105例老年人尿路感染临床分析

目的为提高老年人尿路感染的诊治水平。方法对105例老年人尿路感染患者进行问顾性分析。结果（1）老年尿路感染以男性多见，男女比例为1：0．8，老年男性尿路感染大部分有易感因素；（2）清洁中段尿培养阳性率低（40％），致病菌以革兰阴性菌（G^-）为主，依次为大肠杆菌、变形杆菌和克雷伯杆菌；革兰阳性菌（G^＋）以肠球菌占首位；（3）常见致病菌对氨苄西林、环丙沙星、复方新诺明的耐药率高达90％，对G^-菌（大肠杆菌）。以亚胺培南的耐药率最低（1．2％），其次为头孢三嗪（20．3％），阿米卡星（22．4％）。而对C^＋菌（肠球菌），万古霉素仍保持最低的耐药率（1．0％）。结论老年尿路感染致病菌主要为G^-菌，经验选用头孢三嗪、阿米卡星、氨苄西林、环丙沙星、复方新诺明已广泛耐药。临床上对老年疑诊有尿路感染者要做细菌耐药性检测，根据其结果合理用药，及时发现和纠正易患因素．     

112例住院老年人尿路感染临床分析

目的 提高对住院老年人尿路感染的认识.以采取积极有效的防治措施.方法 对112例老年人尿路感染患者进行临床分析.结果 1、老年患者多合并有易感因素,临床症状不典型.易误诊漏诊;2、致病菌以G-杆菌居多,常见为大肠埃希菌:3、常见致病菌对复方新诺明及环丙沙星、左氧氟沙星、头孢三嗪、头孢噻肟耐药率高.结论 老年人尿路感染易感因素多,症状常不典型,以大肠杆菌为主,易产生耐药性,抗菌素使用应结合药敏试验.尽量去除易感因素.     

239株尿路感染细菌的分布及耐药性分析

目的 了解怀化地区尿路感染的细菌分布和细菌耐药状况。方法 对疑似尿路感染患者进行中段尿细菌培养和药物敏感试验。结果 经中段尿细菌培养分离出的239株细菌中，大肠埃希氏菌占所有病原菌的首位，占43．5％，肠球菌占第二位，占16．7％，白色念珠菌占第三位，占13．4％；从药敏试验看，大肠埃希氏菌对亚安培南、阿米卡星、哌拉西林／他唑巴坦、头孢他定的耐药率较低，铜绿假单胞菌和非发酵菌对亚安培南的耐药率较低，葡萄球菌和肠球菌对万古霉素的耐药率最低。结论 在尿路感染中主要病原菌为革兰氏阴性杆菌并以大肠埃希氏菌为主。白色念珠菌在尿路感染中占有相当的比例，应引起重视。     

尿路感染常见致病菌分析及耐药性测定

本文分析了临床分离的３７１株致病菌的分布及其耐药性的测定。结果显示,革兰氏阴性杆菌占６１．６％,其中大肠埃希氏菌占４６．５％,革兰氏阳性菌占４８．４％,丁胺卡那霉素、头孢三嗪和头孢噻腭对大肠埃希氏菌、克雷伯菌、铜绿假单孢菌、肠球菌、表皮葡萄球菌耐药性较小。万古霉素对革兰氏阳性球菌的耐药率极低。而青霉素、氨苄青霉素及喹诺酮类药物对致病菌的耐药率较高。     

699例尿路感染病原菌分布及药敏试验分析

目的探讨尿路感染病原菌和耐药性的变化。方法分析我科699例尿液培养阳性的尿路感染病原菌分布及其对抗菌药敏感性。结果革兰氏阴性杆菌占75.59%,其中大肠埃布菌60.33%;革兰氏阳性球菌占24.41%,其中肠球菌属占15.67%,真菌占1.39%;大肠埃布菌对氨苄西林的耐药率最高（80.63%）;对阿米卡星的耐药率明显低于庆大霉素（P〈0.01）,对喹诺酮类耐药率为41.45%～73.60%,对复方新诺明耐药率达60.10%。结论大肠埃希布菌仍是尿路感染的主要病原菌,肠球菌属、变形杆菌、克雷伯菌属、铜绿假单胞菌等病原菌比例有所增加,这些病原菌耐药性高,尤其氨苄西林、喹诺酮类、复方新诺明耐药性高,应注意根据药敏试验调整用药。     

