卡他莫拉氏菌下呼吸道感染58例报告

的 :总结近五年来卡他莫拉氏菌下呼吸道感染的临床特点及对抗生素的敏感性。方法 :(1 )分析 58例卡他莫拉氏菌所致肺部感染的临床资料 ,包括年龄、基础疾病、发病诱因、症状体征、X线表现、治疗转归等 ;(2 )以K -B法 (纸片法 )或Etest法 (MIC纸片法 )测定该菌的体外药敏性。结果 :(1 )男 44例 ,女 1 4例 ,年龄 54± 1 5岁 ,78%的患者有基础疾病 ,主要为COPD、肺心病。症状为咳嗽 (93 % )、发热 (60 % ) ,胸部X线表现为肺部斑片状阴影 (41 4% )。 (2 )药敏试验示该菌呈多重耐药 ,妥布霉素、氧氟沙星、头孢哌酮、头孢三嗪为较敏感抗生素。结论 :卡他莫拉氏菌下呼吸道感染患者多有基础疾病 ,临床表现不典型 ,诊断依靠病原学并结合临床及X线检查 ,治疗应根据药敏并联合应用抗生素     

肺炎克雷伯杆菌肺部感染60例的临床和耐药性研究

目的 了解肺炎克雷伯杆菌肺部感染的临床特征,研究该菌产超广谱β－内酰胺酶（ESBL）的耐药特点。方法 从临床资料,症状和体征,胸部X线检查、治疗和转归等方面分析60例肺炎克雷伯杆菌所致肺感染的临床特征。并用纸片法检测肺炎克雷伯杆菌的体外药敏,60例中34例（56．7％）行ESBL检测。用阿米卡星等16种抗生素,对该菌的体外耐药性行初步研究。结果 60例患者中93．3％的患者有基础疾病,临床症状以发热、咳嗽、咳痰为主,胸部X线大叶肺实变（26．7％）,小叶浸润（58．3％）和肺脓肿（15％）的形成为主要病变,有11例（18．3％）,叶间隙呈弧形下坠形成肺炎克雷伯杆菌肺感染的特殊X线征象。60例患者中,ESBL检测阴性和未行ESBL检测的克雷伯杆菌对多种抗生素较敏感。但产ESBL的肺炎克雷伯杆菌对多种抗生素均交叉耐药,所有受试菌对亚胺培南和含β－内酰胺酶抑制剂的复合抗生素均敏感。结论 肺炎克雷伯杆菌肺感染患者多有基础疾病,临床表现不典型。诊断依靠病原菌并结合临床和X线检查,治疗应根据药敏测定,选择敏感抗生素。联合艇药效果较好。对产ESBL的肺炎克雷伯杆菌引起肺部感染者,应用亚胺培南或含β－内酰胺酶抑制剂的复合物,或者选用药敏测定显示敏感的药物。     

肺炎克雷伯杆菌肺炎62例临床特点及耐药性分析

目的: 了解肺炎克雷伯杆菌肺炎的临床特征,探讨该菌产超广谱β-内酰胺酶(ESBLs)的耐药特点。方法: 对2002~2004年确诊为肺炎克雷伯杆菌肺炎62例的临床特征及药敏结果。结果: 62例中58例有基础疾病,临床症状以发热、咳嗽、咳痰为主。胸部X线以大叶肺实变18例、小叶浸润35例和肺脓肿9例的形成为主要病变。有12例叶间隙呈弧形下坠形成肺炎克雷伯杆菌肺炎的特殊X线征象。62例中,ESBLs检测阴性的克雷伯杆菌对多种抗生素较敏感。但产ESBLs的肺炎克雷伯杆菌对多种抗生素均交叉耐药,所有受试菌对ESBLs抑制剂的复合抗生素及碳青霉烯类抗生素敏感率高。结论: 肺炎克雷伯杆菌肺炎患者多有基础疾病,临床表现不典型。诊断依靠病原菌检测并结合临床和X线检查,治疗应根据药敏测定,合理选择有效抗生素。严禁滥用抗生素,避免医院内产ESBLs菌株的发生和流行。     

