新生儿呼吸机相关性肺炎病原菌分析

目的探讨新生儿呼吸机相关性肺炎(VAP)的发生率及其与通气时间的关系、病原学特点、防治措施。方法收集78例新生儿机械通气并发VAP进行分析。结果新生儿VAP的发生率57.7%,治愈率76.3%。45例VAP平均机械通气时间(125.2±11.0)h,33例未发生VAP平均机械通气时间为(75.3±23.2)h,两者比较差异有显著性意义(P<0.01)。2种细菌混合感染率(40.6%),气道分泌物培养致病菌培养以革兰阴性菌多见,耐药菌株较普遍。结论VAP是新生儿机械通气常见的并发症,其致病菌多为革兰阴性菌。混合感染及耐药是VAP病原学特点,应加强呼吸道无菌管理,其发生率与机械通气时间密切相关。     

新生儿呼吸机相关性肺炎的高危因素和防治

目的：探讨新生儿呼吸相关性肺炎（VAP）的高危因素和防治方法。方法：回顾分析NICU呼吸机治疗的147例危重新生儿的临床资料。结果：VAP发生率46.93％；VAP与胎龄、出生体重呈负相关，与机械通气（MV）时间呈正相关（P〈0.01）；病原菌主要是耐药性条件致病菌，以革兰阴性杆菌为主，革兰阳性球菌次之；多次上机者还培养出真菌；继发VAP与否明显影响治愈率（P〈0.05）。结论：VAP与胎龄、出生体重、MV时间密切相关。致病菌主要是耐药性条件致病菌，综合防治至关重要。     

NICU呼吸机相关性肺炎(VAP)相关因素分析及防治对策

目的:探讨NICU呼吸机相关性肺炎(Ventilator-associated Pneumonia,VAP)的相关因素、病原学特点和防治对策。方法:对我院NICU 2004年12月-2010年6月机械通气治疗的246例新生儿的临床资料进行回顾性分析。结果:VAP的发生率为30.89%,VAP与胎龄、出生体重、机械通气时间密切相关,病原菌以革兰阴性杆菌为主,而且为耐药性条件致病菌,并发VAP后将明显影响治愈率。结论:VAP的发生与胎龄、出生体重呈负相关,与机械通气时间正相关;病原菌以革兰阴性杆菌为主。降低VAP的发生应综合防治。     

新生儿机械通气相关性肺炎的临床分析

目的探讨新生儿机械通气相关性肺炎（Ventilator Association Pneumonia，VAP）的发病、相关因素及病原学特点，为临床防治提供依据。方法对本组127例患儿按插管时间分组，回顾性分析发生VAP有无差异，所有病原学分析全部采取插管内气道分泌物培养。结果127例机械通气的患儿有74例发生VAP。机械通气〉3天的新生儿VAP发生率明显高于≤3天的新生儿（X^2=26．373，P〈0．05）。致病菌以G^-杆菌为主。结论临床上合理应用机械通气，及早撤机，根据致病菌的可能性合理使用抗生素，能有效预防及治疗VAP。     

新生儿呼吸机相关性肺炎76例临床分析

目的探讨新生儿呼吸机相关性肺炎（VAP）的高危因素、病原学特点和防治方法。方法对我院NICU2005年12月—2008年3月机械通气治疗的146例新生儿的临床资料进行回顾性分析。结果VAP的发生率为52.05%,VAP与胎龄、出生体重、机械通气时间密切相关,病原菌以革兰阴性杆菌为主,并发VAP后将明显影响治愈率。结论VAP的发生与胎龄、出生体重、机械通气时间密切相关,病原菌主要是革兰阴性杆菌,降低VAP的发生预防为主很重要。     

