呼吸机相关肺炎危险因素临床研究

目的探讨影响呼吸机相关肺炎（VAP）的危险因素。方法对2004年5月至2009年11月入住重症监护病房采用机械通气治疗的160例患者进行回顾性队列研究,将患者按相关危险因素自然分组,比较VAP发病率,并进行多因素非条件Logistic回归分析。结果160例行机械通气治疗的患者中有77例发生VAP,发病率为48．1％。机械通气≥5d、仰卧位、应用抑制胃酸分泌药、进行侵入性操作、应用糖皮质激素、白蛋白〈30g／L、多器官功能障碍综合征（MODS）与各自对照组比较,其机会比（OR）及OR值95％可信区间比较差异有统计学意义,是影响VAP发生的危险因素。结论机械通气较长时间、仰卧位、应用抑制胃酸分泌药（制酸剂）、侵入性操作、应用糖皮质激素、白蛋白〈30s／L、发生MODS是影响VAP发生的主要危险因素。     

内科ICU呼吸机相关肺炎危险因素研究

目的 探讨在内科ICU影响呼吸机相关肺炎(VAP)的危险因素.方法 对2003年8月～2006年8月入住内科重症监护病房(ICU)采用机械通气治疗的220例患者进行回顾性分析,将患者按相关危险因素自然分组,采用χ2检验比较VAP发病率.结果 220例行机械通气治疗患者中有147例发生VAP,发病率为66.8%.机械通气≥5 d、仰卧位、应用抑制胃酸分泌药、进行侵入性操作、应用糖皮质激素、白蛋白＜30 g/L、多器官功能障碍综合征(MODS)与各自对照组比较,其相对比分别是2.73、1.82、2.45、5.67、2.76、3.49、2.06倍,P值均＜0.05,有统计学意义.结论 机械通气≥5 d、仰卧位、应用抑制胃酸分泌药、进行侵入性操作、应用糖皮质激素、白蛋白＜30 g/L、多器官功能障碍综合征(MODS)是影响VAP发生的主要危险因素.     

重型颅脑损伤院内获得性肺炎危险因素探讨与护理对策

目的:探讨重型颅脑损伤(SBI)患者院内获得性肺炎(NP)的危险因素与相关护理对策。方法:对2006年1月~12月入住ICU的神经外科360例,哥拉斯哥昏迷分级(GCS)≤8分的颅脑损伤患者进行回顾性研究,将患者按相关危险因素自然分组,采取χ2检验比较NP的发病率,并进行分析。结果:360例重型颅脑损伤患者169例并发NP。老年患者,受伤后呕吐,带人工气道,留置胃管,受伤前吸烟,应用抑制胃酸分泌药及糖皮质激素NP发病率明显增高。结论:加强意识障碍颅脑损伤老年患者呼吸道管理,减少侵入性诊疗手段带来的感染机会,控制抑制胃酸分泌药及糖皮质激素的应用,增强营养严密监测病源微生物滋生,阻断多器官功能障碍综合征(MODS)发展环节,对有效治疗NP发生可起到积极作用。     

急诊重症监护病房呼吸机相关性肺炎危险因素分析

目的探讨急诊重症监护病房(EICU)呼吸机相关性肺炎(VAP)的危险因素及防护措施。方法采用回顾性病例对照研究方法,将185例机械通气治疗≥48 h的患者依据是否发生VAP分为病例组(65例)和对照组(120例),进行单因素和多因素分析VAP发病的危险因素。结果 VAP发病率为35.1%;VAP发病的独立危险因素包括机械通气时间(OR=3.015)、侵入性操作(OR=3.166)、留置胃管(OR=4.757)、使用制酸剂(OR=4.211)、慢性阻塞性肺部疾病(COPD)(OR=4.125)、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)评分(OR=2.366)。结论 EICU进行机械通气具有较高的VAP发病率,影响其发病的危险因素较多,应采取综合预防措施来防止VAP的发生。     

重型颅脑损伤院内获得性肺炎危险因素探讨与护理对策

目的：探讨重型颅脑损伤（SBI）患者院内获得性肺炎（NP）的危险因素与相关护理对策。方法：对2006年1月-12月入住ICU的神经外科360例,哥拉斯哥昏迷分级（GCS）≤8分的颅脑损伤患者进行回顾性研究,将患者按相关危险因素自然分组,采取χ^2检验比较NP的发病率,并进行分析。结果：360例重型颅脑损伤患者169例并发NP。老年患者,受伤后呕吐,带人工气道,留置胃管,受伤前吸烟,应用抑制胃酸分泌药及糖皮质激素NP发病率明显增高。结论：加强意识障碍颅脑损伤老年患者呼吸道管理,减少侵入性诊疗手段带来的感染机会,控制抑制胃酸分泌药及糖皮质激素的应用,增强营养严密监测病源微生物滋生,阻断多器官功能障碍综合征（MODS）发展环节,对有效治疗NP发生可起到积极作用。     