细菌性尿路感染425株细菌及其耐药性分析

目的调查儿科细菌性尿路感染致病菌分布及对抗生素的耐药状况。方法收集儿科尿路感染患儿尿液分离的致病菌，采用K—B法进行药敏试验，用WHO细菌耐药监测软件“WHONET-4”进行统计和分析，NCCLS标准判断细菌耐药性。结果共收集致病菌425株，大肠埃希菌241株(56．7％)、奇异变形杆菌44株(10．3％)、肺炎克雷白菌38株(8．9％)、葡萄球菌41株(9．6％)、粪肠球菌29株(6．8％)、屎肠球菌17株(4％)是主要菌种。大肠埃希菌在尿路感染中所占比例下降较明显，其他细菌的比例尤其是葡萄球菌和肠球菌上升较快。所有菌株耐药率最低的是亚胺培南，其次为氨曲南、丁胺卡那、阿莫西林／克拉维酸等，但其耐药性已有逐步上升的趋势，耐药率最高的是氨苄西林。结论应加强对儿科细菌性尿路感染病原菌及其耐药性监测。     

尿液标本中检出大肠埃希菌的耐药性监测

目的分析从尿液标本中分离的大肠埃希菌的耐药性，指导临床合理用药。方法用VITEK-32型全自动微生物分析仪进行菌株鉴定，用K—B法进行药敏分析，并按NCCLS标准判断细菌耐药性。结果尿液标本中大肠埃希菌对亚胺培南、呋喃妥因、阿米卡星、哌拉西林／他唑巴坦的耐药率最低，分别为0、16．7％、17．5％和21．5％；对氨苄西林、头孢唑啉、环丙沙星、复方新诺明表现出很高的耐药率，分别为96．3％、79．9％、79．6％和73．2％。结论治疗大肠埃希菌引起的尿路感染应根据药敏结果及患者病情进行合理用药。     

2型糖尿病患者合并尿路感染的病原菌分布和耐药性分析

目的：探讨研究2型糖尿病患者（T2DM）合并尿路感染（UTI）的病原菌分布及其耐药性分析,指导临床合理使用抗生素。方法对2006年1月～2013年10月在笔者医院内分泌科住院的311例T2DM进行病原学鉴定及药敏分析。结果311例T2DM合并白细胞尿患者经中段尿培养分离出335株阳性致病菌,其中无症状性菌尿占尿路感染的69．45％。致病菌分布中革兰阴性菌株（G－）占65．37％,以大肠杆菌为主,占48．96％,其次为变形菌属。革兰阳性菌株（G＋）占25．67％,以肠球菌属为主,占11．94％,其次为无乳链球菌。真菌感染率为8．36％。药敏试验表明大肠杆菌对环丙沙星、氨苄西林、左旋氧氟沙星的耐药率高;变形菌属对复方新诺明、呋喃妥因、氯霉素的耐药率高;肠球菌属对复方新诺明、红霉素、环丙沙星的耐药率高;无乳链球菌对复方新诺明、环丙沙星的耐药率高。结论近年来2型糖尿病合并尿路感染患者中无症状性菌尿占主导地位,其病原菌分布中,大肠杆菌仍占首位,且比例逐年升高趋势,对传统抗生素耐药性明显,应高度重视,根据药敏结果合理使用抗生素。     

