儿童社区获得性肺炎多重耐药菌分布及耐药性分析

目的：探讨儿童社区获得性肺炎多重耐药菌分布及耐药性,为临床合理用药提供参考。方法回顾性分析58例0～5岁社区获得性肺炎患儿多重耐药菌的分布及耐药情况。结果58例患儿共检出病原菌63株,革兰阴性菌及革兰阳性菌分别占57．14％和42．86％,主要病原菌为产超广谱β－内酰胺酶（ESBL）大肠埃希菌、产 ESBL 阴沟肠杆菌、产 ESBL 肺炎克雷伯菌、耐甲氧西林金黄色葡萄球菌、耐甲氧西林凝固酶阴性葡萄球菌;多重耐药菌对抗菌药物耐药较为普遍,产 ESBL 革兰阴性菌对亚胺培南耐药率较低,耐甲氧西林的革兰阳性菌对利奈唑胺、万古霉素耐药率较低。结论0～5岁儿童社区获得性肺炎多重耐药菌感染以产 ESBL 大肠埃希菌、产 ESBL 阴沟肠杆菌、产 ESBL 肺炎克雷伯菌、耐甲氧西林金黄色葡萄球菌、耐甲氧西林凝固酶阴性葡萄球菌为主,对抗菌药物普遍存在耐药性。     

重症监护病房感染的病原菌分布与耐药性分析

目的：分析重症监护病房（ICU）患者病原菌的分布及耐药性,为合理应用抗菌药物提供依据。方法：采用美国Mi-croscan Autoscan-4微生物分析仪对细菌做鉴定和药敏试验,应用WHONET5.4软件进行数据分析。结果：共分离出细菌307株,革兰阴性杆菌占85.7%,革兰阳性球菌占14.3%。主要革兰阴性杆菌为鲍曼不动杆菌、大肠埃希菌和铜绿假单胞菌,主要革兰阳性球菌为金黄色葡萄球菌、屎肠球菌和粪肠球菌。铜绿假单胞菌对亚胺培南的耐药率为29.8%,其他3种革兰阴性杆菌为0。革兰阳性球菌对万古霉素耐药率为0,对呋喃托因的耐药率为0-13.3%;大肠埃希菌、肺炎克雷伯菌产超广谱β-内酰胺酶（ESBLs）阳性率分别为54.7%、37.2%,耐甲氧西林金黄色葡萄球菌（MRSA）的分离率为76.9%,耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）的分离率为100.0%;细菌多重耐药现象严重。结论：ICU病房的主要病原菌常为多重耐药菌,耐药性日趋严重,临床医师应根据药敏结果选择敏感性抗菌药物进行治疗。     

2008-2011年我院急诊ICU病原菌的分布趋势与耐药性监测

目的了解急诊ICU病原菌菌群分布及其耐药性,为指导临床治疗和控制医院感染提供细菌学依据。方法采用回顾性调查的方法,对2008年1月～2011年11月我院急诊ICU收治的571例住院患者临床资料进行统计分析。结果共分离病原菌2047株,阳性率为32．8％。分离病原菌以革兰阴性杆菌为主,共1431株,革兰阳性球菌412株,真菌204株。主要病原菌依次为铜绿假单胞菌、大肠埃希菌、肺炎克雷伯菌,其中,产ESBLs的大肠埃希菌104株,产ESBLs的肺炎克雷伯杆菌101株,耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）241株,耐甲氧西林金黄色葡萄球菌（MRSA）37株。结论我院急诊ICU病原菌以革兰阴性杆菌为主,大部分细菌对常用抗菌药物表现为高度耐药和多重耐药。加强病原学和耐药性监测,对于指导临床合理应用抗菌药物和预防医院感染具有重要意义。     

机械通气病人下呼吸道病原学及耐药性分析

目的 分析机械通气病人下呼吸道病原菌的分布特点及耐药情况，为临床防治提供依据。方法 回顾分析169株致病菌的分布及其药敏试验结果，加以整理分析。结果 革兰阳性球菌占37．9％，其中金黄色葡萄球菌位各种分离菌之首，耐甲氧西林金黄色葡萄球菌(MRSA)、耐甲氧西林凝固酶阴性葡萄球菌(MRSCN)及耐甲氧西林表皮葡萄球菌(MRSE)分别占81．5％、84．6％、100％，未发现耐万占霉素菌株荸兰阴性杆菌占62．1％，主要集中在大肠埃希菌、铜绿假单胞菌、肺炎克雷白菌，检出超广谱B-内酰胺酶(ESBLs)产生菌21株。革兰阴性杆菌对亚胺培南、头孢哌酮-舒巴坦和头孢吡肟的耐药率最低。结论 机械通气病人下呼吸道病原菌仍以革兰阴性杆菌为主，细菌耐药性严重，应及时掌握病原菌分布及其耐药性的特点，正确选择抗生素。     

