肺泡灌洗培养阳性病例50例,经鉴定对其分类,并实施纸片扩散法进行丁氨卡那、亚胺培南、氨苄西林、庆大霉素、环丙沙星、头孢哌酮、头孢噻肟、左氟沙星、氨曲南、头孢他啶等10种抗菌药物的药敏试验,调查其耐药性情况。结果本组经API鉴定分离出铜绿假单胞菌23例、大肠埃希菌6例、鲍氏不动杆菌7株及肺炎克雷伯菌7株;嗜麦芽窄食单胞菌4例;真菌3例;耐药性检查结果示除嗜麦芽窄食单胞菌对亚胺培南耐药率75％以外,铜绿假单胞菌对亚胺培南耐药率为8．6％以外,其余大肠埃希菌、鲍氏不动杆菌及肺炎克雷伯菌对亚胺培南的耐药率均为0%.而各类菌属对亚胺培南以外的抗生素均有一定耐药性,其程度不一,尤其鲍氏不动杆菌对亚胺培南以外的其它抗生素的耐药率均高迭100％。结论下呼吸道感染主要致病菌为铜绿假单胞菌,亚胺培南是治疗该病的比较有效的抗生素。     

非发酵菌院内感染及其药敏211例分析

目的:研究本医院非发酵菌感染状况及其对抗生素的药敏情况。方法:分析本院2000年10月-2004年10月临床微生物检验标本,常规方法细菌培养鉴定菌株,MIC法做药敏及用先德荧光快速微生物鉴定、药敏分析系统。结果:非发酵菌占临床细菌分离率19.7%,从其种类构成比来看,其中分离率高的主要有铜绿假单胞菌(占53.6%)、不动杆菌(占16.1%)、嗜麦芽窄食单胞菌(占14%)。对11种常用抗生素耐药率检测显示铜绿假单胞菌耐药率为20%～96%,耐药率低的是多粘菌素B(19.9%)、亚胺培南(23.1%)、不动杆菌属耐药率为18%～85%,耐药率低的是亚胺培南(18.3%)、多粘菌素B(23.1%)、嗜麦芽窄食单胞菌耐药率从28%～100%不等,对亚胺培南耐药率(100%),而耐药率低的是复方新诺明(28.3%)、多粘菌素B(31.1%)。结论:铜绿假单胞菌、不动杆菌以及嗜麦芽窄食单胞菌仍然是引起医院感染的主要非发酵菌,药敏显示其对多数抗生素有较高的耐药率。开展对非发酵菌的培养和耐药性的动态监测,对控制院内感染、指导临床医师合理用药具有深远意义。     

106例非发酵菌感染及其耐药性分析

目的:了解医院非发酵菌感染状况及其对抗生素的耐药性.方法:常规方法细菌培养鉴定菌株,(K-B)纸片扩散法做药敏及用ATB系统鉴定细菌和药敏.结果:非发酵菌占临床细菌分离率19.9%(106/532),从其种类构成比来看,其中分离率高的主要有铜绿假单胞菌占53.7%(57/106),不动杆菌占16%(17/106),嗜麦芽窄食单胞菌占14%(15/106).对11种常用抗生素耐药率检测显示铜绿假单胞菌耐药率为20%～96%,耐药率低的是多粘菌素B为20%,亚胺培南为23%.不动杆菌属耐药率为18%～85%,耐药率低的是亚胺培南为18%,多粘菌素B为23%.嗜麦芽窄食单胞菌耐药率从28%至100%不等,对亚胺培南耐药率为100%,而耐药率低的是复方新诺明为28%,多粘菌素B为31%.结论:铜绿假单胞菌、不动杆菌以及嗜麦芽窄食单胞菌仍然是引起医院感染的主要非发酵菌,药敏的显示对多数抗生素有较高的耐药率.开展对非发酵菌的培养和耐药性的动态监测,对控制院内感染和指导临床合理用药具有重要意义.     

