颅脑外伤术后医院获得性肺炎危险因素分析及防治措施

目的探讨颅脑外伤术后医院获得性肺炎危险因素及防治措施。方法收集我院2004年10月至2007年9月颅脑外伤术后住院患者406例，对发生医院获得性肺炎的危险因素进行回顾性分析。结果57例医院获得性肺炎患者经积极治疗，51例治疗效果满意，死亡6例。造成医院获得性肺炎的危险因素有手术麻醉方式、接受机械通气、住院时间长、气管切开、昏迷、误吸、应激性高血糖、抗菌药物应用、空气环境污染等。结论增强感染控制意识，加强病房管理，做好空气消毒，严格无菌操作规程，合理应用抗菌药物是预防医院获得性肺炎的重要措施。     

NICU脑出血患者并发医院获得性肺炎临床特点分析

目的:探讨NICU脑出血患者并发医院获得性肺炎的易感因素、病原学及防治方法。方法:对42例NICU脑出血并发医院获得性肺炎患者的临床资料进行分析总结。结果:NICU脑出血患者医院获得性肺炎的几率较高,占28.57%。高龄、机械通气、气管切开、常患有多种基础疾病是医院获得性肺炎的常见危险因素。痰培养显示病原体以革兰氏阴性菌为主。结论:脑出血患者院内获得性肺炎是多种因素相互作用的结果,检测病原体,正确使用抗生素,有利于减少医院获得性肺炎的发生,降低病死率。     

急性脑梗死患者医院获得性肺炎危险因素分析

目的探讨急性脑梗死患者医院获得性肺炎的危险因素。方法应用回顾性调查研究方法,统计726例急性脑梗死患者的临床资料,分析医院获得性肺炎的危险因素。结果 726例急性脑梗死患者中发生医院获得性肺炎41例,发生率为5.65%。患者年龄、基础疾病数、侵入性操作、NIHSS评分、住院时间以及抗菌药物使用是急性脑梗死患者发生医院获得性肺炎的独立危险因素,其中侵入性操作（OR=6.763）的危险性最高。结论急性脑梗死患者医院获得性肺炎的危险因素复杂,根据不同危险因素,实施针对性的措施可减少医院获得性肺炎的发生。     

重症监护病房老年脑卒中患者医院获得性肺炎的临床分析

目的:探讨老年脑卒中患者医院获得性肺炎的临床危险因素.方法:采用回顾性研究的方法,对随机选取104例ICU脑卒中患者,其中52例合并医院获得性肺炎者,52例未合并医院获得性肺炎患者的临床资料进行统计分析.结果:统计学分析显示,年龄、意识障碍、应用糖皮质激素、侵入性诊疗技术、球麻痹是医院获得性肺炎的易患因素.临床症状不典型,痰培养阳性率为88.5%,革兰阴性杆菌为主占65.4%,其次为真菌占17.95%.医院获得性肺炎的脑卒中患者明显高于无肺部感染脑卒中者病死率.结论:重症老年脑卒中患者在院内获得性肺炎的发生率及死亡率均较高,提示在临床的工作中应加强监护,保护易感人群,减少危险因素,合理使用抗生素,减少感染的发生率.     

恶性肿瘤患者并发重症医院获得性肺炎的临床分析

目的:分析医院恶性肿瘤患者并发重症医院获得性肺炎的临床特点,探讨有效的预防措施。方法:回顾性分析10 587例恶性肿瘤患者并发重症医院获得性肺炎的临床资料。结果:10 587例恶性肿瘤患者并发重症医院获得性肺炎,发病率为4.68%,引起感染的病原菌种类以革兰阴性菌为主,占49.54%,真菌感染也占较大比例,占44.98%,真菌感染以假丝酵母菌属为首;并发重症医院获得性肺炎与患者年龄、多次化疗、有COPD病史、有长时间烟龄、住院时间长、血清白蛋白低等危险因素有关。结论:恶性肿瘤患者易发生医院感染,进展为重症医院获得性肺炎,死亡率高,必须加强医院感染的管理,控制易感因素,规范抗菌药物的使用,减少医院感染的发生。     

