新冠肺炎疫情期与疫情前儿科住院患儿医院感染的发生季度、年龄段和发生部位的比较

摘要 目的 为降低新冠肺炎疫情常态化防控期住院患儿医院感染发生率提供依据。方法 选择在新冠肺炎疫情前于儿科住院的患儿1 188例以及在新冠肺炎疫情期于儿科住院的患儿916例为研究对象,对其住院患儿医院感染的发生季度、年龄段及发生部位进行比较。结果 在新冠肺炎疫情期,不同季度住院患儿医院感染发生率差异有统计学意义(P<0.05),新冠肺炎疫情期第一季度住院患儿医院感染率显著低于新冠疫情前(P<0.05)。在新冠肺炎疫情前及疫情期,不同年龄段住院患儿医院感染发生率差异均有统计学意义(P<0.05)。新冠肺炎疫情前与疫情期儿科住院患儿在医院感染及呼吸道感染发生率的差异均有统计学意义(P<0.05)。结论 新冠肺炎疫情期多种防疫措施的实施,显著降低了住院患儿医院感染发生率,年龄小的患儿医院感染高发,值得关注。     

收治重症新型冠状病毒肺炎患者隔离病区的病房管理

目的探讨收治重症新型冠状病毒肺炎(简称新冠肺炎)患者的隔离病区的病房有效管理。方法在医院感染管理科、护理部等职能科室的指导下,根据科室的实际情况对隔离病区进行科学有效的管理。结果提高了病区收治重症新冠肺炎患者的时效性,保障了护理质量和医务人员的安全。结论在医院救治新冠肺炎的特殊时期,通过科学的病区布置、积极有效的防护培训,保证了重症新冠肺炎患者及疑似新冠肺炎患者的及时抢救治疗和医务人员的自身安全。     

新冠肺炎疫情期间肿瘤内科患者的护理管理

总结了新冠肺炎疫情期间肿瘤医院内科住院患者的护理管理体会。主要护理管理对策包括:病区管理、人员管理、病情观察、心理支持、出院管理等,本科室护理管理的重点是加强医院感染的防控工作。通过有效的护理管理和医院感染控制措施的落实,医院在疫情期间未发生医务人员及患者感染新冠肺炎的情况。     

新冠肺炎疫情下小儿外科病房管理策略

在新冠肺炎爆发流行的形势下，为高效启动小儿外科病房对新冠肺炎的防护程序，保障病区患儿的安全，四川大学华西第二医院小儿外科结合病房特点，从建立健全疫情防控管理制度、加强环境管理、加强病区人员管理、加强防护物资管理这四方面探索，加强新冠肺炎疫情下小儿外科病房的管理，保护抵抗力较弱的围手术期儿童患者，有效控制院内感染，保障患儿及临床工作人员生命安全，取得良好效果，具有推广参考价值。     

32例湖北省新型冠状病毒肺炎患儿临床研究

目的 探讨湖北省新型冠状病毒肺炎(新冠肺炎)患儿的临床特点.方法 收集2020年1月21日?至2月14日在华中科技大学同济医学院附属武汉儿童医院住院确诊为新冠肺炎并给予中医治疗的32例患儿入院时的临床资料,包括一般资料、流行病学资料、血常规、病原学资料〔新型冠状病毒(2019-nCoV)核酸检测、呼吸道病原学9项、血培...     

新型冠状病毒肺炎防控期间儿童内科病房感染管理实践

摘要：文章总结了新冠肺炎防控期间,儿童内科病房感染管理工作重点,主要包括：制订出入院管理措施,优化病房空间布局及管理,加强人员管理、培训、防护,加强病房清洁、消毒管理等内容。2020年１—３月,浙江大学医学院附属儿童医院儿童内科病房收治患儿共786例,其中疑似新冠肺炎0例,特殊感染0例;陪护家属出现发热症状5例,经后续追踪其核酸检测结果均为阴性,其患儿予以解除隔离;家属满意度为97%;防控期间实现患儿、陪护家属、工作人员零感染。     

