某医院1993年至2000年下呼吸道医院感染分布及其危险因素监测

目的 :了解下呼吸道医院感染的发生与分布 ,分析其危险因素 ,为预防和控制医院感染提供依据。方法 :对某院 1 993年至 2 0 0 0年前瞻监测的 1 2 6 6 6 5例住院患者中发生的 1 0 4 7例下呼吸道医院感染的分布规律和危险因素进行分析。结果 :下呼吸道医院感染率为 0 .83% ,占所有感染的 1 7.90 %。男性感染率显著高于女性 (分别为 1 .0 2 %和 0 .6 0 % ,P <0 .0 5 )。感染率的年龄分布呈“V”型 ,<3岁和≥ 6 0岁人群的感染率显著升高。内科和儿科感染率分别为 1 .34%和 1 .33%。 1 993年至 2 0 0 0年 8a间的感染率呈显著下降趋势。Logistic回归分析显示下呼吸道医院感染的独立危险因素为年龄 (OR =1 .0 2 )、免疫抑制剂治疗 (OR =2 .34)、化疗 (OR =2 .4 8)、患肿瘤 (OR =1 .31 )、合并慢性阻塞性肺疾病 (OR =2 .32 )、住ICU病房 (OR =2 .84 )、住院期间发生昏迷 (OR =3.2 6 )、气管切开 (OR=1 0 .4 4 )、接受透析治疗 (OR =5 .2 5 )和骨 /腰穿刺 (OR =2 .0 5 )等。结论 :基础疾病、侵袭性操作、免疫功能低下、住ICU等是发生医院感染的主要危险因素。建立完善的医院内感染监控系统 ,针对高感染危险人群开展前瞻性目标性监测是降低下呼吸道医院感染率的有效途径     

儿童肾病综合征院内感染问题(附146例临床分析)

目的探讨边远山区综合性儿科原发肾病综合征患儿并发医院感染的特点、易感因素及防治措施。方法采用回顾性调查法分析146例肾病综合征患儿的有关临床资料。结果原发肾病综合征患儿医院感染率达40.41%;感染为多器官系统,以呼吸系统感染为多,冬、春季是感染的主要季节;年龄越小患儿感染机会越高(χ2=32.20,P<0.005);单纯性肾病感染率高于肾炎性肾病(χ2=3.615,υ=1,P<0.01);住院时间延长,感染率也随着明显增加(χ2=25.74,P<0.005)结论医院感染与患儿年龄、体液免疫功能低下、临床类型、住院天数及广谱抗生素的使用有关。     

妇女宫颈沙眼衣原体感染情况分析

目的:观察妇女宫颈沙眼衣原体(CT)的感染情况。方法:采集宫颈分泌物用免疫层析法检测我院门诊不孕患者和非真菌、滴虫性阴道炎的患者的CT共5 4 6 7例。结果:CT的感染率为9.2 6 % ,而且存在季节性的感染,夏季的感染率高于冬季(χ2 =6 0 .6 89,P <0 .0 1) ;CT在不同年龄组的妇女中感染率差异存在显著性(χ2 =17.5 82 ,0 .0 1

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儿童肾病综合征并发医院感染影响因素分析

①目的　探讨肾病综合征病儿并发医院感染的易感因素与防治措施。②方法　采用回顾性调查法调查分析136例肾病综合征病儿的相关临床资料。③结果　肾病综合征病儿医院感染发生率为32.8%;感染部位以呼吸道为主(54.3%),其次为消化道(19.6%);医院感染率的高低与病儿住院天数、糖皮质激素和免疫抑制剂的联合应用、血清IgG水平等因素有关(χ2=9.52~12.38,P<0.01)。④结论　住院天数较长、血清IgG水平低下、糖皮质激素与免疫抑制剂的联合应用等是儿童肾病综合征病儿发生医院感染的高危因素,应加强对这类病儿的管理和观察。     

恶性肿瘤患者并发医院内感染病例分析

目的 :探讨恶性肿瘤患者并发医院感染的原因。方法 :对该院 2 0 0 1年 1月～ 2 0 0 2年 6月间住院的各类恶性肿瘤及白血病患者共 795例 ,分别按年龄、住院时间分组 ,观察其医院感染率、死亡率、感染部位、致病菌及各种易感因素。结果 :795例中并发医院内感染 185例 ,感染率、例次感染率、感染致恶化死亡者分别达2 3.3% ,38.2 % ,2 1.1%感染部位涉及血液、上呼吸道、肺部、消化道、泌尿道、口腔、肛周、注射部位等。细菌培养获得各类病原菌 2 6 4株 ,包括普通细菌 2 16株、真菌 4 3株、L型细菌 5株 ,限于条件未做厌氧菌培养。结论 :5 1岁年龄组例次感染率明显高于 5 0岁以下组 (P <0 .0 5 ) ;感染组住院天数明显长于未感染组 (P <0 .0 5 ) ;WBC 2 .0× 10 9/L以下组感染率明显高于WBC 2 .0× 10 9/L以上组 (P <0 .0 5 )同时与医疗操作、化疗强度、广谱抗生素使用天数等易感因素均有相关性。     

南宁市育龄妇女弓形虫感染的流行特征

目的 :了解南宁市育龄妇女弓形虫感染率及流行特征。方法 :用间接红细胞凝集试验 (IHA)对 14 95例育龄妇女进行弓形虫抗体检测 ,并用 χ2 统计分析。结果 :14 95例育龄妇女弓形虫抗体阳性率为 7.0 2 %。不同职业对象中以家务工作、农民高于其他职业人员 ,不同职业间差异显著 (χ2 =2 8.13,P <0 .0 1) ;郊区人群弓形虫感染率高于市区人群 (χ2 =4 .6 1,P<0 .0 5 ) ;与猫有接触史的人群弓形虫感染率高于与猫无接触史的人群 (χ2 =17.6 8,P <0 .0 1)。结论 :不同职业及城乡育龄妇女弓形虫感染率存在差别 ,与宠物猫有接触的育龄妇女弓形虫感染率较无接触者高     

