成人呼吸窘迫综合征并多系统器官功能衰竭

自1985年10月至1990年8月,我院内外科临床诊断为成人呼吸窘迫综合征(ARDS)合并多系统器官功能衰竭(MOF)者共9例,现报告如下。临床资料9例ARDS并MOF,男4例,女5例;年龄16～76岁,平均48岁。基础疾病:严重肺部感染2例,化脓性胆囊炎术后2例;肝脓肿、脑出血、严重胸腹挤压伤,DDV中毒,食管自发性破裂引起脓胸各1例。器官衰竭的数目(包括肺),3个器官衰竭8例,四个器官衰竭1例。器官衰竭的频度(不含肺):肝功能衰竭6例;肾功能衰竭3例;     

脑出血合并多脏器功能衰竭死亡93例报告

从我院178例脑出血死亡病例中,收集到多器官功能衰竭(MOF)93例,现分析如下。临床资料一、性别与年龄男性61例,女性32例,年龄>60岁者67例,<60岁者26例。二、器官衰竭数MOF93例中,共208个器官衰竭。各脏器衰竭的频率见附表。其中二器官衰竭45例,三器官衰竭34例,四器官衰竭4例。讨论 MOF是指两个或两个以上器官的功能衰竭,可同时发生或相继出现。本组所有病例均有脑衰,脑衰所致的神经性肺水肿,导致其它脏器的低氧血症及相应的功能不全或衰竭。本组肺衰占59.1%,其发生机理是:1.中枢神经系统严重损害,早期发生肺水肿。2.意识障     

肺心病并发多器官功能衰竭63例临床分析

目的总结肺心病并发多器官功能衰竭（MOF）的防治经验。方法回顾性分析8年来我院收治的慢性肺心病280例,其中合并MOF者63例。结果63例肺心病合并MOF者中,死亡43例,总死亡率68%;并发2个器官衰竭者死亡率52%（15/29）;并发3个器官衰竭者死亡率65%（11/17）;并发4个以上器官衰竭者死亡率100%（17/17）。结论肺心病合并MOF,受累器官越多,病死率越高,年龄越大,病死率越高。减少死亡率的关键在于控制感染,预防发生脑、肾、胃肠、肝、DIC等并发症。     

182例老年人肺炎与多器官衰竭的临床分析

本文分析了我院1978～1988年收治的182例老年人肺炎与多器官衰竭(MOF)的临床资料。发现老年肺炎易导致MOF的发生,其发生率为11.5％(21/182),MOF发生前均有两种以上慢性疾病及器官功能不全。本组器官衰竭的顺序为肺、心、肾、肝、     

多器官功能衰竭的诊断与治疗及预防

多器官功能衰竭(MOF)系指不同疾病发病24小时后.出现二个或二个以上器官同时或先后发生功能衰竭的综合征。MOF在高危人群中的发生率一般为6％～22％,病死率与累及器官数有关,衰竭的器官越多病死率越高,二个器官衰竭达50％～     

肝硬化并发多器官功能衰竭23例分析

114例失代偿期肝硬化并发多器官功能衰竭(MOF)23例,占20.17%,病死率为52.2%,死亡者均有≥4个器官衰竭.其中肝功能Child Ⅲ级者占83.3%.肾脏不可逆损害占83.3%,并发脑水肿脑疝4例.MOF诱因以消化道大出血为首位,感染次之.文内对MOF受累器官的分析、诱因的防治等作简要讨论.     

综合分析肺部感染诱发老年多器官功能不全综合征的临床特点

目的综合分析肺部感染诱发老年多器官功能不全综合征(multiple organ dysfunction syndrome in the elderly,MODSE)的临床特点。方法回顾性综合分析我院老年科64例因肺部感染诱发MODSE患者的临床特点、影像和实验室资料、APACHEⅡ评分变化等情况。结果 64例因肺部感染诱发MODSE患者均存在≥3种基础疾病,以脑血管疾病最多,占70.3%(45/64)。全部肺部感染病原体以耐药铜绿假单胞菌54.7%(35/64)、金黄色葡萄球菌28.1%(18/64)为多见。好转41例(64.1%),死亡23例(35.9%),其中2个器官功能衰竭者死亡3例(13.1%,2/23),3个器官功能衰竭者死亡18例(72.3%,18/23),≥4个以上器官功能衰竭者2例全部死亡。存活患者APACHEⅡ评分明显低于死亡患者。结论肺部感染是诱发MODSE主要诱因之一,基础疾病、受累器官越多,APACHEⅡ评分高,抗菌药物初始治疗不合理者,病死率越高。早期、合理使用抗菌药物治疗,对肺部感染诱发的MODSE具有重要临床价值。     

