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目的 了解抗生素封管治疗中心静脉导管相关性脓毒症（ＣＲＳ）的疗效及适应证。方法 对１３例ＣＲＳ病人，用含头孢他淀０．５ｇ的肝素生理盐水溶液５ｍＬ作中心导管封管，进行前瞻性调查研究。结果 １３例ＣＲＳ病人用抗生素封管治疗ＣＲＳ，其中７例有效，６例无效。６例封管治疗无效病人的菌群为：金黄色葡萄球菌３例，阴沟肠杆菌２例，硝酸盐阴性杆菌１例。这些菌株对头孢他啶皆耐药。结论 抗生素封管治疗ＣＲＳ的方法有一定     

危重病患者中心静脉插管相关性感染的前瞻性研究

作者对加强医疗病房收治的危重病患者留置的中心静脉插管相关性感染（ＣＲＳ）进行了研究,以了解其患病率及危险因素。研究结果显示,总共１５１根中心静脉插管中,１３根（８．６％）伴有ＣＲＳ;危重病患者ＣＲＳ的发生率为每天１６．７次／１０００导管。插管时患者存在其它感染灶、插管穿刺部位、插管留置时间、拔管后２４小时内体温下降程度均与明确的ＣＲＳ相关;插管操作时间、拔管时体温、拔管后２４小时内患者体温下降程度均与没有ＣＲＳ呈显著相关。作者认为,危重病患者ＣＲＳ的发生率较高,导管穿刺和留置过程中仔细操作和护理是降低ＣＲＳ发生率的关键。     

泌尿系统的耐甲氧西林金黄色葡萄球菌感染及其耐药性研究

目的了解泌尿系统耐甲氧西林金黄色葡萄球菌（ＭＲＳＡ）感染的现状及其耐药性。方法采用ＮＣＣＬＳ制订的方法和标准测定从泌尿系统感染标本中分离的２８２株金黄色葡萄球菌的耐药性,通过ＷＨＯＮＥＴ－３统计分析。结果本组ＭＲＳＡ占同期金黄色葡萄球菌感染的６５６％,其中以肾盂引流液、血液和伤口分泌物分离的ＭＲＳＡ比例较高。全部ＭＲＳＡ均对青霉素,氨苄青霉素和苯唑西林耐药;对第一、二、三代头孢类抗生素、氨基糖甙类和新型喹诺酮类抗生素均有程度不同的耐药,仅万古霉素和伊米配能对其仍敏感。结论对严重ＭＲＳＡ感染应在药敏试验指导下选用敏感抗生素治疗。     

冷血心肌麻痹液温度对肌浆网Ca2+摄取和释放的影响

评价冷血心肌麻痹液（ＣＢＣ）温度对肌浆网（ＳＲ）Ｃａ２＋摄取和释放的影响。方法测定ＣＢＣ不同温度停搏１２０分钟和再灌注后心肌匀浆ＳＲ４５Ｃａ２＋摄取及钉红阻滞ＳＲＣａ２＋释放通道后ＳＲ４５Ｃａ２＋摄取的变化。结果停搏期１６℃和２０℃ＳＲ　４５Ｃａ２＋摄取降幅分别为１７．０９％和２１．１６％（Ｐ＜０．０５）;停搏期４、８、１２℃、再灌注后各组ＳＲ　４５Ｃａ２＋摄取与对照组差异均无显著意义（Ｐ＞０．０５）。ＳＲＣａ２＋释放通道阻滞后各组停搏和再灌注后ＳＲ摄４５Ｃａ２＋增幅差异无显著意义（Ｐ＞０．０５）。结论ＣＢＣ温度不同所表现的保护效果差异与ＳＲＣａ２＋摄入受损有关,ＳＲＣａ２＋释放不受影响。     

