脾切除术后凶险性感染

脾切除术后凶险性感染(overwhelming post-splenectomy infection,OPS)是一种极端严重的全身性脓毒症,可发生于术后6个月至数年,多见于术后2~3年。其临床特点是发病隐匿,病初可能有轻度流感样症状,继而骤然寒战、高热,随即出现头痛、恶心、呕吐、上腹部弥漫性疼痛、腹泻、全身乏力等,病情发展快,迅速发生昏迷,并伴有明显酸中毒、休克、凝血功能障碍,可在几小时内死亡[1]。本文就OPSI的风险因素及发生机制、临床表现、诊断、预防等方面做一综述。     

肝部分切除患者术后并发感染的相关影响因素分析

目的探讨肝部分切除患者术后感染的影响因素,为预防肝切除术后感染的发生提供理论依据。方法回顾性分析2007年12月至2012年12月210例诊断为肝癌行肝部分切除患者的临床资料,将其分为感染组和非感染组,比较2组相关临床资料,采用logistic逐步回归法进行统计学分析,筛选影响术后感染的关键性变量。结果肝部分切除术后有30例感染,感染率为14.3%。患者的年龄、手术时间、失血量、有无输血及有无肝硬化,2组比较差异均有统计学意义(P0.05)。logistic回归分析显示,患者的年龄、手术时间、失血量、有输血及肝硬化是肝部分切除术后感染的关键危险因素。结论年龄大于等于60岁、手术时间大于等于5 h、失血量大于等于3 000 mL、有输血及合并肝硬化是肝部分切除术后感染并发症的关键危险因素。     

脾脏海绵状血管瘤一例

1 临床资料 病例,男,38岁,因体检发现脾占位8+月,感左上腹部疼痛1+月入院。查体无特殊,体检时,彩超发现脾脏内异常回     

迟发性脾破裂34例临床分析

目的探讨迟发性脾破裂的临床特点及治疗效果。方法对1996-2006年我院收治的34例迟发性脾破裂病例的临床资料进行回顾性分析。结果34例急诊患者均行脾切除术,33例痊愈出院,1例合并严重颅脑外伤,术后死于脑疝。结论迟发性脾破裂的特点是外伤后有一定间歇期,症状明显缓解致使部分患者麻痹大意,故其危险性比一般的脾破裂更大,死亡率较高。     

112例外伤性脾破裂保脾手术的临床治疗分析

脾脏是腹部内脏中最容易受损的器官。在腹部闭合性损伤中,脾破裂可高达40%。在腹部开放性伤中,脾破裂也达10%[1]。近年来,脾破裂保脾手术取得了新进展,随之保脾手术也逐渐推广到各级医院临床外科。选择我院及教学医院从2000年1月到2013年1月治疗的脾破裂保脾手术112例的完     

肾移植术后肺部感染23例临床分析

目的分析肾移植术后肺部感染的临床特点和诊治措施。方法对23例肾移植术后并发肺部感染患者的临床资料进行回顾性分析。结果23例患者中巨细胞病毒感染9例,其中合并细菌感染2例。细菌感染7例,其中复合细菌感染1例,细菌合并真菌感染2例;肺部真菌感染4例。发生细菌败血症1例,真菌败血症1例。另3例未检出病原体。经综合治疗本组中22例治愈,1例死亡,为细菌合并真菌感染的重症肺部感染者,死亡原因为急性呼吸窘迫综合征。结论肾移植术后合并肺部感染病情复杂,死亡率较高;可靠的病原学诊断、及时而有效的综合治疗可提高其治愈率。     

脾脏肿瘤的诊断与治疗(附9例报告)

脾脏肿瘤在临床上少见，约占全身肿瘤的0．03％。近年来．随着B超、CT、MRI等影像学检查的普及，脾脏肿瘤病例报道越来越多。我院自1995年8月至2005年12月共收治9例，均经手术治疗个病理诊断确诊，现将其诊断与治疗报告如下。     

腹部术后肺部感染47例临床分析

目的探讨腹部术后肺部感染的原因，以降低肺部感染率。方法对572例腹部手术的病例资料进行回顾性分析，探讨47例腹部术后肺部感染的相关因素。结果572例腹部术后肺部感染47例．感染率8．22％。年龄〉60岁患者的感染率为17．58％，远高于其他低龄两组（P〈0．05）；上腹部术后感染率19．87％较下腹部术后肺部感染率4．04％高，两者差异有统计学意义（P〈0．01）；原有呼吸系疾病患者肺部感染发生率17．02％与无原发呼吸系疾病患者肺部感染率6．49％比较，差异有统计学意义（P〈0．05）；留置胃管患者的肺部感染率26．38％远高于未留置管者5．6％，差异有统计学意义。以上因素导致腹部术后肺部感染患者住院时间延长。结论腹部术后肺部感染与年龄、手术部位、原有呼吸系疾病、留置胃管等因素相关，因此应积极预防，控制感染．减轻患者经济负担。     

