铜绿假单胞菌的分离情况及耐药性分析

目的了解铜绿假单胞菌感染现状、分布特征及其耐药性,指导临床合理用药。方法回顾性分析北京儿童医院2007年1月至2009年12月临床分离出的1 195株铜绿假单胞菌的标本来源、感染科室分布及耐药情况。结果 1 195株铜绿假单胞菌中79.4%来自痰及咽拭子,9.5%来自尿液,3.6%来自血液;病区分布中呼吸内科占46.7%,重症监护病房占20.8%,外科占7.9%。3 a间铜绿假单胞菌对环丙沙星、庆大霉素、哌拉西林和哌拉西林/他唑巴坦的耐药率变化差别有统计学意义(P<0.05)。铜绿假单胞菌对亚胺培南和头孢他啶的耐药率呈逐年上升趋势,铜绿假单胞菌对美洛培南及替卡西林/克拉维酸的耐药率呈逐年下降趋势,但差别均无统计学意义(P>0.05)。结论临床分离的铜绿假单胞菌多来自于痰及咽拭子标本和呼吸内科。及时准确地细菌鉴定和药物敏感试验能尽早发现铜绿假单胞菌的院内感染情况,为临床治疗提供重要的实验室依据。     

2008年度新乡市中心医院铜绿假单胞菌耐药性分析

目的:了解铜绿假单胞菌临床分离株的耐药现状.方法:收集2008年度临床分离的铜绿假单胞菌株584株,用Kirby-Bauer法做药敏试验,并根据耐药表型分析可能存在的耐药机制.结果:临床分离的铜绿假单胞菌耐药率依次为头孢哌酮舒巴坦28.4%,亚胺培南34.0%,环丙沙星36.5%,左氧氟沙星43.2%,头孢他啶48.0%,阿米卡星49.2%,哌拉西林-他唑巴坦55.1%,哌拉西林62.5%,氨曲南62.6%,替卡西林-克拉维酸63.9%.结论:临床分离的铜绿假单胞菌耐药率相对较高,耐药机制非常复杂,需引起实验室和临床密切关注.     

铜绿假单胞菌的耐药分析

目的：分析铜绿假单胞菌的耐药情况。方法：用K-B法对细菌环进行测量。结果：272株铜绿假单胞菌中,多粘菌素E的耐药率为3.1%,环丙沙星为7.4%,亚胺培南10.4%,哌拉西林/他唑巴坦10.8%,美洛培南15.0%,替卡西林15.6%,替卡西林/克拉维酸15.6%,哌拉西林17.8%,左氧氟沙星18.2%,头孢吡胯28.7%,妥布霉素28.7%,氨曲南41.4%,阿米卡星50.0%,庆大霉素59.6%,氨苄西林/舒巴坦100.0%。结论：铜绿假单胞菌造成的感染率越来越高,耐药性也越来越高,我们必须重视此种情况。     

86株铜绿假单胞菌耐药性分析

目的了解医院铜绿假单胞菌的分布及耐药状况。方法标本经分离培养，用法国生物梅里埃公司ATB细菌鉴定仪及配套试剂，对菌株进行鉴定和药敏试验。结果86株铜绿假单胞菌中48株来源于痰，对氨苄西林-舒巴坦、复方新诺明耐药率分别为9：5．3％、90．7％，对替卡西林、替卡西林＋克拉维酸、哌拉西林、哌拉西林＋他唑巴坦、庆大霉素、妥布霉素、环丙沙星的耐药率在40％～60％之间，美洛培南、阿米卡星耐药率达23．2％、25．6％，多粘菌素E、亚胺培南、头孢吡肟、头孢他定耐药率分别为11．6％、12．8％、13．9％、18．6％。结论铜绿假单胞菌是下呼吸道感染的主要致病菌之一，其耐药机制复杂，有多重耐药性。希望临床医生在治疗铜绿假单胞菌感染过程中，充分考虑其耐药机制，选耐药率低的药物，主张联合用药，减少多重耐药菌株的传播。     

多重耐药铜绿假单胞菌临床分布及耐药性观察

目的探讨多重耐药铜绿假单胞菌临床分布及耐药性情况。方法收集2014年1月~2015年4月长兴县中医院重症监护室248例患者铜绿假单胞菌临床标本,采用培养鉴定和药敏试验进行检测。结果分离铜绿假单胞菌210株,其中,多重耐药菌60株,多重耐药菌检出率为28.6%。60株多重耐药铜绿假单胞菌主要分布在痰液(40株,66.7%),其次为伤口分泌物(11株,18.3%)、尿液(9株,15.0%)。耐药情况分析结果显示,头孢他啶(41.7%)、头孢吡肟(38.3%)、哌拉西林(48.3%)、替卡西林(58.3%)、哌拉西林/他唑巴坦(58.3%)、替卡西林/克拉维酸(58.3%)、氨苄西林/舒巴坦(100.0%),耐药率均较高;氨曲南(33.3%)、亚胺培南(30.0%)、美罗培南(30.0%)、庆大霉素(40.0%)、阿米卡星(26.7%)、环丙沙星(33.3%)、左氧氟沙星(33.3%),耐药率均较低。检出10株泛耐药菌株,检出率为16.7%,通过补充药敏实验,6株(60.0%)对头孢哌酮/舒巴坦耐药,对于多黏菌素B无耐药发生。结论对于多重耐药铜绿假单胞菌可以采用青霉烯类、喹诺酮类联合用药治疗,对于泛耐药菌株可以应用多黏菌素B进行治疗。     