不动杆菌致呼吸机相关肺炎的临床特点

目的探讨不动杆菌所致呼吸机相关肺炎(VAP)的临床特点.方法采集45例由不动杆菌所致呼吸机相关肺炎患者下呼吸道及呼吸机通气环回路标本,对分离菌株以纸片法行药物敏感试验.结果45例患者中年龄＞60岁者31例;平均通气(17±11)d,5 d后发生VAP者占73.3%.全部患者均有基础疾病,其中最常见的为呼吸系统疾病(37.8%)、神经系统疾病(22.2%)和外伤(22.2%).28.9%为混合感染.临床表现为发热、呼吸道脓性分泌物、肺部实变.X线主要以双下肺野斑片状阴影为主,病死率37.8%.分离菌株耐药率高,存在多重耐药,较敏感抗生素为多粘菌素、亚胺配南、米诺环素、氧氟沙星、阿米卡星等.结论不动杆菌所致VAP患者基础疾病多,临床表现缺乏特异性,病情严重,病死率高,细菌耐药性广,临床应早期获得病原学诊断、选用敏感抗生素、加强呼吸环路的消毒.     

金黄杆菌肺部感染的临床和致病性研究

目的　探讨金黄杆菌致肺部感染的临床特征及致病性。方法　研究 5 2例金黄杆菌致下呼吸道感染的临床资料 ,采用平板稀释法测定常用抗生素对该菌株的最低抑菌浓度 ,测定金黄杆菌对小鼠的半数致死量(LD50 )。结果　① 5 2例中 >6 0岁者 36例 ,所有病例均有基础疾病 ,主要为慢性阻塞性肺疾病和恶性肿瘤。气管插管或气管切开 17例。 35例有长期应用广谱抗生素史 ,感染前患者的住院时间平均为 35 .6d。 38.5 %为混合感染。临床症状及X线摄片的表现缺乏特异性。②药敏试验提示该菌耐药性广 ,头孢哌酮 /舒巴坦、氧氟沙星、环丙沙星、复方磺胺甲恶唑和哌拉西林为相对敏感抗生素。③ 2 0株菌株的LD50 范围为每只小鼠 4 .11× 10 6～ 5 .6 8× 10 8,提示该菌属的毒力相对较弱。结论　金黄杆菌毒力较弱 ,其所致下呼吸道感染多发生于有基础疾病、免疫力低下、长期使用抗生素的老龄患者 ,细菌耐药率高 ,临床表现缺乏特征性 ,治疗应依据药敏选用敏感抗生素     

老年人肺炎克雷伯菌属肺部感染的临床和耐药性分析

目的了解老年人克雷伯菌属肺部感染的f临床特征和细菌耐药性.方法收集我院2000～2001年老年克雷伯菌属肺部感染61例,从病史、症状、体征、胸部X线检查、治疗和转归等方面分析老年克雷伯菌属所致肺部感染的临床特征.用纸片法检测克雷伯菌属对阿米卡星等12种抗生素的体外药敏检测并测β-内酰胺酶(ESBLs).结果94.9%的患者有基础疾病,临床症状以发热、咳嗽、咳痰为主,胸部X线以含有空气支气管症的大叶肺实变(26.2%)、小叶浸润(59.9%)和肺脓肿(14.8%)为主要病变,10例(16.4%)叶间隙成弧性下坠形成克雷伯菌属肺感染的特征X线征象.61例患者中,产ESBLs菌属占31.1%,对多种抗生素交叉耐药,对亚胺培南和部分含ESBLs抑制剂的复合抗生素敏感.结论老年人克雷伯菌属肺感染患者多有基础疾病,临床表现无特异性.诊断依靠病原菌检测并结合临床和X线检查,治疗应根据药敏测定,选择敏感抗菌素.对产ESBLs克雷伯菌属引起肺部感染者,应用亚胺培南或部分含β-内酰胺酶抑制剂的复合物,或者选用药敏测定显示敏感的药物.     

