严重烧伤后真菌感染24例临床分析

真菌感染是严重烧伤后常见感染之一。文献[1]曾对我科1993～1999年烧伤创面进行微生物生态学调查，结果创面真菌感染阳性率为3．8％，而在严重烧伤患者中真菌感染高达10．4％，其临床治疗较为棘手，病死率高。本文总结我科1993～2003年严重烧伤并发真菌感染24例的临床资料，报告如下。     

6例特重烧伤真菌感染的诊治体会

目的探讨严重烧伤病人真菌感染的诊断治疗经验.方法回顾性分析4年来6例特重烧伤真菌感染病例.采用静脉滴注氟康唑或伊曲康唑治疗,合并细菌感染者选用敏感抗生素静滴,无混合感染者尽量不用或选择窄谱抗生素防治细菌感染;并积极及时切痂植皮覆盖创面,特别是可疑霉菌感染创面.结果白色念珠菌感染3例,曲霉菌2例,毛霉菌1例;除1例曲霉菌感染来势凶猛治疗失败外,其余5例均治愈.结论早期诊断、早期防治、合理选择抗真菌药物、积极切痂等创面处理是治疗成功的关键.     

氟康唑对院内深部真菌感染的预防观察与分析

目的 探讨氟康唑与广谱抗生素同步应用预防医院内深部真菌感染的效果。方法187例中重度以上肺部感染者（治疗前痰培养及或涂片有真菌者不入选）随机分成2组：治疗组：静脉用抗生素治疗加口服氟康唑100mg／d，155例；对照组：静脉用抗生素治疗32例。所有病例均选用两种抗生素联合治疗：β-内酰胺类＋氟喹诺酮类。至停用抗生素或治疗过程中病情好转可减少其中一种抗生素时停用氟康唑。疗程均为2周。治疗前后及疗程中每周抽血查肝功能，并记录症状，所有患者于治疗前后及疗程中病情无好转或反复或伴腹泻时均留痰及或大便送检涂片查霉菌及培养。结果 治疗组155例在治疗期间及疗程后有150例无深部真菌感染发生；另有5例出现痰涂片壹到酵母样菌，但痰培养阴性，其病情的好转进程未受影响。对照组32例中有18例并发真菌（白色念珠菌）感染（痰涂片及痰培养均查到真菌），其中继发肺部真菌感染16例；肠道真菌感染2例。所有病例均有不同程度的纳差症状，两组的纳差症状无明显不同。治疗组有3例在停氟康唑前出现了血谷丙转氨酶轻度升高（45-62mmol／L），及时停氟康唑并加保肝治疗3-5d后谷丙转氨酶均恢复正常。对照组有1例血谷丙转氨酶轻度升高（54mmol／L），加保肝治疗1周后恢复正常。结论 氟康唑与抗生素同步应用对院内深部真菌感染的发生有预防作用，此方法效果好、方便、经济、相对安全，值得临床推广。     

念珠菌对7种常用抗真菌药物敏感实验结果分析

近年来酵母样真菌感染已成为医院内感染的重要部分，随着广谱抗菌素、糖皮质激素和免疫抑制剂的广泛应用；肿瘤结核等大量慢性消耗性疾病的出现；器官移植，各种导管介入治疗和手术增加；导致条件致病性真菌(念珠菌)感染日益增多。抗真菌药物相继问世和耐药菌株的出现，抗真菌药物敏感实验逐渐为人重视。我们分析了我院2003下半年住院患者128例真菌感染的鉴定及药敏实验的结果，目的为临床合理使用抗菌药，有效预防真菌感染提供依据。     

真菌性二重感染的原因、诊断、治疗及预防

目的 探讨真菌性二重感染的原因、诊断、治疗及预防。方法 分析了84例真菌性二重感染的病例、均经血液、尿液、大便、痰液、引流物或痂下分泌物的镜下检查或真菌培养，证实真菌性二重感染。结果 白色念珠菌占绝大多数。部位主要为下消化道、口腔、泌尿道及肺部。发生时间集中在使用抗生素2-3周后。发现真菌感染后停抗生素45例，换窄谱抗生素39例。立即抗真菌治疗，临床治愈70例，直接死于真菌二重感染14例。结论 真菌性二重感染多继发于长期用广谱抗生素或免疫力低下病人，镜下发现菌线或真菌培养可确诊 。减少广谱抗生素应用、提高免疫力、保持和培养正常菌群及预防性使用小剂量抗真菌药可减少真菌感染。治疗以抗真菌、培养正常菌群、换用窄谱抗生素及加强支持治疗为基本原则。     