重症监护病房呼吸机相关性肺炎的相关危险因素分析

目的 探究ICU重症监护病房患者发生呼吸机相关性肺炎(VAP)的相关危险因素,指导临床防治措施.方法 对ICU应用机械通气治疗(非心脏手术)患者148例,1 48例患者中出现VAP 34例,对VAP及非VAP患者的性别、年龄、慢性合并症、机械通气时间、再次插管、插管方式、白蛋白水平、营养支持、激素、联合应用抗生素、胃肠内营养等资料进行分析.结果 148例患者中共有34例发生VAP,发生率为22.97％.VAP组及非VAP组患者的年龄、白蛋白水平、机械通气时间、插管次数、气管是否切开、使用抗生素种类、慢性合并症及糖皮质激素使用情况,差异有统计学意义(P＜0.05).多因素回归分析发现年龄≥60岁、机械通气时间≥7d、气管切开、再次插管、慢性合并症≥3种、抗生素的种类≥3种、使用激素是发生VAP的独立危险因素(P＜0.05).结论 ICU重症监护病房患者发生VAP的独立危险因素,包括年龄、机械通气时间、插管成功率、慢性合并症、抗生素联合应用、气管切开、激素的使用等,临床合理控制危险因素可以有效预防VAP的发生.     

呼吸重症监护病房机械通气相关肺炎的危险因素

目的探讨呼吸重症监护病房(RICU)机械通气相关肺炎(VAP)的危险因素。方法对160例入住RICU行机械通气患者的临床资料进行研究，64例发生VAP患者作为观察组，96例未发生VAP患者作为对照组。用SPSS10．0软件进行统计，对发生VAP的危险因素进行分析。结果机械通气时间大于4d(AOR，3．095；95％C1．1．076～8．907；P=0．032)、经鼻气管插管(AOR，4．505；95％CI，1．386～14．644；P=0．009)、APACHE1评分大于2j(AOR，6．689；95％CI，2．097～21．336；P=0．001)、应用H2受体拮抗剂(AOR，5．000；95％CI，1．408～17．759；P=0．008)及仰卧位(AOR，3．365；95％CI，1．009～8．907；P=0．032)是引起VAP的独立危险因素。结论缩短机械通气时间、尽量避免经鼻气管插管、合理使用抗应激性溃疡药物和避免仰卧位是防止VAP发生的重要措施。     

急诊呼吸机辅助通气相关性肺炎的危险因素分析和预防

目的探讨急诊呼吸机辅助通气相关性肺炎(VAP)的危险因素及预防策略。方法选取2009年10月至2012年10月于福建医科大学附属龙岩第一医院呼吸内科治疗的重症患者50例,均采取呼吸机辅助通气治疗,再按其是否发生VAP分为VAP组20例和非VAP组30例,分析性别、年龄、机械通气时间、昏迷与否、ICU观察天数、抗生素联合使用情况、胃内容物吸入与否以及H2受体拮抗剂使用与否与VAP的相关性。结果机械通气时间>3 d、ICU观察天数>7 d、昏迷、联合应用抗生素种类>2种等因素均对VAP的发生造成影响(P<0.05);Logistic回归分析发现机械通气时间≥3 d(OR=2.387)、ICU观察天数>7 d(OR=2.142)、联合应用抗生素种类≤2种(OR=1.669)、胃内容物吸入(OR=1.779)、H2受体拮抗剂(OR=2.006)5个变量是VAP的危险因素。结论机械通气时间等因素是VAP的相关危险因素,临床上联合应用静脉注射抗生素及吸入抗生素可提高VAP患者的疗效。     

基层医院ICU呼吸机相关性肺炎的危险因素与病原学分析

目的分析基层医院ICU VAP的危险因素及病原学情况。方法回顾性分析2013年1月—2014年12月本院ICU收治的机械通气>48 h的118例患者,分VAP组和非VAP组,分析VAP的危险因素及病原学情况。结果VAP组与非VAP组在紧急气管插管,机械通气时间,抗生素种类,糖皮质激素,PPI及镇静药物使用>7天,返流,MODS,ICU停留时间的项目,两组比较差异有统计学意义。紧急插管:52.2%vs 31.9%,P=0.029;机械通气时间:(9.8±3.5)vs(7.3±2.8)天,P=0.038;抗生素种类>2种:52.2%vs 26.4%,P=0.005;使用糖皮质激素:56.5%vs 27.0%,P=0.001;PPI使用>7天:65.2%vs 40.3%,P=0.008;镇静药物使用>7天:58.7%vs38.9%,P=0.035;返流:50%vs 29.2%,P=0.022;合并MODS:47.8%vs 22.2%,P=0.004;ICU停留时间:(13.6±6.6)vs(10.2±5.3)天,P=0.023。使用糖皮质激素、机械通气时间、ICU停留时间是VAP的独立危险因素(多因素Logistic分析的OR值:2.481、1.234、1.075)。基层医院ICU VAP主要以革兰氏阴性菌(82.3%)为主。结论使用激素、机械通气时间、ICU停留时间是基层医院ICU VAP的独立危险因素;而VAP病原菌感染以G-菌为主,可经验使用G-菌敏感的抗生素。     

