肺孢子菌肺炎实验室诊断研究进展

正耶氏肺孢子菌(Pneumocystis jirovecii,PJ)过去称卡氏肺孢子菌(Pneumocystis carinii,Pc),是一种引起呼吸系统严重肺孢子菌肺炎(pneumocystis pneumonia,PCP)的机会性致病菌。PCP主要发生于获得性免疫缺陷综合征(acquired immunodeficiency syndrome,AIDS)、恶性肿瘤以及自身免疫病等免疫功能低下者,临床症状与体征不典型,进展迅速,病死率高,是     

艾滋病合并肺孢子菌肺炎6例临床分析

肺孢子菌肺炎（Pneumoeystis pneumonia,PCP）是由肺孢子菌（PC）引起的急性肺炎,为一种发生于免疫功能低下患者的严重肺部机会性感染,是AIDS患者最常见的机会感染之一,约85．0％的晚期艾滋病患者会合并PCP。随着我国艾滋病患者的逐渐增多,PCP的发病率呈迅速上升之势。本院在2006—2008年共诊断艾滋病合并PCP患者6例,结合其临床资料及影像学特点,如何早期诊断及尽早治疗艾滋病合并PCP,现分析如下。     

艾滋病卡氏肺孢子菌肺炎患者并发呼吸衰竭的高危因素及护理对策

目的探讨艾滋病（AIDS）卡氏肺孢子菌肺炎（PCP）患者并发呼吸衰竭的危险因素,并提出相应的护理干预对策。方法选取68例AIDS合并PCP患者为研究对象,对所有患者并发呼吸衰竭可能的危险因素进行单因素χ2检验以及多因素Logistic回归分析。结果68例AIDS合并PCP患者中,有42例发生呼吸衰竭,发病率61.8%。多因素Logistic回归分析提示：年龄、血红蛋白水平、血CD4＋T淋巴细胞计数、MOS-HIV生理健康总分、HAART、治疗的依从性、合并细菌性肺炎是AIDS合并PCP患者并发呼吸衰竭的独立危险因素。结论 AIDS合并PCP患者出现呼吸衰竭的几率高,且受多种危险因素的影响,临床应当针对性地对这些高危因素进行护理干预,降低呼衰的发病率。     

1例肺孢子菌肺炎非典型临床特征分析

目的分析卡氏肺孢子菌肺炎的临床特点,提高临床医师对PCP的认识。方法对医院呼吸科2011年12月诊治的1例卡氏肺孢子菌肺炎患者的临床资料,包括病史、体征、实验室检查、胸部影像学检查、治疗过程等资料进行分析、总结,并进行文献复习。结果肺孢子菌肺炎临床表现缺乏特异性,在临床上易被延误诊断,根据相关文献报道,在疾病的早期5¹0d未接受治疗,病死率可达75.0%10d未接受治疗,病死率可达75.0%¹00.0%。结论对于不典型临床表现的间质性肺炎,特别是HIV高危者,应考虑到肺孢子菌肺炎的可能。     

肾移植术后肺孢子菌肺炎的诊治

目的 探讨肾移植术后并发肺孢子菌肺炎(PCP)的诊断和治疗,提高对PCP的认识.方法 回顾性分析21例肾移植术后PCP患者的资料.结果 21例肾移植术后PCP患者,临床表现为发热、咳嗽、呼吸困难.胸部X线片示双肺弥漫性间质浸润性改变.治疗首选复方磺胺甲(噁)唑.20例临床治愈出院,死亡1例.结论 早期诊断并及时治疗是提高PCP患者生存率的关键.     

克林霉素联合复方磺胺甲口恶唑片治疗艾滋病并肺孢子菌肺炎的效果观察

目的:探究克林霉素联合复方磺胺甲口恶唑片治疗艾滋病(AIDS)并肺孢子菌肺炎(PCP)的效果.方法:选取2015年9月-2016年9月收治的80例艾滋病并肺孢子菌肺炎患者临床资料进行分析,将其按照不同治疗方式分成对照组(40例)与研究组(40例),对照组予以复方磺胺甲口恶唑片进行治疗,研究组在对照组基础上加用克林霉素治疗,比较两组实验室指标水平、血氧指标情况.结果:两治疗后研究组LDH、ALB水平优于对照组(P<0.05),研究组血氧指标水平显著较对照组优(P<0.05).结论:AIDS并发PCP患者予以复方磺胺甲口恶唑片与克林霉素联合治疗能够有效改善临床症状.     