危重病人应激相关性上消化道出血的药物预防

目的：评价不同的药物用于预防高危危重病人应激相关性上消化道出血（ＳＲ－ＵＧＩＨ）的有效性和安全性。方法：Ｍ组３４例，接受米索前列醇２００μｇ，每８小时一次；Ｒ组３３例，接受雷尼替丁１００ｍｇ，静脉滴注，每１２小时一次；Ｃ组３３例，不接受药物预防性治疗。结果：Ｍ组、Ｒ组的ＳＲ－ＵＧＩＨ的发生率分别为８．８％，１２．１％，比Ｃ组（３０．３％）低（Ｐ＜０．０５），且不增加有关的医院肺炎、多器官功能不全综合征和死亡率（Ｐ＞０．０５）。结论：初步认为小剂量米索前列醇，雷尼替丁间断给药法是预防ＳＲ－ＵＧＩＨ的一种安全有效的方法。     

坐位后颅窗及上颈髓手术麻醉期间及出现空气栓塞时血液动？…

目的 研究后颅窝及上颈髓手术麻醉后坐位及空气栓塞时的血液动力学变化,方法 ２３例择期手术病人以及羟丁酸钠－芬太尼－硫喷妥钠诱导,七氟醚吸入维持,采用Ｓｗａｎ－Ｇａｎｚ导管监测血液动力学变化。结果 坐位前ＲＡＰ,ＳＶＲＩ增高（Ｐ〈０．０５）,ＨＩＲ,ＣＩ,ＳＩ,ＬＶＷＩ,ＬＶＳＷＩ及ＲＶＷＩ,ＲＶＳＷＩ显著降低（Ｐ〈０．０５）;坐起后及其后的３０～６０２分钟ＣＩ,ＳＩ,ＲＶＷＩ,ＲＶＳＷＩ进一步减低     

我院耐甲氧西林金黄色葡萄球菌的耐药性及肠毒素分析

收集了我院１９９４年１０月至１９９５年４月金黄色葡萄球菌１００株，应用药敏试验筛选ＭＲＳＡ，并检测其对１２种抗生素的耐药性，计算ＭＩＣ５０和ＭＩＣ９０，应用乳胶凝集试验法，测定其肠毒素产生率。结果我院总的ＭＲＳＡ阳性率为６０％，烧伤科的ＭＲＳＡ的阳性率为６７．４％，内科６２．５％，骨科４４．５％，ＭＲＳＡ耐药性低于５０％的有万古霉素（３．３％）去甲万古霉素（５％），丁胺卡那霉素（２１．５％）３种，     

冠状动脉旁路移植术中连续心排血量及混合静脉血氧饱和度的 …

目的：观察冠状动脉旁路移植术中连续心排血量和混合静脉血氧饱和度的监测的临床意义及影响因素。方法：５０例冠状动脉旁路移植术病人，从颈内静脉放置ＣＣＯ－ＳＶＯ２Ｓｗａｎ－Ｇａｎｚ导管，连续监测心排血量和混合静脉血氧饱和度的变化。结果：体外循环前ＣＩ最低值为１．１Ｌｍｉｎ＾－１．ｍ＾－１，但ＳｖＯ２均〉６５％，ＣＯ与ＳＶＯ２无相关性。ＣＰＢ中有５例ＳＶＯ〈６５％，其中有２例因Ｃ炒能满足组织氧合的需要，１     

烧伤患者耐甲氧西林金黄色葡萄球菌的感染和治疗

作者分析了９５例烧伤患者创面和全身耐甲氧西林金黄色葡萄球菌（ＭＲＳＡ）感染情况。结果表明，本组ＭＲＳＡ占金黄色葡萄球菌感染的９２．２％。不同类型的创面和不同严重程度的烧伤都可发生创面ＭＲＳＡ感染，但全身性ＭＲＳＡ感染以严重烧伤多见。大多数ＭＲＳＡ对常用的第一、三代头孢类抗生素耐药，仅对万古霉素敏感。全身性ＭＲＳＡ感染仍以万古霉素最为有效。溶葡萄球菌酶作为外用药能有效地控制烧伤创面ＭＲＳＡ感染。     

