急诊科重症监护室呼吸机相关性肺炎的病原菌与危险因素分析

目的探讨急诊科重症监护室(EICU)呼吸机相关性肺炎(VAP)的病原菌分布和危险因素。方法采集2018年1月-12月本院EICU收治的149例行机械通气患者痰标本,进行微生物培养和鉴定,回顾性分析其危险因素。结果149例机械通气患者发生VAP 61例,发生率为40.94%。VAP患者共检出病原菌72株,其中革兰阴性菌占69.44%,革兰阳性菌占19.44%,真菌占11.11%;铜绿假单胞菌、鲍氏不动杆菌、大肠埃希菌、金黄色葡萄球菌和表皮葡萄球菌为主要致病菌。VAP的感染率与年龄、机械通气时间、是否合并基础疾病、是否存在侵入性操作、气管切开、联合用药呈相关性(P<0.05)。结论VAP主要致病菌为革兰阴性菌,年龄、机械通气时间是主要危险因素,应采取有效的干预措施降低VAP的感染率。     

呼吸机相关性肺炎的影响因素及预防对策研究

目的探讨呼吸机机械通气患者发生呼吸机相关性肺炎(VAP)的影响因素及预防对策。方法选择2013年9月-2017年9月医院呼吸疾病加强监护病房(RICU)158例接受呼吸机机械通气患者为研究对象,统计VAP发生情况;采集患者痰液和下呼吸道分泌物,分离鉴定病原菌;采用单因素及多因素Logistic回归方法分析患者发生VAP的影响因素。结果 158例行呼吸机机械通气患者,发生VAP患者43例,发生率为27.22%。43例VAP患者共分离病原菌58株,革兰阴性菌34株占58.62%、革兰阳性菌20株占34.48%、真菌4株占6.90%。革兰阴性菌主要为铜绿假单胞菌、鲍曼不动杆菌和肺炎克雷伯菌;革兰阳性菌主要为金黄色葡萄球菌和表皮葡萄球菌。年龄、机械通气时间、合并糖尿病、侵入性操作、住院时间、抗酸剂、白蛋白水平和预防性使用抗菌药物为发生VAP的影响因素。结论呼吸机机械通气患者VAP发生率较高,病原菌以革兰阴性菌为主,影响因素较多,应根据相关影响因素做好预防措施,降低VAP的发生。     

重症患者呼吸机相关性肺炎的危险因素及预防策略

目的 探讨重症患者呼吸机相关性肺炎(VAP)的发病危险因素和预防策略.方法 对医院2009年6月-2011年5月ICU收治的入科时无肺部感染且进行机械通气＞48 h患者的临床资料进行回顾性调查分析.结果 183例患者发生VAP83例,发生率45.4％,所有VAP患者共检出病原菌165株,其中革兰阴性杆菌最常见,占69.70％,革兰阴性杆菌中以乙酸钙鲍氏复合不动杆菌最多,占39.39％;其他病原菌革兰阳性球菌占25.45％和真菌占4.85％;年龄≥60岁、机械通气时间≥5d、意识障碍、曾使用制酸剂、白蛋白＜30 g和侵入性操作为VAP发生的危险因素.结论 重症患者VAP的发生与上述危险因素有关,应采取严密监控、规范洗手、加强保护性护理、严格呼吸道管理、改进营养支持方法等针对性的非药物干预措施,以减少VAP的发生.     

呼吸机相关性肺炎的危险因素与口腔护理预防效果分析

目的分析呼吸机相关性肺炎(VAP)的危险因素及其口腔护理预防效果,为降VAP提供参考依据。方法收集2012年12月-2015年5月医院心胸外科210例行机械通气患者临床资料,将其随机分为对照组和干预组,每组各105例,对照组患者给予常规口腔护理,干预组患者采用口腔生理盐水冲洗,记录两组患者VAP发生及预后;对机械通气患者发生VAP的危险因素进行多因素logistic回归分析,采用SPSS 16.0软件进行统计分析。结果干预组患者VAP发生率、病死率分别为14.29%、4.76%,显著低于对照组患者的44.76%、13.33%,差异均有统计学意义(P0.05);VAP患者共检出病原菌85株,其中革兰阴性菌、革兰阳性菌、真菌分别占63.53%、30.59%、5.88%;年龄≥65岁、住院时间≥21d、机械通气时间≥14d、APACHEⅡ评分≥18分、有侵入性操作、意识障碍、合并基础疾病、预防性应用抗菌药物是机械通气患者发生VAP的危险因素(P0.05);其中年龄≥65岁、机械通气时间≥14d、APACHEⅡ评分≥18分、侵入性操作是患者发生VAP的独立危险因素(P0.05)。结论口腔生理盐水冲洗可降低机械通气患者呼吸机相关性肺炎发生率,年龄、机械通气时间、APACHEⅡ评分、侵入性操作为机械通气患者发生VAP的危险因素。     

呼吸机相关性肺炎的危险因素及病原菌的耐药性

目的 探讨医院呼吸机相关性肺炎(VAP)的危险因素与病原菌耐药性,为临床预防治疗VAP提供参考依据.方法 回顾性调查212例VAP患者的资料,统计分析其基础疾病、机械通气方式、感染病原菌种类、耐药率等.结果 212例VAP患者均患有严重的基础疾病;机械通气的插管方式为经口(鼻)气管插管及气管切开等;VAP病原菌以革兰阴性菌为主,占75.0％,其中铜绿假单胞菌(PAE)分离率最高,达22.3％;肺炎克雷伯菌(KPN)居第2位(16.5％);革兰阳性菌中耐甲氧西林金黄色葡萄球菌(MRSA)检出率为8.0％;VAP病原菌均出现较强的耐药性.结论 务必制定有效的VAP防治措施,降低VAP发病率,提高临床治愈率.     

