1例耐甲氧西林金黄色葡萄球菌感染性休克的护理体会

金黄色葡萄球菌是临床上常见的毒性较强的细菌,英国的Jevons就首次发现了耐甲氧西林金黄色葡萄球菌(MRSA),从发现至今感染几乎遍及全球,已成为院内感染的重要病原菌之一.感染性休克是感染引起的急性循环功能不全,又称败血性休克,病情凶险,病死率高.现就一例MRSA肺炎、感染性休克并呼吸衰竭、自发性气胸、败血症患者的护理体会报告如下.     

金葡菌败血症并发肺胸膜感染47例临床分析

1963年4月～1985年4月我们共收治金黄色葡萄球菌败血症(以下简称金葡菌败血症)240例,其中伴有肺胸膜感染者47例。本文重点对47例并发肺胸膜感染者的临床表现、早期诊断和治疗进行了分析。 临床资料 一、诊断标准 有败血症的一种或多种急性症状,血、痰、脓液和/或骨髓培养阳性;有肺胸膜感染;部分患者有原发病灶或其他迁徙性病灶。 二、—般资料 47例中男30例,女17例。最小年龄40岁,最大66岁,10岁以下30例,其中8岁以内者24例(占51.06％)。找到原发病灶者24例(占51％),计疖肿6例,上呼吸道感染、痈、脐炎、肠道肛门手术后感染各3例。皮肤脓疱,产后     

2006～2012年院内感染金黄色葡萄球菌耐药性监测及同源性分析

目的调查2006~2012年院内感染金黄色葡萄球菌耐药性并作同源性分析,为控制其院内感染提供依据。方法回顾分析2006~2012年院内感染金黄色葡萄球菌的分布及耐药性,并采用随机引物DNA扩增多态性(RAPD)技术进行同源性分析。结果共检出院内感染金黄色葡萄球菌121株,以呼吸科、泌尿外科和普外科患者居多,在痰液样本中分离率最高。对万古霉素、替考拉宁以外的其他14种抗菌药物表现为不同程度耐药,耐甲氧西林金黄色葡萄球菌检出率65.29%(79/121)。通过RAPD分型,将21株院内感染金黄色葡萄球菌分成8个型。结论医院应严格控制抗菌药物的应用,执行消毒隔离措施,加强医疗器械的使用和消毒管理,防止院内感染流行。     

金黄色葡萄球菌肺炎并金黄色葡萄球菌性败血症二例报告

金黄色葡萄球菌肺炎(金葡菌肺炎)是由金黄色葡萄球菌所引起的急性化脓性肺部感染，常发生于免疫功能受损的患者。金葡菌肺炎病情较重，易并发金葡菌性败血症，病死率较高。2003年我科收治了金黄色葡萄球菌肺炎并金黄色葡萄球菌性败血症患者两例。现报告如下：     

江苏无锡地区社区及医院败血症病原菌与预后的比较

目的 比较社区及医院败血症的病原菌分布特点、预后及相关因素。方法 收集无锡地区2000～2003年4家综合性医院血培养阳性病例共480例,统计分析不同感染类型、相应的病原菌构成及其预后的差别。结果 480例血培养阳性患者77．3％为社区获得性菌血症（CABSI）,22．6％为医院获得性菌血症（HABSI）。CABSI的主要病原菌是凝固酶阴性葡萄球菌（38．0％）、大肠埃希菌（17．8％）、沙门菌（9．4％）和金黄色葡萄球菌（8．3％）;而HABSI常见病原菌依次为凝固酶阴性葡萄球菌（17．4％）、念珠菌（14．7％）、大肠埃希菌（12．8％）、铜绿假单胞菌（11．9％）和克雷伯杆菌（10．1％）。HABSI的平均年龄52．2岁显著高于CABSI患者28．1岁（P〈0．001）。HABSI患者的病死率20．2％显著高于CABSI患者3．0％（P〈0．001）;医院感染组中,铜绿假单胞菌所致的感染病死率最高达38．5％,而社区感染组中肺炎链球菌所致的感染病死率最高,为16．7％。结论 社区及医院败血症的病原菌构成、科室分布、病死率均不同,临床应有针对性地进行抗感染治疗,以降低菌血症的病死率。     