肺癌全肺切除172例临床分析

目的总结全肺切除治疗中晚期肺癌的临床结果,探讨心包内处理肺血管的适应证和手术要点。方法对172例肺癌全肺切除患者进行回顾性分析,左全肺切除135例,右全肺切除37例,其中38例行心包内处理肺血管全肺切除。结果围术期内死亡2例,术后并发症发生率28.48%,随访1、3、5年生存率分别为74.68%、32.02%、21.94%。结论心包内处理肺血管安全可行,全肺切除术可提高手术切除率,是治疗中晚期肺癌的一种有效术式。     

Clinicopathological findings in fulminant-type pneumococcal infection: report of three autopsy cases

Reported herein are three autopsy cases of fulminant-type pneumococcal sepsis with disseminated intravascular coagulation (DIC) resulting in death within a few days of onset of symptoms. Two of the three patients had previously had a splenectomy because of a hematological disorder. None of the patients had received pneumococcal vaccination. On post-mortem every organ had congestion as well as bleeding. Interestingly, severe inflammation of the alveoli was absent despite the sepsis. The cause of death was rapidly progressive pneumococcal sepsis leading to DIC and circulatory failure, which appeared to cause pulmonary congestion and hemorrhage without pneumonia. It is important to understand the pathogenesis of fulminant-type pneumococcal infection because it is life-threatening for compromised hosts.     

Immunoglobulin deficiency in children with a sudden overwhelming infection.

BACKGROUND: A small percentage of previously healthy children develop a sudden overwhelming infection (SOI) that rapidly progresses and results in shock and, occasionally, death. Some of these children may have an undetected Ig deficiency. OBJECTIVE: The aim of this study was to evaluate the incidence of Ig deficiency in children with a SOI. METHODS: A case series study was conducted in a university hospital and included 18 children who either died in the emergency room or required admission to the pediatric intensive care unit secondary to a SOI. Two age-matched control groups included children hospitalized to regular floor beds with an infectious process (infected control group) or a noninfectious process (noninfected control group). Serum left from the initial blood draw, before fluid resuscitation, was collected and stored at -70 degrees C. Total IgG, IgG subclasses, IgM, and IgA were assayed by rate nephelometry in a blinded fashion. RESULTS: In the study group, one of six children under 1 year of age had low Ig levels in comparison with two of nine control patients. In those children over the age of 1 year, 8 of 12 patients (67%) had low Ig levels as compared with 2 of 19 controls (11%) by Fisher's exact test, P = .002. Of those patients with Ig deficiencies, three of eight had isolated IgG deficiency, two of eight had combined IgG and IgA deficiency, three of eight had combined IgG and IgM deficiency. CONCLUSIONS: Children over the age of 1 year who present with a SOI have a significantly higher incidence of Ig deficiencies compared with age-matched controls.     

闽东地区小儿颅内感染52例临床分析

目的 探讨小儿各型颅内感染的临床表现、脑脊液及CT影像学检查在鉴别诊断中的价值。方法 本文回顾性分析了52例1996年3月-2003年5月闵东医院住院的颅内感染患儿的临床表现、脑脊液常规检查及CT影像学表现。结果 脑脊液白细胞数在各型颅内感染中无显著性差异,各组间P>0.05;蛋白含量细菌性感染组(包括化脓性脑膜炎及结核性脑膜炎)显著高于无菌性感染组(包括病毒性脑炎及流行性乙型脑炎),P<0.001;糖含量则前组显著低于后组,P<0.01;组内无显著性差异,P>0.05。氯化物含量结脑显著低于其余各组,P<0.01。结论 脑脊液生化常规对各型颅内感染具有鉴别诊断意义。白细胞计数不能作为鉴别的金标准。CT检查对结脑患儿诊断意义较大。     

高位截瘫患者合并肺部感染的62例临床分析

目的探讨高位截瘫患者合并肺部感染的防治。方法选取2007年1月至2010年12月高位截瘫合并肺部感染患者62例,对其资料进行回顾性研究。结果高位截瘫患者合并肺部感染起病隐匿,临床表现不典型,以双肺感染为主（64.5%）,主要病原菌为革兰氏阴性（G-）杆菌（72.6%）,死亡率为11.3%。结论高位截瘫合并肺部感染与患者呼吸系统功能改变相关,多为坠积性肺炎,G-杆菌为主要致病菌。应早期足量联合使用敏感的抗菌药物。     

Surgical site infection in clean and clean-contaminated cases

The rate of surgical site infections and the frequency of various pathogens causing surgical site infection with their antibiotic resistance pattern in general surgery units were studied. In the period from May 2001 to July 2002, 190 patients admitted for surgery (clean and clean-contaminated elective cases) were assessed preoperatively, intraoperatively and postoperatively. Normal microbial flora was studied within 24 to 48 hours of admission and patients were followed up to 30 days postoperatively. Infected wounds were studied bacteriologically and clinically. The overall infection rate was 8.95%. Surgical site infection rate was 3.03% in clean surgeries and 22.41% in clean-contaminated surgeries. Significant increase was seen in surgical site infection rate with an increase in preoperative stay. The increase in duration of surgery was associated with a significant rise in the rate of surgical site infection. Surgical site infection rate was much higher (22.41%) in cases where a drain was used than in non-drained wounds (3.03%). The most common isolate was Staphylococcus aureus followed by Pseudomonas aeruginosa.     

