颅脑损伤患者下呼吸道感染病原菌分布及耐药性调查

目的了解颅脑损伤患者下呼吸道感染病原菌的分布及耐药状况，为临床合理应用抗菌药物提供参考。方法对2004-012006-03颅脑损伤患者下呼吸道分离的73株细菌用梅里埃BacT／ALERT全自动微生物鉴定仪鉴定，采用纸片琼脂扩散法，按2000年美国国家临床实验室标准化委员会药物敏感试验标准判断结果。结果73例颅脑损伤并发院内下呼吸道感染患者的痰液及经气管切开取得的痰液标本培养分离所得病原株，其中革兰（氏）阴性菌（G^-）占52．05％（38株），G^＋菌占47．95％（35株）；G^-菌中以克雷伯菌属、大肠埃希菌、铜绿假单胞菌、肠杆菌属、嗜麦芽寡养单胞菌为主，5种细菌占G^-菌总数的84．2％；其中克雷伯菌属第1位。其在G菌中占31．58％；克雷伯菌属与大肠埃希菌的超广谱B内酰胺酶（extended spectrum β lactamases，ESBLs）的检出率分别为41．67％、50．00％；亚胺培南、头孢哌酮／舒巴坦对大肠埃希菌、克雷伯菌属、肠杆菌属、单胞菌、不动杆菌属等具高度敏感性。嗜麦芽寡养单胞菌对亚胺培南耐药率达100％。G^＋菌中以葡萄球菌属与肠球菌属为主，共占G^＋菌的91，43％；金黄色葡萄球菌居首位，其在G^＋菌中占42．86％；耐苯唑西林金黄色葡萄球菌（MR—SA）占G^＋菌的93．33％。对万古霉素敏感性为100％。结论颅脑损伤并发下呼吸道感染的主要致病菌常为多重耐药菌和条件致病菌，亚胺培南、头孢哌酮／舒巴坦对G^-致病菌具良好敏感性。万古霉素对G^＋致病菌具高度敏感性。     

神经外科重症监护病房感染患者病原菌分析

目的了解神经外科重症监护病房感染患者致病菌流行病学特征,为预防和治疗神经外科感染提供依据。方法选择神经外科重症监护病房合并感染患者85例,采集痰、脑脊液、血、静脉插管及插管周围皮肤和手术切口分泌物,按常规方法进行细菌培养、鉴定。药敏试验采用微量稀释法,以 VITEK32药物敏感分析卡获得最低抑菌浓度,以标准菌大肠埃希菌ATCC25922、金黄色葡萄球菌 ATCC29213和铜绿假单胞菌ATCC27853菌株进行质量控制。结果判断参照美国国立临床实验室标准委员会标准。结果 85例患者共收集致病菌256株,其中革兰阳性菌80株(31．25％);革兰阴性菌176株 (68．75％),非发酵菌93株(52．84％),肠杆菌科83株(47．16％)。药敏试验结果显示,主要的革兰阴性菌铜绿假单胞菌、肺炎克雷伯杆菌、鲍曼醋酸钙不动杆菌对碳氢酶烯类抗生素敏感;革兰阳性菌金黄色葡萄球菌、凝固酶阴性葡萄球菌对万古霉素敏感率为100％。结论神经外科重症监护病房的主要致病菌以革兰阴性细菌为主,其中以铜绿假单胞菌、肺炎克雷伯杆菌、鲍曼醋酸钙不动杆菌常见;而革兰阳性致病菌则以金黄色葡萄球菌、凝固酶阴性葡萄球菌为主。选择抗生素应首选能覆盖主要致病菌的广谱抗生素。     

神经外科重症监护室病原菌临床分析

目的：研究神经外科重症监护病房（NSICU）中常见的致病菌及其对抗生素的敏感性，以指导临床用药。方法：采用Vitek-Ams System及微量稀释法对临床标本进行培养，检测菌株对常用抗生素的敏感性。结果：常见感染部位是呼吸道、手术创面、中枢神经系统。常见病原菌分别是：铜绿色假单胞菌、肺炎克雷伯菌、产气肠杆菌、嗜麦芽假单胞菌和表皮葡萄球菌。敏感性较高的抗生素有：亚胺培南、万古霉素和头孢他啶。结论：合理使用抗生素是控制医源性感染的关键。     

