高龄患者肺部感染致多器官功能不全综合征的临床分析

目的 探讨高龄患者肺部感染致多器官功能不全综合征(MODSE)的临床特点.方法 回顾性分析1998年8月～2010年8月住我院老年科42例因肺部感染引发MODSE高龄患者的临床资料,观察治疗前后存活患者及死亡患者APACHEⅡ评分变化.结果 42例患者均存在3种以上基础疾病,医院获得性肺炎37例,社区获得性肺炎5例,多...     

老年人重症肺炎预后影响因素分析

目的 探讨老年重症肺炎预后影响因素,以采取相应措施改善预后.方法 回顾性分析2000年2月至2011年5月入住我院的82例老年重症肺炎患者的临床资料.结果 82例患者中医院获得性肺炎67例,社区获得性肺炎15例;存活23例,死亡59例,死亡组年龄明显大干存活组[(84.67±3.58)岁vs (76.25±6.87)岁,P＜0.05].死亡患者治疗前APACHEⅡ评分明显高于存活患者,治疗后存活患者APACHEⅡ评分(16.32±4.24)明显降低,而死亡患者(28.53±2.71)无明显变化,两者比较差异有统计学意义(P＜0.01).受累器官越多,病死率越高.结论 高龄、医院获得性肺炎、基础疾病多、多器官受累、APACHEⅡ评分高是影响老年重症肺炎患者预后的主要危险因素.早期足量抗生素经验性治疗,加强营养支持和免疫治疗,早期预防重要脏器功能衰竭,及时应用机械通气及连续性静脉-静脉血液滤过治疗可降低老年重症肺炎病死率.     

CPIS评分联合CURB-65评分系统在医院获得性肺炎评价中的作用及价值研究

目的研究CPIS评分联合CURB-65评分系统在医院获得性肺炎评价中的作用及价值。方法选取2015年8月-2017年7月医院获得性肺炎患儿139例,114例存活患儿为存活组、25例死亡患儿为死亡组。同期选取120例儿科住院未发生医院获得性肺炎患儿为对照组。观察和比较患儿入组时,医院获得性肺炎感染治疗前后血清PCT水平、APACHEⅡ、CPIS和CURB-65系统评分,分析CPIS和CURB-65系统评分与医院获得性肺炎感染相关性。结果三组患儿入组时血清PCT水平、APACHEⅡ、CPIS和CURB-65系统评分比较,差异无统计学意义;感染治疗前,死亡组血清PCT水平和APACHEⅡ、CPIS、CURB-65系统评分均高于存活组,差异均有统计学意义(P<0.05)。感染治疗后,存活组患儿血清PCT水平及各评分均降低(P<0.05),且降低幅度优于死亡组(P<0.05);CPIS联合CURB-65系统评分对医院获得性肺炎感染的特异性、阳性预测值与PCT、APACHEⅡ相当,但敏感度高于PCT、APACHEⅡ、CPIS评分。CPIS联合CURB-65系统评分分别与PCT、APACHEⅡ评分呈弱正相关性。结论 CPIS评分联合CURB-65系统评分能够快速、系统分析医院获得性肺炎感染患儿信息资料,较PCT等指标更为全面,更利于区分高危人群、低危人群,从而有助于降低高危患儿病死率、减少低危患儿不必要的住院治疗而节约医疗资源。     

老年经皮冠状动脉介入术后肺部感染预后影响因素

目的探究老年经皮冠状动脉介入术(PCI)后肺部感染预后影响因素。方法选择2017年1月-2019年1月于唐山市工人医院行PCI治疗的冠心病患者,将102例PCI术后发生肺部感染的患者纳入感染组,另择100例术后未发生肺部感染的患者作为对照组。收集急性生理学与慢性健康状况(APACHEⅡ)评分、快速序贯器官功能衰竭(qSOFA)评分等资料,测定血清降钙素原(PCT)水平,随访记录28 d存活情况。结果共分离出128株致病菌,其中革兰阴性菌62株(48.44%),革兰阳性菌56株(43.75%),真菌10株(7.81%);感染组血清PCT水平、APACHEⅡ评分、qSOFA评分高于对照组(P0.05),病死组各指标高于存活组(P0.05);合并糖尿病、吸烟史、高PCT水平、高APACHEⅡ评分、高qSOFA评分是肺部感染预后不良的独立危险因素(P0.05);受试者工作特征曲线(ROC)示,血清PCT、APACHEⅡ评分、qSOFA评分预测患者预后的曲线下面积(AUC)分别为0.749、0.853、0.829;APACHEⅡ评分、qSOFA评分分别联合血清PCT及三者联合预测预后的AUC分别为0.858、0.884、0.898。结论老年冠心病PCI术肺部感染患者可伴有血清PCT、APACHEⅡ评分、qSOFA评分的升高,两两联合或多者联合对预后具有更高的预测价值。     