重症监护病房患者细菌感染分布与耐药性分析

目的了解院重症监护中心（ICU）细菌栓出率、分布及耐药特点，为临床治疗和合理使用抗生素提供依据。方法用VITEI（32全自动微生物分析仪鉴定细菌，用纸片扩散法（K—B法）对常用抗菌药物进行耐药性测定。结果在254份检出细菌阳性标本中共培养出287株细菌，其中革兰阴性杆菌225株（78．4％），革兰阳性球菌41株（14．3％），念珠菌21株（7．3％），检出菌来自呼吸道标本占63．4％，其他标本各占5％左右；细菌栓出占构成比前三位的依次为铜绿假单胞菌19．5％、肺炎克雷伯菌16．7％、大肠埃希菌14．3％；耐甲氧西林金黄色葡萄球菌、耐甲氧西林凝固酶阴性葡萄球菌和耐万古霉素的肠球菌的发生率分别为88．2％、70．O％和11．1％；大肠埃希菌和肺炎克雷伯菌的超广谱β-内酰胺酶（ESBLs）的检出率分别为68．6％和65．2％，铜绿假单胞菌对亚胺培南的耐药率为40．2％；白色念珠菌对氟康唑的耐药率为81．3％，对两性霉素的耐药率为3．2％。结论ICU病房革兰阴性杆菌感染仍占主导地位，革兰阴性杆菌对氨苄西林耐药率最高，对亚胺培南耐药率最低（嗜麦牙窄食单胞菌除外），产ESBLS多重耐药；革兰阳性球菌对阿齐霉素耐药率最高，对万古霉素耐药率最低。     

2004年院内细菌耐药监测及临床意义

目的了解我院2004年临床标本中的细菌耐药趋势,探讨临床用药对策。方法对501份临床标本所分离出的22种307株细菌进行鉴定和药敏试验,并进行统计。结果病原菌分离率为60．20％,其中,革兰阴性杆菌46．6％,革兰阳性菌为29．0％、真菌为24．4％。革兰阴性杆菌中产超广谱β-内酰胺酶占16．1％（主要为肺炎克雷伯菌和大肠埃希菌）,耐甲氧西林金黄色葡萄球菌为55．1％,耐甲氧西林凝固酶阴性葡萄球菌为71％,耐万古霉素肠球菌为3．3％,高耐氨基糖苷类肠球菌为70％。药敏结果显示革兰阴性杆菌对头孢哌酮／舒巴坦,头孢哌酮／他唑巴坦耐药率较低,产超广谱。内酰胺酶菌对三代头孢类、氨基糖苷类、喹诺酮类抗生素呈多重耐药,金黄色葡萄球菌和耐甲氧西林凝固酶阴性葡萄球菌对抗生素呈多重耐药,未检出耐万古霉素的葡萄球菌。结论细菌对抗生素呈多重耐药日益严重,临床微生物工作者应加强细菌耐药性监测,为临床诊疗提供合理的用药依据。     

2009年宁夏某综合医院临床分离病原菌分布及耐药性分析

目的了解2009年宁夏医科大学总医院临床分离病原菌的分布及对常用抗菌药物的耐药性。方法对我院2009年临床各科送检标本进行培养分离病原菌3383株,同时进行药敏试验,应用WHONET5.5软件对数据进行统计分析。结果在所分离的病原菌中革兰阴性菌占63.3%,革兰阳性菌占36.7%,分离病原菌以革兰阴性杆菌为主。革兰阴性菌中大肠埃希菌489株（22.8%）、铜绿假单胞菌369株（17.2%）和肺炎克雷伯菌169株（13.8%）;革兰阳性球菌中,凝固酶阴性葡萄球菌（CNS）399株（32.2%）、金黄色葡萄球菌302株（24.4%）和肠球菌属202株（16.3%）。药敏试验结果显示耐甲氧西林金黄色葡萄球菌（MRSA）和耐甲氧西林凝固酶阴性葡萄球菌（MRCNS）分别占金葡菌和CNS的71.8%和86.2%,MRSA比往年有所增加。发现5株耐万古霉素屎肠球菌。肺炎链球菌中未见青霉素耐药菌株。大肠埃希菌对碳青霉烯类抗生素比较敏感,肺炎克雷伯菌对美洛培南耐药率为1.1%。结论我院临床分离病原菌以革兰阴性杆菌为主,MRSA阳性率逐步增长并首次发现5例VRE,需加强细菌耐药性监测与控制。     

