呼吸病房革兰阴性菌2007年耐药性监测结果

目的了解2007年呼吸病房革兰阴性菌中主要病原菌的体外药物敏感性试验（药敏试验）情况,为呼吸病房合理应用抗菌药物提供依据。方法从新疆医科大学第一附属医院呼吸内科2007年住院患者的合格呼吸道分泌物标本中分离出177株革兰阴性菌,菌株来源于149例患者,试验方法与药敏判断均参照全国临床实验标准委员会（NCCLS）标准,分析177株革兰阴性菌的体外药敏试验情况。结果177株革兰阴性杆菌中,肺炎克雷伯菌占27.2%（48/177）,鲍曼不动杆菌占19.8%（35/177）,铜绿假单胞菌占16.4%（29/177）,阴沟肠杆菌占9.6%（17/177）,大肠埃希菌占5.6%（10/177）,嗜麦芽窄食单胞菌占5.6%（10/177）,其他革兰阴性菌占15.8%（28/177）。体外药敏试验显示肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌、阴沟肠杆菌对亚胺培南、美洛培南、头孢哌酮/舒巴坦、头孢吡肟较为敏感,敏感率为53.6%～100.0%,对氨苄西林、氨苄西林/舒巴坦、头孢唑啉、头孢克肟的耐药率较高,嗜麦芽窄食单胞菌对米诺环素无耐药株,敏感率为100.0%。结论不同的革兰阴性菌对各类抗菌药物的耐药性存在差异,感染革兰阴性菌时可以选用头孢哌酮/舒巴坦、头孢吡肟、亚胺培南及美洛培南。     

常见院内分离革兰阴性细菌分布及耐药性监测

目的　了解医院感染常见革兰阴性细菌分布变迁和耐药情况。方法　 2 0 0 1年 7月至 2 0 0 3年 2月该院临床分离菌用Kirby -Bauer法进行药物敏感试验 ,并按美国临床实验标准委员会 2 0 0 0年判断标准进行判断。结果　共分离出革兰阴性菌为 6 0 8株 ,前 3位细菌依次是 :大肠埃希菌占 35 9%、铜绿假单胞菌占 2 0 2 %、肺炎克雷伯菌占 15 8%。耐药性分析显示 :革兰阴性杆菌对临床常用抗生素的耐药率最低为亚胺培南 (0～ 4 2 6 % ) ,最高为奈啶酸 (4 3 5 %～ 10 0 % ) ,大部分细菌呈多重耐药。临床分离菌中产超广谱 β内酰胺酶 (ESBLs)菌株的检出率分别为 :大肠埃希菌为 2 9 8%、肺炎克雷伯菌为 39 6 %、铜绿假单胞菌为 5 7%、阴沟肠杆菌为 4 0 0 %、鲍曼不动杆菌为9 1%、奇异变形杆菌为 14 7%、嗜麦芽窄食单胞菌为 17 4 %。产ESBLs菌株对 2 3种临床常用抗菌药物的耐药率均显著高于不产ESBLs菌株。结论　细菌耐药性仍是目前临床最为严重的问题 ,需要各有关部门共同商讨有效对策。     

连续四年ICU病房院内感染病原菌的耐药性分析

目的 :了解我院重症监护病房 (ICU)院内感染病原菌的耐药性变化趋势。方法 :对我院 ICU2 0 0 0年 1月至 2 0 0 3年 12月院内感染的各类感染标本中分离的 74 1株病原菌加以整理分析 ,并按美国国家临床实验室标准委员会 (NCCL s)标准进行药敏试验 ,并对其耐药性进行分析。结果 :分离出的菌株以革兰阴性杆菌为主 ,其次是革兰阳性球菌、真菌 ,分别占 6 2 % ,2 9% ,9% ,感染部位以肺部最多 5 5 1株 (74 .4 % ) ,泌尿道感染 5 0株 (6 .7% ) ,引起败血症35株 (4.7% ) ,来自各种体液 (胸、腹水、胆汁 ) 5 2株 (7.0 % ) ,来自各种引流液和伤口分泌物 2 5株 (3.4 % ) ,静脉导管13株 (1.8% ) ,其他 15株 (2 .0 % )。革兰阴性杆菌以非发酵菌为主 ,其中铜绿假单胞菌 135株 (18.2 % )、嗜麦芽窄食单胞菌 38株 (5 .1% )、不动杆菌属 37株 (4.9% )及其他非发酵菌 5 7株 (7.7% ) ,其次大肠埃希菌 91株 (12 .3% )、肺炎克雷伯菌 5 3株 (7.2 % )、肠杆菌属 33株 (4.5 % )、其他肠杆菌科 17株 (2 .3% )。铜绿假单胞菌对亚胺培南的耐药率达 4 1.0 % ,呈多重耐药 ,阴沟肠杆菌对头孢他啶、氨曲南的耐药率达 6 0 .0 %、73.3% ,大肠埃希菌、肺炎克雷伯菌产超广谱β-内酰胺酶 (ESBL s)的发生率分别是 4 1.0 %、4 5 .0 % ,亚胺培南?     