急诊老年危重患者凝血纤溶指标的变化及与病情严重程度的关系

目的 通过监测急诊老年危重患者凝血、抗凝、纤溶等指标,观察这些指标的变化及是否与病情严重程度相关.方法 选择年龄≥60岁,符合系统性炎症反应综合征(SIRS)诊断标准且急性生理和慢性健康状况Ⅱ(APACHE Ⅱ)评分≥10分的危重患者67例,24 h内采静脉血进行凝血检测:部分凝血活酶活化时间(APTT)、凝血酶原时间(PT)、凝血酶时间(TT)、D-二聚体(D-D)、纤维蛋白原(Fib)、抗凝血酶-Ⅲ(AT-Ⅲ)、蛋白C(PC)、纤溶酶原激活物抑制物1(PAI-1),并行APACHE Ⅱ评分.按照生存情况分为存活组(43例)和死亡组(24例),按照老年多器官功能不全综合征(MODSE)诊断标准分为MODSE组(30例)和非MODSE组(37例).结果 MODSE组与非MODSE组APACHE Ⅱ评分[(25.83±1.19)分比(18.11±0.73)分]及存活组与死亡组APACHE Ⅱ评分[(18.81±0.72)分比(26.50±1.42)分]比较差异均有统计学意义(P<0.01).与非MODSE组及存活组比较,MODSE组及死亡组PT延长,D-D显著升高,AT-Ⅲ、PC活性显著下降(P<0.05).PT、D-D、PAI-1与APACHE Ⅱ评分呈正相关(相关系数分别为0.328、0.308、0.335,P<0.05);AT-Ⅲ、PC与APACHEⅡ评分呈负相关(相关系数分别为-0.469、-0.559,P<0.01).结论 急诊老年危重患者存在凝血、抗凝、纤溶等指标的紊乱现象,且紊乱程度与疾病的严重程度相关,PT延长、D-D升高以及PC、AT-Ⅲ下降,提示病情严重及预后不良.     

四种评分系统对呼吸机相关性肺炎的预后评估研究

目的 探讨急性生理学和慢性健康评分(APACHEⅡ)、序贯器官衰竭评估(SOFA)评分、临床肺部感染评分(CPIS)及多器官功能障碍综合征(MODS)评分对呼吸机相关性肺炎(VAP)患者的预后评估价值.方法 68例诊断为VAP患者,分别在入院第一个24 h进行APACHEⅡ、SOFA评分、MODS评分及发生VAP第一个24 h进行APACHEⅡ、SOFA评分、CPIS及MODS评分.根据实际预后分为存活组38例和死亡组30例,并根据受试者工作特征曲线下面积(AUROC)与Logistic回归分析评估四种评分系统对VAP患者预后的预测价值.结果 死亡组发生VAP第一个24 h的APACHEⅡ、CPIS、MODS评分及SOFA评分均明显高于存活组.发生VAP第一个24 h的APACHEⅡ、SOFA评分、MODS评分及CPIS AUROC分别为0.80、0.75、0.73、0.71.Logistic回归分析提示发生VAP第一个24 h的APACHEⅡ＞18分是预测VAP患者的独立相关因素(OR值为5.7,95%CI为1.9～20.0,P值为0.013).结论 发生VAP第一个24 h的APACHEⅡ评分可作为预测VAP患者预后的指标.     