细菌性尿路感染病原菌构成及其耐药性分析

目的了解细菌性尿路感染病原菌的构成及其体外耐药性，为临床治疗提供依据。方法回顾性分析2年来尿路感染患者培养获得病原菌及主要致病菌的体外耐药性。结果927株尿路感染病原菌中大肠埃希菌占40．99％，排第一位，其他主要病原菌分别是葡萄球菌属8．63％，铜绿假单胞菌7．77％，阴道加德纳菌6．36％，克雷伯菌属5．50％，念珠菌属5．39％，变形杆菌属3．34％。药敏显示G杆菌对亚胺培南、头孢哌酮／舒巴坦、头孢他定耐药率最低，大肠埃希菌对左旋氧氟沙星耐药率较高，达76％。葡萄球菌绝大多数是MRS菌株，粪肠球菌对青霉素类很敏感，屎肠球菌则相反，未出现耐万古霉素肠球菌，阴道加德纳菌对青霉素类和万古霉素较敏感。结论大肠埃希菌仍是细菌性尿路感染的主要病原菌，阴道加德纳菌也成为重要的尿路感染病原菌之一。临床一线用药已广泛出现耐药，因此必须重视细菌及药敏检测，合理使用抗生素，降低细菌选择性耐药的产生，以提高尿路感染的治愈率。     

2型糖尿病合并尿路感染的病原菌分布及药敏分析

目的探讨2型糖尿病患者(T2DM)合并尿路感染(UTI)的病原菌分布和对抗菌药物的耐药情况,指导临床合理应用抗生素。方法对2006年1月～2009年12月在笔者医院内分泌科住院的T2DM合并UTI患者进行病原学鉴定及药敏试验。结果 243例T2DM合并白细胞尿患者经中段尿培养检出162例阳性致病菌,致病菌检出率为66.67%,其中无症状性菌尿占尿路感染的66.05%。致病菌分布中革兰阴性菌株(G-)占59.26%,以大肠杆菌为主,占42.60%;其次为变形菌属,革兰阳性菌株(G+)占34.57%,以肠球菌属为主,占17.28%,而后为缺乳链球菌,真菌感染率为6.17%。药敏试验表明大肠杆菌对氨苄西林、环丙沙星、复方新诺明的耐药率高;肠球菌对复方新诺明、红霉素和环丙沙星的耐药率高;缺乳链球菌对复方新诺明、四环素的耐药明显。结论近年来T2DM合并UTI的病原菌种类中大肠杆菌仍占首位,但比例有所下降,肠球菌属和念珠菌属有明显上升趋势,应高度重视;对传统抗生素耐药性明显,应根据药敏结果合理使用抗生素;建议可对T2DM患者的无症状性菌尿行积极治疗。     

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…     

Dr.Zhang Ren''''s Experience in the Acupuncture Treatment of Different Diseases with the Same Therapeutic Principle

Dr.Zhang Ren,the chief physician,is the chairman of Shanghai Acupuncture and Moxibustion Association.Having been engaged in medicine for about 40 years,he is experienced in treating various intractable diseases.In his long years of clinical practice,he advocates taking the TCM differentiation as the basis to seek for the acupuncture method for treatment of modern intractable diseases.The author of this essay had the fortune to follow Dr.Zhang in study.The following is a summary of Dr.Zhang's experience in the acupuncture treatment for different intractable diseases with the same therapeutic principle.     

Luo Lingjie''''s Experience in Treating Chronic Nephropathy

In treating chronic nephropathy,Luo Lingjie,a chief physician,pays attention to regulating the balance between yin and yang,treating infection if present,and removing pathogenic factors.He prescribes gentle drugs and uses carefully strongly warming-tonifying ones,emphasizes the importance of persuading the patient to persist in treatment with medication and nurse one's health for recuperation,and is good at combined use of TCM and western medicine therapy and brings the merits of various therapies into full play,with obvious theraoeutic effects.     

Acupuncture Combined with Spinal Tui Na for Treatment of Primary Dysmenorrhea in 30 Cases

Objective: To observe the therapeutic effects in acupunture treatment of primary dysmenorrhea combined with spinal Tui Na, and study its mechanism. Methods: Thirty cases of the treatment group were treated by acupuncture combined with spinal Tui Na, and thirty cases in the control group were treated by routine acupuncture. Results: The total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups (P<0.05). Conclusions: Acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea.     