用乙胺嘧啶-周效磺胺联合剂预防AIDS相关性卡氏肺囊虫感染

卡氏肺囊虫肺炎(PCP)是获得性免疫缺陷综合征(AIDS)患者最常见的条件致病性感染。用 TMP-SMZ 治疗效果明显,但复发率较高。动物实验和 AIDS 患者研究表明,TMP-SMZ 或戊脘脒均不能杀灭卡氏肺囊虫。曾有报道,TMP-SMZ 可用以预防白血病患儿发生肺囊虫病。但是该药可使AIDS 患者产生超敏反应和严重副作用。作者试用乙胺嘧啶-N 效磺胺联合剂(比例1∶20)预防 AIDS 患者的 PCP。     

1例艾滋病病人合并卡氏肺孢子虫肺炎调查

目的探讨AIDS合并卡氏肺孢子菌肺炎的临床表现、诊断和治疗,通过PITC及早发现艾滋病病毒感染者和病人的相关性。方法采用回顾性调查的方法对1例AIDS合并卡氏肺孢子虫肺炎患者的临床特点、实验室检查和64排螺旋CT表现进行分析报告。结果建议在二级以上医疗机构全面推行PITC,尽早发现艾滋病感染者及病人,降低艾滋病感染率和发病率,为政府制定艾滋病防治政策和长期规划提供基础数据。     

非艾滋病免疫功能抑制患者肺孢子菌肺炎的临床特点及诊治探讨

目的研究非艾滋病(AIDS)免疫功能抑制患者发生肺孢子菌肺炎(PCP)的临床特点并对β-D-葡聚糖的诊断价值和治疗药物进行探讨。方法回顾性分析呼吸科2010年7月-2011年6月收治的15例非AIDS免疫功能抑制患者发生PCP的临床表现、实验室检查、治疗及转归,采用STATA 8.0统计软件。结果所有患者发生PCP前均接受了激素或免疫抑制剂治疗,其中14例应用了泼尼松或甲泼尼龙,9例应用了吗替麦考酚酯,15例患者平均APACHEⅡ评分为(16±5)分,氧合指数均<300mm Hg,66.7%的患者CD4淋巴细胞计数<200/μl,93.3%的患者血清β-D-葡聚糖升高;所有患者的抗PCP治疗均联合应用了卡泊芬净和磺胺甲恶唑/甲氧苄啶,总体病死率26.7%,接受无创通气或有创机械通气患者病死率为50.0%,高于未接受无创通气或有创机械通气患者(P=0.077)。结论非AIDS免疫功能抑制患者中PCP的病死率较高,β-D-葡聚糖可以做为PCP感染的一个诊断参考指标,卡泊芬净联合磺胺甲恶唑/甲氧苄啶治疗PCP有效。     

耶尔森氏菌病的治疗

近年来许多国家特别是北欧国家耶尔森氏菌病(下称耶氏菌病)的发病率上升。该病常发现于肠道感染患者,仅次于沙门氏菌病。苏联耶氏菌病有上升趋势。耶氏菌病发病人数增多、临床表现多样性、多器官和系统受累、复发率高、易于转变为迁延和慢性病程、难于诊断和尚无可靠疗法等,给本病的治疗带来很大困难。耶氏菌病的治疗同其他传染病一样,应采用针对病因和发病机理为主的综合疗法。在治疗过程中要考虑到疾病临床型和病情轻重型。病因治疗可用抗生素和其他抗菌药物。     

长春新碱过量引起严重毒副反应1例的护理体会

报道1例霍奇金淋巴瘤患者因误用长春新碱（VCR）10mg一次性静脉推注后治疗护理情况。其出现间断性神志恍惚、眼睑闭合不全、言语不清、口腔黏膜糜烂、全身疼痛、麻痹性肠梗阻、尿潴留、手足麻木等症状,经积极解救,禁食,持续胃肠减压、胃管内注入麻油、开塞露、生理盐水灌肠,合理应用肠外营养,注重疼痛、心理护理,做好口腔、肛周护理,预防感染加重,患者病情得到控制好转出院。     

Correlates of stages of change of smoking among inhabitants of deprived neighbourhoods