新型冠状病毒肺炎重症应急隔离病区护理管理措施的应用研究

目的探讨新型冠状病毒肺炎重症应急隔离病区护理管理的有效性。方法 2020年2月14日—3月14日,本院援鄂医疗队在接管重症应急隔离病区期间共收治83例新冠病毒肺炎患者,在隔离病区通过采用完善应急隔离病区的各项规章制度、加强护理质量控制管理、优化配置护理人力资源、加强患者健康教育、标识管理、医院感染管理等措施进行全面病房管理。结果 1个月内收治的新冠肺炎患者中出院42人,转院、转科40人;危重症、重症转为轻症52人。未发生医务人员感染事件。结论新冠肺炎重症应急隔离病区通过有效的护理管理,可以避免院内交叉感染,保障医务人员的安全,将整体护理融入到护理服务过程中,取得患者的配合,帮助患者康复。储备适当的人力资源是保证启动应急预案的前提。     

小儿轮状病毒肠炎医院感染预防与控制管理体会

总结小儿轮状病毒肠炎医院感染预防与控制的管理体会。通过培训,对儿科病房新入院疑似轮状病毒肠炎患儿主动筛选和疑似隔离,入院后根据病情分室隔离,严格交接班,制定疾病治疗规范,落实消毒隔离措施,加强预防措施的监控。65例轮状病毒肠炎患儿平均住院天数2.5d,均治愈出院;病房无医院感染发生。     

血常规参数在SARS-CoV-2感染确诊患者、疑似患者、甲型及乙型流感患者中诊断与鉴别诊断的意义

目的了解新型冠状病毒(SARS-CoV-2)感染初期血常规特点,分析SARS-CoV-2感染确诊患者、疑似患者、甲型及乙型流感患者血常规等指标,为早期临床诊断治疗提供依据。方法回顾性分析2019年11月至2020年2月该院发热门诊就诊患者,通过诊断标准将其分为SARS-CoV-2感染确诊患者、疑似患者、甲型及乙型流感患者,对4组患者进行血常规筛查,选择有鉴别意义的标志物。结果该研究纳入发热门诊发热待查患者91例,其中SARS-CoV-2感染确诊患者9例,疑似患者31例,甲型流感患者31例,乙型流感患者20例。SARS-CoV-2感染确诊患者与另外3组相比,白细胞与血小板为有鉴别意义的生物标志物,与流感患者相比,淋巴细胞同样为有鉴别意义的生物标志物。结论血常规参数在SARS-CoV-2感染确诊患者、疑似患者、甲型及乙型流感患者中诊断与鉴别诊断具有一定的意义,可以作为核酸检测的重要补充。     

Acute appendicitis mimicking infectious enteritis: diagnostic value of sonography.

OBJECTIVE: To verify the role of sonography in screening of acute appendicitis in patients admitted to an infectious disease unit for suspected acute infectious enteritis. METHODS: One hundred eighty consecutive patients (102 male and 78 female; age range, 5-72 years; mean age, 31 years) admitted for suspected infectious enteritis or typhoid fever were prospectively studied with abdominal sonography within 48 hours after admission. None of the patients had peritoneal irritation. Forty-six patients (25%) had white blood cell counts of more than 10,000/mm3 (range, 10,300-18,000/mm3). The diagnosis of acute appendicitis was made when a detectable appendix with an anteroposterior diameter of greater than 7 mm could be seen on sonography. RESULTS: Eleven (6%) of 180 patients had thickened appendixes (anteroposterior diameter range, 7-14 mm); 2 of them had periappendiceal abscesses. Four (36%) of 11 patients with acute appendicitis had high white blood cell counts. All sonographic diagnoses of acute appendicitis and periappendiceal abscesses were confirmed at surgery. Sonography ruled out acute appendicitis in 169 patients. In all of them, clinical and sonographic follow-up excluded the diagnosis of acute appendicitis. Normal appendixes were shown on sonography in 38 (22%) of 169 cases and were not detectable in 131 (78%) of 169. CONCLUSIONS: Sonography of the appendix is a useful method for early assessment of acute appendicitis in patients thought to have enteritis or typhoid fever.     

Prognostic implications of myocardial necrosis triad markers' concentration measured at admission in patients with suspected acute coronary syndrome

The aim of the study was to analyze the prognostic implications of 3 myocardial necrosis markers measured at admission in short-term observation of patients with suspected acute coronary syndrome. The study group consisted of 336 consecutive patients whose concentration of cardiac troponin I, creatine kinase-MB fraction, and myoglobin were measured at admission. All patients referred due to chest pain and suspected acute coronary syndrome and were followed up for 30 days. The patients who died had statistically higher concentration of cardiac troponin I (8.7 +/- 17.2 vs 0.9 +/- 3.2 ng/mL; P = .0006), myoglobin (215.2 +/- 181.5 vs 109.7 +/- 151.5 ng/mL; P = .003), and creatine kinase-MB (21.9 +/- 30.7 vs 8.8 +/- 25.9 ng/mL; P = .005), compared to patients who stayed alive. There was statistically significant increase in 30-day all-cause mortality with increasing numbers of positive markers-0.6% for patients with nonpositive marker, 3.4% for patients with 1 positive marker, and 11.5% for patients with at least 2 positive markers (P = .001 for trend).     

