重症肺炎患者感染性休克的危险因素分析及护理对策研究

目的探讨重症肺炎患者感染性休克的危险因素和护理对策。方法选取我院2014年2月至2015年2月的重症肺炎发生感染性休克的患者124例,分析危险因素,探讨抢救治疗成功的护理对策。结果 80例患者被成功抢救,重症肺炎患者并发感染性休克的危险因素包括有患COPD、消化道出血、营养不良、高龄和受累器官在3个以上,有以上危险因素患者的病死率显著较高(P<0.05)。经过全面综合的护理后,病死率降低(P<0.05)。结论重症肺炎患者感染性休克的危险因素较多,造成患者的病死率升高。及时的诊断和治疗以及综合的护理策略对提高抢救的成功率和降低病死率有积极的作用。     

重症肺炎的诊治

重症肺炎既可发生于社区获得性肺炎(community acquired pneumonia,CAP),为重症社区获得性肺炎(SCAP),也可发生于医院获得性肺炎(hospital acquired pneumonia,HAP),为重症医院获得性肺炎(SHAP).     

重症社区获得性肺炎的预后影响因素分析

目的 分析重症社区获得性肺炎(SCAP)的预后影响因素,改善临床治疗预后.方法 回顾性分析2009年2月至2012年6月收治114例确诊为SCAP患者的病历资料,所有患者均记录性别、年龄、病史、实验室检查、病原体检查结果,诊断的规程,治疗措施,疗程和预后等信息,分析预后相关因素.结果 SCAP的单因素分析共纳入10项具有统计学意义的因素,包括年龄＞75岁、慢性阻塞性肺疾病、意识模糊/定向力障碍、急性肾衰竭、呼吸频率≥30次/min、pH值＜7.3、机械通气、无创通气、感染性休克、初始联合用药;选出有统计学意义的10项因素作为自变量,以住院期间死亡为因变量,采用Enter法多因素Logistic回归进行多因素分析,最终筛选出4项具有统计学意义的因素,其中3项具为危险因素,包括感染性休克、急性肾衰竭、意识模糊/定向力障碍,无创通气为保护因素.结论 SCAP患者发病率高、预后差,感染性休克、急性肾衰竭、意识模糊/定向力障碍是SCAP预后的独立危险因素,无创通气为保护因素,控制危险因素有助于干预措施制定,应重视感染性休克、急性肾衰竭等肺外并发症的识别,关注患者精神症状表现,及早进行无创通气,从而改善预后,降低病死率.     

感染性休克患者预后的危险因素分析

目的研究感染性休克患者预后的危险因素。方法选取2016年1月～2019年9月马鞍山市人民医院90例感染性休克患者作为研究对象,记录90例患者中死亡病例,并作为预后不良组,余患者作为预后良好组。比较两组患者基本资料和实验室指标水平,采用logistic多因素分析法分析感染性休克患者不良预后的高危因素。结果 90例患者中死亡24例,为预后不良组,患者ICU治疗时间显著短于预后良好组患者,APACHEⅡ和SOFA评分均高于预后良好组,差异均有统计学意义(P 0.05)。预后不良组患者血乳酸清除率、血小板计数及白蛋白水平低于预后良好组,CRE、cTnⅠ及BNP均显著高于预后良好组,差异均有统计学意义(P 0.05)。logistic多因素分析显示APACHEⅡ评分(OR=2.062,P=0.000)、SOFA评分(OR=3.114,P=0.033)、cTnⅠ(OR=1.792,P=0.000)及BNP(OR=2.308,P=0.006)是感染性休克患者不良预后的危险因素(P 0.05),血乳酸清除率(OR=0.675,P=0.004)和白蛋白水平(OR=0.548,P=0.000)是其不良预后的保护因素(P 0.05)。结论感染性休克患者预后与患者APACHEⅡ评分、SOFA评分、心肌损伤标记物及白蛋白水平相关,临床应引起重视。     

小儿感染性休克死亡相关危险因素分析

目的 探讨感染性休克患儿死亡危险因素,以期采取针对性措施,降低病患死亡率.方法 回顾性调查2003年1月-2011年9月32例感染性休克患儿的临床资料,分析临床特点,研究相关因素,包括年龄、性别、基础疾病、病原菌、临床征象、并发症等变量,采用单因素分析和多因素logistic回归,分析感染性休克死亡相关危险因素.结果 32例患儿中死亡13例,病死率40.63％;细菌学检出病原菌32株,前4位病原菌依次为铜绿假单胞菌、酿脓链球菌、肺炎克雷伯菌及大肠埃希菌,分别占37.49％、15.62％、12.50％和9.38％;单因素分析显示,死亡组与存活组的白细胞计数、血清乳酸值、血糖、血小板计数、多脏器功能失常综合征(MODS)受累脏器数、小儿危重病例评分、抗菌药物应用不当、CRP、白蛋白之间差异有统计学意义(P＜0.05);logistic多因素分析显示血清乳酸值、多脏器功能失常综合征(MODS)受累脏器数及抗菌药物应用不当是感染性休克患儿死亡的独立危险因素.结论 感染性休克患儿病死率高,乳酸水平升高、合并MODS以及抗菌药物应用不当是影响患儿死亡的危险因素,应针对上述因素制定针对性预防措施.     

