心内直视术后深静脉留置导管细菌学分析

近年来 ,医院感染倍受重视 ,现代侵入性治疗措施是医院感染的重要来源 [1 ,2 ]。心脏外科术后几乎都要行深静脉穿刺置留导管来监测及输液。1999年 2～ 7月 ,笔者对这些导管进行病原菌培养分析 ,并探讨与医院感染的关系。1　临床资料1.1　对象　对心脏外科术后深静脉留置导管进行分段病原菌培养分析 ,同时记录病人性别、年龄、病种及手术类型、拔管时体温、导管留置时间等。1.2　方法　根据工作需要 ,决定要拔除的深静脉插管口周围皮肤常规用碘酒、酒精消毒 ,在无菌条件下拔除静脉留置管 ,剪下其尖端 1cm及皮下段 1cm,分别送培养。行导管皮下…     

高压氧干预下急性脑梗死患者CD11及CD54变化及其对预后的影响

目的 探讨高压氧干预下急性脑梗死(ACI)患者CD11和CD54变化及其对预后影响.方法 将ACI患者64例分为对照组33例和高压氧治疗组(高压氧组)31例.对照组行常规治疗,高压氧组行常规治疗并高压氧治疗.2组患者均在发病≤72 h及发病第7,10,12和20天晨抽取外周静脉血测定CD11a、CD11c和CD 54,并在相同发病时间采用神经功能缺损程度评分(NDS).另外选取健康者25例作为正常对照,仅抽取周围静脉血测定CD11a、CD11 c和CD54.结果 高压氧组和对照组在发病≤72 h时CD11a、CD11c和CD54表达达到高峰,2组之间各指标差异不显著,第7天都开始呈现下降趋势.高压氧组CD11a、CD11 c高峰持续时间7 d,对照组持续10 d;CD54高峰持续时间高压氧组为10 d,对照组为12 d.经相关和线性回归分析发现,发病第20天时NDS的水平(近期疗效)和发病半年、1年时NDS的水平(远期疗效)分别有97.3%、96.7%及96.6%可用发病前CD11a和/或CD11c和/或CD54的水平以及其他相关因素解释.结论 高压氧治疗可缩短ACI患者CD11a、CD11 c和CD54高峰维持时间.高压氧可干预细胞黏附分子的变化过程,缩短异常时限,减少它们的表达,对ACI患者有保护作用.同时治疗前CD11a、CD11c和CD54的表达可预测病情的轻重,影响近远期疗效,预测预后.

Abstract：

Objective To observe the changes of CD11 a, CD11c and CD54 and its' influence on prognosis after the intervention of hyperbaric oxygen(HBO) in patients with acute cerebral infarction (ACI).Methods Sixty-four ACI patients were divided into control group( C group) and HBO therapy group( HBOT group).C group (33 cases) received routine treatment only, HBOT group ( 31 cases) received routine treatment and hyperbaric oxygen therapy.CD 11 a, CD11 c and CD54 were measured in both groups at ≤72h, the 7th d, 10th d, 12th d, 20th d after ACI, and neural functional damage scores(NDS) were evaluated at the same time.CD11a, CDllc and CD54 were also measured in normal control group (25 cases).Results Plasma levels of CD11a, CD11c and CD54 rose significantly both in HBOT group and C group and peaked at≤72 h after ACI, there was no significant difference between two groups (P > 0.05), then declined at the 7th d.Levels of CD11 a, and CD11c maintained at the peak for 7 d in H BOT group and for 10 d in C group.CD54 peak remained for 10 d in HBOT group, and for 12 d in C group.A correlation analysis and linear regression analysis showed that the NDS levels at 20th d (short-term curative effect), 6 months and 12 months (long-term outcome) could be explained by 97.3 % , 96.7% and 96.6% , respectively by the admission levels of CD11 a and/or CD11 c and/or CD54 and other related factors.Conclusion After hyperbaric oxygen therapy peak level duration of CD11a, CD11c and CD54 could be shortened.Hyperbaric oxygen could influence intercellular adhesion molecule changing process, reduce leukocytes adhesion, decrease expressions of CD11a CD11c and CD54, and protect ACI patients.Before treatment, expression of CD11a, CD11c and CD54 may predict the severity, short or long-term outcome and prognosis of ACI patients.     