老年人心衰致多器官衰竭65例临床分析

本文分析了以心脏为首发衰竭器官诱发多器官衰竭(MOF)的诱因,以感染、情绪激动及劳累为主,各占57.41％、31.48％,另有11.11％由室上速及室速诱发。因此,对于老年人,特别有心肾脑等疾患者,积极控制感染和严重心律失常,避免劳累和情绪激动,有利于预防心衰而诱发MOF。     

老年脑血管病并发多脏器衰竭46例分析

多器官衰竭(简称MOF)是指两个以上器官同时或先后发生的功能衰竭,是近10年来急救医学领域中研究的新课题。然而老年MOF是最近才被认识的老年急救医学中严重危及生命的临床综合征。对脑血管病并多器官衰竭国内尚未见报导,本文回顾性总结了我院1980年至1987年收治老年脑血管病患者804例,其中并发MOF 46例(占5.72％),兹报导如下。     

慢性肺心病急性发作期并发多脏器衰竭120例分析

多脏器衰竭(MOF)是指多个器官的功能在严重感染或创伤后,在短时间内同时或相继出现二个及二个以上系统器官衰竭。现就我院1985～1989年间收治的460例慢性肺心病(简称肺心病)患者资料作一回顾性分析,旨在探讨肺心病与MOF的关系,为改进治疗措施提供依据,以降低MOF的发生率与病死率。临床资料本组460例肺心病急性发作期患者中,并发MOF120例。男61例,女59例,年龄45～84岁。60岁以上者80例(67％)。本组患者均根据尹氏[尹本义,等。中华结核和呼吸系疾病杂志,1986;9(3):139]提出的诊断标准诊断。结果本组中二个脏器衰竭者为89例(74.2％),死亡15例(15.9％);三个脏器衰竭者21     

Prevalence and risk factors of infections by multiresistant bacteria in cirrhosis: a prospective study

Epidemiology, risk factors, and clinical effect of infections by multiresistant bacteria in cirrhosis are poorly known. This work was a prospective evaluation in two series of cirrhotic patients admitted with infection or developing infection during hospitalization. The first series was studied between 2005 and 2007 (507 bacterial infections in 223 patients) and the second between 2010 and 2011 (162 bacterial infections in 110 patients). In the first series, 32% of infections were community acquired (CA), 32% healthcare associated (HCA), and 36% nosocomial. Multiresistant bacteria (92 infections; 18%) were isolated in 4%, 14%, and 35% of these infections, respectively (P < 0.001). Extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E; n = 43) was the main multiresistant organism identified, followed by Pseudomonas aeruginosa (n = 17), methicillin-resistant Staphylococcus aureus (n = 14), and Enterococcus faecium (n = 14). The efficacy of currently recommended empirical antibiotic therapy was very low in nosocomial infections (40%), compared to HCA and CA episodes (73% and 83%, respectively; P < 0.0001), particularly in spontaneous bacterial peritonitis, urinary tract infection, and pneumonia (26%, 29%, and 44%, respectively). Septic shock (26% versus 10%; P < 0.0001) and mortality rate (25% versus 12%; P = 0.001) were significantly higher in infections caused by multiresistant strains. Nosocomial origin of infection (hazard ratio [HR], 4.43), long-term norfloxacin prophylaxis (HR, 2.69), recent infection by multiresistant bacteria (HR, 2.45), and recent use of β-lactams (HR, 2.39) were independently associated with the development of multiresistant infections. Results in the second series were similar to those observed in the first series. CONCLUSIONS: Multiresistant bacteria, especially ESBL-producing Enterobacteriaceae, are frequently isolated in nosocomial and, to a lesser extent, HCA infections in cirrhosis, rendering third-generation cephalosporins clinically ineffective. New antibiotic strategies tailored according to the local epidemiological patterns are needed for the empirical treatment of nosocomial infections in cirrhosis.     

