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1.
2006年中国十家教学医院革兰阴性杆菌的耐药状况   总被引:11,自引:0,他引:11  
目的 监测2006年我国革兰阴性杆菌的耐药性.方法 收集2006年9-12月10家教学医院987株非重复的革兰阴性杆菌.菌株经中心实验室复核后,采用琼脂稀释法测定美罗培南等广谱抗菌药物的最低抑菌浓度(MICs).结果 10种抗菌药物对于629株肠杆菌科细菌的抗菌活性的敏感率由大至小依次为:美罗培南(敏感率99.8%)、业胺培南(敏感率99.5%)、哌拉西林/三唑巴坦(91.3%)、阿米卡星(89.3%)、头孢吡肟(83.8%)、头孢哌酮/舒巴坦(79.7%)、头孢他啶(74.7%)、头孢噻肟(57.7%)、头孢曲松(56.6%)、环丙沙星(53.6%).大肠埃希菌中超广谱β内酰胺酶(ESBL)的发生率为59.0%,高于肺炎克雷伯菌(33.0%)和奇异变形杆菌(8.0%).对于大肠埃希菌和肺炎克雷伯菌,抗菌活性最高的依次是美罗培南、业胺培南(99.2%~100%)、哌拉西林/三唑巴坦(90.8%~97.0%)、阿米卡星(83.8%~92.4%).头孢吡肟对肺炎克雷伯菌的活性高于其对大肠埃希菌的活性(85.4%vs.65.2%).对于阴沟肠杆菌、产气肠杆菌、弗劳地柠檬酸菌,活性最高的依次为美罗培南、亚胺培南(99.2%~100%)、阿米卡星(85.2%~92.6%)、头孢吡肟(81.5%~85.9%)、哌拉西林/三唑巴坦(73.4%~87.2%)、头孢哌酮/舒巴坦(65.6%~77.7%)和环丙沙星(53.1%~72.3%).对于铜绿假单胞菌,活性最高的药物依次为阿米卡星(83.5%)、美罗培南(79.1%)、哌拉西林/三唑巴坦(74.1%)和亚胺培南(70.9%).鲍曼不动杆菌对于亚胺培南、美罗培南、头孢哌酮/舒巴坦的敏感性最高,敏感率分别为79.1%、73.4%、59.7%.多重耐药的鲍曼不动杆菌达到53.0%.对于洋葱伯克霍尔德菌,抗菌活性较高的依次是美罗培南(73.3%)、头孢他啶(73.3%)、哌拉西林/三唑巴坦(62.2%).结论 碳青霉烯类对肠杆菌科仍保持高活性,但鲍曼不动杆菌、铜绿假单胞菌的耐药件明显增加,值得关注.  相似文献   

2.
重症监护病房革兰阴性杆菌耐药性监测   总被引:1,自引:0,他引:1  
目的:调查从我院重症监护病房(ICU)患中分离的革兰阴性杆菌耐药状况,并探讨对耐药菌感染的治疗策略。方法:用E试验法测定100株革兰阴性杆菌对12种抗菌的最低抑菌浓度(MIC)。结果:亚胺培南和头孢哌酮-舒巴坦对所有受试菌仍保持最高抗菌活性,细菌的耐药率分别为9%和11%,哌拉西林-三唑巴坦、头孢吡肟次之,耐药率分别为19%和21%。阿米卡星、头孢他啶、阿莫西林-克拉维酸的耐药率分别为25%、26%和30%。其他抗菌药耐药率在43%-54%之间。头孢吡肟对铜绿假单胞菌抗菌活性最强,其敏感率达89%,头孢哌酮-舒巴坦、阿米卡星次之均为84%,亚胺培南、头孢他啶敏感率分别为79%和74%。筛选出超广谱β内酰胺酶(ESBLs)产生菌19株,抗菌活性最强的是亚胺培南、头孢哌酮-舒巴坦和哌拉西林-三唑巴坦,敏感率分别为84.1%、78.9%、和68.4%。结论:亚胺培南可作为ESBLs产生菌所致重症感染的首选药物,而β内酰胺酶抑制剂与β内酰胺酶类抗生素的复合制剂可作为治疗产β内酰胺酶耐药株感染的选用药物之一。  相似文献   