123株铜绿假单胞菌感染分布及耐药性分析

目的了解铜绿假单胞菌的感染分布及耐药现状,为临床治疗感染提供依据。方法采用VITEK系统进行细菌鉴定及药敏检测,应用WHONET软件进行耐药统计分析。结果铜绿假单胞菌最常见分离自痰标本(69.1%),其次是伤口分泌物(14.6%)。对铜绿假单胞菌耐药率较低的的药物依次为哌拉西林/他唑巴坦(24.4%)、亚胺培南(27.6%)、阿米卡星(39.0%)、头孢他啶(40.7%)、氨曲南(46.7%),铜绿假单胞菌对头孢曲松、头孢吡肟、哌拉西林、替卡西林/克拉维酸、庆大霉素、妥布霉素、环丙沙星和左氧氟沙星的耐药较严重,耐药率在52.8%~92.7%之间。结论铜绿假单胞菌耐药性较严重,合理用药及加强细菌耐药性监测十分必要。     

铜绿假单胞菌的感染情况和耐药性分析

目的:了解本地区铜绿假单胞菌的感染和耐药状况,为临床治疗该菌感染提供最有效的抗生素.方法:采用常规的方法培养分离,鉴定和药敏采用法国梅里埃生物工程公司的试剂作测定.结果:共分离培养出铜绿假单胞菌156株,其对19种抗生素耐药率依次为:复方氨苄西林100 %(156/156)、复方磺胺甲唑91.7 %(143/156)、庆大霉素43.6 %(68/156)、替卡西林32.7 %(51/156)、哌拉西林 32.7 %(51/156)、头孢吡肟32.1 %(50/156)、复方替卡西林 30.8 %(48/156)、头孢他定26.9 %(42/156)、哌拉西林PYO 26.3%(41/156) 、复方哌拉西林25.6 %(40/156)、替卡西林PYO25.0 %(39/156)、替卡西林-克拉维酸PYO 25.0 %(39/156)、妥布霉素21.8 %(34/156)、环丙沙星20.5 %(32/156)、阿米卡星19.2 %(30/156)、哌拉西林-他唑吧坦PYO 18.6 %(29/156)、多粘霉素E 13.5 %(21/156)、美洛匹宁 9.6 %(15/156)、亚胺培南 5.1 %(8/156).结论:我院治疗由铜绿假单胞菌引起的感染首选抗生素为亚胺培南,其次为美洛匹宁、多粘霉素E;而复方氨苄西林、复方磺胺甲唑等不宜采用.由于该抗生素的耐药性存在地区差异性,治疗该菌引起的感染时,应结合当地药敏结果选择有效的抗生素.     

铜绿假单胞菌的临床分离和药敏情况分析

目的分析铜绿假单胞菌的临床分离和药敏情况,指导临床合理使用抗生素。方法对本院2016年1月~2017年10月临床分离的524株铜绿假单胞菌采用统一的方法、设备和判断标准进行耐药性检测,使用WHONET5.6进行数据分析。结果铜绿假单胞菌耐药率在50%以上的抗生素包括复方新诺明、阿莫西林/克拉维酸、氯霉素、头孢噻肟、四环素、氨苄西林、呋喃妥因和头孢唑啉,敏感性高于70%的抗生素包括头孢他啶、哌拉西林、左旋氧氟沙星、头孢吡肟、美洛培南、环丙沙星、亚胺培南、哌拉西林/他唑巴坦、庆大霉素、阿米卡星和多粘菌素B。结论铜绿假单胞菌的耐药机制复杂,应加强对铜绿假单胞菌的临床分布及耐药性监测,指导临床合理使用抗生素,采取有效的防范措施控制医院感染,采取多种治疗策略最大限度减少铜绿假单胞菌耐药性发展。     

160株铜绿假单胞菌感染分布和耐药性分析

目的了解铜绿假单胞菌感染分布的特点及对14种常用抗生素耐药的特点。方法用VITEK-32全自动细菌鉴定仪鉴定为铜绿假单胞菌160株进行来源监测及对其药敏试验进行统计分析。结果160株铜绿假单胞菌中,主要来自于痰和咽拭子131株(占81.8%),其次为伤口分泌物12株(7.5%)。铜绿假单胞菌对氨苄西林、头孢唑啉、复方新诺明耐药率达100%,而对呋喃坦啶和氨苄西林/舒巴坦的耐药率也高达99.7%和98.7%;亚胺培南、氟喹诺酮类、哌拉西林/他唑巴坦有较高的敏感率,分别为84.4%、84.0%、83.8%、88.8%。阿米卡星和妥布霉素敏感率最高,分别为93.8%和91.3%。结论临床应结合体外药敏试验合理选用抗菌药物,阿米卡星和妥布霉素可作为治疗铜绿假胞菌感染的首选药物。     

铜绿假单胞菌耐药性探讨

目的探讨临床铜绿假单胞菌耐药情况。方法对160株临床分离的铜绿假单胞菌进行15种药物敏感试验,用MH平板采用WHO推荐的K-B法。结果氨苄西林、复方新诺明、阿莫西林/克拉维酸耐药率在95%以上;头孢三嗪、头孢噻肟、替卡西林/克拉维酸、庆大霉素、哌拉西林、氧氟沙星等耐药率在40%～60%;哌拉西林/三唑巴坦、氨曲南、环丙沙星等耐药率在30%左右,阿米卡星、亚胺培南、头孢他啶等耐药率在20%以下。结论铜绿假单胞菌对氨苄西林、复方新诺明、阿莫西林/克拉维酸完全耐药,对碳氢酶烯类药物亚胺培南(11.9%)、头孢他啶(13.8%)耐药率最低;氨基甙类中的阿米卡星(20.1%)和环丙沙星(30%)耐药率相对较低。临床上宜选择耐药率<20的药物;对耐药率在40%～60%的药物慎用;耐药率>70%的药物最好不用。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

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…     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

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.     

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.     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.