气管导管生物膜与呼吸机相关性肺炎

呼吸机相关性肺炎在机械通气患者中非常常见,因其高发病率、病死率及高医疗费用,使其成为ICU工作者不得不面临的难题之一.本文就呼吸机相关性肺炎的发病机制及其预防措施作一概述.     

呼吸机相关性肺炎的预防研究进展

呼吸机相关性肺炎是机械通气患者常见并发症,是重症监护病房院内感染主要原因.目前,该病发病率、病死率高,预防可能是控制该病流行和发病的最佳策略.该文将近年来有关呼吸机相关性肺炎预防措施的研究进展作一综述,旨在寻找有效的预防措施,以降低呼吸机相关性肺炎的发病率和病死率.     

血必净对严重脓毒症并发呼吸机相关性肺炎发病率的影响

目的观察血必净注射液对严重脓毒症患者呼吸机相关性肺炎发生的影响。方法严重脓毒症并发呼吸衰竭需要机械通气的成年住院患者100名，随机分为血必净治疗组和常规对照组，观察两组病人呼吸机相关性肺炎的发生率，28天病死率，ICU住院时间，呼吸机治疗时间以及抗生素使用天数。结果血必净治疗组呼吸机相关性肺炎的发生率，病死率降低，ICU住院时间，呼吸机治疗时间以及抗生素使用天数缩短，有统计学差异。结论血必净可以降低严重脓毒症患者发生呼吸机相关性肺炎的发病率。     

呼吸机相关性肺炎的流行病学和诊治进展

呼吸机相关性肺炎发病率逐年增高,致残率、致死率也呈上升趋势.本文通过对呼吸机相关性肺炎的发病机制、发病相关因素及病原体流行病学的分析,总结呼吸机相关性肺炎的诊疗进展及目前主要的治疗方案.     

人工鼻联合密闭式吸痰管预防呼吸机相关性肺炎的疗效

机械通气相关性肺炎(VAP)越来越受到关注。据报道,VAP是医院内肺炎的一种特殊类型,发病率为9%~70%,病死率为50%~69%〔1,2〕。因此,降低VAP发病率、病死率,对临床有一定的指导意义。本文探讨人工鼻及密闭式吸痰管对ICU呼吸机相关性肺炎的影响。     

呼吸机相关性肺炎诊断进展

呼吸机相关性肺炎是一类特殊类型的医院内感染,尤其对于危重症患者,其发病率和病死率均较高。由于呼吸机相关性肺炎临床诊断标准的局限性,如何早期诊断尚存在争议。本文结合近年来的相关进展作简要综述,以期提高呼吸机相关性肺炎的诊断水平。     

呼吸机相关肺炎的研究进展

呼吸机相关肺炎(VAP)是一种经气管插管或气管切开进行机械通气过程中的医院获得性肺炎,为一种常见而严重的并发症.由于长时间的重症监护及住院,呼吸机相关肺炎可使患者病死风险提高43％.据国内医院调查[1],呼吸机相关肺炎发生率高达43.1％,病死率为51.6％,而据国外文献报道呼吸机相关肺炎的死亡率达24％～50％,高出无呼吸机相关肺炎患者的2倍多;如果是多重耐药菌感染,死亡率高达76％[2].呼吸机相关肺炎发病率高,治愈极为困难,病死率居高不下,一直是临床和医院感染控制工作者关注的焦点之一.     

呼吸机相关性肺炎临床分析

目的探讨呼吸机相关性肺炎（VAP）易感因素及防治措施。方法回顾性分析67例VAP患者的临床资料。结果分泌物培养发现单一病原菌感染者42例（62.7%）,有两种及其以上病菌感染者25例（37.3%）,合并真菌感染13例（19.4%）。经过治疗,39例（58.2%）肺炎得到控制,其中,32例（37.8%）脱离呼吸机,2例（3.0%）无法脱机,5例（7.5%）死亡。28例（41.8%）肺炎未愈或原发病加重导致死亡。结论 VAP发病率较高,但是有效的防范措施和治疗措施一定程度上可以降低发病率和病死率。     

机械通气撤机策略与方法

机械通气是合并严重呼吸衰竭患者的有效抢救手段,目的是为原发病的治疗争取到宝贵的时间.机械通气本身可导致致命的并发症,如呼吸机相关性肺炎、呼吸机诱导肺损伤等,增加患者的住院病死率及医疗费用[1].     

可溶性髓样细胞触发受体-1对呼吸机相关性肺炎早期诊断的临床意义

呼吸机相关性肺炎（VAP）即经气管切开或是气管插管接受辅助或控制通气,通气时间48小时以上或停止机械通气（MV）或去除人工气道48小时之内出现的肺炎.随着医疗技术的发展,建立人工气道呼吸机辅助通气已成为治疗危重患者的重要措施,而VAP也随之成为机械通气过程中常见的严重并发症之一,发生率为9％～69％,病死率为20％～50％,其在抗生素治疗不当和多重耐药菌感染患者中的病死率高达70％.     

Cement and Concrete Nanoscience and Nanotechnology

Concrete science is a multidisciplinary area of research where nanotechnology potentially offers the opportunity to enhance the understanding of concrete behavior, to engineer its properties and to lower production and ecological cost of construction materials. Recent work at the National Research Council Canada in the area of concrete materials research has shown the potential of improving concrete properties by modifying the structure of cement hydrates, addition of nanoparticles and nanotubes and controlling the delivery of admixtures. This article will focus on a review of these innovative achievements.     