呼吸机相关性肺炎病原菌分布及耐药性分析

目的：了解呼吸机相关性肺炎病原菌分布及耐药菌,便于临床经验性抗感染治疗的药物选择。方法：对56例使用呼吸机后发生呼吸机相关性肺炎患者分离出的163株病原菌及药物敏感试验进行分析。结果：革兰阴性菌123株（占75．46％）,其中铜绿假单胞菌40株,鲍曼不动杆菌37株,嗜麦芽寡养单胞菌28株,大肠埃希菌14株,肺炎克雷伯菌4株。革兰阳性菌31株,其中,葡萄球菌27株,肠球菌2株,耐甲氧西林金葡菌2株。真菌3株为白色念株菌。厌氧菌6株,脆弱类杆菌5株。药物敏感显示：铜绿假单胞菌、鲍曼不动杆菌、嗜麦芽寡养单胞菌对抗菌药物多重耐药率高,肺炎克雷伯菌对头孢哌酮／舒巴坦、亚胺培南仍有较好的敏感性,革兰阳性菌对哌拉西林舒巴坦、万古霉素均有较好的敏感性,耐甲氧西林金葡菌对万古霉索敏感。结论：呼吸机相关性肺炎以革兰阴性菌为主,且多重耐药;革兰阳性菌对万古霉素敏感;真菌、厌氧菌为混合感染。     

PICU婴幼儿重症肺炎498例细菌病原学及耐药性检测

目的:探讨重症肺炎患儿细菌病原学及其耐药情况。方法:对498例PICU病房婴幼儿重症肺炎患儿痰培养阳性标本结果进行回顾性统计分析。结果:(1)分离出细菌309株,其中革兰阴性(G-)杆菌226株,占73.14%,病原菌主要为大肠埃希杆菌、肺炎克雷伯菌、铜绿假单胞菌、阴沟肠杆菌;革兰阳性(G+)球菌83株,占26.86%,主要病原菌为金黄色葡萄球菌、表皮葡萄球菌。(2)药敏结果提示革兰阴性(G-)杆菌对常用抗革兰阴性杆菌抗生素耐药,仅对亚胺培南、头孢哌酮/舒巴坦、头孢吡肟、派拉西林/三唑巴坦较敏感。结论:PICU婴幼儿重症肺炎常见的致病菌为大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、阴沟肠杆菌、金黄色葡萄球菌,革兰阴性杆菌对抗菌药物的耐药性较普遍,加强综合防治和抗生素的合理使用是降低感染和细菌耐药的重要保证。     

呼吸道感染者痰中致病菌的分布与耐药性的分析

目的:了解本院呼吸道感染者痰中致病菌的分布及耐药状况。方法:对我院2001年7月至2004年7月间呼吸道感染住院患者及门诊患者送检的1 319例痰标本进行细菌培养,对其中分离出的736株致病菌进行细菌鉴定,测定并分析其药物敏感性。结果:1 319例痰标本中共分离出736株致病菌,其中革兰阴性杆菌386株居首位占52.4%,位居前四位的依次是肺炎克雷伯氏菌、铜绿假单胞菌、大肠埃希氏菌、阴沟肠杆菌;革兰阳性球菌184株占25.0%:真菌166株占22.6%。体外药物敏感试验显示肺炎克雷伯氏菌、铜绿假单胞菌、大肠埃希氏菌对亚胺培南、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、阿米卡星、头孢他啶较为敏感;阴沟肠杆菌除对亚胺培南、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦较敏感外,对其他抗生素的耐药率大于50.0%。金黄色葡萄球菌、表皮葡萄球菌、肺炎链球菌对万古霉素、头孢曲松、氨苄西林/舒巴坦敏感性较高。结论:临床医生应根据细菌药物敏感试验合理使用抗生素,以减少细菌耐药菌株的产生。     