Immunodeficiency-related lymphoproliferative disorders: prospective data from the United Kingdom Children's Cancer Study Group Registry

Clinical data and biological samples were prospectively collected in 42 children with lymphoproliferative disease (LPD) secondary to organ/bone marrow transplant-related immunosuppression (30: 11 liver, 10 heart/lung, 8 kidney and 1 bone marrow), other drug-induced immunosuppression (2), congenital immunodeficiency (8) or human immunodeficiency virus (HIV)-related immune dysfunction (2). Ages ranged from 10 months to 17 years and there were 15 girls. Pathology was centrally reviewed and showed polymorphic features in 5 cases, monomorphic in 23, mixed pattern in 5 patients and 9 other types. Using the Revised European-American Classification of Lymphoid Neoplasms, 5 were B lymphoblastoid, 24 were high-grade B and 14 were other subtypes. Using the Pittsburgh classification, 9 were lymphadenopathic, 10 were systemic, 25 were lymphomatous and, with the Murphy grouping for non-Hodgkin's lymphoma (NHL), 10 were localized and 32 non-localized. Twenty-four out of 38 evaluable cases were Epstein-Barr virus positive. Thirty-five patients were evaluable for clonality; 24 were monoclonal and 11 were polyclonal. Reduced immunosuppression in solid organ transplant patients resulted in resolution of disease in 14/24, which was sustained in 11. Nineteen patients received chemotherapy, 14/18 evaluable responded, which was sustained in 8 cases. Seven out of 29 solid organ transplant and 10/13 other immune-deficient patients died. In the largest group of patients, solid organ transplants, no significant clinical or biological characteristics that predicted outcome were identified. In the transplant group close monitoring of response during reduction in immunosuppression is essential and the early use of B NHL chemotherapy may be effective.     

Aerobic and anaerobic microbiology of external otitis.

Microbiological and clinical data from 46 patients with external otitis were retrospectively evaluated. Specimens were processed for isolation of aerobic and anaerobic bacteria. A total of 42 aerobic bacteria, 22 anaerobic bacteria, and 3 Candida albicans organisms were recovered. Aerobic bacteria only were isolated from 31 patients (67%), anaerobic bacteria only were isolated from 8 (17%), and mixed aerobic and anaerobic bacteria were isolated from 4 (9%). C. albicans alone was recovered from two patients (4%), and the organism was mixed with aerobic bacteria in one case (2%). The most common isolates were Pseudomonas aeruginosa (19 instances), Peptostreptococcus species (11), Staphylococcus aureus (7), and Bacteroides species (5). One isolate was recovered from 30 patients (65%), 2 isolates were recovered from 11 (24%), and 3 isolates were recovered from 5 (11%). beta-Lactamase activity was detected in 32 isolates recovered from 27 specimens (59%). These data illustrate the polymicrobial nature of external otitis in one-third of the patients and the role of anaerobic bacteria in one-quarter of them. Further prospective studies are warranted for evaluating the role of anaerobic bacteria in this infection and the therapeutic implications of these findings.     

Microbiological results of bronchoalveolar lavage that was performed for opportunistic pulmonary infections

Between 2001-2002; in 62 cases, 33 (53%) male, 29 (47%) female, mean age 51.4 +/- 18.1 years) bronchoalveolar lavage (BAL) was performed for diagnosis of opportunistic pulmonary infection and specimens were evaluated for results of microbiological examinations. There was hematological malignancy in 18 (29%) and solid organ malignancy in 13 (21%) cases. Thirty-one (50%) cases were immunocompromised for reasons other than malignancy. By endoscopic evaluation endobronchial lesion was seen in 2 (3%) cases, indirect tumor signs were seen in 2 (3%) cases and signs of infection were seen in 11 (18%) cases. Forty-even (76%) cases were endoscopically normal. Acid-fast bacilli (AFB) direct examination was positive in 3 (5%) cases. In 4 (6%) cases mycobacterial culture was positive, Mycobacterium tuberculosis-polymerase chain reaction (PCR) was also positive in these four cases. Examination of gram-stained smears for bacteria was associated with infection in 14 (23%) cases. Bacteriologic cultures were positive for single potential pathogen in 10 (16%) cases, and for mixed pathogens in 7 (11%) cases for a total number of 17 (27%). Fungal cultures were positive in 3 (5%) cases all of which had hematological malignancy. As a result in 24 (39%) cases microbiological agent of infection is determined: in four mycobacteria, in 17 bacteria other than mycobacteria and in three fungi.     