2007-2009年我院3种非发酵革兰阴性杆菌药物敏感性调查

目的:了解鲍曼不动杆菌、铜绿假单胞菌、嗜麦芽窄食单胞菌对常用抗菌药物的耐药性。方法:K-B法对分离菌株进行抗菌药物药敏试验。结果:分别分离铜绿假单胞菌、鲍曼不动杆菌、嗜麦芽窄食单胞菌745、367和25株。鲍曼不动杆菌耐药率达90%(头孢哌酮/舒巴坦例外,18%)。铜绿假单胞菌对复方新诺明、头孢噻肟、庆大霉素、哌拉西林耐药率80%。嗜麦芽窄食单胞菌分离率不高,对环丙沙星、头孢哌酮/舒巴坦、复方新诺明耐药率小于35%,对头孢噻肟、氨曲南、哌拉西林耐药率均超过80%。多重耐药菌株数分离率呈上升趋势,2009年58.54%菌株对5种抗生素均耐药。结论:3种非发酵糖革兰阴性杆菌耐药性严重,临床应根据药敏结果合理使用抗生素。     

106例非发酵菌感染及其耐药性分析

目的：了解医院非发酵菌感染状况及其对抗生素的耐药性。方法：常规方法细菌培养鉴定菌株，(K—B)纸片扩散法做药敏及用ATB系统鉴定细菌和药敏。结果：非发酵菌占临床细菌分离率19．9％(106／532)，从其种类构成比来看，其中分离率高的主要有铜绿假单胞菌占53．7％(57／106)，不动杆菌占16％(17／106)，嗜麦芽窄食单胞菌占14％(15／106)。对儿种常用抗生素耐药率检测显示铜绿假单胞菌耐药率为20％～96％，耐药率低的是多粘菌素B为20％，亚胺培南为23％。不动杆菌属耐药率为18％～85％，耐药率低的是亚胺培南为18％，多粘菌素B为23％。嗜麦芽窄食单胞菌耐药率从28％至100％不等，对亚胺培南耐药率为100％，而耐药率低的是复方新诺明为28％，多粘菌素B为31％。结论：铜绿假单胞菌、不动杆菌以及嗜麦芽窄食单胞菌仍然是引起医院感染的主要非发酵菌，药敏的显示对多数抗生素有较高的耐药率。开展对非发酵菌的培养和耐药性的动态监测，对控制院内感染和指导临床合理用药具有重要意义。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

Development on Adjustable Calibration Marker for Shock Wave Focus

Shock wave lithotripsy （SWL） is a treatment of choice for upper urinary stones. However, this procedure is inappropriate for obese patients because the focus is often unable to reach the target owing to the limited focal distance in shock wave source. Although treating such patients in a blast path may increase the application length of shock wave source, it＇s difficult to find this path on the lithotripter monitor. For this reason, we invented an adjustable calibration marker in order to set an effective focus in the shock wave hath.     

Study on the TCM Pathogenesis of Angiopathic Complications of Type II Diabetes

Excess production of reactive oxygen species(ROS)of mitochondrion mediated by hyperglycemia is the common pathogenesis of angiopathic complications of diabetes.TCM holds that the damp from the dysfunction of spleen.kidney and liver is the causative factor of complications of diabetes.This is similar to the mechanism of Ros resulting in angiopathic complications of diabetes.When the angiopathic complications of type II diabetes mellitus(T2DM)are difierentiated as caused by turbid damp in TCM can be explained as ROS.Since the obstruction of pathogenic damp in channels and collaterals is said to be the main pathogenesis,the treating principle should be dissolving the damp to remove the obstruction.     

Leptin, Ghrelin and TNF-α before and after Hypo-caloric Traditional Chinese Diet and Auricular Acupuncture

INTRODUCTION Obesity is a complex emergent problem, which can be possibly solved not only by the diet but also by the life style and promotion of a constant physical exercise. 1, 2 No doubt careful attentions must be given to the nutritional condition of obese people, the dietary habits, the somatic build (i.e. distribution of fat mass) and the organic functions linked to formation of the fat mass. All the parameters should be constantly monitored before, during and after a diet treatment. 3, 4, 5     

Relationship between Dysglycemia and Carotid Atherosclerosis in Tibetan Population

People with dysglycemia are at high risk for atherosclerotic diseases. This study aims at investigating the atherosclerotic vascular damage in dysglycemia and its metabolic origin in Tibetan population.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

Luo Lingjie's Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.