加强治疗病房人工气道病人痰培养细菌耐药性监测

目的了解加强治疗病房（ICU）人工气道病人呼吸道感染的病原菌分布特征与细菌耐药情况。方法对我院2007年1月至12月ICU人工气道病人痰标本所有细菌分离株及其耐药进行回顾性分析。结果细菌总数507株,革兰阴性杆菌81．5％,革兰阳性球菌13％,真菌5．5％;革兰阳性菌中,耐甲氧西林金黄色葡萄球菌（MRsA）占金黄色葡萄球菌的89．7％,耐甲氧西林凝固酶阴性葡萄球菌（MRCN）占凝固酶阴性葡萄球菌100％;革兰阴性菌分离株仍占多数,对第三代头孢菌素耐药率较高,其中鲍曼不动杆菌所占比例明显增加,达到38．9％。万古霉素对MRSA、MRCN及肠球菌属的敏感率均为100％。结论ICU人工气道病人下呼吸道感染以革兰阴性菌感染为主,且鲍曼不动杆菌所占比例明显增加;细菌耐药率较前明显升高。应加强ICU细菌耐药监测,了解细菌分布及耐药变化,指导临床合理用药,防止耐药菌株的传播。     

宁夏回族自治区2018—2020年血液标本细菌分布及耐药性分析

目的 了解近2018—2021年宁夏回族自治区临床血液培养标本中细菌分布及耐药性,为血流感染疾病防治提供依据。方法 收集2018—2020年宁夏回族自治区细菌耐药监测网点医院的血培养分离菌及耐药性资料,用WHONET5.6软件进行统计分析。结果 2018—2020年共收集血液标本分离细菌6 757株,其中革兰阴性菌3 697株（占54.7%),革兰阳性菌3 060株（占45.3%)。革兰阴性菌中大肠埃希菌2 074株（占30.7%）、肺炎克雷伯菌696株、铜绿假单胞菌139株和鲍曼不动杆菌121株;革兰阳性菌中凝固酶阴性葡萄球菌1 691株（占25.0%）、金黄色葡萄球菌 442株、链球菌属431株、肠球菌属379株。大肠埃希菌和肺炎克雷伯菌对头孢曲松、亚胺培南耐药率分别为56.6%和22.6%、1.0%和3.7%。铜绿假单胞菌和鲍曼不动杆菌对亚胺培南耐药率为9.0%（12/139）和80.7%（71/121）。耐甲氧西林金黄色葡萄球菌（MRSA）检出率26.8%,耐甲氧西林凝固酶阴性葡萄球菌检出率70%,未发现对万古霉素、利奈唑胺耐药葡萄球菌属细菌。3年仅1株耐万古霉素粪肠球菌,未检出耐利奈唑胺葡萄球菌和肠球菌。结果 宁夏回族自治区临床血液标本分离菌以大肠埃希菌、凝固酶阴性葡萄球菌、肺炎克雷伯菌多见。其中大肠埃希菌和肺炎克雷伯菌对三代头孢菌素的耐药率较平稳,对碳青霉烯类耐药率呈低水平。鲍曼不动杆菌对碳青霉烯类耐药率呈高水平,耐甲氧西林金黄色葡萄球菌检出率有所上升,应密切关注。     

血培养检出473株病原菌的耐药性分析

目的 研究菌血症中病原菌分布以及常见病原菌耐药情况.方法 对473株血培养分离所得菌株进行菌株鉴定和药敏试验.结果 革兰阳性球菌175株,革兰阴性杆菌263株,真菌35株.耐甲氧西林金黄色葡萄球菌(MRSA)和耐甲氧西林凝固酶阴性葡萄球菌(MRSCN)分别占金黄色葡萄球菌和凝固酶阴性葡萄球菌的79.5%和77.4%,金黄色葡萄球菌的耐药率比凝固酶阴性葡萄球菌要高,未发现对万古霉素耐药的葡萄球菌和肠球菌.产超广谱β-内酰胺酶(ESBLS)大肠埃希菌和产ESBLS肺炎克雷伯菌分别有39株和21株,大肠埃希菌和肺炎克雷伯菌对亚胺培南都敏感.铜绿假单胞菌和不动杆菌对常用抗菌药物的耐药率较高.真菌对4种常用药物的耐药率很低.结论 引起菌血症的种群不同,耐药性差异较大.     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.