新生儿机械通气相关性肺炎的临床分析

目的探讨新生儿机械通气相关性肺炎(VentilatorAssociationPneumonia,VAP)的发病、相关因素及病原学特点,为临床防治提供依据。方法对本组127例患儿按插管时间分组,回顾性分析发生VAP有无差异,所有病原学分析全部采取插管内气道分泌物培养。结果127例机械通气的患儿有74例发生VAP。机械通气>3天的新生儿VAP发生率明显高于≤3天的新生儿(χ2=26.373,P<0.05),致病菌以G-杆菌为主。结论临床上合理应用机械通气,及早撤机,根据致病菌的可能性合理使用抗生素,能有效预防及治疗VAP。     

新生儿呼吸机相关性肺炎的病原菌及耐药性分析

目的探讨新生儿呼吸机相关性肺炎病原菌感染现状及耐药性，为防治VAP提供科学依据。方法对新生儿VAP的病原体及耐药性进行回顾性研究，分析44例新生儿VAP的临床资料及呼吸道分泌物细菌培养与药敏结果。结果新生儿VAP的发生率为53．53％；病原菌以革兰阴性杆菌为主，占菌株总数的80．49％；铜绿假单胞菌、克雷伯杆菌、鲍曼不动杆菌、大肠杆菌是新生儿VAP的主要致病菌，且多为耐药菌。结论尽量减少机械通气时间、拉制原发病和合理使用抗生素是减少VAP的关键。     

呼吸机相关性肺炎48例临床分析

目的：探讨机械通气并发呼吸机相关性肺炎（VAP）的临床病原学特点、治疗及预后。方法：回顾性分析127例气管插管机械通气患者的临床资料，并对其中48例VAP患者进行相关因素分析。结果：127例气管插管机械通气中并发VAP48例，其中各类细菌混合感染者27例（56．25％），单一细菌感染者21例（43．75％）；VAP致病菌以G^-杆菌感染为主，占53．62％，药敏试验显示对多种抗生素耐药；治愈或好转34例，死亡14例，病死率29．17％。结论：VAP的临床病原学特点是以G一杆菌为主的混合感染；在获得下呼吸道分泌物标本培养结果之前，采取经验性抗菌治疗可改善预后；同时应采取多种措施。尽可能降低VAP的发生率。     

新生儿呼吸机相关性肺炎临床分析

目的随着现代新生儿医学的发展,机械通气的增加,新生儿呼吸机相关性肺炎（ventilator-associatedpneumonia,VAP）成为NICU倍受关注的话题,本文着重探讨新生儿呼吸机相关性肺炎的发病率、高危因素、病原学特点、耐药性及预防措施,为VAP的防治提供一定的理论依据。方法回顾分析2008年1月～2009年1月我院新生儿重症监护室（NICU）中使用呼吸机机械通气154例危重新生儿临床资料。结果154例进行机械通气的患儿中有57例发生了VAP,发生率为37.0%。通过统计分析发现VAP的发生与早产、低出生体重、插管次数、原发肺部疾病及是否早期大剂量使用丙球密切相关（P〈0.05）。主要病原菌为革兰阴性杆菌,占84.2%,其中以肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌最多见,且多为耐药菌。结论VAP的病原以革兰阴性杆菌为主,对美洛培南、亚胺培南、环丙沙星等最为敏感,应该根据细菌培养结果正确合理选择抗生素,才能提高机械通气的效率。     

呼吸机相关性肺炎48例临床分析

目的 分析重症监护病房（ICU）机械通气患者并发呼吸机相关性肺炎（VAP）的临床相关因素和细菌学特点。方法 回顾性分析呼吸机相关性肺炎患者48例发病时间和病原学特点。结果 ICU重症患者机械通气1≥48h 112例，并发VAP48例，发病率为42．8％。重症患者并发VAP时病死率35．4％。VAP机械通气平均发生在（5．3±2．5）d。与机械通气时间、意识障碍相关；VAP致病菌以革兰氏阴性杆菌感染为主，占81．8％，药敏试验显示对多种常用抗生素耐药。结论 ICU呼吸机相关性肺炎发生率、病死率高，尽可能缩短呼吸机使用时间、合理使用抗生素、严格无菌操作，有利于呼吸机相关性肺炎控制。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.