高压氧干预下急性脑梗死患者细胞黏附分子变化及对预后的影响

目的 对急性脑梗死(acute cerebral infarction,ACI)患者CD11b、CD11c和CD54作动态观察,找出其变化规律及高压氧(hyperbaric oxygen,HBO)对该规律的影响,并进一步阐明HBO对ACI患者脑血管的保护作用;同时对ACI患者治疗前CD11b、CD11c和CD54与近、远期神经功能恢复程度相关性进行探讨.方法 64例ACI患者分2组:HBO组31例,常规治疗联合HBO治疗;治疗对照组33例,仅行常规治疗.2组分别在治疗前(发病≤72 h)及治疗第7、10、12、20天晨抽取外周静脉血测定CD11b、CD11c和CD54,并在相同治疗时间进行神经功能缺损程度评分(neural functional damage scores,NDS).另外选取正常对照组25人,仅抽取周围静脉血测定CD11b、CD11c和CD54.结果 HBO组和治疗对照组治疗前CD11b、CD11c和CD54表达明显升高,达到高峰,2组各指标差异无统计学意义(P＞0.05),第7天均开始下降.HBO组CD11b、CD11c高峰持续时间为7d,治疗对照组持续10 d;HBO组CD54高峰持续时间为10 d,治疗对照组持续12d.经相关性和线性回归分析发现,发病第20天时NDS水平(近期疗效)和发病半年、1年时NDS的水平(远期疗效)分别为97.2％、96.7％及97.6％,可用CD11b和/或CD11c和/或CD54的上调水平以及其他相关因素解释.结论 HBO治疗后可缩短ACI患者CD11b、CD11c和CD54高峰持续时间.说明HBO可干预细胞黏附分子的变化过程,缩短其异常时限,减少它们的表达,对ACI患者有保护作用,并减少白细胞的黏附.同时治疗前CD11b、CD11c和CD54的表达可预测病情的轻重,影响近、远期疗效,为研究如何调控或抑制CD11b、CD11c和CD54的表达、减少对血管的损伤及早期制定更全面的治疗方案提供依据.     

福州市生活饮用水有机提取物遗传毒性分析

目的 评价福建省福州市生活饮用水及其水源水的体外遗传毒性.方法 随机选择福州市5个区县(市)(分别为A区、B市、C区、D县、E市)各1家水厂,采集出厂水和水源水各2001,经XAD-2树脂柱收集其中的有机物,采用体外单细胞凝胶电泳试验和体外微核试验检测其遗传毒性.结果 单细胞凝胶电泳试验测定Olive尾矩发现B、D和E出厂水3个高剂量组[B:(1.321 4±0.50)、(1.310±0.82)、(1.209±0.74)μm;D:(1.297±0.48)、(1.2894±0.76)、(1.235 4±0.69)μm;E:(1.553±0.65)、(1.534±0.68)、(1.507±0.73)]及D和E水源水最高剂量组[(1.1ll±0.53)、(1.225±0.64) μm]均高于阴性对照组[(0.530±0.22)μm],(P<0.05或P<0.01);体外微核试验计算微核率(‰)发现B、D、E出厂水和E水源水3个高剂量组[B:(32.667±11.02)、(30.00 4±10.00)、(26.833±10.17);D:(31.833±5.19)、(30.167±5.71)、(26.667±5.50);E出厂水:(34.00±7.40)、(31.00±7.46)、(27.50±8.64);E水源水:(30.00±9.88)、(29.50±9.71)、(25.50±9.73)]及D水源水前2个高剂量组[(27.167±6.59)、(25.667±7.03)]均高于阴性对照组(14.833±7.70),(P<0.05或P<0.01).结论 福州市生活饮用水水源水和出厂水受到一定程度的有机物污染.     

中西医结合治疗帕金森病便秘32例

目的观察中西医结合治疗帕金森病便秘的疗效。方法按随机数字表法,治疗组32例用中西药治疗,对照组28例用西药治疗,4周为1个疗程。结果治疗组在便秘症状积分、排便困难程度、粪便软硬程度、排便频率、伴随症状、生存质量自评量表评分上优于对照组。结论中西医结合治疗帕金森病便秘疗效优于西药治疗。     

固相萃取/气相色谱-质谱联用法同时测定水中116种半挥发性有机物

目的:建立固相萃取/气相色谱-质谱联用同时测定水中116种半挥发性有机物的方法。方法:采用C18固相萃取柱富集吸附水样中的目标组分,以二氯甲烷和乙酸乙酯洗脱浓缩,DB-5MS毛细管柱分离,采用气相色谱-质谱联用的全扫描模式进行分析,选择特征离子定量。结果:能简便、快速、有效地分离检测水中的116种半挥发性有机物,方法的线性范围宽,相关系数大于0.9961,响应因子的相对标准偏差小于4.92%,样品加标回收率在81.6%～119.8%之间。结论:本法具有较高的选择性、灵敏度和准确度,对多种水样适应性好,适合水中116种半挥发性有机物的同时检测分析。     

二甲基甲酰胺生物接触限值的研究

目的研究我国职业接触二甲基甲酰胺(DMF)的生物限值。方法气相色谱法检测工作场所空气中二甲基甲酰胺浓度和作业工人班末尿中甲基甲酰胺(NMF)浓度,同时研究两者的相关性。结果 DMF接触者班末尿中NMF浓度与工作场所空气中DMF浓度有密切正相关(Y=0.3389X+3.0297,r=0.9986,P0.01)。根据作业场所空气中DMF的国家职业卫生标准,按回归方程推导出职业接触DMF的生物限值。结论 DMF接触者生物接触限值推荐值:班末尿中NMF为12.0 mg/gCr。     

