神经外科重症患者肺部感染多重耐药菌的危险因素分析

目的 调查神经外科重症患者合并肺部感染的病原菌分布及耐药情况,并分析其肺部多重耐药菌(MDRO)感染的危险因素.方法 回顾性分析187例伴有肺部感染的神经重症患者的临床资料、肺部病原菌分布和MDRO的耐药情况,并根据其痰培养病原菌是否为多重耐药菌将患者分为耐药菌组和非耐药菌组,分析神经重症伴肺部感染患者感染MDRO的危...     

神经重症患者肺部感染的危险因素分析

目的明确神经外科重症患者并发肺部感染的影响因素,为肺部感染的防治提供参考。方法选择中山大学附属第八医院(深圳福田)神经外科自2017年5月至2018年5月收治的65例神经重症并发肺部感染患者进入研究,收集患者一般资料、实验室检查结果、胸部CT等影像检查结果,以及住院时间、抗生素/呼吸机使用情况、有无气管切开等治疗情况,明确影响神经重症患者肺部感染的独立因素。结果本组患者中不同病种患者肺部感染发生率差异有统计学意义(P<0.05),脑出血性疾病患者感染率最高,达到50.8%(32/63)。入院GCS评分(OR=2.903,95%CI:1.069~7.881,P=0.037)、血清白蛋白含量(OR=3.690,95%CI:1.157~11.768,P=0.027)、使用呼吸机(OR=15.799,95%CI:6.305~39.591,P=0.000)、气管切开或气管插管(OR=7.036,95%CI:2.913~16.993,P=0.000)、糖尿病病史(OR=2.442,95%CI:1.026~5.809,P=0.043)、预防性使用抗生素(OR=6.021,95CI%:2.340~15.489,P=0.000)是神经重症患者发生肺部感染的独立危险因素。结论促进患者意识恢复,缩短住院时间,减少气管插管和呼吸机使用,纠正低蛋白血症和糖尿病等并发症能有效防止神经重症患者肺部感染的发生。     

动脉瘤蛛网膜下腔出血患者外周血淋巴细胞程序性死亡受体1表达特性及意义的研究

目的通过观察动脉瘤蛛网膜下腔出血(aSAH)患者外周血淋巴细胞程序性死亡受体1(PD-1)的表达,探索其在aSAH患者中的表达特性及意义。方法选取aSAH患者共计21例,根据Glasgow昏迷量表(GCS)评分分为有神经症状组(GCS15分,10例)和无神经症状组(GCS=15分,11例)。另选取6名健康志愿者作为正常对照组。使用流式细胞仪检测PD-1在各组患者外周血CD4~+和CD8~+ T淋巴细胞的表达情况,分析其特性及意义。结果无神经症状组PD-1~+CD4~+T淋巴细胞百分率和PD-1~+CD8~+ T淋巴细胞百分率均明显高于正常对照组,明显低于有神经症状组(均P0.05)。aSAH患者PD-1~+CD4~+ T淋巴细胞百分率和PD-1~+CD8~+ T淋巴细胞百分率与GCS评分密切相关,Spearman系数分别为0.87和0.83(均P0.05)。aSAH患者中,有神经症状组肺部感染发病率明显高于无神经症状组(P0.05),且有肺部感染组PD-1~+CD4~+ T淋巴细胞百分率和PD-1~+CD8~+ T淋巴细胞百分率明显高于无肺部感染组(均P0.05)。结论aSAH患者,特别是有神经症状的患者,CD4~+和CD8~+ T淋巴细胞PD-1表达强度明显增加,其表达强度增加与aSAH后神经症状严重程度和出血后肺部感染有相关性。     

急性脑血管疾病合并肺部感染相关因素分析

目的探讨急性脑血管疾病合并肺部感染因素及预防措施。方法选择721例急性脑血管疾病患者作为研究对象,观察肺部感染患者及按1∶1比例选择同期未发生肺部感染急性脑血管疾病相关因素差异。结果 721例急性脑血管疾病患者合并肺部感染60例(8.32%);肺部感染组年龄、意识障碍、预防使用抗生素、脱水剂应用时间、侵入性操作、胃酸抑制剂、住院时间、均高于无肺部感染组(P0.05),是引起肺部感染的相关因素。结论急性脑血管疾病患者并发肺部感染发生率较高,影响因素复杂,应实施针对性预防措施以降低肺部感染的发生。     

急性脑卒中患者合并肺部感染危险因素及预后

目的 探讨急性脑卒中患者肺部感染的危险因素及并发肺部感染对预后的影响,寻求降低肺部感染发生率的方法.方法 对392例急性脑卒中患者,回顾性分析89例并发肺部感染的发生率与年龄、基础病、病种、意识障碍、侵入性检查、治疗及预后的关系.结果 急性脑卒中患者并发肺部感染的发生率为22.7%,高龄、意识障碍、原有糖尿病、心脏病、侵入性检查、治疗及卒中史患者其肺部感染发生率明显升高.结论 急性脑卒中并发肺部感染是多种因素作用的结果,肺部感染影响急性脑卒中患者的功能恢复,控制院内肺部感染可有效提高脑卒中治疗的成功率.     

