神经外科手术患者下呼吸道医院感染危险因素分析

目的探讨神经外科手术患者下呼吸道医院感染的危险因素,为制定下呼吸道医院感染控制措施提供依据。方法采用目标性监测的方法对神经外科病人术后下呼吸道医院感染发病率及相关危险因素进行调查分析。结果267例神经外科手术患者分析发现气管切开、意识障碍、手术时间>2 h、年龄≥60岁是神经外科下呼吸道医院感染的危险因素。结论神经外科手术患者是下呼吸道医院感染的高危人群,应采取综合措施降低下呼吸道医院感染的发病率。     

下呼吸道医院感染的调查和危险因素分析

下呼吸道医院感染的调查和危险因素分析苏菲，邹礼明，何乃萍，马红秋，何源沁目前医院感染已成为一个突出问题，受到广泛重视。医院内感染病例中以肺部感染发病率最高［１］。为加强防治措施，我们对１５１例下呼吸道医院感染病例进行分析，探讨其发生规律及有关危险因素...     

233例食管癌患者术后医院感染分析

目的：探讨食道癌患者术后医院感染的危险因素，为有效控制医院感染提供科学依据。方法：2004年6月-2008年12月233例食管癌患者临床资料进行回顾性分析。结果：食管癌患者术后医院感染发病率为20．52％，感染部位主要为手术切口、下呼吸道和胸腔，医院感染率随着住院时间的延长而明显增高。结论：食管癌医院感染的发生与患者的年龄、住院天数和手术后时间等因素密切相关；针对高危因素有针对性采取术中严格无菌操作、术后保持引流管通畅、合理使用抗菌药物等控制措施，对降低医院感染的发生有重要意义。     

2001年我院医院感染现况流行病学调查及分析

目的：为进一步研究医院感染发生规律及发生的危险因素。以降低医院感染发生率。方法；对我院2001年6月27日住院的695例患进行医院感染及其危险因素的横断面调查研究。结果：医院感染发生率为7.91%，其中下呼吸道感染占32.72%。上呼吸道感染占27.27%，泌尿道感染占10.91%，气管切开，使用呼吸机，动静脉置管，泌尿道插管为医院感染的高危因素。医院感染的主要病原体依次为金黄色葡萄球菌，铜绿假单胞菌；合并真菌感染8例，术后预防性使用抗生素的比例偏高。结论：对存在上述危险因素的患应加强监测。重视无菌操作技术，加强对抗生素的合理应用及管理，用于预防应严格控制。     

ICU医院感染目标性监测危险因素分析及预防策略

目的:为发现ICU医院感染危险因素,研究预防策略,降低感染率提供依据。方法:对2013年9月至11月入住ICU的161例患者进行目标性监测,统计分析医院感染危险因素。结果:161例ICU患者共发生医院感染30例次,医院感染例次率为18.63%,医院感染例次日感染发病率为22.92‰,泌尿道插管相关泌尿道感染发病率为5.19‰,血管导管相关血流感染发病率为10.60‰,呼吸机相关肺炎性肺炎感染发病率为8.38‰;其医院感染构成部位以下呼吸道感染及败血症为主,分别为40.00%及26.67%,不同部位构成比差异有统计学意义(P<0.01)。结论:ICU医院感染发病率高,下呼吸道感染所占比重高,"三管"发病率较高,应注意"三管"及下呼吸道感染的预防。     

下呼吸道医院感染210例的危险因素分析

目的探讨下呼吸道医院感染的危险因素，加强预防，降低发病率。方法对我院2003年1月至12月22863例出院病人进行调查分析。结果医院感染人数689例，医院感染率3．01％，其中下呼吸道感染210例，占全院医院感染病例的30．49％，居全院医院感染部位的首位，其中儿童、年老（60岁以上）体弱、接受过呼吸道侵入性操作以及长期使用抗生素等病人感染率较高。结论年老体弱、接受过呼吸道侵入性操作及长期使用抗生素等病人是引起下呼吸道医院感染的危险因素。     