重症脑血管病患者院内获得性肺炎临床观察

目的探讨重症脑血管病患者院内获得性肺炎（NP）的病原菌分布及抗生素应用。方法选取我院36例重症脑血管病患者，分别于入院第3d、4d、5d、9d及16d取呼吸道分泌物进行培养及药敏试验，对NP的病原学资料进行分析。结果36例重症脑血管病患者呼吸道分泌物共培养出病原菌9种、139株，出现频率位居前4位的菌株依次为金黄色葡萄球菌、铜绿假单胞菌、肺炎克雷伯菌和阴沟肠杆菌。药敏试验结果表明革兰阴性（G^-）菌对亚胺培南最敏感，而革兰阳性（G^＋）菌普遍对万古霉素敏感。结论重症脑血管病患者NP的主要病原菌是金黄色葡萄球菌和铜绿假单胞菌，金黄色葡萄球菌普遍对万古霉素敏感，故可作为治疗首选药物，而铜绿假单胞菌对丁胺卡那及环丙氟哌酸较敏感，亚胺培南次之，对头胞菌素类则耐药率较高，故前两类药物可作为铜绿假单胞菌感染的经验性用药。     

急性脑卒中并发院内获得性肺炎192例临床分析

目的 探讨急性脑卒中患者并发院内获得性肺炎的致病菌构成及防治措施.方法 回顾性分析我院192例急性脑卒中并发院内获得性肺炎患者的临床资料.结果 192例患者呼吸道分泌物培养出13种、116株致病菌,大肠埃希菌、铜绿假单胞菌、肺炎克雷伯菌和金黄色葡萄球菌居前4位.其中革兰阴性菌对亚胺培南敏感,革兰阳性菌则对万古霉素敏感.结论 急性脑卒中并发院内获得性肺炎的主要致病菌为大肠埃希菌和制绿假单胞菌.对患者加强医疗护理措施.加强医院感染的管理,提高急性脑卒中并发肺炎的预见性.积极控制肺炎有利于降低其死亡率.     

重症脑血管病患者院内获得性肺炎的病原菌分布及对抗生素敏感性的研究

目的研究重症脑血管病患者院内获得性肺炎(NP)的病原菌分布及对抗生素的敏感性。方法选取我院神经重症监护病房(NICU)42例重症脑血管病患者,分别于入院第3d、4d、5d、9d及16d取呼吸道分泌物进行培养及药敏试验,对NP的病原学资料进行分析。结果42例重症脑血管病患者呼吸道分泌物共培养出病原菌15种、163株,出现频率位居前4位的菌株依次为金黄色葡萄球菌、铜绿假单胞菌、肺炎克雷伯菌和阴沟肠杆菌。药敏试验结果表明革兰阴性(G-)菌对亚胺培南最敏感,而革兰阳性(G )菌普遍对万古霉素敏感。结论重症脑血管病患者NP的主要病原菌是金黄色葡萄球菌和铜绿假单胞菌。金黄色葡萄球菌普遍对万古霉素敏感,故可作为治疗首选药物;而铜绿假单胞菌对丁胺卡那及环丙氟哌酸较敏感,亚胺培南次之,对头孢菌素类则耐药率较高,故前两类药物可作为铜绿假单胞菌感染的经验性用药。     

神经外科重症监护室获得性感染15株假单胞菌培养及药敏研究

目的 研究神经外科重症监护室（ICU）获得性感染假单胞菌属杆菌的培养及其药敏情况。方法 回顾性分析2002年1月～2006年2月神经外科ICU512例患者的呼吸道分泌物、尿、血、脑脊液标本的细菌培养、药敏资料，从中分析检获的15株假单胞杆菌细菌培养及药敏资料。结果 在15株革兰氏阴性菌（G）假单胞杆菌中，铜绿假单胞杆菌7株、产碱假单胞杆菌6株、嗜麦芽假单胞杆菌2株。对19种常用抗生素药敏试验结果为铜绿假单胞菌对亚胺培南、氨曲南敏感率分别为85．71％、71．43％；产碱假单胞杆菌对亚胺培南和氨曲南的敏感率均为66．67％：两者对三代头孢和喹诺酮类有较高耐药性。嗜麦芽假单胞杆菌对亚胺培南及氨曲南敏感率均为100％。对其余17种抗生素均耐药。结论 神经外科患者感染假单胞杆菌是临床面临的一个严重问题，合理使用预防性抗菌药物、及时进行细菌培养和药敏试验、避免交差感染等措施可有效降低假单胞杆菌感染的发生率。提高治愈率。     

原发性帕金森病87例临床分析及文献复习

目的探讨帕金森病发病年龄对临床表现和预后的影响。方法选取2005年2月-2008年4月在南昌大学第一附属医院神经内科门珍和住院就诊的原发性PD患者共87例，分为早发组（≤50岁）20例和晚发组（〉50岁）67例。比较早发患者和晚发患者的性别构成、发病年龄、家族史、首发症状、非运动症状、辅助检查、药物治疗情况。结果早发组的明确阳性家族史比例显著高于晚发组，合并自主神经和感觉障碍的非运动症状的比例显著低于晚发组。2组在性别构成、首发症状、辅助检查、药物治疗情况的比较上无显著性差异。结论帕金森病的发病年龄和患者的临床表现异质性关系密切，遗传因素可能在早发帕金森病中起更重要的作用。     