新生儿早发型与晚发型败血症临床特征及病原学研究

目的探讨新生儿早发型与晚发型败血症临床特征、病原菌分布及耐药情况,为临床采取有效的感染防控措施提供参考依据。方法选取2014年1月-2018年12月血培养阳性的97例新生儿败血症患儿,根据发病时间分为早发型(日龄≤3d)和晚发型(日龄3d),对新生儿早发型与晚发型败血症的临床特征、病原菌分布和耐药情况进行分析。结果早发型败血症36例(37.1%,36/97),其中早产儿20例(55.6%,20/36),低出生体重儿18例(出生体重2500g,50.0%,18/36);革兰阴性菌感染69.4%(25/36),革兰阳性菌感染27.8%(10/36),真菌感染2.8%(1/36);前三位主要病原菌分别为大肠埃希菌(69.4%,25/36)、B组链球菌(16.7%,6/36)、牛链球菌Ⅱ型(8.3%,3/36)。晚发型败血症61例(62.9%,61/97),其中早产儿50例(82.0%,50/61),低出生体重儿49例(80.3%,49/61);革兰阴性菌感染68.9%(42/61),革兰阳性菌感染24.6%(15/61),真菌感染6.6%(4/61);前三位主要病原菌分别为肺炎克雷伯菌(45.9%,28/61)、葡萄球菌(19.7%,12/61)、大肠埃希菌(13.1%,8/61)。早发型败血症中早产、低出生体重儿比例显著少于晚发型;其大肠埃希菌、B组链球菌感染显著多于晚发型;而其肺炎克雷伯菌、葡萄球菌、多重耐药菌感染显著少于晚发型(P 0.05)。共检出35株多重耐药菌,大肠埃希菌、肺炎克雷伯菌、凝固酶阴性葡萄球菌、金黄色葡萄球菌中多重耐药菌株比例分别为7/33、21/28、6/6、1/6。结论晚发型败血症多见于早产儿、低出生体重儿。大肠埃希菌和B组链球菌是早发型败血症的主要病原菌;肺炎克雷伯菌和葡萄球菌是晚发型败血症的主要病原菌。多重耐药菌感染多见于晚发型败血症,使控制医院感染和选用合适的抗生素成了临床难题。     

重视与加强深部真菌感染的临床研究

近20年来深部真菌感染呈持续增多趋势，据报道1980年至1990年，美国真菌医院感染由2‰增至4‰，念珠菌败血症增加5倍。1995-2002年美国49所医院连续7年的监测资料显示：念珠菌败血症在医院感染败血症中居第4位，仅次于凝固酶阴性葡萄球菌、金葡菌和肠球菌，病死率则居首位。念珠菌败血症的发生率在住院患为4．6‰，在社区人群中年发病率为8～10／10万，病死率29%～47．1％。     

社区与院内感染新生儿败血症晚发型的临床观察及护理

目的分析新生儿败血症晚发型的临床特点,评估护理措施。方法回顾性分析该院2009-2013年收治的新生儿败血症晚发型病例84例,按发生地点分为社区感染组64例,院内感染组20例,收集其临床及护理资料,进行统计分析。结果新生儿败血症晚发型临床表现多样,社区感染组低体温、拒乳发生率高于院内感染组,而院内感染组呼吸暂停发生率高于社区感染组,差异均有统计学意义(P0.05);社区感染组呼吸道感染、脐部感染率高于院内感染组,差异有统计学意义(P0.05);主要致病菌为凝固酶阴性葡萄球菌、大肠埃希菌、金黄色葡萄球菌,对比两组致病菌分布情况,差异无统计学意义(P0.05)。结论对新生儿败血症晚发型应密切观察,争取早期诊断,在合理用药的同时,给予积极合理的护理干预,可提高其治愈率。     

医院内耐甲氧西林金黄色葡萄球菌监测与护理措施

目的：为了寻求有效的护理措施，降低耐甲氧西林金黄色葡萄球菌（MRSA）院内感染的发生，方法：对2000年1－5月ICU205例病人中MRSA院内感染进行相关因素分析，结果ICU MRSA占金黄色葡萄球菌的88．6％，MRSA院内感染率是7．3％，结论：严密的消毒隔离措施，加强留置导管的护理及严密的呼吸道管理，能有效地降低MRSA院内感染率。     