神经内科下呼吸道感染危险因素分析

目的探讨神经内科下呼吸道感染的危险因素并提出相应的对策。方法对我院2009年6月至2010年6月神经内科900份病例进行回顾性分析,总结其发生下呼吸道感染的例数、危险因素,并提出相应的对策。结果 900例患者中发生医院感染100例,其中下呼吸道感染55例,占55.0%。其危险因素为性别与年龄、住院时间、使用呼吸机及心血管疾病等。结论下呼吸道感染是是神经内科感染的高发部位,应对主要危险因素进行重点监控和预防,降低感染率和死亡率。     

院内下呼吸道感染相关因素及防范措施

目的：探讨医院内患者下呼吸道感染的发生原因及预防对策。方法：对2007年及2008年医院下呼吸道感染病例进行分析。结果：2008年全年发生医院感染537例中下呼吸道感染261例,占医院感染发病率的48.60%,比2007年降低了2.26个百分点。结论：切断传播途径、做好空气、环境及有关器具的卫生学监测,加强病房管理和基础护理等措施,可以降低医院下呼吸道感染率,减轻患者痛苦。     

老年住院患者医院感染危险因素分析

目的:探讨老年住院患者医院感染的相关因素及预防策略。方法:分析673例老年住院患者的临床资料,对可能影响医院感染的相关变量进行单因素分析与Logistic回归分析。结果:673例住院患者中有52例发生医院感染,医院感染好发于上呼吸道、下呼吸道、胃肠道、泌尿道。患者住院时间、年龄、糖尿病、脑血管疾病、侵入性操作5个变量是影响医院感染的相关独立危险因素,住院时间为最主要的因素。结论:老年患者医院感染发生与住院时间、年龄、糖尿病、脑血管疾病及侵入性操作有关。重视危险因素的防治,可降低老年科患者医院感染率。     

137例医院内下呼吸道感染的分析

目的：了解医院内下呼吸道感染状况及病原菌组成和耐药情况。方法：对我院出院病历15777份作回顾性调查。结果：137例病人发生142例次医院内下呼吸道感染,感染率0．9％。主要危险因素是老年人、住院时间长、基础疾病,病原菌以G^-菌为主。医院感染菌株的耐药率普遍较高。结论：对高危患者应重视医院内下呼吸道感染,合理应用抗生素。     

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.     

APPLICATION OF LORNOXICAM TO PATIENT-CONTROLLED ANALGESIA IN PATIENTS UNDERGOING ABDOMINAL SURGERIES

FOR anesthesiologis s ,treatingpostoperativepainhas alwaysbeen a problem.Althoughopioidshave been provedtobe effective,theirsideeffectscouldnotbeignored.With thedevelopmentofscienceand pharmacology,many drugs with aspectsof satisfactoryanalgesicefficacyand couldbe welltoleratedby patientshave been developed.And lornoxicamisone of them, which isa non-steroidalanti-inflammatorydrug (NSAID ), with analgesic, anti-infl-ammatory,andantipyreticproperties.Itseliminationhalf-time(3 to 5 hours) isle…     

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.     

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.     

Scientific principles and rigorous processes should be followed in developing clinical guidelines for therapeutic interventions of integrative medicine

A clinical guideline for the therapeutic interventions of integrative medicine may be defined as a written document which states a series of recommendations on therapeutic interventions of integrative medicine for a special disease or condition. The guideline may provide assistance to medical professionals in making clinical decisions aimed at improving the clinical outcome of patients and reducing the costs of medical care（~＇4~. Recommendations issued by a guideline should be based on the best available evidence in both Western and Chinese medicine. For fulfilling this purpose, the development of clinical guidelines for therapeutic interventions in the field of integrative medicine should follow scientific principles and undergo a rigorous processes.