3.
191株铜绿假单胞菌对10种药物的体外抗菌活性分析   总被引:1,自引:0,他引:1  
目的分析我院铜绿假单胞菌的耐药持点.指导临床用药。方法收集2004年7月~2005年6月自我院分离的191株铜绿假单胞菌,采用纸片扩散法进行药物敏感试验,数据分析采用WHONET5.3软件。结果191株铜绿假单胞菌分离株中,耐药率〈30%的抗菌药物仃哌拉西林/三唑巴坦、亚胺培南、头孢他啶、头孢吡肟和阿米卡星,其中对亚胺培南耐药率达到22.5%,ICU分离菌对哌拉西林、哌拉西林/三唑巴坦。亚胺培南、头孢他啶、头孢吡肟和阿米卡星的耐药率高于非ICU21.7%~42.6%(P〈0.05)。结论 了解铜绿假单胞菌的耐药现状,有利于为临床合理用药提供依据。  相似文献   

4.
目的 监测2010年中国革兰阴性杆菌的耐药性.方法 收集2010年9-12月全国13家教学医院的1 259株非重复的革兰阴性杆菌.菌株经中心实验室复核后,采用琼脂稀释法测定美罗培南等广谱抗菌药物的MIC.药敏结果判断采用CLSI 2011年M100-S21标准.结果 14种抗菌药物对845株肠杆菌科细菌的抗菌活性,敏感性依次为美罗培南829株(98.1%)、阿米卡星794株(94.0%)、亚胺培南761株(90.0%)、哌拉西林/他唑巴坦739株(87.5%)、头孢吡肟701株(83.0%)、厄他培南696株(82.4%)、头孢哌酮/舒巴坦678株(80.3%)、黏菌素637株(75.4%)、头孢他啶591株(70.0%)、环丙沙星499株(59.1%)、头孢西丁463株(54.8%)、头孢曲松452株(53.5%)、头孢噻肟442株(52.3%)、米诺环素435株(51.5%).大肠埃希菌中ESBL的发生率为61.3% (106/173),高于肺炎克雷伯菌[41.2% (70/170)].大肠埃希菌对美罗培南、亚胺培南、阿米卡星、哌拉西林/他唑巴坦保持较好的敏感性,而对环丙沙星、头孢曲松和头孢噻肟的耐药率较高.肺炎克雷伯菌对美罗培南、亚胺培南、阿米卡星和黏菌素的敏感率均保持在90%以上,而对头孢曲松和头孢噻肟的耐药率较高.阴沟肠杆菌、产气肠杆菌、弗劳地柠檬酸菌,对美罗培南、阿米卡星、头孢吡肟、头孢哌酮/舒巴坦、亚胺培南、哌拉西林/他唑巴坦、厄他培南的敏感率都保持在80.0%以上.对于铜绿假单胞菌敏感性较高的药物为黏菌素(98.4%,182株)、阿米卡星(85.9%,159株)、哌拉西林/他唑巴坦(80.0%,148株)、头孢他啶(79.5%,147株)、美罗培南(74.1%,137株)、环丙沙星(74.1%,137株)、头孢吡肟(73.5%,136株)、亚胺培南(71.9%,132株)和头孢哌酮/舒巴坦(70.8%,131株).鲍曼不动杆菌对碳青霉烯类的敏感率小于37.0%,对米诺环素敏感率为47.8%.97.8%(176株)的鲍曼不动杆菌对黏菌素敏感,泛耐药鲍曼不动杆菌和铜绿假单胞菌发生率分别为60.1%(108株)和18.9%(35株).结论 碳青霉烯类对肠杆菌科仍保持高活性,但鲍曼不动杆菌和铜绿假单胞菌的耐药性增加,鲍曼不动杆菌对碳青霉烯类的耐药性显著增加.  相似文献   

5.
目的了解江都地区肠杆菌科细菌产β-内酰胺酶的类型及耐药状况,并比较不同产酶茵对常规抗菌药物的耐药率。方法利用琼脂纸片扩散(K—B)法按美国国家临床实验室标准委员会(CLSI)规定检测超广谱β-内酰胺酶(ESBLs),用头孢西丁敏感试验筛查AmpC酶并做三维确证试验。结果在165株肠杆菌科细菌中,41株产ESBLs(24.9%),22株产AmpC酶(13.3%),8株同时产ESBLs和AmpC酶(4.9%)。不同产酶菌对13种抗菌药物耐药率明显不同,亚胺培南耐药率最低,哌拉西林/他唑巴坦、头孢吡肟次之。结论治疗产ESBLs和(或)AmpC酶的肠杆菌科细菌感染,亚胺培南等碳青霉烯类药物为首选,哌拉西林/他唑巴坦、头孢吡肟、头孢哌酮/舒巴坦及阿米卡星为备选药物。  相似文献   