BACKGROUND: This study examines the prevalence and correlates of stages of change of smoking, in terms of psychosocial, structural and sociodemographic factors, among inhabitants of deprived neighbourhoods. METHODS: Cross-sectional data were obtained from a survey on health related behaviour. Subjects were 2009 current and former smokers, aged 20-46, living in deprived neighbourhoods in Rotterdam, the second largest city in the Netherlands. Three groups of smokers were formed according to the stages of change-definitions of the Transtheoretical Model: smokers not planning to quit (precontemplators), smokers planning to quit (contemplators/preparators) and former smokers (actors/maintainers). Smokers planning to quit and smokers not planning to quit were compared regarding psychosocial factors (attitude, social norm, self-efficacy), structural factors (neighbourhood problems, material deprivation, financial problems, employment status) and sociodemographic factors (age, gender, marital status, cultural background, educational level). Former smokers were compared with smokers planning to quit regarding structural and sociodemographic factors. Logistic regression was used to assess correlates of stages of change. RESULTS: Smokers planning to quit (prevalence = 19%) reported a more positive attitude, stronger social norms and higher self-efficacy expectations in quitting smoking than smokers not planning to quit (prevalence = 57%). Smokers planning to quit less often were Dutch-born, more often had attended higher vocational schooling or university and more often reported experiencing two or more neighbourhood problems compared to smokers not planning to quit. Former smokers (prevalence = 24%) were older, more often Dutch-born, married, employed and higher educated, compared to smokers planning to quit. Furthermore, former smokers less often reported material deprivation and financial problems than smokers planning to quit. CONCLUSION: Among people living in deprived neighbourhoods, different factors correlate with different stages of change of smoking. Implications for health promotion are discussed.     

Choice of measures of vaccination and estimates of risk of pediatric pertussis

BackgroundVaccination uptake at the individual level can be assessed in a variety of ways, including traditional measures of being up-to-date (UTD), measures of UTD that consider dose timing, like age-appropriate vaccination, and risk reduction from individual doses. This analysis compared methods of operationalizing vaccination uptake and corresponding risk of pertussis infection.MethodsCity-wide case-control study of children in Philadelphia aged 3 months through 6 years, between 2001 and 2013. Multiple logistic regression was used to isolate the independent effects of each measure of vaccination uptake and the corresponding relative odds of pertussis.ResultsBeing UTD on vaccinations was associated with a 52% reduction in risk of pertussis (OR 0.48, 95% CI: 0.34, 0.69). Evaluation of delayed receipt of vaccine versus on-time UTD yielded similar results. There was a decrease in risk of pertussis for each additional dose received with the greatest reduction in pertussis infection observed from the first (OR 0.48, 95% CI: 0.28, 0.83) and second dose (OR 0.17, 95% CI: 0.08, 0.34). Additional doses conferred minimal additional protection in this age group.ConclusionExamining vaccination status by individual doses may offer improved predictive capacity for identifying children at risk for pertussis infection compared to the traditional UTD measure.     

上海市某医院骨科平均住院日影响因素分析

对上海市某医院2003年-2007年骨科出院病人的住院日描述性分析．2003年-2007年骨科的床位利用指数与平均住院日相关性分析．2003年-2007年骨科床位与医护比例分析．2007年骨科前10大病种平均住院目影响因素分别进行单因素相关性分析和多因素逐步回归分析（STATA软件）。通过对骨科10大病种住院日影响因素分析,术前等待天数、手术类型、是否输血分别对10个、9个和8个病种的住院目有影响。输血因素和手术类型是医院不可控、由病人的病情决定的,术前等待天数是管理因素,是最值得医院重视的影响因素。     

两种不同肌瘤剔除术治疗子宫肌瘤的临床疗效比较

目的:比较腹腔镜子宫肌瘤剔除术与腹式子宫肌瘤剔除术的临床疗效。方法:回顾分析63例腹腔镜子宫肌瘤剔除术与61例腹式子宫肌瘤剔除术的临床资料,比较2种手术方式的手术时间、术中出血量、肛门排气时间、使用抗生素时间、术后感染率、体温恢复正常时间、住院时间等情况。结果:两组患者接受子宫肌瘤剔除术顺利完成,腹腔镜组手术时间长于开腹组(P0.05),腹腔镜组术中出血量及剔除肌瘤个数均少于开腹组(P0.05),术后腹腔镜组体温恢复正常时间、肛门排气时间、抗生素使用及住院时间均短于开腹组,两组患者最多随访6个月,腹腔镜组平均康复时间较开腹组短(P0.05),两组随访B超均未发现明显肌瘤结节。结论:腹腔镜子宫肌瘤剔除术损伤小,恢复快,住院时间短,是值得推广的微创手术。     