Hotel NHS and the acute abdomen – admit first,investigate later

Aim: To determine the financial consequences of a policy of admission first, followed by definitive investigation for patients with an admission diagnosis of suspected acute abdomen. Results: Over a 1‐month period, 122 patients were admitted with a suspected surgical diagnosis of acute abdomen (55 men, 67 women); age range 16–95 years (median: 56.5). Based on surgical operation required (n = 36), death after admission (n = 6, three postoperative deaths) and/or severe surgical illness (n = 17), 56 required surgical inpatient admission, while 66 did not. The patients who did not require admission spent significantly shorter time in hospital than those who required admission (median: 5 days vs. 8.5 days; p = 0.0000). Total hospital hotel and investigation cost (not including ITU or theatre costs) for all 122 patients was £330,468. Overall, £205,468 was consumed by these 56 patients who required admission, while £125,000 was spent on 66 patients whose clinical course did not justify admission; 92% of which was spent on hospital hotel costs and 8% on the cost of imaging and/or endoscopy. Discussion and conclusion: On a national basis, emergency General Surgery admissions account for 1000 Finished Consultant Episodes per 100,000 population. The findings of this study suggest that this equates to a national NHS spend of £650 million each year, for the hotel costs of patients that could arguably avoid surgical admission altogether. Continuing to admit patients with a suspected acute abdomen first and then requesting definitive investigation makes neither clinical nor economic sense.     

Interleukin-6 and lipopolysaccharide-binding protein in acute appendicitis in children

The aim of the study was to evaluate the diagnostic accuracy of interleukin-6 (IL-6) and lipopolysaccharide-binding protein (LBP) in children with acute appendicitis (AA) and to compare this with the diagnostic accuracy of routinely used C-reactive protein (CRP) and white blood cell (WBC) count. Eighty-two consecutive children admitted to our Department because of suspected AA were enrolled in this prospective study and classified into two groups: group 1 (49 children who underwent surgery for AA) and group 2 (33 children with no surgery with diagnosis of non-specific abdominal pain or sonographic mesenteric lymphadenitis). There were no negative appendectomies during the time of the study. The patients were further classified into three subgroups: subgroup 1A (43 patients with advanced AA), subgroup 2A (11 patients with mesenteric lymphadenitis) and subgroup 2B (10 patients with non-specific abdominal pain). The perforation rate was 32.7 %. WBC count and serum CRP, IL-6 and LBP were measured on admission. Area under receiver operating characteristic (ROC) curve (AUC), sensitivity, specificity and predictive values were evaluated. Serum IL-6 and LBP were significantly higher in group 1 than in group 2. The highest AUC for AA was that for IL-6 (0.776), followed by WBC count (0.684), CRP (0.637) and LBP (0.635). In conclusion, only IL-6, determined on admission, showed medium diagnostic accuracy, while other laboratory markers showed low diagnostic accuracy for AA in children. The new laboratory markers therefore do not significantly improve the diagnosis of AA.     

Validation of NACB and IFCC guidelines for the use of cardiac markers for early diagnosis and risk assessment in patients with acute coronary syndromes

BACKGROUND: International guidelines have been established for the use of cardiac markers in the early diagnosis and risk assessment of patients with acute coronary syndromes. METHODS: A single center, prospective observational study was conducted in a tertiary care university hospital on 200 consecutive patients with suspected acute myocardial infarction (AMI). Blood was drawn on admission and after 2, 4, 8, 12 and 24 h for the measurement of CK-MB/CK activity, myoglobin, CK-MB mass and troponin I. A 6-week follow-up was undertaken for the combined end point of acute coronary syndrome and death. RESULTS: Myoglobin showed an early diagnostic sensitivity of 0.65 on admission, 0.90 after 2 h and 0.92 after 4 h compared with 0.46, 0.74 and 0.88 for CK-MB/CK activity. The combination of myoglobin and cTnI increased the diagnostic value compared with myoglobin alone on admission, 2 and 4 h later. In multivariate analysis, cTnI and CK-MB/CK mass, but not myoglobin and CK-MB/CK activity, were shown to be independent predictors on the 6-week follow-up. CONCLUSIONS: Repetitive myoglobin measurements within 4 h of admission, combined with at least one early troponin test, was shown to be the strategy of choice in early AMI diagnosis and prognosis assessment.     