金黄杆菌下呼吸道感染的临床特征及其药物敏感性

目的:探讨金黄杆菌致下呼吸道感染的临床特征及其对抗生素的敏感性,以指导临床诊断及治疗.方法:研究52例金黄杆菌致下呼吸道感染的临床资料,采用平板稀释法测定常用抗生素对该菌株的最低抑菌浓度,测定金黄杆菌对小鼠的半数致死量(LD50).结果:52例中>60岁者36例,全部病例均有基础疾病,主要为慢性阻塞性肺疾病、恶性肿瘤.气管插管或气管切开17例,35例有长期应用广谱抗生素史,感染前患者的住院时间平均为35.6 d.20例(38.5％)为混合感染.临床症状及X线表现缺乏特异性.药敏试验提示该菌耐药性广,舒哌酮、氧氟沙星、环丙沙星、复方磺胺甲唑及哌拉西林为相对敏感抗生素.20株菌株的LD50范围为4.11×106～5.68×108/mouse,提示该菌属的毒力相对较弱.结论:金黄杆菌毒力较弱,其所致下呼吸道感染多发生于有基础疾病、免疫力低下、长期使用抗生素的老龄患者,细菌耐药率高,临床表现缺乏特异性,治疗应依据药敏选用敏感抗生素.     

新生儿感染性肺炎224例细菌学分析

目的通过对新生儿感染性肺炎细菌学分析,探讨社区获得性肺炎和医院感染性肺炎细菌学特点,更好地指导临床应用抗生素。方法根据肺炎获得的地点分为社区获得性肺炎（CAP）和医院感染性肺炎（HAP）。CAP于入院24 h取痰。HAP于胸部X线片证实后取痰。应用法国梅里埃公司VTTEK细菌鉴定仪鉴定菌种,药敏采用KB纸片扩散法。结果肺炎克雷伯菌是本研究中CAP组和HAP组共同的主要致病菌。大肠埃希菌为CAP组中第2位,鲍氏不动杆菌为HAP组致病第2位。药敏试验分析,肺炎克雷伯菌和鲍氏不动杆菌对较常用的青霉素类和头孢类耐药率高。肺炎克雷伯菌和大肠埃希菌对亚胺培南均敏感,4例鲍氏不动杆菌对亚胺培南不敏感。CAP组和HAP组中革兰氏阴性杆菌产ESBLs分别为18.2%和42.9%,可能与患儿在住院期间使用三代头孢菌素有关。结论新生儿CAP致病菌有明显地区差异,应根据各地检测结果指导临床使用抗生素。     

下呼吸道不动杆菌感染36例临床分析

目的探讨不动杆菌致下呼吸道感染的临床特点、危险因素和对抗生素的敏感性。方法对36例不动杆菌致下呼吸道感染患者的临床、痰细菌培养及药敏结果进行回顾性分析。结果36例均为院内感染。>65岁者23例(63.9%);患有2种或2种以上基础疾病者20例(55.6%);36例发病前均应用多种抗生素;应用糖皮质激素或免疫抑制剂18例(50%),侵袭性治疗10例(27.8%)。雾化吸入13例(36.1%)。死亡9例,病死率25%。临床症状及X线表现无特异性。药敏试验呈现对多种常用抗革兰氏阴性杆菌的抗生素耐药。结论老年、基础疾病多、免疫力低下、长期应用抗生素、侵袭性治疗及雾化吸入为不动杆菌下呼吸道感染的危险因素。其临床症状重,耐药率高,预后差。亚胺培南、左旋氧氟沙星、头孢哌酮-舒巴坦、头孢他啶为较有效药物。     

医院内获得性肺炎病原菌及耐药特点

目的　探讨医院内获得性肺炎病原菌构成及耐药情况 ,为合理使用抗生素控制感染提供依据。方法　回顾性分析 115例医院获得性肺炎临床分离菌的病原菌及药敏结果进行统计分析。结果　共检验出致病菌 10 2株 ,病原菌以G-杆菌为主 ,为 66.7% ,前三位依次为 :铜绿假单胞菌、肺炎克雷伯菌、不动杆菌属 ;G+ 菌占 2 1.5 7% ,含真菌混合感染 11.8%。药敏结果显示G-杆菌呈现多重比例耐药 ,对第三代头孢、喹诺酮类、氨基糖甙类较敏感 ,对广谱的青霉素类均耐药 ;G+ 球菌耐药率较高 ,对万古霉素高度敏感。结论　结合药敏结果联合应用抗生素值得临床重视。     

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.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

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.