尘肺病患者145例死因调查

目的分析汉中市尘肺病的发生、发展和死亡原因，以提高尘肺病患者的生存质量。方法对145例尘肺病患者的死因进行回顾性分析，计算其平均发病年龄、死亡年龄及患尘肺病后的存活年限。结果矽肺的平均发病年龄和死亡年龄均早于煤工尘肺和石棉肺，尘肺病的主要死因为患肺部疾患，患尘肺病后的平均存活年限为12a。结论加强职业健康体检工作，对尘肺病人做到早发现早治疗和预防并发症的发生。     

性发育异常发病机制的研究进展

正常的性腺分化可分为3个过程：原始性腺形成、性别决定和卵巢/睾丸发育。在任一环节中,基因表达或调控发生异常均有可能导致性发育异常疾病的发生。性发育异常是指染色体、性腺和解剖性别不典型。随着分子生物学技术的发展,不断地发现新的基因或信号通路参与性腺分化和发育,如SRY、SF1、WT1、Sox9等基因与睾丸发育密切相关,Wnt/Rspo1/B连环蛋白通路、Dax1、Foxl2等基因在卵巢分化中发挥着重要作用,一些非编码RNA和转化生长因子也有重要的调节功能,且睾丸和卵巢发育均为主动过程,即使在出生后因某些基因的改变两者间也可出现横向分化。这些为揭示性分化异常的发病机制提供了可能。     

西林瓶装注射用水的装量检查分析

为了检查西林瓶装注射用水的实际分装量是否符合2005年版《药典》三部要求,按照2005年版《药典》三部中“生物制品分装和冻干规程”,分装规格为0．8ml的西林瓶装注射用水10000瓶,随机在分装过程的前、中、后阶段共抽取100瓶,轧盖、目检。分别用1ml标定注射器及1ml普通无菌注射器抽取每瓶注射用水的实际体积,以t检验法对实际抽取量与标示量的差值进行统计学分析,结果显示其与2005年版《药典》三部要求分装附加量为0．1ml相比有显著性差异（P〈0．001）。     

One-year stability of the Measure of Processes of Care

BACKGROUND: The Measure of Processes of Care (MPOC) is a 56-item self-administered measure designed to examine what parents of a child with a chronic health problem think of the services they and their child receive, and to measure the extent to which these services are family-centred. Reliability and validity of the MPOC were established in prior studies. The aim of the present study was to assess the 1-year stability of the MPOC to justify its use as an evaluative tool. METHODS: Nine paediatric rehabilitation centres in the Netherlands participated in this short longitudinal survey study. Subjects were 205 parents (response rate 74.8%) of children aged 1-18 years who received care in one of the participating paediatric rehabilitation centres. All subjects filled out two MPOCs with a 1-year interval. RESULTS: All correlations between the scale scores of the MPOC at the first and second administration were relatively high and significant (range: 0.443-0.609, all P < 0.001), demonstrating high inter-individual stability. However, all mean scale scores, except for Providing General Information, significantly reduced after 1 year. CONCLUSIONS: The MPOC has a moderate 1-year stability. However, because of its tendency to score lower when repeated after 1 year, its use as an evaluative follow-up instrument to assess the effectiveness of a programme intervention is restricted.     

儿童皮质发育畸形的MRI诊断

目的探讨儿童皮质发育畸形(MCD)的MRI表现特点,为MCD的早期诊断提供依据。 方法选择2010年1月至2012年12月在四川省医学科学院·四川省人民医院放射科经MRI检查确诊为MCD的44例患儿为研究对象。回顾性分析及总结其MRI影像学特征。本研究遵循的程序符合四川省医学科学院·四川省人民医院人体试验委员会制定的伦理学标准,得到该委员会批准,征得受试对象及其监护人知情同意,并与监护人签署临床研究知情同意书。 结果本组44例经MRI确诊为MCD患儿中,巨脑回-无脑回为17例,多小脑回为14例,灰质异位为9例,脑裂畸形为4例。MCD的MRI特点中,巨脑回表现为脑回增宽、皮质增厚及白质变薄;无脑回表现为正常脑沟、脑回消失,皮质增厚及白质变薄;多小脑回表现为脑回增多、细小;灰质异位表现为皮质下及侧脑室周围深部白质区结节状、团块状或带状病灶,信号与灰质信号相同;脑裂畸形表现为从侧脑室到脑表面贯穿大脑半球的裂隙,表面覆盖灰质。 结论MRI是诊断儿童MCD的可靠影像学方法。