糖尿病酮症酸中毒合并院内获得性肺炎危险因素分析

目的分析糖尿病酮症酸中毒合并院内获得性肺炎的感染危险因素,为临床预防其发生提供方法。方法对2006年1月-2010年12月入住我院内科病房的237例糖尿病酮症酸中毒患者进行回顾性研究,其中186例合并院内获得性肺炎;结合痰培养及药敏试验,对其中可能的多项致病危险因素进行分析。结果糖尿病酮症酸中毒患者并发院内获得性肺炎的主要危险因素有意识状态、住院日、气管切开、鼻饲胃管及肺部基础疾病。共培养出病原菌165株,革兰阴性杆菌与革兰阳性球菌分别占50.91%和44.24%。革兰阴性杆菌中以克雷伯菌属、大肠埃希菌和铜绿假单胞菌为主,对亚胺培南/西司他汀、哌拉西林/三唑巴坦、含有内酰胺酶抑治剂的头孢哌酮舒巴坦较敏感;革兰阳性菌中以金黄色葡萄球菌为主,对万古霉素均敏感。结论在糖尿病酮症酸中毒的诊治过程中,加强对这些医院感染危险因素的处理,可能是减少院内获得性肺炎发生的主要措施。     

精神病患者医院获得性肺炎危险因素分析

目的　了解精神病院内医院获得性肺炎的感染率及其危险因素。方法　对我院近 6年来发生的 4 1例医院获得性肺炎感染病例进行分析 ,并选择同期住院的没有发生医院感染的患者作为对照组。结果　医院获得性肺炎感染率为 0 6 8% ,经Logistic回归分析发现医院获得性肺炎与住院次数≥ 3次、合并躯体疾病、使用氯氮平、实验室检查结果异常等 4个因素相关 (P <0 0 5 )。结论　精神病院内医院获得性肺炎感染有其特殊性 ,必须针对重点人群、高危因素及相关环节制定防治措施。     

脑卒中并发医院获得性肺炎危险因素分析

目的:探讨脑卒中患者发生医院获得性肺炎的危险因素及预防控制措施。方法:回顾性调查分析67例脑卒中并发医院获得性肺炎的临床资料,与同期住院无医院获得性肺炎脑卒中患者比较。结果:脑卒中患者并发医院获得性肺炎的危险因素与年龄大、基础病、侵入性操作(如气管切开、气管插管、频繁插胃管及吸痰)、广谱抗生素、意识、卧床时间、吞咽障碍及吸烟有关。结论:积极治疗基础病、合理使用抗生素、减少侵入性操作、支持治疗、注意手卫生及无菌操作、加强危险因素的监测及控制,是预防控制医院感染的重要措施。     

233例急性脑梗死神经内科住院患者医院获得性肺炎危险因素分析

目的：探讨急性脑梗死患者院内获得性肺炎危险因素与控制方法。方法回顾性分析233例住院急性脑梗死患者,统计分析不同性别、不同年龄段、是否吸烟、是否合并原发病、是否有球麻痹、是否有意识障碍、是否大脑中动脉大面积脑梗死与获得性肺炎的关系。结果多因素Logistic分析提示,发生医院内获得性肺炎OR的大小依次是吞咽障碍（2.013）、既往COPD病史（2.455）、意识障碍（5.326）、大面积大脑中动脉脑梗死（6.011）。结论年龄（>75岁）、糖尿病、COPD、吞咽障碍、意识障碍、NIHSS评分（≥10）、大面积大脑中动脉脑梗死是急性脑梗死住院患者发生医院获得性肺炎的危险因素。既往COPD病史、吞咽障碍、意识障碍、大面积大脑中动脉脑梗死等4个因素为急性脑梗死住院患者发生医院获得性肺炎的独立高危因素。     

大面积脑梗死并发医院获得性肺炎的相关危险因素分析

目的探讨大面积脑梗死患者并发医院获得性肺炎（HAP）的相关危险因素。方法2011年1月至2013年5月共收治大面积脑梗死患者134例,根据是否并发HAP,分为HAP组与非HAP组,对其发生HAP的相关资料采用二分类逐步Logistic回归进行多因素分析。结果大面积脑梗死患者医院获得性肺炎的发生率为61．9％（83／134）,糖尿病、慢性阻塞性肺疾病（COPD）、慢性心力衰竭、意识障碍（GCS评分〈8分）、延髓麻痹、气管插管与切开、营养状态是大面积脑梗死后发生医院获得性肺炎的独立危险因素。结论大面积脑梗死患者易发生医院获得性肺炎,应针对上述危险因素,采取综合措施,降低大面积脑梗死患者医院获得性肺炎发生率。     

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.