妇科恶性肿瘤患者术后尿路感染病原菌分布及影响因素研究

摘要 目的 了解住院妇科恶性肿瘤患者术后尿路感染病原菌分布情况和影响因素,旨在为有效干预提供依据。方法 通过感染监测和病原菌分离鉴定技术,对某医院住院妇科恶性肿瘤患者术后尿路感染情况和病原菌分布及相关危险因素进行统计分析。结果 共分析恶性肿瘤患者238例,发生术后尿路感染56例,尿路感染的发生率为23.53%。从尿路感染患者的尿标本中共分离培养出病原菌81株,其中大肠埃希菌所占分离菌株总数的50.62%。多因素分析结果显示,年龄>60岁、尿管插管次数>2次、留置尿管时间>7 d以及膀胱冲洗是导致妇科恶性肿瘤患者术后尿路感染的独立危险因素。结论 妇科恶性肿瘤术后尿路感染的发生率较高,大肠埃希菌是最常见的病原菌,可针对感染危险因素制定有效干预措施。     

宫颈癌根治术后膀胱造瘘带管法导尿的应用价值——附45例报告

目的:探讨宫颈癌根治术后膀胱造瘘带管法导尿的应用价值. 方法:91例宫颈癌根治患者,术后分别行膀胱造瘘带管法(研究组,45例)导尿和经尿道留置尿管法(对照组,46例)导尿,观察研究组膀胱造瘘管的手术并发症,比较2组术后尿潴留发生率、术后留置瘘管(对照组为尿管)的时间、术后由于排尿困难重插尿管次数及术后尿路感染的发生率.结果:研究组拔除造瘘管后伤口自行愈合、无明显渗液44例(98%),拔除造瘘管后造瘘口有少许渗液1例(2%),予伤口换药、抗生素局部喷涂,8日后愈合;对照组术后24例(52%)需重插尿管.研究组尿潴留率、术后留置瘘管(对照组为尿管)的时间、重插尿管次数及尿路感染率分别为100%、22(16～34)日、0及37%,对照组则分别为51%、15(10～38)日、1(0～4)次及36%,2组术后尿潴留发生率、术后留置瘘管或尿管的时间及重插尿管次数比较差异有统计学意义(均为P＜0.01),2组尿路感染发生率比较差异无统计学意义(P＞0.05). 结论:宫颈癌根治术后膀胱造瘘带管法简便、易行,不增加术后尿路感染率,值得在临床推广应用.     

留置尿管导致尿路感染相关因素分析

目的：探讨留置尿管导致尿路感染的相关因素。方法：对2 607例留置尿管患者进行监测、分析。结果：2 607例留置尿管患者中有42例发生尿路感染,感染率为16.11%;留置尿管时间在≤2 d、7～10 d、11～14 d、15～21 d的感染率分别为0.16%、50%、57.89%、100%;尿培养中病原菌以大肠埃希菌最为常见,其他依次为粪肠球菌、肺炎克雷伯菌、白色念珠菌等。结论：导尿术、留置尿管时间、老年患者、抗菌药物的不合理应用是导致尿路感染的重要危险因素;针对各种相关因素,采取有效地预防措施,可降低感染率的发生。     

不同留置导尿时间对腹腔镜下宫颈癌根治术后膀胱功能的影响

目的探讨腹腔镜下宫颈癌根治术后不同留置导尿时间对膀胱功能恢复的影响。方法对妇科腹腔镜下行宫颈癌根治术的62例患者随机分为两组,分别留置导尿7d和10d后拔除尿管,观察拔除尿管后残余尿测定及排尿情况。结果腹腔镜下行宫颈癌根治术后留置导尿10d组患者拔除尿管后残余尿合格率及排尿正常率明显高于7d组患者。结论腹腔镜下行宫颈癌根治术后留置导尿10d拔除尿管更有利于膀胱功能恢复。     

Kegel运动联合膀胱容量测定在宫颈癌根治术后膀胱功能恢复中的应用

目的探讨Kegel运动联合膀胱容量测定在宫颈癌根治术后膀胱功能恢复中的应用价值。方法依照手术时间顺序,2016年7月至12月行全麻下宫颈癌根治术患者47例设为对照组,2017年1月至6月行全麻下宫颈癌根治术患者45例设为观察组。对照组采用常规夹闭导尿管定时放尿进行膀胱功能锻炼。观察组采用Kegel运动联合膀胱容量测定指导膀胱功能锻炼。观察两组患者置管期间尿路感染率、留置导尿管的时间及拔管后残余尿量、第1次排尿成功率、尿潴留发生率。结果对照组尿路感染率14.9%,留置导尿管的时间(11.98±1.215)d,残余尿量(84.00±67.492)ml,第1次排尿成功率68.1%,尿潴留发生率17.0%;观察组尿路感染率2.2%,留置导尿管的时间(9.58±0.839)d,残余尿量(56.78±38.438)ml,第1次排尿成功率91.1%,尿潴留发生率4.4%,两组患者以上指标比较差异均有统计学意义(P0.05)。结论宫颈癌根治术后采用Kegel运动联合膀胱容量测定进行膀胱功能锻炼,不仅能促进术后膀胱功能恢复,而且为导尿管拔除提供客观依据,有效减少了尿潴留和尿路感染的发生。     