福州市生活饮用水及其水源水有机提取物的体内遗传毒性研究

目的：探讨福州市生活饮用水及其水源水的体内遗传毒性。方法：随机选择福州市5个区县（市）各1家水厂,采集水源水和出厂水各200 L,经XAD-2树脂柱收集其中的有机物,采用小鼠骨髓细胞微核试验和精子畸形试验检测其遗传毒性。结果：长乐市、平潭县水厂出厂水和水源水及福清市水厂出厂水具有致突变性;各出厂水有机提取物的致突变性基本高于同厂水源水。结论：福州市部分生活饮用水水源水和出厂水受到一定程度的有机物污染。     

冠状动脉病变程度及中医证型对冠心病患者左室重构的影响

目的探讨冠心病患者冠状动脉狭窄程度、病变支数、中医证型与左室重构的关系。方法收集261例疑似冠心病患者的冠状动脉造影和超声心动图检查结果,根据冠状动脉造影结果分为冠心病组231例,非冠心病组30例。冠心病组按狭窄程度分为完全闭塞组、重度狭窄组、中度狭窄组和轻度狭窄组;按病变支数分为3支病变组、2支病变组和单支病变组;根据中医证型分为气虚血瘀组、痰阻心脉组、阴寒凝滞组、心肾阴虚组、阳气虚衰组。比较不同狭窄程度、病变支数、中医证型患者左室形态学指标[左室舒张末期内径(LVED)、左室收缩末期内径(LVES)、左心房内径(LAD)、左室后壁厚度(LVPW)、室间隔厚度(IVST)、左室重量指数(LVMI)]和左室收缩功能指标[左室短轴缩短率(LVFS)、射血分数(EF)、每搏输出量(SV)]、左室舒张功能指标[舒张早期最大流速/舒张晚期最大流速(E/A)]的差异。结果与非冠心病组比较,完全闭塞组、3支病变组、2支病变组及阳气虚衰组患者LVED、LVES、LAD、LVPW、IVST、LVMI、SV升高,LVFS、EF、E/A下降(P<0.05或P<0.01);重度狭窄组患者LVED、LVES、LAD、LVPW、LVMI、SV升高;中度狭窄组患者LVPW、LVMI升高(P<0.05或P<0.01)。与单支病变组比较,3支病变组和2支病变组LVFS、EF降低(P<0.05)。气虚血瘀组患者LVED、LVES、LAD、LVMI高于非冠心病组(P<0.05)。阳气虚衰组患者LVMI高于其他证型组(P<0.05),LVED、LVES高于心肾阴虚组(P<0.05)。结论冠心病不同病变程度、病变支数、中医证型影响左室重构程度,特别是完全闭塞、3支病变、阳气虚衰证的患者左室重构明显,并且左室形态结构改变早于左室功能改变。     

高压氧干预下急性脑梗死患者CD11及CD54变化及其对预后的影响

Objective To observe the changes of CD11 a, CD11c and CD54 and its' influence on prognosis after the intervention of hyperbaric oxygen(HBO) in patients with acute cerebral infarction (ACI).Methods Sixty-four ACI patients were divided into control group( C group) and HBO therapy group( HBOT group).C group (33 cases) received routine treatment only, HBOT group ( 31 cases) received routine treatment and hyperbaric oxygen therapy.CD 11 a, CD11 c and CD54 were measured in both groups at ≤72h, the 7th d, 10th d, 12th d, 20th d after ACI, and neural functional damage scores(NDS) were evaluated at the same time.CD11a, CDllc and CD54 were also measured in normal control group (25 cases).Results Plasma levels of CD11a, CD11c and CD54 rose significantly both in HBOT group and C group and peaked at≤72 h after ACI, there was no significant difference between two groups (P > 0.05), then declined at the 7th d.Levels of CD11 a, and CD11c maintained at the peak for 7 d in H BOT group and for 10 d in C group.CD54 peak remained for 10 d in HBOT group, and for 12 d in C group.A correlation analysis and linear regression analysis showed that the NDS levels at 20th d (short-term curative effect), 6 months and 12 months (long-term outcome) could be explained by 97.3 % , 96.7% and 96.6% , respectively by the admission levels of CD11 a and/or CD11 c and/or CD54 and other related factors.Conclusion After hyperbaric oxygen therapy peak level duration of CD11a, CD11c and CD54 could be shortened.Hyperbaric oxygen could influence intercellular adhesion molecule changing process, reduce leukocytes adhesion, decrease expressions of CD11a CD11c and CD54, and protect ACI patients.Before treatment, expression of CD11a, CD11c and CD54 may predict the severity, short or long-term outcome and prognosis of ACI patients.