脑卒中患者医院内获得性感染危险因素分析

目的探讨脑卒中患者医院内获得性感染发生的危险因素及防治措施。方法对2004年1月至12月首次脑卒中250例住院患者进行回顾调查统计分析。结果脑卒中患者医院内获得性感染率为17.20%,其中脑出血、脑梗死患者医院内感染率分别为32.47%(25/77)、10.40%(18/173),远高于同年医院平均院感感染率(5.95%)。结论单因素分析提示住院时间、卒中性质、呼吸道基础病史(慢支、肺结核等)、意识障碍、侵袭性操作、糖皮质激素使用、抗生素的预防使用和H2受体阻滞剂使用与脑卒中患者医院内获得性感染有关;多因素分析提示住院天数、呼吸道基础病、H2受体阻滞剂使用是脑卒中患者医院内获得性感染的危险因素,应引起高度重视,在临床治疗和护理过程中加强防护,以防为主,减少院内获得性感染的发生。     

72例医院获得性肺炎及病原菌种类分布的临床分析

目的 探讨医院获得性肺炎的发病情况、治疗转归及预后.方法 采用回顾性调查,分析本院2003～2004年72例医院获得性肺部感染的发病率、易感人群、发病因素和基础疾病、临床特点、病原菌的种类和分布.结果 调查和分析感染致病因素、治疗结果,控制医院感染,降低医院获得性肺部感染发生率.结论 老年人、肿瘤患者及基础疾病较严重者是医院感染的易感人群.     

类风湿关节炎患者肺部感染的临床特点及其危险因素分析

目的 探讨类风湿关节炎（rheumatoid arthritis, RA）患者合并肺部感染的临床特点及危险因素。方法 回顾性研究合并肺部感染RA住院患者52例和未合并感染RA住院患者200例临床资料,其中严重感染21例,分析RA合并肺部感染及肺部严重感染的临床特点及危险因素。结果 RA患者中合并肺部感染52例,痰培养送检阳性率为36.54%,检出25株病原菌,其中细菌10株,支原体3株,真菌12株;肺部感染相关危险因素分析提示年龄＞60岁、病程≥10年、吸烟、慢性肺疾病、激素治疗为独立危险因素,抗风湿药物（DMARDs）治疗为保护因素。肺部严重感染相关危险因素分析提示病程≥10年、吸烟、慢性肺疾病、激素治疗、补体C4降低为独立危险因素,DMARDs治疗为保护因素。结论 RA患者肺部感染的致病菌主要是真菌和细菌,当RA患者病程≥10年、吸烟、合并慢性肺疾病、激素治疗、补体C4降低时应注意肺部严重感染风险,DMARDs治疗可以降低RA患者肺部感染的风险。     

老年真菌败血症4例临床分析

真菌败血症临床相对少见，常为医院获得性感染。我院ICU病房2003年1月至今共遇到4例，均为伴有基础疾病的老年人，现报告如下，并结合有关文献进行分析。     

老年精神分裂症患者医院感染的危险因素分析

目的分析精神科病房老年精神分裂症患者医院感染的相关危险因素,为降低精神科病房老年患者医院感染率提供临床依据。方法通过分析2013-03—2015-05住院的207例老年精神分裂症患者病历,对其临床资料进行回顾性分析,统计可能导致患者医院感染的各项危险因素,采用单因素及多因素非条件logistic回归分析。结果 207例老年精神分裂症患者中,发生医院感染者为37例,医院感染率为17.87%。其中呼吸系统感染为19例,占51.35%;单因素分析显示老年精神分裂症患者医院感染发生与高龄(70岁)、病程长(25年)、住院天数长(≥180 d)、精神疾病症状控制差、伴有严重基础疾病、长期使用广谱抗菌药物、行为能力衰退有关,差异有统计学意义(P0.05);多因素分析显示合并严重基础疾病的危险性最高(OR=4.128)。结论老年精神分裂症患者医院感染发生与患者高龄、病程长、合并严重基础疾病、精神疾病症状控制差、行为能力衰退等密切相关,临床应采取有针对性的干预措施,以减少医院感染的发生率。     