革兰阴性杆菌对亚胺培南耐药率的变迁

目的调查革兰阴性杆菌对亚胺培南的耐药率变迁。方法收集2007年1月-2009年12月从蚌医附院患者各种临床标本中分离的革兰阴性杆菌,使用VITEK-32全自动微生物分析仪进行细菌鉴定和药敏试验,对结果进行回顾性分析。结果共分离出革兰阴性杆菌2256株,42个细菌种,肠杆菌科细菌1258株,占55.76%,非发酵菌751株,占33.29%,分离率前5位的病原菌分别是大肠埃希菌、鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌和阴沟肠杆菌。肠杆菌科细菌对亚胺培南的耐药率较低,除聚团肠杆菌外,其他肠杆菌科细菌对亚胺培南的耐药率均〈10．00％,肺炎克雷伯菌6．94％和大肠埃希菌4．83％。嗜麦芽窄食单胞菌、鲍曼不动杆菌、铜绿假单胞菌、洛菲不动杆菌和荧光假单胞菌对亚胺培南的耐药率分别为100．00％、66．84％、35．29％、28．00％和25．00％。结论临床分离的革兰阴性杆菌以大肠埃希菌、鲍曼不动杆菌、铜绿假单胞菌为主,亚胺培南对肠杆菌科细菌具有非常强的体外抗菌活性,对非发酵菌的体外抗菌活性较差,铜绿假单胞菌、鲍曼不动杆菌、大肠埃希菌和肺炎克雷伯菌对亚胺培南的耐药率呈上升趋势。     

胆石症患者胆汁中的病原菌分布及药敏分析

目的 探讨胆石症(CL)患者胆汁中的病原菌分布、构成及药敏情况.方法 选取行胆管手术的CL患者224例,采集胆汁标本,进行细菌种类鉴定和药敏试验.结果 共分离到病原菌207株,其中革兰阴性菌166株(80.19%)、革兰阳性菌39株(18.84%)、真菌2株(0.97%).最常见的病原菌依次为大肠埃希菌83株(40.10%)、铜绿假单胞菌37株(17.87%)、阴沟肠杆菌33株(15.94%)、肠球菌属29株(14.01%).主要革兰阴性菌仅对亚胺培南100%敏感,此外大肠埃希菌和肺炎克雷伯菌对头孢哌酮/舒巴坦、阿米卡星的敏感率较高,铜绿假单胞菌和阴沟肠杆菌则对头孢吡肟、左氧氟沙星、阿米卡星的敏感率较高;主要革兰阳性菌对利奈唑胺100%敏感、对万古霉素高度敏感,此外肠球菌属对庆大霉素、葡萄球菌属对左氧氟沙星的敏感率也较高.结论 CL患者胆汁中的病原菌对大多数常用抗菌药物均产生了不同程度的耐药性,临床应根据药敏试验结果合理选用抗菌药物.     

下呼吸道感染病原菌分布与耐药性研究

目的：探讨病原菌在下呼吸道感染疾病中的分布情况及相关耐药性。方法选择广东省茂名市人民医院下呼吸道感染患者100例作研究对象,统计分析病原菌分布及耐药性。结果副流感嗜血杆菌46株,占4.6%;铜绿假单胞菌365株,占36.5%;阴沟肠杆菌41株,占4.1%;肺炎克雷伯杆菌174株,占17.4%;流感嗜血杆菌69株,占6.8%;嗜麦芽窄食单胞菌115株,占11.5%;大肠埃希菌83株,占8.3%;鲍曼不动杆菌84株,占8.4%;其他33株,占3.3%。药敏试验结果：（1）耐药率最高：阴沟肠杆菌为氨苄西林,占97.6%;铜绿假单胞菌为派拉西林,占32.9%;大肠埃希菌为氨苄西林,占96.4%;肺炎克雷伯菌为氨苄西林,为100.0%;嗜麦芽窄食单胞菌为亚胺培南,占100.0%。（2）耐药药率最低：阴沟肠杆菌为亚胺培南,占0.0%;铜绿假单胞菌为头孢他啶,占12.3%;大肠埃希菌为亚胺培南,占0.0%;肺炎克雷伯菌为亚胺培南,为0.0%;嗜麦芽窄食单胞菌为环丙沙星,占26.1%。结论下呼吸道感染病原菌以铜绿假单胞菌最为常见,常用抗菌药物在革兰阴性菌中耐药性呈较高水平,需加强检测病原菌及监测耐药性,以促进合理用药。     