医务人员手部及其所持移动电话病原菌分布与院内感染的相关性研究

目的 研究医务人员手部及其所持移动电话病原菌分布与院内感染的相关性.方法 按分层随机抽样的方法选取汕头大学医学院第二附属医院内科系统的30名医务人员为研究对象,在医务人员处于不同操作状态时进行手部及其所持移动电话随机采样,分析医务人员手部及其所持移动电话的病原菌分布状况;同时对该院近期院内感染的病原菌分布状况进行统计.比较医务人员手部及其所持移动电话的病原菌分布状况与院内感染的病原菌分布状况.结果 30名医务人员手部及所持的移动电话病原菌为金黄色葡萄球菌(50.00％,50.00％)、凝固酶阴性葡萄球菌(26.67％,26.67％)、表皮葡萄球菌(13.33％,13.33％)、枯草杆菌(10.00％,10.00％),其中金黄色葡萄球菌最常见,凝固酶阴性葡萄球菌次之.医务人员手部及所持移动电话所携带的病原菌分布状况完全一致.该院2014年1～6月份院内感染所检出的病原菌中,金黄色葡萄球菌最常见,凝固酶阴性葡萄球菌次之.医务人员手部及其移动电话所携带病原菌均与本院院内感染的病原菌具有一定的相关.结论 医务人员手部所携带病原菌与移动电话病原菌分布一致,均与该院院内感染的病原菌有一定的相关.因此,应重视医务人员的手卫生,操作状态时禁用移动电话,以免藉由移动电话导致院内感染的发生.     

Visiting rights only: the diplomas in nursing in the UK in the interwar period

The aim of this article is to explore the institution and organisation of the diplomas in nursing at the universities of Leeds and London, which were established in 1921 and 1926, respectively. It will be argued that the success of these courses for the individuals who undertook them, and the profession as a whole was ultimately limited. It is accepted that the purpose of the diplomas was at least in part for the nursing elite to maintain their grip on the leadership. Nevertheless, the institution of the courses, when few women in general attended university, identifies a 'radicalness' within the profession, which has rarely been considered. Moreover, that there was a body of nurses capable of university level education challenges previous assumptions.     

Pitfalls in the Care of the Psychiatric Patient in the Emergency Department

Background

Care of the psychiatric patient in the Emergency Department (ED) is evolving. As with other disease states, there are a number of pitfalls that complicate the care of the psychiatric patient.

Objective

The purpose of this article is to update Emergency Physicians concerning the pitfalls in caring for the psychiatric patient, and possible solutions to deal with these pitfalls.

Discussion

The article will address the burden of the psychiatric patient, staff attitudes, medical clearance process, treatment of the agitated patient, suicidal patients, and admission decisions.

Conclusions

Alternative care resources, collaboration with Psychiatry, staff education, improvement in the medical clearance process, proper use of restraint and seclusion, and appropriate choice of medication for agitated patients can help avoid some of the top pitfalls in the care of the psychiatric patient in the ED.     

Changes in the parameters of the rhythms of the electrolyte-excreting function of the kidneys in women in relation to the seasons of the year

The characteristics (period, mesor, amplitude) of the rhythms of urinary excretion of sodium, potassium, chlorine, calcium, magnesium, and phosphorus were examined in normal women during various seasons. The urine was collected for 5 days with 4-hour intervals. The rhythms were detected and their parameters established with the use of mathematical methods for the assessment of the tested curve fragments repetitions and by the least squares nonlinear method. The rhythms of renal urinary and electrolyte excretion were found very smooth, particularly so in the fall and winter. The circadian rhythms have been found the most stable during all the seasons. Examinations of individual electrolyte excretion have shown that Na and K excretion is more stable all the year round and therefore this parameter is the most informative for the detection of disorders in renal electrolyte excretion.     

Choosing the choices in the USA: examples in the maternity area

The concept of choice has featured prominently in both the recent united Kingdom (UK) health care reforms and in the debate relating to the care of childbearing women. An invitation to the USA facilitated contemplation of the health care system on which the recent UK reforms have been modeled. The impact of the health system on mother's choices was a source of particular interest. The implications for midwives, their practice and their relationships with their clients and colleagues emerge clearly. It may be that the United States' model of health care does not answer the needs of the UK.     

Change in the drug-metabolizing function of the liver in patients in the postoperative period in relation to the type of anesthesia]

Anesthesia-dependent changes in pharmaco-metabolic liver function have been studied in patients operated on for cosmetic facial defects. It has been established that the postoperative period in patients subjected intraoperatively to general combined anesthesia and controlled lung ventilation was characterized by inhibited drug metabolism in the liver, which required correction of the drug doses to reduce the risk of side and toxic effects of pharmacotherapy. Patients operated on under local procaine anesthesia had no considerable changes in pharmaco-metabolic liver function in the postoperative period.