急性脑血管病死亡病例医院感染临床分析

目的 :探讨急性脑血管病 (ACVD)死亡患者医院感染及相关危险因素。方法 :对 1994年 12月 - 2 0 0 2年 12月在我院住院治疗的 2 5 2 0例急性脑血管病患者中死亡的 2 2 8例患者医院感染情况进行调查分析。结果 :住院期间死亡的 2 2 8例急性脑血管病患者中发生医院感染 6 2例 (2 7 2 % ) ,其中 12 7例脑出血患者发生医院感染 2 9例(2 2 8% ) ,10 1例脑梗死患者发生医院感染 33例 (32 7% )。 >6 0岁发生医院感染 39例 (6 3.0 % ) ,感染大多发生在住院的 2～ 2 0d ,部位以下呼吸道感染为主 (5 2 6 % ) ,其次为泌尿道感染 (2 4 .4 % ) ,引起医院感染的病原菌以G-菌和真菌为主 (41.7%、35 .4 % ) ,其次为G 菌 (2 2 .9% )。结论 :老年、意识障碍、住院日、侵袭性操作、泛用抗菌药物是导致医院感染的主要危险因素 ,对急性脑血管病患者在积极治疗基础疾病的同时特别要加强基础护理 ,针对各种相关危险因素采取有效综合防治措施。     

我院呼吸内科真菌性医院感染的调查与耐药性分析

目的探讨呼吸内科真菌性医院感染的分布、基础疾病、危险因素和耐药性。方法对142例病例进行回顾性调查分析并统计资料。结果呼吸内科真菌性医院感染以白色念珠菌为主，慢性阻塞性肺病、支气管扩张、肺癌占基础疾病的前3位，患者抵抗力下降和侵入性诊疗措施是其主要的危险因素，真菌的耐药性也逐渐增多。结论临床上应重视呼吸内科患者的真菌性医院感染，改善患者的基础状况，合理诊疗，减少真菌耐药性的发生，有效地预防和治疗呼吸内科真菌性医院感染.     

产ESBLs大肠埃希菌血流感染的危险因素分析

目的分析产超广谱β-内酰胺酶(ESBLs)大肠埃希菌引起血流感染的常见危险因素,为临床血流感染控制提供依据。方法采用回顾性方法对2014年1月至2018年12月该院289例大肠埃希菌血流感染的危险因素进行单因素Logistic回归分析,评估其与血流感染的相关性。结果 289例大肠埃希菌血流感染患者中,123例为ESBLs阳性,166例为ESBLs阴性。17种危险因素中发现9种危险因素与产ESBLs大肠埃希菌引起的医院血流感染具有显著关系,分别是手术、败血症征兆、安置尿路导管、安置中心静脉导管、胆道疾病、尿路感染、感染性休克、基础疾病、抗生素使用超过3类。结论产ESBLs大肠埃希菌血流感染为多种因素所致,主要与侵袭性操作、基础疾病和抗生素不合理使用等因素有关。     

ICU医院感染常见危险因素及护理策略

<正>据相关文献报道医院获得性感染的发生率为5%~30%,危重病患者医院感染的发生率为18%~50%,较普通患者高3~18倍[1]。而重症监护室医院感染问题是导致最终治疗失败的重要原因之一[2]。现将ICU医院感染常见危险因素及护理策略综述如下。1危险因素ICU最常见的医院感染为呼吸道感染、泌尿道感染、血液感染[3]。其高发的主要原因有:患者的基础疾病复杂,存在多器官功能障碍及衰竭;有创操作治疗多,各种侵入性的导管及     

老年患者医院获得性肺部感染原因分析及护理对策

目的研究住院老年患者医院获得性肺部感染相关性因素,采取护理对策降低感染率。方法通过回顾性调查方法,对某医院重症监护病房(ICU)住院老年患者医院感染监测结果进行调查与分析,有针对性地建立护理对策。结果该医院ICU医院获得性肺炎的发生与患者年龄段、意识状态和卧床时间、基础疾病和侵入性操作有密切关系。结论对入住ICU的患者早期及时进行综合性评估,应用痰培养+药敏结果选用敏感抗菌药物,同时结合肺炎严重程度评分(PSI)进行危险分层评价患者病情,对高危患者确定适宜的治疗方案,加强呼吸道和院感防控管理、提高医护人员防范意识及督促防范措施落实,能有效降低ICU老年患者医院获得性肺部感染(HAP)感染率,改善患者预后,降低死亡率,减少医疗资源的浪费。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.