ICU机械通气患者呼吸机相关性肺炎危险因素与干预措施

目的探讨ICU机械通气患者发生呼吸机相关性肺炎(VAP)的危险因素及干预措施,为降低VAP发生率提供依据。方法回顾性分析2013年3月-2014年4月医院收治的360例ICU机械通气患者临床资料,分析其病原菌分布及相关危险因素;采用SPSS19.0软件对数据进行统计分析,计数资料比较用χ2或校正χ2检验及Fisher′s精确概率法;对VAP影响因素分析采用单因素与多因素logistic回归分析。结果 360例ICU机械通气患者发生VAP 118例,发生率为32.78%;共检出病原菌142株,其中革兰阴性菌91株占64.08%,以鲍氏不动杆菌、铜绿假单胞菌为主,革兰阳性菌47株占33.10%,以金黄色葡萄球菌为主,真菌5株占3.52%,以白色假丝酵母菌为主;单因素及多因素logistic回归分析发现,年龄60岁、机械通气时间5d、血清白蛋白含量30g/L、APACHEⅡ评分18分、有意识障碍、应用制酸剂、侵入性操作、留置胃管等因素是发生VAP的独立危险因素(P0.05)。结论 ICU机械通气患者发生呼吸机相关性肺炎危险因素较多,应采取针对性措施,严密监控,加强护理措施,以降低VAP发生率。     

慢性阻塞性肺疾病患者呼吸机相关肺部感染的临床研究北大核心CSCD

目的研究慢性阻塞性肺疾病(COPD)患者实施机械通气过程中并发呼吸机相关肺部感染(VAP)的病原菌分布和相关危险因素,为临床治疗VAP提供参考依据。方法选取2012年1月-2016年1月128例实施机械通气的COPD患者为研究对象,观察COPD患者接受机械通气过程中的VAP发生率,对发生VAP的相关因素进行单因素和多因素logistic回归分析,同时患者留取合格痰标本进行痰培养检测病原菌分布情况。结果128例COPD患者发生VAP 88例,VAP发生率为68.75%;88例VAP患者痰标本共培养出病原菌125株,其中革兰阴性细菌103株占82.4%,革兰阳性细菌3株占2.4%,19株真菌占15.2%;COPD患者实施机械通气后发生VAP的独立危险因素为气管插管、合并糖尿病、机械通气持续时间≥3d、吸烟史以及留置胃管;VAP患者的病死率为31.8%,明显高于非VAP患者的7.5%。结论 COPD患者实施机械通气VAP发生率高,发生VAP的相关危险因素较多,临床应针对感染病原菌合理应用抗菌药物。     

慢性阻塞性肺疾病患者呼吸机相关肺部感染的临床研究

目的研究慢性阻塞性肺疾病(COPD)患者实施机械通气过程中并发呼吸机相关肺部感染(VAP)的病原菌分布和相关危险因素,为临床治疗VAP提供参考依据。方法选取2012年1月-2016年1月128例实施机械通气的COPD患者为研究对象,观察COPD患者接受机械通气过程中的VAP发生率,对发生VAP的相关因素进行单因素和多因素logistic回归分析,同时患者留取合格痰标本进行痰培养检测病原菌分布情况。结果128例COPD患者发生VAP 88例,VAP发生率为68.75%;88例VAP患者痰标本共培养出病原菌125株,其中革兰阴性细菌103株占82.4%,革兰阳性细菌3株占2.4%,19株真菌占15.2%;COPD患者实施机械通气后发生VAP的独立危险因素为气管插管、合并糖尿病、机械通气持续时间≥3d、吸烟史以及留置胃管;VAP患者的病死率为31.8%,明显高于非VAP患者的7.5%。结论 COPD患者实施机械通气VAP发生率高,发生VAP的相关危险因素较多,临床应针对感染病原菌合理应用抗菌药物。     

呼吸机相关性肺炎临床特征观察

目的 探讨呼吸机相关性肺炎(VAP)临床特征及预防对策.方法 回顾性分析280例机械通气治疗患者的临床资料,观察VAP发生率、病原学检查结果、影响VAP相关因素、VAP对预后的影响.结果 280例患者合并VAP90例,发生率32.14％;90例患者培养出病原菌130株,其中革兰阴性杆菌80株,占61.54％,革兰阳性球菌30株,占23.08％,真菌20株,占15.38％;引起VAP的危险因素包括:胃内容物反流、呼吸机应用时间长、平卧位置、APACHEⅡ评分高;发生VAP患者的死亡率为18.89％,高于未发生VAP的4.21％ (P＜0.05).结论 VAP发生率较高,应采取有效的预防措施,降低VAP的发生;对于VAP治疗抗菌药物采用降阶梯治疗措施.     

呼吸机相关性肺炎的病原菌调查及治疗与护理对策

目的探讨呼吸机相关性肺炎(VAP)的危险因素、病原菌分布及治疗与护理对策。方法对医院168例VAP患者临床资料、感染病原菌进行调查与统计分析。结果机械通气、原发基础疾病、抗菌药物的不合理使用是VAP患者发病的重要危险因素;VAP致病菌均为多药耐药细菌,其构成比居前3位的是:铜绿假单胞菌(29.2%)、肺炎克雷伯菌(22.6%)、鲍氏不动杆菌(17.9%)。结论对VAP应采取综合性防治措施,缩短机械通气时间,重视消毒隔离工作,加强机械通气患者的护理,以降低感染率,提高治愈率。     

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.     

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.     

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.     

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.     

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.     

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.     

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.