2002～2005年我院临床主要病原菌及药敏变化分析

目的了解临床主要病原菌和药敏变化,研究其应对措施。方法回顾性调查分析2002年12月~2005年11月住我院患者各种标本中分离的病原菌和抗菌药敏感试验结果。结果4年间共分离病原菌4263株,其中前6位细菌3389株(占79.50%),分别是大肠埃希菌986株(占23.13%),金黄色葡萄球菌691株(占16.21%),铜绿假单胞菌676株(占15.86%),克雷伯菌476株(占11.17%),表皮葡萄球菌371株(占8.70%),其它假单胞菌189株(占4.43%)。常用抗生素中氨苄西林的抗菌活性最低,对表皮葡萄球菌和金黄色葡萄球菌的敏感率分别是3.5%和3.65%;头孢唑林、氨苄西林/舒巴坦、奥格门丁对铜绿假单胞菌的敏感率最低,分别是4.44%、8.86%、6.71%。抗菌活性最高的是万古霉素和亚安培南。结论临床病原菌中革兰阴性细菌仍为优势菌,尤其是铜绿假单胞菌的检出率逐年增加,其它阴性细菌检出率逐年降低;革兰阳性菌的检出率逐年增加,主要是金黄色葡萄球菌的检出率逐年快速增加,而对常用抗菌药的敏感性呈下降趋势。     

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.     

Acupuncture Treatment of Vomiting

CASE HISTORY A female patient, 46 years old, head of the foreign affairs department of a certain university in Beijing, paid her first visit on October 9, 2006, with the chief complaint of vomiting for one month. She got vomiting after meals in early September. Before that, she had discomfortable sensation in the stomach due to angry with others, but she didn't pay much attention. Later, it developed into vomiting after eating. After the vomiting, the discomfort would be relieved, but with slight hypodynamia. She was once diagnosed as having 'neurogenic vomiting'. Having taken some western and Chinese drugs, the above symptoms were a little bit improved, but she would have nausea upon eating and with regurgitation. Because of the fear for vomiting, she did not dare to have food intake, with body weight reduction of 6 kilos in one month.     

Qiu Baoguo''''s Experience in Treating Consumptive Syndromes after Radio-Chemotherapies

Radiotherapy and chemotherapy are the important modern medical therapies for malignant tumors,yet they can also bring about serious local and systemic toxic side reactions so to decrease the patient;'s life quality,manifested by a series of consumptive symptoms.Having engaged in the combined work of Chinese and western medicine for nearly 50 years,the research fellow Qiu Baoguo in Henan Provincial Academy of TCM has developed his unique views on the TCM study of consumptive syndromes.The author of this essay had once the fortune tO follow Dr.Qiu in clinic,and specially would like to introduce in the following Dr.Qiu's experience in treating consumptive syndromes after radio-chemotherapies for patients with malignant tumor.     

Insomnia Due to Deficiency of Both the Heart and Spleen Treated by Acupuncture-Moxibustion and Chinese Tuina

OBJECTIVE: To observe therapeutic effects of the comprehensive therapy of acupuncture-moxibustion and Chinese Tuina for treatment of insomnia due to deficiency of both the heart and spleen. METHODS: 92 cases were divided randomly into the treatment group (treated by acupuncture-moxibustion and Chinese Tuina) and the control group (treated by acupuncture-moxibustion). RESULTS: The therapeutic effect of the treatment group was obviously superior to that of the control group (the CHI2 test showed P < 0.01). CONCLUSIONS: The comprehensive therapy of acupuncture-moxibustion and Chinese Tuina can give marked therapeutic effects for treatment of insomnia due to deficiency of both the heart and spleen.     

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.