254例急性呼吸道感染病例病原学调查分析

目的 分析急性呼吸道感染病例的病毒病原构成,掌握主要病原体活动水平及变化规律,了解丰台地区急性呼吸道感染病原谱.方法 以2010-2012年成人急性呼吸道感染病例为研究对象,收集病例基础信息,采集鼻咽拭子标本,使用多重PCR及RT-PCR对流感病毒、呼吸道合胞病毒、腺病毒、副流感病毒、偏肺病毒、冠状病毒、鼻病毒、博卡病毒和肺炎支原体等9种病原进行检测,数据分析使用SPSS 17.0软件.结果 254例标本中154例检测阳性,阳性率为60.63％,男女阳性检出率无统计学差异.冬春季致病病原体以流感病毒、副流感病毒及支原体为主,夏季仅检出副流感和支原体.流感样病例的主要病原体为流感病毒及副流感病毒;肺炎病例致病病原体主要为肺炎支原体.2010-2011年流感流行季甲型流感病毒为优势病原,2011-2012年流感流行季乙型流感病毒为优势病原.结论 2010-2012年间,北京丰台地区引起成人急性呼吸道感染的主要病原为流感病毒、支原体和副流感病毒.不同季节的优势病原不同.     

Autopsy cases of fulminant-type bacterial infection with necrotizing fasciitis: group A (beta) hemolytic Streptococcus pyogenes versus Vibrio vulnificus infection

Two autopsy cases of fulminant-type infection associated with necrotizing fasciitis were analyzed clinicopathologically. Both cases involved 57-year-old alcohol abusers. The former was a woman with group A (beta) hemolytic Streptococcus pyogenes infection, and the latter was a man with Vibrio vulnificus infection. The sudden onset of shock with high fever resulted in sepsis, decreased clotting, and hepatorenal symptoms, followed by death within a few days. Post-mortem examination showed widespread congestion and bleeding, and alcoholic liver cirrhosis was observed. Necrotizing fasciitis was identified in both cases. Bacteria from the pharynx or intestinal tract invaded the blood, and marked bacterial proliferation produced sepsis, resulting in necrotizing fasciitis. Despite the presence of sepsis, bilateral pulmonary congestion and bleeding were observed without pneumonia. Due to the rapid progression of sepsis, there was no time for granulocyte migration from the bone marrow. It seems that almost all mature granulocytes which had already existed in the bone marrow accumulated at the focus of necrotizing fasciitis because the bone marrow had few mature granulocytes and lacked hypercellularity. The cause of death in each case was circulatory collapse due to septic shock. It was difficult to distinguish the type of infection on histopathology. Cultures were necessary to determine the bacterial agents involved.     

Malignant intramuscular forearm tumor with overwhelming squamous element

Squamous cell carcinoma (SCC) arising in the skeletal muscle is rare. A case of a 19-year-old female patient with an intramuscular forearm tumor showing a histopathologically overwhelming squamous element is presented. Microscopic examination revealed the classical features of SCC, including horn pearls, individual cell keratinization and intercellular bridge. A malignant spindle cell component was not detected. Neither evidence of another primary site nor skin lesion over the tumor was found and no metastatic lesion was detected in the 5 years since the appearance of the mass.     

支气管肺发育不良8例患儿6年临床随访

目的总结8例支气管肺发育不良（BPD）患儿的6年临床随访结果。方法对温州医学院附属育英儿童医院2004年1月至2005年12月出生的8例BPD患儿分别在1、3和6岁龄时联系来院门诊随访或以电话随访,以探讨BPD的中远期随访结局。结果 1岁龄3例电话随访,5例来院随访;3岁龄2例电话随访,6例来院随访;6岁龄均来院随访。因肺炎或急性支气管炎反复再入院治疗：1岁以内8例22例次,～3岁3例6例次,～6岁1例次。1岁以内4例10例次出现喘息,～3岁3例6例次出现喘息,～6岁2例3例次出现喘息。6岁龄时常规肺通气功能检查5/8例（62.5%）提示小气道功能改变、轻度阻塞性通气功能障碍等;X线胸片检查显示两肺纹理增多增粗、紊乱,不规则实变影3例;毛玻璃样改变和囊泡形成3例;局限性肺气肿2例。结论 BPD患儿1岁龄时明显增加了再次入院风险,学龄前期趋于减少,但6岁时仍有62.5%病例提示常规肺通气功能异常,部分病例胸部影像学为毛玻璃样改变、囊泡形成和局限性肺气肿。