感染性休克患者发生呼吸机相关性肺炎病原菌与影响因素分析

目的探究感染性休克患者发生呼吸机相关性肺炎的病原菌特点及影响因素分析。方法回顾性分析2014年1月-2017年12月医院收治的感染性休克并接受呼吸机治疗超过48h的患者120例的临床资料。分析发生呼吸机相关性肺炎(VAP)患者的病原菌及耐药性;分析患者年龄、机械通气时间、使用抗菌药物情况等临床资料,归纳感染性休克患者发生VAP的影响因素。结果 120例患者共有48例发生VAP,发生率为40.00%;共培养分离病原菌64株,其中革兰阴性菌40株占62.50%,以鲍氏不动杆菌和铜绿假单胞菌为主;革兰阳性菌14株占21.88%,以金黄色葡萄球菌为主;真菌10株占15.63%;年龄、机械通气时间、急性生理与慢性健康(APACHEⅡ)评分、使用抗菌药物种类是感染性休克患者发生VAP的影响因素(P<0.05)。结论感染性休克患者发生VAP的病原菌耐药形势严峻,应当引起重视;应针对感染性休克患者发生VAP的影响因素,采取相应措施以降低VAP的发生率。     

感染性休克死亡率和危险因素分析

目的分析感染性休克的死亡率及其危险因素。方法回顾总结2002年1月-2005年10月110例感染性休克患者临床资料,采用单因素方差分析和多因素Logistic回归对死亡因素进行分析。结果110例感染性休克患者死亡率为67.2%,全身炎症反应综合征(SIRS)评分、器官衰竭个数是感染性休克死亡危险因素,器官衰竭个数是强危险因素(OR=55.184)。结论感染性休克病死率极高,防治器官功能衰竭是改善预后的关键。     

肾镜碎石术后感染性休克的危险因素分析

目的 探讨微通道经皮肾镜碎石术(M-PCNL)后发生感染性休克的相关危险因素,以指导预防工作。方法 临床选取2010年3月-2013年4月收治的M-PCNL后发生感染性休克20例(休克组)进行临床回顾性研究,选取同期M-PCNL后未发生感染性休克100例作为对照组,观察两组患者手术时间、手术部位、年龄、性别、结石大小、尿路感染及培养、术前是否存在基础疾病等各项因素与感染性休克发生的联系。结果 休克组患者女性占85.0%显著高于对照组的55.0%,有糖尿病史患者占55.0%显著高于对照组的28.0%,术前尿细菌培养阳性占70.0%显著高于对照组的21.0%,术前预防性抗菌药物使用时间<3d者占80.0%显著高于对照组的20.0%,以上均为M-PCNL后感染性休克发生的高危因素(P<0.05)。结论 对患者及时进行血糖控制,预防性给予抗菌药物治疗,对于预防M-PCNL后感染性休克有着较高的临床意义。     

医院获得性肺炎预后及鲍氏不动杆菌感染危险因素分析

目的对医院患者感染鲍氏不动杆菌(AB)发生的医院获得性肺炎(HAP)的危险因素和HAP患者的预后进行回顾性分析,为预防和治疗医院获得性肺炎尤其是鲍氏不动杆菌感染的HAP提供依据。方法选取2014年1月-2015年12月医院HAP患者114例,通过多元logistic回归因素进行分析,评价HAP患者感染鲍氏不动杆菌的危险因素与HAP预后相关的危险因素。结果 114例HAP患者中发生呼吸机相关性肺炎15例,痰培养为鲍氏不动杆菌29例,患者病死率为43.0%;感染前30天内入住ICU、机械通气、使用碳青霉烯类抗菌药物为感染鲍氏不动杆菌的HAP独立危险因素;感染时APACHEII评分>18、合并ARDS、合并休克是HAP死亡的独立危险因素。结论对于ICU患者、有机械通气史患者要警惕鲍氏不动杆菌感染风险,尽量减少ICU住院日及机械通气时间;临床上滥用碳青霉烯类抗菌药物会增加住院患者感染鲍氏不动杆菌风险,HAP患者感染时APACHEⅡ评分可以预估患者的预后。     

急诊重症肺炎并发感染性休克的临床的治疗及护理措施

目的：研究重症肺炎并发感染性休克的临床治疗方式及相对应的护理措施。方法：收治重症肺炎并发感染性休克患者29例,分析治疗方法及影响死亡率的因素。结果：治愈28例,死亡1例,治愈率96.5%。结论：重症肺炎并发感染性休克死亡率比较高,死亡原因与多种因素有关,临床应给予及早治疗和全面护理。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.