我院耐甲氧西林金黄色葡萄球菌的耐药性及肠毒素分析

收集了我院１９９４年１０月至１９９５年４月金黄色葡萄球菌１００株，应用药敏试验法筛选ＭＲ－ＳＡ，并检测其对１２种抗生素的耐药性，计算ＭＩＣ５０和ＭＩＣ９０。应用乳胶凝集试验法，测定其肠毒素产生率。结果我院总的ＭＲＳＡ阳性率为６０％，烧伤科的ＭＲＳＡ阳性率为６７．４％，内科６２．５％，骨科４４．５％。ＭＲＳＡ耐药性低于５０％的有万古霉素（３．３％）、去甲万古霉素（５％）、丁胺卡那霉素（２１．５％）３种。ＭＲ－ＳＡ产肠毒素率为１００％，其中产两种以上者占３５％，而ＭＳＳＡ产肠毒素率仅为２０％，其中产两种以上者占５％。     

Investigation on central venous catheter related sepsis]

We made an investigation on central venous catheter related sepsis (CRS) in recent 5 years (1987-1991). The incidence of CRS was high; 16.0% (125 out of 782 cases) or 13.1% (135 out of 1029 catheters). CRS occurred frequently during 2-3 weeks after catheter insertion. The incidence of CRS was not affected by the kind of disease (malignant or benign), complication (diabetes, liver cirrhosis, collagen disease) operation or administration of antibiotics. Eight percent out of 91 organisms isolated from culture of catheter tips were so-called resistant strains; multi-drug resistant Staphylococci (16), Pseudomonas aeruginosa (5), fungi (49), etc. Complications (shock, acute renal failure, secondary pneumonia, fungal endophthalmitis) broken out in 18 patients (14.4% out of 125 CRS). Fungi were isolated from 14 out of 18 complicated cases, furthermore fungi were isolated alone in 11 cases. No complication were seen among cases from which gram positive cocci were isolated alone. Body temperature and white blood cell count of complicated cases were significantly higher than those of uncomplicated cases. The duration until removal of catheter from outbreak of fever in complicated cases was significantly longer than that in uncomplicated cases.     

Catheter-related sepsis in patients on intravenous nutrition: a prospective study of quantitative catheter cultures and guidewire changes for suspected sepsis

One hundred and ninety-five central venous catheters used for intravenous nutrition in 113 patients were studied prospectively. Catheter-related sepsis (CRS), defined by recovery of the same organism from the catheter tip and peripheral blood cultures, occurred with only 3.3 per cent of catheters or 2.3 per 1000 days of therapy. In contrast, CRS was suspected with 30 per cent of catheters and catheter contamination occurred in 37 per cent. Contamination was defined by a positive catheter tip culture without recovery of the same organism from the blood. CRS was present in 4 of 12 cases (33 per cent) with greater than 1000 colony forming units on the catheter tip but in only 2 of 54 (4 per cent) with fewer organisms. Thirty-eight cases suspected of having CRS were randomized to have catheter removal and later replacement, or replacement over a guidewire. There were no significant differences in the catheter contamination rate but there were significantly fewer problems of insertion in the guidewire group. However, transfer of Klebsiella sp., during the guidewire procedure, resulted in subsequent sepsis in one case. It is concluded that replacement of catheters over a guidewire is a safe and convenient way of establishing whether sepsis is catheter-related. Because organisms may be transferred, the procedure is not an appropriate treatment for catheter-related sepsis.     