Xenogeneic materials for the surgical treatment of aortic infections

BackgroundThe surgical treatment of aortic infections (AIs) is challenging. In situ aortic reconstructions represent nowadays the favored therapy for fit patients and xenogeneic materials are used increasingly. The aim of this study was to present our experience with xenogeneic reconstructions for AI using self-made bovine pericardium tubes and/or the biosynthetic Omniflow^® II graft.MethodsThis retrospective single-center study included all patients undergoing xenogeneic aortic and aortoiliac reconstructions from December 2015 to June 2020. Patient comorbidities, symptoms, procedural characteristics, types of pathogens and postoperative outcomes were analyzed.ResultsTwenty-eight patients [23 male (82%), median age 68 (range, 28–84) years] were included. Ten patients (36%) had native AIs and 18 (64%) had graft infections, including 3 (11%) aortoesophageal and 2 (7%) aortoduodenal fistulas (ADF). Twenty-four patients (86%) were symptomatic, the most common symptoms being contained aortic rupture (n=8) and sepsis (n=4). The surgical procedures were infra- and juxtarenal aortic repairs (n=11, 39% and n=7, 25%), thoracoabdominal aortic repairs (type IV: n=1, 4%; type V: n=3, 11%), descending thoracic aortic repairs (n=4, 14%) and 2 reconstructions (7%) involving the ascending aorta/aortic arch. Most were urgent (n=10, 43%) or emergent operations (n=11, 35%). Identification of pathogen(s), mostly Gram-positive bacteria, was possible in 25 patients (89%). Twelve patients (43%) had polymicrobial infections and 6 (21%) infections with multi-resistant bacteria. In-hospital mortality was 32% (n=9) due to acute cardiac failure (1/9), endocarditis (1/9), bleeding (3/9) and sepsis (4/9). The most frequent complications were transient need for dialysis (n=12, 43%) and persisting sepsis (n=11, 39%). Two early occlusions of Omniflow^® II grafts were observed (7%). Median follow-up (FU), during which 2 patients died of non-aortic causes, was 14 months (95% CI: 9–19 months). Freedom from reoperation was 100%, there was no evidence for reinfection during FU.ConclusionsXenogeneic orthotopic reconstructions for AI can be performed at all aortic levels. Combining bovine pericardium and the Omniflow^® II graft can be useful for reconstructing the branched aortic segments and both materials show appropriate early to midterm outcomes. Nonetheless, AIs are serious conditions associated with relevant morbidity/mortality rates, even in a specialized center.     

监护病房与普通病房下呼吸道铜绿假单胞菌感染的临床和耐药性对比研究

目的 通过对比重症监护病（ICU）与普通病房下呼吸道铜绿假单胞菌（PA）感染的临床资料和细菌耐药性,为临床合理防治提供依据。方法 分析1997年5月-2001年12月间发生于ICU和普通病房的323例（ICU163例,普通病房160例）下呼吸道PA感染患者的临床资料及自下呼吸道标本分离出的1387株PA（ICU879株,普通病房508株）的体外药敏活性。结果 323例患者的基础疾病较重,以慢性阻塞性肺疾病合并呼吸衰竭（23.31%的ICU患者和12.50%的普通病房患者）和恶性肿瘤（14.72%的ICU患者和14.38%的普通病房患者）最多。易患因素多而复杂,尤其侵袭性操作ICU明显多于普通病房,ICU较普通病房耐药率高,2000年后药物敏感性明显下降。药敏试验结果显示,PA对头孢哌酮-舒巴坦,哌拉西林-三唑巴坦,职权米卡星,头孢他啶,头孢吡肟,亚胺培南,哌拉西林,头孢哌酮,替卡西林-克拉维酸,环丙水利生的耐药率依次为1.0%,2.5%,6.1%,9.2%,11.3%,13.5%,13.8%,16.4%,17.2%及20.2%,ICU患者治疗效果差,病死率高。结论 PA致下呼吸道感染大多发生于免疫功能低下患者,各种易感因素促成本病发生,PA对常用抗生素亦存在一定耐药性,临床应根据药物敏感性选用抗生素。     

Invasive filamentous fungal infections associated with renal transplant tourism

S. Shoham, F. Hinestrosa, J. Moore Jr, S. O'Donnell, M. Ruiz, J. Light. Invasive filamentous fungal infections associated with renal transplant tourism.
Transpl Infect Dis 2010: 12: 371–374. All rights reserved Abstract: ‘Transplant tourism,’ the practice of traveling abroad to acquire an organ, has emerged as an issue in kidney transplantation. We treated a patient who developed invasive aspergillosis of the allograft vascular anastomosis after receiving a kidney transplant in Pakistan, prompting us to review the literature of invasive mycoses among commercial organ transplant recipients. We reviewed all published cases of infections in solid organ transplant recipients who bought their organs abroad and analyzed these reports for invasive fungal infections. Including the new case reported here, 19 cases of invasive fungal infections post commercial kidney transplant occurring in 17 patients were analyzed. Infecting organisms were Aspergillus species (12/19; 63%), Zygomycetes (5/19; 26%), and other fungi (2/19; 5%). Invasive mold infections were present at the transplanted graft in 6/17 patients (35%) with graft loss or death in 13/17 (76%) of patients and overall mortality (10/17) 59%. Invasive fungal infections, frequently originating at the graft site, have emerged as a devastating complication of commercial renal transplant and are associated with high rates of graft loss and death.     

