浅谈各种杂症致因在郁

临床各种疑难杂症,病机复杂,作者从临床接触各种病种分析,致因从郁论之。     

Etiology and prognosis of non-convulsive status epilepticus

Although non-convulsive status epilepticus (NCSE) is an important type of epilepsy, it is not often recognized. In order to analyze the clinical characteristics and outcome in patients with NCSE, we examined the medical records of patients with NCSE admitted to the Seoul National University Hospital between June 2005 and October 2008. The clinical details and electroencephalography records of 34 adult NCSE patients (aged over 16 years) were collected. Their mean age was 47 years (standard deviation 20 years, range, 16–87 years), and 20 were female. Twenty-seven patients (79.4%) showed decreased awareness with acute onset, and seven (20.6%) were obtunded or comatose. Ten patients (29.4%) had a history of epilepsy, and four (11.8%) had a history of stroke. NCSE was etiologically attributed to acute medical or neurological problems in 25 patients (73.5%), was cryptogenic in three (8.8%), and was secondary to underlying epilepsy in six (17.7%). Acute symptomatic etiology was associated with poor recovery (p = 0.048), with all unresponsive patients in this acute symptomatic group. Eight (23.5%) of the 34 NCSE patients did not recover or died, whereas nine (26.5%) recovered. Our study shows that the presence of acute symptoms or central nervous system infection is associated with poor outcome, suggesting that a high level of vigilance is required to identify and prevent complications.     

急诊科重症患者医院感染的病原学研究

目的探讨急诊科重症患者医院感染的病原学特点,为防治急诊科重症患者医院感染提供指导。方法以2015年1月10日～2017年12月23日我院500例急诊科重症患者为观察对象,对500例急诊科重症患者的临床资料进行回顾性分析,研究急诊科重症患者医院感染的病原学特点。结果 56例患者发生院内感染,以呼吸道感染、泌尿道感染、血液感染、腹腔感染、胸腔感染、手术切口感染较常见,导致感染的主要危险因素为使用呼吸机;共分离出201株病原菌,以革兰阴性菌、革兰阳性球菌、真菌、支原体较常见,所占比分别为60.20%、21.39%、9.95%、8.46%,且革兰阴性菌的所占比相比其他病原菌明显更高(P0.05);病原菌总体排名前五位分别为铜绿假单胞菌(22.39%)、鲍曼不动杆菌(13.43%)、金黄色葡萄球菌(11.94%)、肺炎克雷伯菌(10.45%)、大肠埃希菌(6.47%)。革兰阴性菌多对氨曲南、亚胺培南、环丙沙星、头孢曲松、左氧氟沙星、丁胺卡那的耐药性较高,革兰阳性球菌对万古霉素、替考拉宁无耐药性,但对环丙沙星、左氧氟沙星、克林霉素、青霉素、红霉素的耐药性较强。结论急诊科重症患者医院感染的病原菌以革兰阴性菌为主,耐药性较普遍,为保证抗感染效果,应结合患者的药敏试验结果合理为其选择对应抗菌药物。     

A群链球菌病原学与流行病学研究进展

A群链球菌（GAS）所致疾病谱广泛，轻者如咽炎、扁桃体炎、猩红热等，重者如坏死性筋膜炎、急性肾小球肾炎、链球菌中毒性休克综合征（STSS）等。本文从GAS的病原学和流行病学两方面进行综述。     

HIV as a risk factor of coronary artery disease and of acute coronary syndrome

The number of HIV positive patients in the developed and developing countries is ever growing. Apart from the obvious implications of HIV such as AIDS development, other potentially lethal complications may arise, one of which is the effect of HIV affliction on the coronary system. HIV patients may develop coronary artery disease at a very young age and the myocardial infarction in these patients can be hard to correctly diagnose at the beginning due to the often confusing clinical picture. This paper summarizes the current knowledge on the association between HIV and coronary artery disease and illustrates it on two case reports.