Complications of Central Venous Catheterization of the Subclavian Vein: The Influence of a Parenteral Nutrition Team

Early and late complications of central venous catheterization were investigated in 488 consecutive catheters, 389 introduced in the subclavian vein by a percutaneous puncture technique, 84 by a cut down technique of the cephalic vein, and 15 by a peel away technique. Care and introduction of the catheters was controlled by the parenteral nutrition team in 239 cases.
Immediate and late complications were found using both the puncture and venous cut down techniques, but immediate complications differed in the two groups due to the different methods of insertion.
The rate of catheter related sepsis (CRS) did not differ significantly when the group under control of the nutrition team was compared with the group without nutritional control (5.9 vs. 6%). The rate of CRS was 1 CRS/220.7 days of therapy in the puncture group and 1 CRS/342.2 days of therapy in the venous cut down group. Catheter tips and blood were cultured from both CRS and non-CRS patients, and the micro-organisms identified.
Catheters were withdrawn, under supervision of the nutrition team, for a number of reasons including death, thrombosis, and technical problems, but suspicion of CRS accounted for a high percentage of withdrawals (18% in the puncture group, 16.6% in the venous cut down group). It is suggested that, when CRS is suspected, removal of the catheter should be delayed until all other possibilities have been investigated.     

Safety of central venous catheter change over guidewire for suspected catheter-related sepsis. A prospective randomized trial

We conducted a study to determine the safety of guidewire exchange of central venous catheters suspected of causing catheter-related sepsis (CRS). Out of a total of 146 patients studied prospectively 41 (28%) suspected of having CRS, were randomly allocated to have their catheters changed over a guidewire (group I) or replaced by a new contralateral venipuncture (group II). One hundred and five patients (group III) requiring only one catheterization served as a control group. Positive semiquantitative cultures (greater than or equal to 15 colonies per plate) of the catheter tip constituted a reliable index of CRS (positive and negative predictive value of 100%). No significant difference in catheter contamination rate and CRS rate was found between group I and II (p = 0.13) and between group I and II versus group III. Nevertheless, there were fewer problems of insertion in the guidewire group (p = 0.03). We conclude that changing a central venous catheter over a guidewire is as safe and has better patient acceptability than inserting a new one, as the proven CRS rate is low (2%) despite a high (27%) suspected rate.     

Do multi-lumen catheters increase central venous catheter sepsis compared to single-lumen catheters?

Triple-lumen catheters (TLC) are now routinely used in critically ill and multiply injured patients who require multi-port central venous access. An apparent rise in catheter contamination and catheter-related sepsis (CRS) occurred in patients receiving total parenteral nutrition (TPN) through a TLC as opposed to a single-lumen catheter (SLC). A prospective study was performed to determine rates of catheter contamination and CRS in multiple trauma and general surgical-medical patients who received TPN through TLC's and SLC's. Three hundred seven TLC's and 68 SLC's were placed in 234 patients during a 12-month period. There was no statistically significant difference in the rate of contamination or CRS between the two groups although there was a trend toward increased CRS and contamination in the TLC group. TLC's may be used for short-term administration of TPN without significant increase in catheter contamination or CRS.     

Catheter‐related sepsis in ultrasound‐guided percutaneously inserted long‐term tunnelled central venous catheter: A review of 50 patients

Objective: Ultrasound‐guided percutaneous insertion of a long‐term tunneled central venous catheter (TCVC) is now a very common procedure, but catheter‐related sepsis remains a significant problem. This study aims to review our results concerning this complication. Methodology: Fifty‐seven central venous catheters were inserted into 50 patients percutaneously under ultrasound guidance in Queen Elizabeth hospital for between 1 March 2003 and 30 April 2004. Data was retrospectively collected and analysed from hospital records. Results: This study had a successful placement rate of 100%. The overall complication rate was 31% (18 out of 57), comprised of four mechanical complications (all occurring within 30 days of insertion). There was no complication documented within the first 24 h. Fourteen patients developed infective complications, and of these eight patients were classified as catheter‐related sepsis, all requiring premature removal of their catheters. There were in total 6161 catheter days, with the incidence rate of catheter‐related sepsis of 1.2 per 1000 catheter days. The infecting organisms were heterogeneous, with the majority being Gram‐positive cocci (47%). Our study found that patients who developed neutropaenia within 30 days after insertion were significantly associated with catheter‐related sepsis (P < 0.05). Conclusion: Insertion of TCVC under ultrasound guidance is a safe method with a high success rate. Incidence of catheter‐related sepsis of TCVC under percutaneous guidance was comparable to the open method. Neutropaenia developing within 30 days after ultrasound‐guided percutaneous insertion of central venous catheter may be associated with increased risk of catheter‐related sepsis.     