肋骨内固定联合肋间神经阻滞治疗多发性肋骨骨折的疗效

目的：探讨肋骨内固定手术与肋间神经阻滞联合应用对严重胸部创伤多发肋骨骨折患者的治疗效果。方法将180例多发肋骨骨折患者随机分为观察组和对照组，分别采用联用肋骨内固定与肋间神经阻滞治疗方法和传统非内固定疗法，比较2组疗效和并发症情况。结果观察组住院时间，患者肺不张、肺部感染等并发症发生率以及疼痛评分均低于对照组，差异有统计学意义（P＜0.05）。结论肋骨内固定术辅以肋间神经阻滞能在最短时间内减轻患者疼痛，更快恢复胸廓及肺部功能，预防肺部并发症，值得临床推广。     

系统性红斑狼疮患者肺部感染的分析与护理

目的对186例住院的系统性红班狼疮(SLE)患者并发肺部感染的情况进行回顾研究,分析护理干预在SLE并发肺部感染时的意义。方法对所有患者活动性指数进行评分,分析狼疮活动评分及治疗措施与肺部感染的关系,并发肺部感染患者的病原学特点及其与患者预后的关系。结果中、高度狼疮活动组肺部感染的患病率明显高于轻度活动组,使用较大剂量糖皮质激素的患者发生肺部感染的几率升高,发生肺部感染的78例患者中40例细菌培养阳性,住院天数明显延长,病死率增高。结论SLE患者有易发生感染的倾向。加强原发病的治疗,激素及抗生素的合理运用,都是预防和控制肺部感染重要条件。加强患者的健康教育及护理干预,增加患者对自身疾病和治疗的认识,尽可能的减少肺部感染,对改善患者的预后具有重要意义。     

重型颅脑损伤患者肺部感染发生率与吸烟的关系

颅脑外伤是常见的神经外科急症,每年15万人死于颅脑外伤,是青壮年第一位死亡因素[1].肺部感染是加重病情甚至导致患者死亡的主要因素.吸烟已成为当今世界性的健康问题之一,全世界吸烟总人口达15亿左右,中国有世界1/3的吸烟人口.吸烟可以引起肺部的病理改变从而大大增加了肺部感染的几率,肺部感染作为重度颅脑损伤患者最常见的并发症之一,严重影响患者的预后,是引起患者死亡的主要因素之一[2].因此,我们对吸烟的颅脑损伤患者发生肺部感染及其预后情况进行病例对照研究,以了解吸烟对重度颅脑损伤肺部感染及预后的影响,为临床治疗提供理论依据.     

持续中心静脉压监测在神经重症患者中应用价值探讨

目的探讨持续中心静脉压监测在神经重症患者中的应用价值。方法选择我科神经重症监护室持续中心静脉压监测患者与同期病人进行对照,比较2组间的一般资料,GCS评分,APACHE?Ⅱ评分,住院期间输液量、心衰发生率、肺部感染率及抗生素暴露时间、入住监护室时间、病死率等指标。结果通过持续中心静脉压监测指导下调整补液治疗,中心静脉压监测组发生心衰例数及肺部感染比例较对照组明显减少(P0.05),入住监护室时间缩短,病死率有所下降,但差异无统计学意义(P0.05)。结论对神经重症患者进行持续中心静脉压监测,可有效掌握患者的循环血容量变化情况,更好地指导临床治疗,从而有效降低相关并发症,改善预后。     

老年脑卒中住院患者肺部感染的危险因素分析

目的分析老年脑卒中住院患者肺部感染的危险因素及应对策略。方法将2010-07—2011-06我院神经内科收治的86例老年脑卒中患者根据是否发生肺部感染情况分为肺部感染组(43例)与对照组(43例),回顾性分析2组患者的临床资料,总结老年患者发生肺部感染的危险因素。结果分析比较肺部感染组与对照组患者在意识状态、卧床时间、基础疾病、饮食状况等方面的差异,结果显示意识障碍或昏迷、卧床>1周、伴糖尿病、伴COPD、鼻饲饮食是神经内科老年住院患者发生肺部感染的危险因素。结论针对神经内科老年住院患者发生肺部感染的危险因素进行有效全面的护理,减少细菌存留的时间与数量,防止老年患者发生误吸现象,对有效预防肺部感染的发生具有重要作用。     