6.
目的 探讨咸阳地区阴沟肠杆菌的产酶现状及其抗菌药物的应用.方法 收集2012年6月-2013年5月临床分离无重复的100株阴沟肠杆菌,采用KB琼脂扩散法检测超广谱β内酰胺酶(ESBLs)和通过改良三维试验检测AmpC,碳青霉烯酶的检测采用亚胺培南+ EDTA法,MIC检测采用微量倍比稀释法,按CLSI法规进行.结果 在100株阴沟肠杆菌中,产ESBLs酶的为49%,产AmpC酶的为29%,碳青霉烯酶的为0%,同时产ESBLs和AmpC酶为29%.药敏结果是哌拉西林/他唑巴坦、头孢哌酮/舒巴坦、美洛培南、头孢吡肟、环丙沙星、阿米卡星和头孢他啶的抑菌率分别为64.7%,58.8%,100%,70.6%,70.6%,64.7%,41.1%.联合药物头孢吡肟、哌拉西林/他唑巴坦、美洛培南、头孢哌酮/舒巴坦与阿米卡星对阴沟肠杆菌的协同及相加作用分别为(17.64-41.18)%,(11.76-47.06)%,(5.88-52.94)%和(0-58.83)%.联合药物头孢吡肟、哌拉西林/他唑巴坦、美洛培南、头孢哌酮/舒巴坦与环丙沙星对阴沟肠杆菌协同及相加作用分别为(11.76-23.54)%,(5.88-11.77)%,(11.77-47.06)%和(5.88-17.65)%.结论 产酶的阴沟肠杆菌在该地区处于一个相对较高的水平,因此临床医师应根据药敏结果选用抗菌药物.  相似文献   

7.
重症监护病房革兰阴性杆菌耐药性监测与分析   总被引:7,自引:0,他引:7  
目的了解重症监护病房(ICU)革兰阴性杆菌对临床常用抗菌药的耐药性变化,以指导合理选择抗菌药物。方法采用纸片扩散法对2003年1月-2004年12月我院ICU分离出的革兰阴性杆菌进行药敏检测,按NCCLS2003年版标准判断结果。结果2年中分离出245株革兰阴性杆菌,其中以不动杆菌(48.2%)和铜绿假单胞(11.0%)为主的非发酵菌占65.3%,74.5%来自痰液标本。亚胺培南的总敏感率最高(93.9%),对除嗜麦芽窄食单胞菌外的其他革兰阴性杆菌具有很好的抗菌活性;革兰阴性杆菌对头孢他啶、头孢哌酮-舒巴坦、头孢吡肟、哌拉西林-三唑巴坦和阿米卡星的敏感率多数为44%~68%,对其他抗菌药高度耐药;头孢他啶和复方磺胺甲嘿唑对嗜麦芽窄食单胞菌的敏感率高达73.3%。大肠埃希菌和肺炎克雷伯菌产ESBLs菌株分别占26.3%和32.3%;产酶菌株对多数常用抗菌药物耐药率高于非产酶菌株,对亚胺培南无耐药,头孢哌酮-舒巴坦和哌拉西林-三唑巴坦对产ESBLs菌株抗菌活性明显强于其他头孢菌素。结论非发酵菌在从ICU分离出的革兰阴性杆菌中占有较高比例,亚胺培南对除嗜麦芽窄食单胞菌外的其他革兰阴性杆菌具有较好的抗菌活性,其他抗菌药物抗菌活性较低。  相似文献   

8.
目的探讨慢性阻塞性肺疾病合并支气管扩张病原菌分布及耐药性分析。方法采用WHO-NET5.6回顾分析我院呼吸科2011年1月至2012年12月接受治疗的慢性阻塞性肺疾病合并支气管扩张病患者126例,使用珠海迪尔系统对其痰液标本培养分离株进行鉴定,用MIC法对所分离菌株进行常用抗菌药物的敏感性测定。结果共分离菌株77株,其中革兰阴性杆菌64株,占81.1%;革兰阳性球菌9株,占11.7%;真菌4株,占5.2%。铜绿假单胞茵、大肠埃希菌和流感嗜血杆菌的分离率位列前三位。药敏结果:31株铜绿假单胞菌对哌拉西林他唑巴坦、替卡西林/克拉维酸钾、头孢噻肟、头孢哌酮、美罗培南、环丙沙星、左氧氟沙星的耐药率〉75%。但对哌拉西林、头孢哌酮/舒巴坦、头孢吡肟、阿米卡星、奈替米星等较敏感。10株大肠埃希菌对B.内酰胺类抗菌药物耐药率较高,对亚胺培南、美罗培南、头孢哌酮/舒巴坦、头孢拉定、哌拉西林/他唑巴坦、阿米卡星等较敏感。9株流感嗜血杆菌对氨苄西林、头孢呋辛、四环素全部耐药;对复方新诺明耐药率较高,为88.9%。未出现三代头孢、亚胺培南、环丙沙星和阿奇霉素耐药株。8株肺炎链球菌对阿莫西林/克拉维酸钾、红霉素、阿奇霉素、四环素、克林霉素的耐药率〉75%,对万古霉素、头孢吡肟、左氧氟沙星、环丙沙星敏感。结论慢性阻塞性肺疾病合并支气管扩张病原菌种类多样,但以革兰阴性杆菌为主,细菌耐药现象严重,耐药机制复杂,临床应定期监测抗菌药物使用和耐药率变化,合理选择抗菌药物。  相似文献   