猪肺磷脂注射液联合经鼻持续气道正压通气对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性的影响

目的 探讨猪肺磷脂注射液联合经鼻持续气道正压通气(NCPAP)对呼吸衰竭早产儿的临床疗效及肌酸激酶同工酶活性(CK-MB)的影响.方法 选取呼吸衰竭早产儿80例,分为观察组和对照组各40例.对照组采用NCPAP给氧治疗,观察组给予NCPAP给氧联合猪肺磷脂气管内给药.观察两组患儿治疗前及治疗12h、24 h后PaO2、PaCO2、血氧饱和度(SaO2)、pH的变化情况,检测治疗前及治疗5d后血清CK-MB水平;评估两组患儿的临床治疗效果.结果 两组患儿PaO2、PaCO2、SaO2、pH比较,差异均有统计学意义(P＜0.05),其中观察组治疗后的PaO2、SaO2、pH均高于对照组,PaCO2则低于对照组.两组的PaO2、SaO2、pH均随观察时间延长而升高(P＜0.05),PaCO2均随观察时间的延长而降低(P＜0.05).观察组治疗有效率为87.5％,显著高于对照组的70.0％ (P ＜0.05).治疗5d后两组患儿血清CK-MB水平均较前降低(P＜0.05),且观察组明显低于对照组(P＜0.05).结论 猪肺磷脂注射液气管内给药联合NCPAP可以显著降低呼吸衰竭早产儿CK-MB的含量,提高治疗有效率,起到很好的呼吸循环支持作用.     

Survey and practice of reporting quality of randomized controlled clinical trials on traditional Chinese medicine

Evidence obtained from randomized controlled trials （RCTs） has been generally accepted as the gold standard in the evaluation of clinical effectiveness. Readers need to understand the trial design, implementation, results, analysis and interpretation, so as to fully Jnderstand the results of RCTs. Thus, the investigators of RCTs have to report these items in a complete, accurate and clear manner. Since 1998, we have conducted several evaluations on the reporting quality of RCTs published in Chinese journals on traditional Chinese medicine （TCM） and results have shown that there is an urgent need for higher quality RCTs on TCM.     

TCM Treatment of Ankylosing Spondylitis by Tonifying the Kidney and Strengthening the Governor Vessel

Ankylosing spondylitis is a chronic and progressive disorder with inflammation mainly involving the central axis joints. It mainly affects the cervical spine and the lumbosacral area, with the pathogenesis closely related to the kidney and the Governor Vessel (GV). TCM holds that the syndrome is deficiency in origin and excess in superficiality, which is due to insufficiency of the kidney, deficiency of GV, and blocking of the channels with the invasion of exogenous evil, leading to poor circulation of qi and blood and malnutrition of the bones, muscles and joints. The TCM method of tonifying the kidney and strengthening GV to regulate circulation of qi and blood and check the arthralgia pain should be adopted, with the Kidney-Tonifying and GV Strengthening Decoction (益肾强督汤) prescribed.     

IMPROVING P-gp EXPRESSION IN HUMAN MONONUCLEAR CELLS IN VITRO TRANSFECTED BY MULTIDRUG RESISTANCE-1 mRNA

CHEMOTHERAPY playsa greatrolein the treat- ment of malignanttumors,especiallyingynecolo- gicalones.But inanticancerchemotherapy,leuko-cytopeniaisfrequentlytheprimarydose-limitingsideeffect factor.Moreover,cancersarefrequentlychemoresistantbe-causeof overexpressionof P-glycoprotein(P-gp), which isencodedby multidrugresistancegene (MDR1 ) and detectableinup to50% ofhuman cancersand renderscellsresistancetoanticancerdrugs.The safetyand potentialtherapeuticbenefitof mdr1 gene transferredto h…