临床抗感染决策对NICU新生儿败血症心肌损害的影响

目的 研究临床首选不同抗生素的抗感染决策对NICU新生儿败血症心肌损害发生率的影响.方法 采用前瞻性临床研究方法,分析了入住NICU的112例新生儿败血症患儿心肌损害的发生率与首选不同的抗生素及其抗感染治疗效果的关系.结果 治疗有效者88例,心肌损害的发生率为43%,显著低于无效者(79%,P＜0.05).抗感染疗效差,5 d内需更换抗生素者心肌损害的发生率显著高于不需更换者(P＜0.05).头孢地嗪(CDZ)组43例,心肌损害的发生率为33%,显著低于首选其他抗生素组,即复方抗生素组和单方抗生素组(70%,56%,P＜0.05).结论 尽早选择安全、有效的抗生素,减少抗生素的更换率,可降低新生儿败血症心肌损害的发生率.CDZ治疗新生儿败血症临床疗效好.     

新生儿败血症的监护

1引言 新生儿败血症是指新生儿期细菌侵入血循环并在其中生长繁殖，产生毒素所造成的全身感染。该病可引起全身各脏器损害，其主要临床表现为不吃、不哭、不动、面色不好、精神萎靡、嗜睡、黄疸、出血倾向、休克，肝、脾肿大等。其发生率占活产婴儿的0．1％～1％，病死率为10％～50％，存活儿有相当一部分发生后遗症，严重威胁着新生儿的健康。对新生儿败血症患儿的各项指标进行监护和监测可清楚了解病情的进展，以便临床采取有效治疗措施，提高治愈率，减少后遗症的发生率。     

婴幼儿轮状病毒性肠炎心肌损害及相关因素分析

目的：了解婴幼儿轮状病毒性肠炎的心肌损害的发生率及相关因素。方法：对73例病毒学确诊为轮状病毒性肠炎的患儿行心肌酶谱,血生化,心电图及胸片检查,并对临床资料进行分析。结果：轮状病毒性肠炎的婴幼儿心肌损害发生率达52．1％,伴严重腹泻、脱水,酸中毒时心肌损害发生率分别为：62．2％,58．9％,68．0％,明显高于单纯腹泻的心肌损害（P＜0．05）。而心肌损害不受发病年龄及是否存在发热、呼吸道感染影响（P＞0．05）。结论：轮状病毒性肠炎易并发心肌损害,心肌损害程度与腹泻轻重、脱水程度,酸中毒有关,与发病年龄,是 在发热与呼吸道感染无关。     

新生儿败血症中血小板变化的比较和分析

目的：探讨新生儿败血症患者血小板计数与病情的关系。方法：对41例患儿诊断为新生儿败血症前后进行血培养和血小板计数。结果：感染前血小板数量为202．1±80．4，感染后为104．8±77．4，发现血小板数量随感染轻重而增减，感染重者血小板计数较轻者少（P〈0．01）。结论：新生儿败血症感染轻重与血小板数量变化具有相关性。     

降钙素原对新生儿败血症的诊断价值

目的：探讨新生儿败血症患儿血中降钙素原（PCT）的变化。方法：采用放射免疫法检测32例新生儿败血症（其中24例血培养阳性，8例血培养阴性而临床确诊）患儿血中PCT浓度的改变，同时以32例普通细菌感染和新生儿缺氧缺血性脑病（HIE）患儿作为对照。结果：新生儿败血症患儿急性期血中PCT浓度明显增高，与对照组相比P〈0．01，在疾病的恢复期PCT浓度明显下降，治疗前后PCT浓度下降，比较有显著性差异，P〈0．05。结论：PCT可以作为判断新生儿败血症的早期实验室指标之一。     

脐血胆红素检测在新生儿黄疸中的应用

目的：探讨脐血胆红素与新生儿黄疸的关系。方法新生儿分娩后取脐血作胆红素测定并跟踪其后情况,结合临床资料进行分析。结果新生儿高胆血症发生率为28．0％。136例新生儿中,随脐血总胆红素浓度增加,新生儿高胆红素血症发生率也增高,且当脐血总胆红素大于或等于35μmol／L 时,新生儿黄疸发生率高达77．4％。黄疸组与非黄疸组间比较差异有统计学意义（P ＜0．05）。结论新生儿黄疸发生率与脐血总胆红素浓度密切相关,通过检测脐血总胆红素浓度对预测新生儿黄疸有一定价值。     

新生儿败血症心电图改变及其临床意义

【目的】探讨新生儿败血症早期心电图改变及其临床意义。【方法】选择68例新生儿败血症患儿,在入院24 h内进行常规心电图检查,对心电图异常患儿进行动态监测,3d后心电图持续异常者结合血清心肌酶谱检测,了解心肌损害情况。【结果】68例新生儿败血症患儿早期有心电图改变的为48例(70.05%);3d后持续心电图异常者为37(54.4%),其中心肌酶活性增高的72.9%(27/37),提示心肌损害。【结论】新生儿败血症早期常有心电图的改变,持续异常改变高度提示心肌损害发生。新生儿败血症患儿进行动态心电图观察,对临床及时发现和防止心肌损害有重要的临床意义。     