9.
目的 了解近3年本院呼吸道铜绿假单胞菌药敏变化趋势,指导临床合理使用抗菌药物.方法 收集并分析2006年至2008年我院呼吸道标本铜绿假单胞菌药敏资料.结果 近3年来,对铜绿假单胞菌敏感率增幅排在前5位的抗菌药依次是头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、环丙沙星、左氧氟沙星、亚胺培南.2006年,对铜绿假单胞菌敏感率超过70%抗菌药为阿米卡星:2007年为亚胺培南、阿米卡星、氨曲南和环丙沙星;2008年为阿米卡星、亚胺培南、环丙沙星和左氧氟沙星.中介敏感比率呈上升趋势的抗菌药物有氨曲南、头孢哌酮/舒巴坦、头孢噻肟.3年来,中介敏感比率保持在10%以上的抗菌药物有关罗培南、头孢哌酮/舒巴坦、左氧氟沙星和头孢吡肟.耐药率降幅前5位依次为头孢哌酮/舒巴坦、头孢吡肟、哌拉西林/他唑巴坦、左氧氟沙星和环丙沙星.3年来,铜绿假单胞菌耐药率均低于20%抗菌药为阿米卡星;耐药率在20%~30%抗菌药为亚胺培南和美罗培南.结论 近3年头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、环丙沙星、左氧氟沙星、亚胺培南等对铜绿假单胞菌敏感性逐年增加.2008年,阿米卡星、亚胺培南、环丙沙星和左氧氟沙星等对铜绿假单胞菌存在较高敏感率.  相似文献   

10.
目的 了解珠海市人民医院2009~2010年住院患者常见的菌群分布及其耐药性,为细菌性感染的诊治提供参考依据.方法 用生物梅里埃公司的ATB鉴定系统进行菌种鉴定和药敏试验,用ATBPLUS VER3.0软件统计分析结果.结果 2009~2010年共分离出革兰阴性杆菌3 032株,其中铜绿假单胞菌占29.55%,肺炎克雷伯菌占33.44%,大肠埃希菌占27.51%,阴沟肠杆菌占5.80%,其他革兰阴性杆菌占3.70%.铜绿假单胞菌耐药率高于60%的抗菌药物有头孢噻吩、头孢噻肟、头孢西丁.肺炎克雷伯菌对美罗培南、亚胺培南、头孢吡肟、阿米卡星菌、妥布霉素、哌拉西林/三唑巴坦敏感.大肠埃希菌对第三代头孢菌素、氟喹诺酮类的耐药率增高,对亚胺培南、美罗培南、阿米卡星敏感,对哌拉西林/三唑巴坦、头孢他啶及奈替米星较敏感.阴沟肠杆菌呈多重耐药.结论 该地区常见革兰阴性杆菌的构成比及耐药率和国内其他地区有一定的差异,且细菌多重耐药情况更为严重.  相似文献   

11.
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.  相似文献   

12.
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.  相似文献   

13.
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.  相似文献   

14.
目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4%(55/72)]明显高于成功组[31.7%(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3%(42/72)]高于成功组[38.1% (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9% (28/72)]高于成功组[23.8%(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大<6 cm、胎头位于坐骨棘上及宫口开大8~10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1%(44/72)]高于成功组[38.9%(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2%(52/72)]明显高于成功组[34.1 %(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.  相似文献   

15.
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.  相似文献   

16.
Ranganath C  Heller AS  Wilding EL 《NeuroImage》2007,35(4):1663-1673
Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.  相似文献   

17.
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.  相似文献   

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19.
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.  相似文献   

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