烧伤患者真菌感染特点研究及分析

目的 探索烧伤患者近年来真菌感染特点及治疗进展。方法 将2007年11月～2010年11月我院收治的3053例烧伤患者作为研究对象,对其中怀疑有真菌感染的184例患者取其创面分泌物、中段尿、痰液、深静脉导管、血液作为标本做真菌培养及药敏试验,并对结果进行统计分析。 结果 在3053例烧伤患者中,阳性病例33例,发病率为1.08%;送检的436份标本中有65份阳性标本,阳性率为14.91%。其中,烧伤面积大于70%TBSA 13例,50%～69%TBSA 8例,30%～49%TBSA 7例,小于30%TBSA 5例。检出最多的是近平滑假丝酵母菌和热带假丝酵母菌,少见菌种如曲霉菌、毛霉菌、酵母样真菌亦有发现;药敏结果提示除热带假丝酵母菌和白色假丝酵母菌对三唑类药物耐药较严重外,其他真菌对目前临床常用抗真菌药物均较敏感。结论 烧伤患者真菌感染中,以近平滑假丝酵母菌和热带假丝酵母菌感染为主,临床治疗过程中应注意加强深部组织培养意识,并结合临床表现及培养结果,早期确诊,以尽早确定治疗方案。     

烧伤创面严重感染的手术治疗（151例治疗分析）

目的：介绍一组烧伤病例创面严重感染手术治疗的经验及措施。方法：对151例创面严重感染病人,围手术期彻底清创,加强抗感染治疗,剥痂与切痂相结合,肢体禁止挤压驱血,创面覆盖前彻底清洗,外用抗生素。结果：151例病人没有因手术引起感染扩散的病例,相反感染症状明显改善,各种方式植皮及皮瓣转移均取得满意的疗效。结论：烧伤创面严重感染并非手术禁忌证,针对感染的措施是保证手术成功的关键。     

严重烧伤患者合并真菌感染17例的治疗体会

目的：分析烧伤后真菌感染的相关因素,进一步探讨真菌感染的防治措施。方法：通过对本科2008年5月～2013年2月17例严重烧伤并发深部真菌感染患者的临床资料进行分析、总结。结果：白色念珠菌是严重烧伤真菌感染的主要病原菌,长期使用广谱抗菌药物是最常见的诱因,烧伤严重程度、侵入性操作、大剂量激素的应用等也是重要的危险因素。结论：积极控制感染相关危险因素,合理使用抗菌药物,减少侵入性操作,提高患者机体免疫力和尽早切削痂治疗等是预防真菌感染的主要措施。     

34例COPD合并肺部真菌感染的临床分析

目的 探讨COPD患者合并肺部真菌感染临床特点及发病危险因素。方法 回顾性分析34例COPD患者合并肺部真菌感染的临床资料。结果 34例患者均接受抗真菌治疗，真菌转阴32例，治愈25例．死亡70例均非真菌感染所致。结论 肺部真菌感染中以白色念珠菌感染最多见。所有病例经积极治疗原发病，及时抗真菌治疗，并适当应用免疫增强剂，使肺部真菌感染得到控制。     

复方萘替芬喷雾剂及冷霜的研制与应用

目的：观察烧伤创面抗真菌感染及防治浅部真菌病外用新药复方萘替芬(S1123)的体外抑菌效果和临床疗效。方法：(1) 体外检测萘替芬、酮康唑和S1123的最低抑菌浓度, 比较3种药物的抗真菌效果; (2) 将S1123和对照药品应用于烧伤创面,在治疗前后取创面痂皮进行真菌培养,观察真菌转阴率;(3) 观察S1123冷霜治疗某舰艇部队浅部真菌病患者1 927例的效果。结果：S1123对丝状真菌和酵母菌具有广谱、高效的抑菌作用,对常见的致病真菌――曲霉和念珠菌,其最小抑菌浓度分别为0.156,0.625 μg/ml。临床使用双盲法观察3 d真菌感染转阴率达77.71％,与对照组比较相差非常显著。对浅部真菌病治疗的有效率为95.6％。结论：S1123是一种疗效很好的外用抗真菌新药。     

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.     

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.     

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…     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.