小剂量多巴胺治疗重度窒息新生儿肾功能损害的临床疗效

目的：探讨采用小剂量多巴胺治疗重度窒息新生儿肾功能损害的临床疗效,为临床治疗提供依据。方法选取2011年10月至2013年10月郧西县人民医院接诊的重度窒息新生儿肾功能损害患儿70例,随机分为研究组与对照组,各35例;对照组患儿根据其肾功能损害采取对症处理,而研究组患儿在对照组基础上加用小剂量多巴胺治疗;记录并对比两组患儿治疗前、治疗后3 d、7 d时血尿素氮（BUN）与血肌酐（Cr）水平,同时对两组患儿临床治疗总有效率以及包括新生儿缺氧缺血脑病（HIE）、心功能损害、胃肠功能损害及肾功能损害在内的脏器损害情况进行对比分析。结果研究组治疗总有效率94．29％（33／35）明显高于对照组77．14％（27／35）,组间比较差异有统计学意义（P＜0．05）;研究组患儿在治疗后3 d、7 d时Cr与BUN水平皆有明显下降,而对照组在治疗后7 d时呈明显下降,与治疗前比较差异均有统计学意义（P＜0．05）,但研究组患儿改善更明显,组间比较差异有统计学意义（P＜0．05）;研究组患儿在各个脏器损害发生率上皆低于对照组,且组间比较胃肠功能与肾功能损害的发生率差异均有统计学意义（P＜0．05）。结论采用小剂量多巴胺治疗重度窒息新生儿肾功能损害可以取得较好的效果,其总有效率较高,并能明显减少胃肠、肾等脏器的损害,改善患儿Cr与BUN水平,促进患儿早日康复,值得临床借鉴。     

新生儿窒息与肾功能损害70例临床分析

目的：探讨新生儿窒息与肾功能损害的关系。方法：对70例窒息新生儿与30例无窒息新生儿作血尿素氮(BUN)及肌酐(Cr)检测．并进行分析观察。结果：70例窒息新生儿中血BUN、Cr显著高于无窒息对照组(P＜0．001)，重度窒息组血BUN、Cr显著高于轻度窒息组(P＜0．05)，体重＜2500g组BUN、Cr显著高于体重＞／2500g组(P＜0．025)，胎龄＜37周组BUN、Cr显著高于胎龄≥37周组(P＜0．05)。结论：新生儿窒息缺氧会导致肾功能损害．血BUN、Cr可作为判断肾功能受损的指标。     

新生儿败血症死亡相关因素分析

目的探讨新生儿败血症死亡的相关因素。方法回顾性分析商丘市中医院新生儿重症监护室2005年1月至2010年12月收治的106例诊断为新生儿败血症病例的临床资料。比较存活和死亡患儿的临床特点并进行单因素χ2检验。结果 106例患儿中,存活94例,死亡12例,总病死率11.3%;并应用统计学方法对胎龄等6项因素对本病死亡的影响做出分析,结果显示,胎龄、入院体质量、凝血功能、休克并多脏器损害、白细胞计数对本病死亡有显著影响。结论凝血功能、休克并多脏器损害等5项因素与新生儿败血症死亡显著相关。     

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.     

Prospects for the control of neglected tropical diseases by mass drug administration

The prospects for the control of neglected tropical diseases, including soil-transmitted helminthiasis, shistosomiasis, lymphatic filariasis, onchocerciasis and trachoma, through mass drug administration, are exemplified by the elimination of the trachoma as a public-health problem in Morocco. In spite of this and other striking successes, mass drug administration programs are faced with major challenges resulting from suboptimal coverage and lack of efficacy. At current suboptimal coverage rates, programs may need prolongation for an extended period, increasing costs and undermining sustainability. Community participation through health education and information appears to be crucial to improve coverage and to achieve sustainability. Implementation of complementary measures, such as vector control, improved hygiene and environmental sanitation, are important to further control transmission and to prevent re-emergence of the infection and, again, may only be achieved effectively through community-based initiatives. To reduce costs and to relieve pressure on the health system, combining neglected tropical disease programs in areas where diseases coexist and integration with existing control programs for malaria, tuberculosis and HIV/AIDS is advocated. The risk of developing drug resistance is of particular concern in view of the lack of alternative drugs, and reduced treatment efficacy due to emerging resistance is evident for the soil-transmitted helminths and onchocerciasis. Given the risk for the development of drug resistance and the need for a high degree of participation, close attention should be paid to the monitoring of the coverage and efficacy of the different program components.     