伴与不伴心房颤动的急性缺血性脑卒中临床特征比较

目的　比较伴与不伴心房颤动的急性缺血性脑卒中患者的临床特征。方法　比较 90例心房颤动患者和 15 3例非心房颤动患者的脑卒中危险因素、脑栓塞和脑血栓形成比例、疾病的严重程度及预后。结果　心房颤动组中 ,女 5 6例 (6 2 .2 % ) ,男 34例 (37.8% ) ;非心房颤动组中 ,女 6 5例 (42 .5 % ) ,男 88例 (5 7.5 % ) ,心房颤动组的女性比例明显高于非心房颤动组 (χ2 =8.83,P <0 .0 1)。心房颤动组中 ,合并糖尿病 13例 (14 .4 % ) ,非心房颤动组 4 9例 (32 .0 % ) ,心房颤动组中糖尿病患者比例明显低于非心房颤动组 (χ2 =9.2 2 ,P <0 .0 1)。心房颤动组中 ,合并脑栓塞 6 1例 (6 7.8% ) ,非心房颤动组 18例 (11.8% ) ,心房颤动组中脑栓塞患者比例明显高于非心房颤动组 (χ2 =81.0 3,P <0 .0 1)。心房颤动组发生急性缺血性脑卒中后 ,意识改变情况 (Glasgow评分 ,t=3.4 4 ,P <0 .0 1)及神经功能缺损程度 (t =5 .0 9,P <0 .0 1)均较非心房颤动组严重。心房颤动组住院期间 ,4 4 .4 % (40例 )的患者发生再梗死 ,明显高于非心房颤动组的 2 8.1% (43例 ,χ2 =6 .73,P <0 .0 1)。心房颤动组住院期间 ,死亡率为 15 .6 % (14例 ) ,明显高于非心房颤动组的 7.2 % (11例 ,χ2 =4 .30 ,P <0 .0 5 )。结论　心房颤动患者     

HP—CagA基因型与胃十二指肠溃疡相关性的病例对照研究

探讨昆明地区胃十二指肠溃疡与HP -CagA感染的相互关系 .方法 :采用病例对照研究 ,病例组活动性十二指肠溃疡 (DU) 4 8例 ,胃溃疡 (GU) 4 8例 .对照 1组为同期住院的本科及其它科住院的非胃十二指肠疾病患者 48例 .对照 2组为同期普查的健康人群 48例 .血清HP -CagA -IgG抗体的检测采用斑点金免疫渗泸法 (DIGFA) .结果 :192例中 ,HP -CagA -IgG总的检测率为 5 0 5 2 % (97/ 192 ) ,其中DU组85 42 % (4 1/ 48) ,GU组 70 83 % (34/ 48) ,非消化系统疾病组 2 5 0 % (12 / 48) ,健康人组 2 0 83 % (10 /48) .Du组的HP -CagA -IgG阳性率显著高于两个对照组 (χ2 =2 0 10 3 ,P <0 0 0 0 1) ;GU组CagA -IgG阳性HP感染率显著高于两个对照组 (χ2 =13 92 1,P <0 0 0 1) .结论 :提示昆明地区CagA阳性的HP感染与DU和GU的发病密切相关 ;高毒株HP感染是溃疡形成的重要因素 .     

1356例系统性红斑狼疮医院感染因素分析

目的　探讨系统性红斑狼疮 (SLE)患者院内感染的临床特点及相关因素。方法　对诊断为SLE 13 5 6例患者进行回顾性分析。结果　共有 43 9例 (3 2 .3 7% )患者合并院内感染 ,其中呼吸道感染 2 11例 ,皮肤感染 92例 ,泌尿道感染 69例 ,其它 67例。SLE患者的中、高度组院内感染率均明显高于轻度组 (P <0 .0 1) ;>3 0d组的感染率高于≤ 3 0d组(P <0 .0 1) ;使用激素及免疫抑制剂感染率高于非使用组 (P均 <0 .0 1)。结论　SLE患者院内感染率以呼吸道、皮肤及泌尿道感染为主 ;感染与患者的病情 ,使用激素、环磷酰胺等免疫抑制剂和住院天数密切有关。     

住院母婴医院感染136例分析

目的 :分析产科病例中医院感染发病情况和病因 ,采取切实有效的控制措施 ,降低医院感染率。方法 :对产科母婴同室2 5 5 4例住院病历进行总结、分析。结果 :4年中 ,住院分娩 2 5 5 3例 ,其中剖宫产 832例 ,发生医院感染的母婴 81例 ,感染率9.74 % ;阴道分娩 172 1例 ,发生医院感染的母婴 5 5例 ,感染率 3.2 0 % ,剖宫产感染率明显高于阴式产 (P <0 .0 0 5 )。结论 :新生儿体液免疫未完善 ,防御机制未成熟 ,产妇体力消耗、失血等削减机体抵抗力 ,尤其是手术创伤致使病菌易伺机侵入 ,引起局部或全身感染 ,为降低医院感染率和降低剖宫产率必须采取综合管理措施     

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.     

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.     

Notes for contributors to Journal of Nanjing Medical University

Journal of Nanjing Medical University (English Edition) JNMU, sponsored by Nanjing Medical University, was established in 1987. It is a bimonthly comprehensive English medical journal published locally and abroad.Since 2007, Journal of Nanjing Medical University (English Edition )was granted Elsevier the full publishing and distribution rights worldwide for the Electronic Edition, excluding the People's Republic of China.