慢性饮酒、吸烟与骨质疏松的相关性研究

目的 探讨长期大量慢性饮酒、吸烟等不良生活方式与骨质疏松的关系.方法 以乏力、腰背痛、双下肢酸困为主诉,且有长期大量慢性饮酒史、吸烟史,无其他慢性疾病史的年轻男性患者45例为观察对象,测定其血钙(Ca)、血磷(P)和血肌酐(Cr)、尿素氮(BUN)、血糖(Glu)、天门冬酸氨基转移酶(AST)、丙氨酸基转移酶(ALT)、血清碱性磷酸酶(ALP)、甲状腺功能、全段甲状旁腺激素(iPTH)、1,25-二羟维生素D3[1,25-(OH) 2D3]、双能X线骨密度仪测定腰椎L1-4及左侧股骨近段(包括颈、股骨颈上部、大粗隆)骨密度(BMD),分析饮酒、吸烟对骨量的影响.以感冒发热就诊、年龄相当、无饮酒、吸烟史及慢性疾病史的45例男性为对照组.结果 观察组1,25(OH)2D3水平均降低,血钙水平偏低,血磷正常,碱性磷酸酶呈不同程度地升高,骨密度T值提示观察组27例骨质疏松,12例骨量减少,6例正常骨量;而对照组仅有6例为骨量减少,1例骨质疏松,38例为正常骨量,两组比较差异有统计学意义(P＜0.05).结论 长期慢性大量饮酒吸烟影响骨量,甚至易导致骨质疏松.     

Medical and Psychology Students' Knowledge and Attitudes Regarding Aging and Sexuality

The current study surveys medical and doctoral psychology students (N = 100) from an urban northeastern university regarding knowledge and attitudes toward elderly sexuality and aging using the Facts on Aging Quiz, the Aging Sexuality Knowledge and Attitudes Scale, and measures of interest in gerontology, academic/clinical exposure to aging and sexuality, and contact with elders. The current study found that psychology students demonstrated greater aging knowledge than medical students; however, both groups showed gaps in knowledge about sexuality. Married students had greater academic/clinical exposure and greater knowledge about aging but less permissive attitudes toward elderly sexuality. Generally, knowledge about aging was the strongest correlate of knowledge about sexuality. Level of knowledge about sexuality was not associated with attitudes. Attitudes toward sexuality and aging may be more strongly tied to demographic variables reflective of religious beliefs or adherence to sociocultural norms.     

Leptin and cellular and innate immunity in abstinent alcoholics and controls

BACKGROUND: Basic studies indicate that in vitro and in vivo doses of leptin modulate cellular immune responses. Given evidence that concentrations of leptin are altered in alcoholics who also show immune abnormalities, this study examined the relationships between circulating levels of leptin and markers of cellular and innate immunity. METHODS: Circulating levels of leptin, natural killer cell (NK) activity, interleukin-2 (IL-2)-stimulated NK activity, and concanavalin A-stimulated production of IL-2, IL-6, IL-10, and IL-12 were compared between abstinent DSM-IV alcohol-dependent men (n = 27) and age- and gender-matched controls (n = 34). RESULTS: As compared with controls, alcoholics showed lower NK activity (p < 0.01) and a trend for lower levels of leptin (p = 0.055). In the total sample, leptin predicted NK activity (beta = 0.33; p < 0.05) after controlling for the confounding influence of body mass index, alcohol intake, and smoking. Leptin was not correlated with any of the cytokine measures. To examine whether the effects of leptin were mediated by its direct action on NK, additional studies examined in vitro effects of leptin on NK activity in healthy volunteers (n = 10); leptin doses (0.1, 1, and 10 nM) yielded levels of NK activity comparable to those with media alone. CONCLUSIONS: These data show that circulating levels of leptin are associated with NK activity in humans and suggest that abnormal in vivo concentrations of leptin may contribute to the declines of NK activity in alcoholics who are at risk for infectious diseases.     

自身免疫与动脉粥样硬化的发生发展

在动脉粥样硬化的发生发展过程中,自身免疫具有重要作用,本文就近年有关动脉粥样硬化的免疫机制的研究进展作一简要综述.     

中青年超重和肥胖与高血压及高同型半胱氨酸血症的相关性研究

目的探讨中青年超重和肥胖与高血压及高同型半胱氨酸血症的相关性。方法选取2012年1月—2013年10月在我院进行常规健康体检者750例,测量受试者血压、身高、体质量及血清同型半胱氨酸(Hcy)水平。结果男性超重、肥胖检出率分别为36.87%(198/537)和13.97%(75/537),均高于女性的16.43%(35/213)和7.50%(16/213)(P0.05)。超重者和肥胖者高血压和高同型半胱氨酸血症检出率分别为21.03%(49/233)和11.16%(26/233)、46.12%(42/91)和41.76%(38/91),均高于正常者的9.16%(37/404)和2.23%(9/404),肥胖者高于超重者(P0.01)。收缩压(SBP)、舒张压(DBP)及血清Hcy与BMI呈正相关(r值分别为0.639、0.515、0.497,P0.01)。结论中青年尤其是男性超半数存在超重或肥胖,高血压及高同型半胱氨酸血症与BMI呈正相关,超重和肥胖者高血压及高同型半胱氨酸血症的发生率高,应积极防治。