儿童急性阑尾炎的超声诊断

目的探讨超声检查在儿童急性阑尾炎诊断中的应用价值。方法对246例临床疑为急性阑尾炎的患儿予以急诊腹部B超检查。通过测量阑尾外径,观察阑尾腔内容物,阑尾壁有无充血,以及阑尾周围情况等来判断是否存在阑尾炎。结果246例急性腹痛患儿中,114例超声诊断为急性阑尾炎,其中97例急诊手术切除阑尾,另17例阑尾脓肿予非手术治疗,于6个月后择期手术。术后病理均证实诊断无误。余132例患儿中121例肠系膜淋巴结炎,6例卵巢囊肿,1例胆总管囊肿,1例肠系膜囊肿,2例右肾积水,1例右侧输尿管结石。肠系膜淋巴结炎患儿予非手术治疗,其中103例好转,18例因症状不消失仍施以阑尾切除术,病理报告5例为化脓性阑尾炎,13例为单纯性阑尾炎。结论超声检查在儿童急性阑尾炎的诊断中有实用价值。     

Color Doppler ultrasonographic evaluation of osteomyelitis in children.

We investigated the capability of color Doppler sonography in evaluating acute osteomyelitis in children. Twelve children suspected of having osteomyelitis were evaluated with color Doppler ultrasonography at admission and at regular intervals to observe the inflammatory process of osteomyelitis, determine the response of antibiotic therapy, and predict the need of surgery in these patients. At admission, color Doppler flow within or around the infected periosteum was found in patients with symptoms for 4 days or longer, whereas those with symptoms for less than 4 days showed no color Doppler flow within and around the periosteum. During sonographic follow-up, six cases were found to have increased color Doppler vascular flow within and around the affected periosteum, and two of them had periosteal abscess. They eventually required surgical treatment. Persistent or increased color Doppler flow during follow-up examination correlated with elevated serum levels of C-reactive protein as well. Our study indicated that color Doppler vascular flow within or around the infected periosteum correlated with advanced acute osteomyelitis, and surgery usually was required in these patients. Those with early stage acute osteomyelitis usually showed no vascular flow within or around the infected periosteum. Thus, color Doppler sonography allowed detection of advanced osteomyelitis and revealed the progression of inflammation during antibiotic therapy. Color Doppler ultrasonography might be valuable in determining the efficacy of antibiotic therapy and justifying the need for operation.     

Interleukin‐6 and lipopolysaccharide‐binding protein in acute appendicitis in children

The aim of the study was to evaluate the diagnostic accuracy of interleukin‐6 (IL‐6) and lipopolysaccharide‐binding protein (LBP) in children with acute appendicitis (AA) and to compare this with the diagnostic accuracy of routinely used C‐reactive protein (CRP) and white blood cell (WBC) count. Eighty‐two consecutive children admitted to our Department because of suspected AA were enrolled in this prospective study and classified into two groups: group 1 (49 children who underwent surgery for AA) and group 2 (33 children with no surgery with diagnosis of non‐specific abdominal pain or sonographic mesenteric lymphadenitis). There were no negative appendectomies during the time of the study. The patients were further classified into three subgroups: subgroup 1A (43 patients with advanced AA), subgroup 2A (11 patients with mesenteric lymphadenitis) and subgroup 2B (10 patients with non‐specific abdominal pain). The perforation rate was 32.7?%. WBC count and serum CRP, IL‐6 and LBP were measured on admission. Area under receiver operating characteristic (ROC) curve (AUC), sensitivity, specificity and predictive values were evaluated. Serum IL‐6 and LBP were significantly higher in group 1 than in group 2. The highest AUC for AA was that for IL‐6 (0.776), followed by WBC count (0.684), CRP (0.637) and LBP (0.635). In conclusion, only IL‐6, determined on admission, showed medium diagnostic accuracy, while other laboratory markers showed low diagnostic accuracy for AA in children. The new laboratory markers therefore do not significantly improve the diagnosis of AA.