呼吸机相关性肺炎危险因素病例对照分析与护理策略

目的分析呼吸机相关性肺炎(ventilator associated pneumonia,VAP)的危险因素,为临床预防治疗VAP提供参考依据。方法回顾2010年1月～2011年12月我院864例机械通气时间≥48 h患者的相关住院资料,以同期726例非VAP为对照组,分析VAP发病的危险因素。结果 VAP发病率为15.9%。单因素分析发现,机械通气>5 d、侵入性操作、留置胃管、APACHEⅡ评分>15分、意识障碍、口腔护理、抬高床头、每日唤醒排痰与发生VAP有关(P<0.01或P<0.05);Logistic回归分析发现APACHEⅡ评分>15分、意识障碍、留置胃管、机械通气>5 d和神经损伤为VAP发生的独立危险因素,而口腔护理、患者抬高30°、每日唤醒排痰是VAP的保护性因素。结论机械通气具有较高的VAP发病率,合理的护理策略与尽早撤机缩短机械通气有利于防止VAP的发生。     

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.     

Analysis of CK-19,PDX-1,Nestin,Ngn3 in different donor islet purity in rats

Objective: To investigate if there are the CK-19, PDX-1, Nestin, Ngn3 positive cells in the donor islets of different purity in rats. Methods: Thirty male adult SD rats were randomly divided into 3 groups. Islets were isolated using digestion by ductal injection of collagenase. Group Ⅰ (n=10): Separating cell preparations were not purified, Group Ⅱ(n=10): Islet sediment was purified with 25% Ficoll400 ,Group Ⅲ (n=10): Islet sediment was purified with 25% and 11% Ficoll-400. The levels of protein of CK-19, PDX-1, Nestin and Ngn3 were detected by immunohistochemistry and the mRNA of CK-19, PDX-1, Nestin, Ngn3 was amplified by RT-PCR. Results: After two different purification methods applied, three islet preparations of different purities were obtained. The difference of islet purity was significant among various groups (P＜0.05). Compared with group Ⅱ and group Ⅲ,the protein and mRNA of CK-19, PDX-1, Nestin,Ngn3 were both higher in group Ⅰ; group Ⅲ was poorly expressed. Conclusions: The three different islet purity donor islet have different CK-19, PDX-1, Nestin, Ngn3 positive cells within them, indicating that there are some islet stem cells in the purified donor islet.     

A preliminary screening study on the associated proteins in human psoriasis vulgaris by serum proteomics technologies

Objective：To investigate the optimum screening conditions of associated proteins in human psoriasis vulgaris by serum proteomics technique, and to screen the different expression proteins related with psoriasis vulgaris. Methods：Serum samples of peripheral blood were collected from newly diagnosed psoriasis vulgaris patients in the clinic, and 20 matched healthy persons. Serum albumin IgG was removed by filtering with ProteoExtract Albumin/IgG. After comparative proteomics analysis the different protein spots were identified using 2-DE and MS. Results ：Electrophoresis figures with high resolution and reproducibility were obtained. Three different expression proteins were found only in the serum from psoriasis vulgaris patients, while nine other different proteins expressing from healthy volunteers. Conclusion：The protein expression was different in the serum between the psoriasis vulgaris patients and healthy volunteers. It was hoped that we could find the biomarkers related to psoriasis vulgaris by using proteomics.     

A CASE OF HUGE GASTRIC DISOPYROBEZOAR

PYTOBEZOARS are common bezoars in gastrontestinal tract, commonly seen in stomach and mall intestine,1but huge disopyrobezoars are     

Acupuncture Treatment of Chest Bi Syndrome

CASE HISTORY A male,a retired officer of 61 years old,paid his first visit on May 12,2006.The patient stated that 2 weeks before he suddenly got paroxysmal precordial choking pain,with irregular attacks.Each attack would last several seconds to several minutes.The attack was accompanied with heavy oppressed sensation in the precordial region,palpitation,lassitude,and in severe cases,sweating,which was once diagnosed by a hospital as'coronary heart disease'.Recalling the case history,the patient said that several days before he got angry with others because of some affairs in work,and he was not so used to the life pattern since he had just retired from his busy working post.At usual times,he was quick tempered and peevish.In recent days,he had poor appetite,and loose stool.     

Instructions to Contributors

The English edition of Chinese Journal of Integrative Medicine is edited and published by the Chinese Journal of Integrated Traditional and Western Medicine Press.Original scientific papers of advanced clinical and experimental medicine in the field of complementary/alternative medicine or integrative medicine are expected.