老年重症脓毒症645例临床分析

目的对老年重症脓毒症患者的临床特征进行分析。方法回顾性地分析2005年6月至2009年1月武警总医院干部病房收治的所有老年脓毒症患者的临床资料。结果 645例老年(年龄≥65岁)重症脓毒症,总住院病死率为61.1%,住重症监护病房(ICU)内病死率为41.4%;总住院时间(中位数)21d,住ICU时间(中位数)20d;急性生理学与慢性健康状况评分(APACHEⅡ)值8～58分,中位数分值26分;脓毒性休克发生率为40.2%,病死率为70.7%。共计进行了935例次各种标本的细菌培养,总的培养阳性率为30%。与社区获得性感染组相比,医院获得性感染组的APACHEⅡ、住ICU天数和住院天数显著增加。各脏器功能障碍的发生率分别为呼吸77.9%,凝血44.3%,中枢神经53.2%,心31.5%,胃肠48.1%,肾20.5%,肝14.6%。发生脑功能、呼吸功能、肾功能、凝血功能、心血管功能、胃肠功能障碍组的病死率显著高于无功能障碍组的病死率。老年脓毒症的病死率随着脏器功能障碍数目的增加而显著升高。结论老年重症脓毒症患者病死率高,容易并发各种院内感染,合并多器官功能障碍,应加强脏器功能支持和保护的综合治疗。     

Aetiology of community-acquired pneumonia: serological results of a paediatric survey

Serological methods are routinely used in the diagnosis of viral and atypical bacterial respiratory infections. Recently, they have also been applied to typical bacteria, such as Streptococcus pneumoniae. The aim of this study was to determine the aetiology of paediatric community-acquired pneumonia (CAP) in both ambulatory and hospitalized patients, by using antibody assays. During a 15-month prospective surveillance, paired sera were studied for antibodies to 14 microbes in 101 children with symptoms of acute infection and infiltrates compatible with pneumonia on chest radiographs. A potential causative agent was detected in 66 (65%) patients. Evidence of bacterial, viral and mixed viral-bacterial infection was demonstrated in 44%, 42% and 20% of the CAP cases, respectively. The most commonly found agents included Mycoplasma pneumoniae (27%), Pneumococcus (18%) and respiratory syncytial virus (17%). Human metapneumovirus (hMPV) was detected in 5 (5%) children. Pneumococcal infections were evenly distributed among the age groups studied. Our results confirm the role of S. pneumoniae in paediatric CAP at all ages, those of M. pneumoniae at >2 y of age and emphasize the emerging role of hMPV. The high proportion of mixed viral-bacterial infections highlights the need to treat all children with CAP with antibiotics.     

Microaerophilic streptococcal infection in children

A total of 148 isolates of microaerophilic streptococci (MS) (47 Streptococcus constellatus, 43 Streptococcus intermedius and five Gemella morbillorum) were cultured from 123 children. There were predisposing conditions in 47 (38 %) patients of which most common were previous surgery (14), trauma (11), malignancy (9) diabetes (6) and immunodeficiency (5). MS were the only bacteria isolated from 12 (10 %) patients and mixed infections were encountered in 111, when the number of isolates varied between two and seven (average 3·0) isolates per specimen. The bacteria most commonly isolated with MS were anaerobic cocci (70 isolates), Bacteroides fragilis group (54), pigmented Prevotella and Porphyromonas (34) and Escherichia coli (26). Most B. fragilis and E. coli were recovered from intra-abdominal infections, and those of skin and soft tissue adjacent to the rectum. Most pigmented Prevotella and Fusobacteria were isolated from oropharyngeal, pulmonary, head and neck sites. Most MS were recovered from abscesses (43 %), the abdominal cavity (17 %), sinuses (10 %) and chest infections (9 %). Antimicrobial therapy was administered to all patients, in 61 this was combined with surgical drainage or correction. Three patients died. These data illustrate that MS can occasionally be associated with infection in children.