鲍氏不动杆菌感染患者死亡影响因素及炎症因子对预后评估的价值

目的探讨血清降钙素原(PCT)、超敏C-反应蛋白(hs-CRP)水平在重症监护病房(ICU)肺部鲍氏不动杆菌感染患者预后的诊断价值,并分析鲍氏不动杆菌感染患者死亡的影响因素。方法选取2015年1月-2019年8月鹰潭市人民医院收治的发生肺部鲍氏不动杆菌感染的ICU患者100例,根据患者28 d后的预后情况分为死亡组(42例)和存活组(58例)。比较两组患者血清PCT、hs-CRP水平和急性生理学和慢性健康状况评分系统Ⅱ(APACHEⅡ)、序贯器官功能衰竭评分(SOFA)评分情况;采用单因素及多因素Logistic回归分析影响ICU肺部鲍氏不动杆菌感染患者预后死亡的影响因素;运用受试者工作特征(ROC)曲线分析PCT、hs-CRP对ICU肺部鲍氏不动杆菌感染患者预后的评估价值。结果 28 d后,ICU肺部鲍氏不动杆菌感染患者的病死率为42.00%。APACHE-Ⅱ评分、SOFA评分、PCT水平、hs-CRP水平是ICU肺部鲍氏不动杆菌感染患者死亡的影响因素(P<0.05)。两项指标联合评估患者预后的特异性、灵敏度、曲线下面积(AUC)分别为88.87%、87.91%、0.885均高于单一指标(P<0.05)。结论血清PCT和hs-CRP水平用于ICU肺部鲍氏不动杆菌感染患者预后具有一定评估价值。     

三种评分系统对呼吸机相关性肺炎患者预后评估的分析

目的 探讨急性生理学与慢性健康状况评分(APACHEⅡ)、序贯器官衰竭评估评分(SOFA)、临床肺部感染评分(CPLS)对呼吸机相关性肺炎(VAP)患者的预后评估价值.方法 59例诊断为VAP患者,分别在入院第一个24 h及发生VAP第一个24 h进行APACHEⅡ、SOFA及CPIS评分.根据受试者工作特征曲线下面积(AUROOC))与Logistic回归分析评估三种评分系统对VAP患者预后的预测能力.结果 死亡组发生VAP第一个24 h的APACHEⅡ、CPIS及SOFA评分的分值均明显高于存活组.发生VAP第一个24 h内的APACHEⅡ、SOFA及CPIS评分AUROOC分别为0.81、0.72、0.70.Logistic回归分析显示发生VAP第一个24 h的APACHEⅡ>16分是预测VAP患者的独立相关因素(OR值为5.1;95%CI为1.3-18;p值为0.019).结论 发生VAP第一个24 h内的APACHEⅡ评分可作为预测VAP患者的预后指标.     

老年人重症肺部感染APACHE Ⅱ评分的临床价值

[目的]准确评估老年人重症肺部感染的危重程度及预后。[方法]对老年人重症肺部感染患者进行回顾性分析,采用急性生理改变与慢性健康评估系统（APACHEⅡ）对疾病的危重程度进行评分。[结果]全组APACHEⅡ评分均值为21.5分。57例死亡患者为24.4分,明显高于123例存活患者的18.1分（P﹤0.01）。经治疗5 d后,存活组评分明显下降,死亡组评分明显升高（P均﹤0.01）。随着APACHEⅡ评分增高,并发症发生率从7.1%升至80.0%;病死率从0逐渐升高至100.0%（P均﹤0.01）。[结论]APACHEⅡ评分系统是评估老年人重症肺部感染病情危重程度预后的较好指标,值得在临床工作中推广使用。     

血浆sFLT-1在重症肺炎中的预测价值及与APACHEⅡ评分的相关性分析

目的分析血浆sFLT-1在重症肺炎中的预测价值及与APACHE Ⅱ评分的相关性。方法选择2016年12月-2018年12月我院收治的重症肺炎患者90例,依据疾病类型分为重症肺炎组(A组,n=30)、重症肺炎合并感染性休克组(B组,n=30)和重症肺炎合并多器官功能障碍综合征组(C组,n=30),比较三组患者的血清CRP、PCT、WBC、sFLT-1水平、APACHE Ⅱ评分,分析存活与死亡患者的血清sFLT-1水平、APACHE Ⅱ评分及其相关性。结果 A组患者的血清CRP、PCT水平、APACHE Ⅱ评分均显著低于B组、C组(P0.05),血清sFLT-1水平均显著低于B组、C组(P0.05)。三组90例患者中,存活48例,死亡42例,存活率和死亡率分别为53.3%、46.7%,存活患者的血清sFLT-1水平、APACHE Ⅱ评分均显著低于死亡组(P0.05),血清sFLT-1水平与APACHE Ⅱ评分呈正相关(r=0.647,P0.05)。结论血浆sFLT-1在重症肺炎中的预测价值高,与APACHE Ⅱ评分呈正相关。     

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.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

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.     

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.     

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.     

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.     

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.     

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.