Mechanism of action of tubocurarine on nicotinic cholinoreceptors of neurons of the sympathetic ganglia of rats

Tubocurarine (Tc) effect on membrane currents elicited by acetylcholine (ACh) was studied in isolated superior cervical ganglion neurons of rat using patch-clamp method in the whole-cell recording mode. The "use-dependent" block of ACh current by Tc was revealed in the experiments with ACh applications, indicating that Tc blocked the channels opened by ACh. Mean lifetime of Tc-open channel complex, tau, was found to be 9.8 +/- 0.5 s (n = 7) at -50 mV and 20-24 degrees C. tau exponentially increased with membrane hyperpolarization (e-fold change in tau corresponded to the membrane potential shift by 61 mV). Inhibition of the ACh-induced current by Tc (3-30 microM/1) was completely abolished by membrane depolarization to the level of 80-100 mV. Inhibition of ACh-induced current was augmented at increased ACh doses. It is concluded that the open channel block produced by Tc is likely to be the only mechanism for Tc action on nicotinic acetylcholine receptors in superior cervical ganglion neurons of rat.     

The effect of age of onset of PD on risk of dementia

Background Dementia occurs in the majority of patients with Parkinson’s disease (PD). Late onset of PD has been reported to be associated with a higher risk for dementia. However, age at onset (AAO) and age at baseline assessment are often correlated. The aim of this study was to explore whether AAO of PD symptoms is a risk factor for dementia independent of the general effect of age. Methods Two community-based studies of PD in New York (n = 281) and Rogaland county, Norway (n = 227) and two population-based groups of healthy elderly from New York (n = 180) and Odense, Denmark (n = 2414) were followed prospectively for 3–4 years and assessed for dementia according to DSM-IIIR. All PD and control cases underwent neurological examination and were followed with neurological and neuropsychological assessments. We used Cox proportional hazards regression based on three different time scales to explore the effect of AAO of PD on risk of dementia, adjusting for age at baseline and other demographic and clinical variables. Findings In both PD groups and in the pooled analyses, there was a significant effect of age at baseline assessment on the time to develop dementia, but there was no effect of AAO independent of age itself. Consistent with these results, there was no increased relative effect of age on the time to develop dementia in PD cases compared with controls. Interpretation This study shows that it is the general effect of age, rather than AAO that is associated with incident dementia in subjects with PD. Received in revised form: 22 December 2005     

Limits of deinstitutionalization--perspectives of relatives of psychiatric patients

After a hopeful beginning, the social process of the reintegration of those with severe mental illness has come to a standstill. I am led to wonder whether "the community" really wants to live together with people suffering from severe mental illness, and if so, how closely? As long as the medical treatment of mental illness provided by the general practitioners is fundamentally deficient, as they are not able to prescribe the necessary interventions--such as out-patient psychiatric nursing, and service providers in the out-patient sector are content with offering increasingly intensive forms of care for the less seriously ill at the cost of the Social Welfare System--the reintegration of those with serious mental illness remains an illusion--which is mainly to the benefit of providers of residential care in homes and hostels.     

Denervation study of synapses of organ of corti of old world monkeys

Fine structural characteristics of synapses in the spiral organ of Corti were examined, with reference to differences between inner and outer haircell systems, and to location of neurons of origin of efferent axons. Surgical interruption of crossed olivocochlear bundle, of vestibular nerve, of facial nerve, and excision of superior cervical ganglia were used to determine the pathways of efferent axons. Interruption of the vestibular nerve near the brainstem results in degeneration of all efferent terminals on outer hair cells. Mid-line lesions at, and caudal to, the facial colliculus result in degeneration of about half of these efferent terminals. Efferent synaptic bulbs to the inner hair-cell system are small, of the order of one micron, and form type 2 junctions with afferent dendrites. They tend to have more large dense-core vesicles (about 80 nm) than the large efferent terminals of the outer hair-cell system, and appear to be the terminals of axons in the habenula perforata, which exhibit varicosities laden with large dense core vesicles. The varicosities are unaffected by excision of the superior cervical ganglia. So far as our material can reveal, it appears that the varicosities in the habenula perforata do not survive vestibular root interruption, nor do the efferent processes in the internal spiral bundle or at the base of inner hair cells. Most interestingly, the afferent processes of the inner hair-cell system, as identified for example by their relation to pre-synaptic bodies in the inner hair cells, are subject to a trans-synaptic reaction after severance of the vestibular root. They undergo a dramatic cytological transformation, characterized by increase of volume, engorgement with microtubules, microfilaments, microvesicles of various sizes, and clusters of lysosomes. Thus, both the efferent and afferent terminals of the inner hair-cell system show marked cytological differences from the corresponding terminals of the outer hair cell system.