Bacterial meningitis: an update of new treatment options

The outcome of bacterial meningitis critically depends on the rapid initiation of bactericidal antibiotic therapy and adequate management of septic shock. In community-acquired meningitis, the choice of an optimum initial empirical antibiotic regimen depends on the regional resistance patterns. Pathogens resistant to antibacterials prevail in nosocomial bacterial meningitis. Dexamethasone is recommended as adjunctive therapy for community-acquired meningitis in developed countries. In comatose patients, aggressive measures to lower intracranial pressure <20 mmHg (in particular, external ventriculostomy, osmotherapy and temporary hyperventilation) were effective in a case–control study. Although many experimental approaches were protective in animal models, none of them has been proven effective in patients. Antibiotics, which are bactericidal but do not lyse bacteria, and inhibitors of matrix metalloproteinases or complement factor C5 appear the most promising therapeutic options. At present, vaccination is the most efficient method to reduce disease burden. Palmitoylethanolamide appears promising to enhance the resistance of the brain to infections.     

Imaging choices in occult hip fracture

Background: Hip fracture is a common injury, with an incidence rate of > 250,000 per year in the United States. Diagnosis is particularly important due to the high dependence on the integrity of the hip in the daily life of most people. Objectives: In this article we review the literature focused on hip fracture detection and discuss advantages and limitations of each major imaging modality. Discussion: Plain radiographs are usually sufficient for diagnosis as they are at least 90% sensitive for hip fracture. However, in the 3–4% of Emergency Department (ED) patients having hip X-ray studies who harbor an occult hip fracture, the Emergency Physician must choose among several methods, each with intrinsic limitations, for further evaluation. These methods include computed tomography, scintigraphy, and magnetic resonance imaging. Conclusion: We present an evidence-based algorithm for the evaluation of a patient suspected to have an occult hip fracture in the ED. Also outlined are future directions for research to distinguish more effective techniques for identifying occult hip fractures.     

Systematic Reviews Published in the April 2012 Issue of the Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD but monthly online. The April 2012 issue (second DVD for 2012) contains 5045 complete reviews, 2182 protocols for reviews in production, and 17,084 short summaries of systematic reviews published in the general medical literature. In addition, there are citations of 674,000 randomized controlled trials, and 15,400 cited papers in the Cochrane methodology register. The health technology assessment database contains just over 11,000 citations. One hundred and seventeen new reviews have been published in the last 3 months of which 12 have potential relevance for practitioners in pain and palliative medicine. The impact factor of the Cochrane Library stands at 6.186. Readers are encouraged to access the full report for any articles of interest as only a brief commentary is provided.     

Platelets,thrombosis, coagulation,and atherosclerosis

When I first got the invitation to join a medical delegation going to Moldova, I thought for a moment that our destination was the fictional country in the old Marx Brothers movie Duck Soup. On further checking, it turns out that entertaining place was called Freedonia. I now know that Moldova is indeed a real country, bordered on the west by Romania and on the other three sides by the Ukraine. It is a proud country, rich with traditions, and its people are warm, giving, eager to learn ways to improve their healthcare system, and deeply appreciative of our attempts to help them in the task.     

Advance Care Planning

Predictors of patient wishes and influence of family and clinicians are discussed. Research findings on patient decision-making relating to preferences in end-of-life care are described. Advance directives and durable powers of attorney are defined and differentiated. Most patients have not participated in advance care planning and the need for more effective planning is documented. Appropriate times for discussions of such planning are described. Scenarios discussed include terminal cancer, chronic obstructive pulmonary disease, AIDS, stroke, and dementia. Patient satisfaction is discussed, as is a structured process for discussions about patient preferences. Results of patient responses to hypothetical scenarios are described. Invasiveness of interventions, prognosis and other factors that favor or discourage patient preferences for treatment are discussed. Findings resulting from research funded by the Agency for Healthcare Research and Quality (AHRQ) are discussed. This research can help providers offer end-of-life care based on preferences held by the majority of patients under similar circumstances.     

Spiritual Dimensions of Nursing Practice. edited by V. B. Carson

The Cochrane Library of Systematic Reviewsis published quarterly. Issue one for 2004 of the library was published in February 2004. This issue contains 3,329 reviews and protocols of which 1,921 are fully published reviews. The trials database now stands at over 400,000 records with an additional 4,427 one-page summaries of non-Cochrane reviews in the NHS database of reviews of effectiveness (DARE). This version of the library contains the results of an extensive search for RCTs on EMBASE. The latest library contains 84 new reviews, seven are considered relevant to practitioners in pain and palliative care. References are published in the same format as the citation for Cochrane reviews.     

Évaluation,par l’imagerie ultrasonore,du recrutement musculaire,de la force motrice et de la détente verticale du quadriceps après électromyostimulation (cas de 15 étudiants de l’INJS)

The increase of strength seems to be an element of performance in some sports.