Central venous line sepsis in the intensive care unit A study comparing antibiotic coated catheters with plain catheters

A randomised controlled clinical trial was undertaken to evaluate the efficacy of antibiotic bonded lines in the reduction of central venous catheter infection. One hundred and seventy-six plain and bonded catheters were inserted into one hundred and ten patients in an intensive care unit, many of whom were admitted with evidence of sepsis. The catheters used in the study group, which had been pre-treated by the manufacturers with the cationic surfactant tridodecylmethylammonium chloride, were bonded with vancomycin 1 g made up in 10 ml of water immediately prior to insertion. The catheters used in the control group were neither pre-treated nor bonded with vancomycin. Eighty percent of control group catheters were infected compared with 62% of study catheters (p = 0.01). The most common organism isolated was coagulase negative staphylococcus. We conclude that antibiotic bonding can reduce central venous catheter infection even in a patient population with a high incidence of sepsis.     

骨科感染病原菌谱与抗菌谱3年报告

[目的]了解骨科病人所感染菌群及其耐药性,指导临床正确应用抗生素。[方法]对骨科门诊及病房细菌感染病人的708份分泌物、脓液等标本进行需氧培养,并对检出菌按K-B法做体外药敏实验。[结果]检出致病菌259株,G 菌占47.9%,其中金黄色葡萄球菌33.0%,凝固酶阴性葡萄球菌14.9%;G-菌占52.1%,其中假单胞菌属占7.3%,不动杆菌属占6.1%。药敏显示革兰阳性球菌对青霉素及苯唑青霉素的耐药率逐年升高,对万古霉素的敏感性最高为100%。革兰阴性杆菌对亚胺培南的敏感率最高,3年平均95.8%,对头孢他啶也较敏感,但有逐年下降的趋势,对环丙沙星、阿米卡星、哌拉西林的耐药率较高,分别为46.0%、47.0%、51.2%。[结论]骨科病人感染的病原菌中,G-杆菌占大多数且有上升趋势,G 球菌感染发生率少于G-杆菌,单菌株以金黄色葡萄球菌占首位。对G-球菌可以选用万古霉素、苯唑青霉素、诺氟沙星等;对G-杆菌可以选用亚胺培南、头孢他啶。革兰阴性杆菌引起骨科感染有上升趋势,耐药也较严重,加强感染菌及药敏检测,合理使用抗生素非常必要。     

胆道感染患者196例胆道细菌培养及耐药分析

目的：了解胆道感染患者胆汁中主要致病菌的分布及其抗生素敏感情况。方法对福建医科大学附属龙岩第一医院2008年1月至2012年1月间收治的196例胆道感染患者进行胆汁细菌培养和抗生素敏感情况分析。结果从164例患者的胆汁中共分离171株需氧菌,总阳性率为83.67%（164/196）。171株中革兰阴性菌112株,占65.50%;革兰阳性菌59株,占34.50%。革兰阴性菌的主要致病菌包括大肠埃希菌（35.00%）、肠球菌（27.49%）、肺炎克雷白菌（10.00%）和铜绿假单胞菌（4.00%）。革兰阴性菌对碳青酶烯类药物、阿米卡星、头孢哌酮/舒巴坦仍比较敏感,耐药率分别为低于1.8%、3.5%、11.1%;革兰阳性菌对氨苄西林、阿莫西林/克拉维酸钾的耐药率分别为低于6.1%、0。耐万古霉素的肠球菌（VRE）检出率依然较低,粪肠球菌、屎肠球菌对万古霉素的耐药率分别为2.6%、0。结论头孢哌酮/舒巴坦、阿米卡星可作为治疗胆道感染的首选用药。当革兰阳性菌如肠球菌或耐甲氧西林凝固酶阴性葡萄球菌为致病菌时,应根据胆汁培养结果选用窄谱抗生素。