神经内科重症监护病房致病细菌的菌群分析

目的 了解神经内科重症监护病房(NICU)患者医院感染发生情况及病原菌流行病学,提出医院感染控制措施。方法 对我院NICU于2002年5月至2004年4月间收治的237例患者分离致病菌的情况及其感染原因进行回顾性分析，共采集并分析326份标本,包括146份痰标本、87份血液标本、46份尿液标本、28份大便标本及19份脑脊液标本。结果 326份标本中，有细菌生长324株。其中革兰氏阴性杆菌178株，阳性率54.94%，其中大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌、不动杆菌、阴沟肠杆菌的分离率较高。革兰氏阳性球菌107株，阳性率33.02%，其中金黄色葡萄球菌、肠球菌、凝固酶阴性葡萄球菌的分离率较高。真菌感染39株，阳性率12.04%。常见的感染部位为肺感染和尿路感染。结论 加强神经内科重症监护病房的细菌监测,及时发现菌群分布，合理使用抗生素，消除医院内的易感染因素，对有效控制NICU感染十分重要。     

急性脑卒中患者并发肺部感染的发病率及病原体分析

目的：探讨急性脑卒中患者并发肺部感染的发病率及病原体特点。方法：对并发肺部感染的急性脑卒中患者进行临床分析和病原学分析。结果：急性脑卒中患者肺部感染总发生率为14．4％。标本培养检出病原体革兰阴性菌98株（41．9％），革兰阳性菌89株（38％），真菌47株（20．1％）。药物敏感性实验示不动杆菌、假单胞菌和葡萄球菌均耐药率较高。结论：出血性脑卒中患者肺部感染发生率高于缺血性脑卒中患者，脑卒中患者并发肺部感染以革兰阴性菌为主。革兰阴性菌对亚胺培南／西司他丁敏感度高。革兰阳性菌对万古霉素较敏感。     

Bibliography of officers of department of mental hygiene

Psychiatric Quarterly -     

Sense of coherence as a predictor of subjective state of health: results of 4 years of follow-up of adults

A number of cross-sectional population studies have shown that a strong sense of coherence (SOC) is associated with various aspects of good perceived health. The association does not seem to be entirely attributable to underlying associations of SOC with other variables, such as age or level of education. OBJECTIVE: The aim of the study reported here was to determine whether SOC predicted subjective state of health. METHODS: The study was carried out as a two-way panel mail survey of 1976 individuals with 4 years interval for two collections of data. The statistical method used was multivariate cumulative logistic modeling. Age, initial subjective state of health, initial occupational training level, and initial degree of social integration were included as potential explanatory variables. RESULTS: A strong SOC predicted good health in women and men. CONCLUSIONS: SOC can be interpreted as an autonomous internal resource contributing to a favorable development of subjective state of health. SOC data should, however, be regarded as complementary to and not a substitute for information already known to be associated with increased risk of future ill health.     

Evaluation of the quality of life of schizophrenic patients: validation of the brief version of the Quality of Life Interview

The main objective of the study was to determine the psychometric properties (mainly, validity and reliability) of the French language version of the brief Quality of Life Interview (QoLI). That instrument evaluates both the subjective and objective aspects of quality of life. METHODS: 128 patients fulfilling the DSM IV criteria for schizophrenia were included. Quality of life was evaluated using the brief QoLI. Schizophrenic symptoms were evaluated using the Positive and Negative Syndrome Scale (PANSS). The validity of the internal structure of the QoLI was investigated by means of item analysis, study of the correlations between the items and between the item-dimensions and principal component analysis addressing the subjective fields. The validity of the external structure was mainly investigated through the nomological validity study. The reliability of the scale was evaluated by studying the internal consistency. In addition, the acceptability of the scale was documented. RESULTS: The results of the study of the validity of the internal structure confirmed the pertinence of the pre-defined fields, particularly the subjective fields. Only some of the subjective fields of the QoLI showed significant correlations with the PANSS sub-scales. The acceptability of the scale was satisfactory. CONCLUSIONS: The psychometric properties of the French language version of the brief QoLI appeared satisfactory. The brief QoLi was shown to be an easily used instrument for assessment of the various objective and subjective aspects of the quality of life of schizophrenic patients.     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.