老年监护室患者导尿管相关尿路感染病原菌及其感染危险因素研究

目的探讨老年监护室患者导尿管相关尿路感染病原菌及感染危险因素,为导尿管相关尿路感染的临床防治提供参考。方法选取2017年1月-12月在医院诊治的100例老年监护室住院患者,采集尿液进行病原菌培养、菌株鉴定,同时调查可能影响导尿管相关尿路感染发生的危险因素。结果有26例患者尿液培养阳性,感染率为26.00%,共培养出病原菌32株,其中革兰阴性杆菌21株(65.63%),革兰阳性球菌11株(34.37%),主要感染病原菌为大肠埃希菌、屎肠球菌及粪肠球菌,分别占34.38%、12.50%、12.50%。年龄80岁、合并糖尿病、合并肾结石、留置尿管时间7d、APACH II评分15分、有膀胱冲洗、有胃肠减压、有灌肠等操作时感染率为52.38%、50.00%、83.33%、31.65%、31.58%、30.86%、38.10%、30.49%,年龄65～80岁、无糖尿病、无肾结石、留置尿管时间≤7d、APACH II评分≤15分、无膀胱冲洗、无胃肠减压、无灌肠等操作时感染率为18.99%、17.57%、18.18%、4.76%、8.33%、5.26%、5.41%、5.56%,比较差异有统计学意义(P0.05)。Logistic回归分析Logistic回归分析显示年龄80岁、合并糖尿病、合并肾结石、留置尿管时间7d、APACH II评分15分、膀胱冲洗、胃肠减压、灌肠等是引起导尿管相关尿路感染发生的独立危险因素(P0.05)。结论大肠埃希菌为主的革兰阴性杆菌是引起老年监护室患者导尿管相关尿路感染的主要病原菌,引起患者感染发生的危险因素较多,应针对可防控因素进行干预降低感染的发生。     

令皮欣预防宫颈癌根治术后留置尿管尿路感染患者的护理干预

目的探讨综合护理干预在令皮欣预防宫颈癌根治术后留置尿管尿路感染中的应用效果。方法选取本院收治的110例宫颈癌根治术患者作为研究对象,患者术后均接受尿管留置且采用令皮欣预防尿路感染,根据护理策略的不同分为对照组(常规护理)与观察组(综合护理干预),比较2组患者尿路感染发生情况。结果观察组患者尿管留置第3、7、10、14天的尿路感染发生率均显著低于对照组(P<0.05);观察组患者在尿管拔除时的身体功能、社会功能、情绪功能、角色功能4个维度评分均显著高于对照组(P<0.05)。结论在宫颈癌根治术后患者尿管留置期间采用令皮欣预防尿路感染的基础上实施综合护理干预,可有效降低尿路感染发生率,减轻患者痛苦,促进术后顺利康复,对提高患者生活质量与改善预后具有积极作用。     

ICU病人留置尿管相关尿路感染病原菌分布及预防

[目的]分析ICU病人留置尿管相关尿路感染发生情况及病原菌分布,探讨感染病原菌来源及感染预防策略.[方法]对2006年7月-2008年6月ICU留置尿管病人分离出的病原菌及其药敏结果进行分析.[结果] ICU医院感染发生率27.8%,留置尿管病人中泌尿道感染发生率为20.8%(78/375),感染病原菌以革兰阴性菌为主,占56.3%,真菌占29.5%,革兰阳性菌占14.3%.肠杆菌科中大肠埃希菌产超广谱β内酰胺酶(ESBLs)株检出率53.1%,肺炎克雷伯菌37.5%.未出现耐万古霉素肠球菌.[结论]ICU留置尿管病人医院感染病原菌以革兰阴性菌为主,且感染率较高,应尽量避免不必要的留置导尿;严格无菌操作和手卫生规范,加强对重点菌种如耐万古霉素肠球菌、产ESBLs大肠埃希菌和肺炎克雷伯菌等的专项监测.     

189例宫颈癌患者术后导尿细菌培养及药敏结果分析

目的:了解宫颈癌患者术后导尿细菌培养病原菌种类及其对抗生素的耐药性。方法:对我院2006年1月至2008年1月189例宫颈癌术后患者,留置导管5~7天后的留置导尿细菌培养及药敏结果进行回顾性分析。结果:189份导尿标本中尿培养阳性87份,阳性率为46.0%,其中临床无症状或者尿常规白细胞&lt;5/HPF的有37例,占尿培养阳性患者的42.5%。189份导尿标本中诊断尿路感染的共50例,发生率为26.5%。尿培养共检出病原菌95株,检出率居前的分别是热带假丝酵母菌29.5%(28/95),大肠埃希菌16.8%(16/95),阴沟肠杆菌14.7%(14/95),粪肠球菌8.4%(8/95)。另外在87份尿培养阳性标本中,混合感染(由两种或三种菌)占8.1%(7/87),酵母菌的检出率占阳性标本的41.4%(36/87)。药敏结果提示除酵母菌外的大多数病原菌呈多重耐药性。结论:宫颈癌术后导尿患者,尿培养以假丝酵母菌检出率最高,其次为大肠埃希菌、阴沟肠杆菌、粪肠球菌。预防性使用抗生素不能降低尿路感染的发生率,加强护理、及早拔管对控制宫颈癌术后泌尿系统感染和减少耐药菌的产生十分重要。     

洁悠神预防宫颈癌根治术后留置尿管伴随性尿路感染的效果观察

[目的]探讨洁悠神预防宫颈癌根治术后病人留置尿管伴随性尿路感染(CAUTI)的效果。[方法]将112例首次接受宫颈癌根治术的住院病人随机分为对照组和实验组,对照组术后按护理常规进行尿管护理,每日2次。实验组术后按护理常规进行尿管护理的同时,选用洁悠神喷洒于尿道口、导尿管、会阴部的皮肤黏膜及其接触到的衣裤、被褥,每日2次。[结果]实验组留置尿管期间尿路感染发生率明显低于对照组(P<0.05)。[结论]应用洁悠神对宫颈癌根治术后留置尿管病人进行尿管护理,有效地降低了尿路感染的发生。     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.