１１８ 例支气管扩张合并感染患者的病原学及药敏分析

目的：分析118例支气管扩张合并感染住院患者的病原学及药敏情况,以指导临床抗菌药物的应用。方法对因支气管扩张合并感染需要住院的118例患者的痰培养和药敏结果进行回顾分析。结果118例痰培养68例阳性,阳性率为57．6％,其中革兰阴性菌66株,占97．0％,最常见的病原菌为铜绿假单孢菌,对第三、四代头孢菌素、氟喹诺酮类、氨基糖甙类、碳青霉烯类抗菌药物敏感。结论支气管扩张患者病原菌分布以革兰阴性杆菌为主,尤其铜绿假单孢菌感染。在药敏结果未报告前,可经验选择第三、四代头孢菌素、碳青霉烯类、氟喹诺酮类或氨基糖甙类抗菌药物。     

老年人院内肺部感染之G一杆菌致病菌及药敏分析

近年来,Ｇ－杆菌致病菌已成为老年院内肺部感染之主要致病菌,且耐药菌株不断增加。为此,我们分析了１４２例老年人院内肺部感染之Ｇ一杆菌致病及药物敏感情况,现报告如下。１材料与方法１．１病例选择１４２例来自我院１９９５年７月～１９９８年７月住院患者,均符合国家卫生部颁发的医院感染诊断标准［１］。男８３例,女４９例;年龄≥６０岁,平均年龄（７０．１２士９．２５）岁。１．２方法对１４２例痰培养为Ｇ一杆菌致病菌之老年院内肺部感染者行致病菌及药敏结果统计、分析。痰培养：晨漱３次,取第２口深部疾送检,连续３次有…     

新生儿呼吸机相关性肺炎88例痰培养分析

目的：探讨本地区近年来新生儿呼吸机相关性肺是院内感染常见菌群及药敏情况，指导临床合理使用抗生素。方法：对本院1998年10月～2004年1月新生儿监护室中呼吸机通气的88例新生儿痰培养结果进行分析。结果：88例中疾培莽阳性27例，发现阳性菌株47株，病原菌依次为鲍氏不动杆菌，嗜麦芽黄假单孢菌、肺杆菌、肺更克雷白氏菌厦口腔链球菌；药敏敏感药物依次为环丙沙星、万古霉素、泰能及复在欣。结论：尽早根据本地区院内感染常见菌及药敏选用抗生素，及时根据患儿痰培养结果调整抗生素。     

老年人反复下呼吸道感染的致病菌分布及耐药性监测

目的：探讨老年人下呼吸道感染致病主药物敏感状况,以指导临床用药。方法：回顾性分析呼吸科急诊留院观察的老年人痰病原菌阳性率、菌种分布特点及耐药情况,与临床经验用药作对照分析。结果：４８０例痰培养标本检出病原菌１５０株,总阳性率为３１．３％,其中Ｇ杆菌占７２．０％。药敏试验显示,不 直菌属、假单胞菌属、肠杆菌属耐经率较低的抗生素胺培南、氨曲南、阿米卡星。结论：老年人反复慢性下呼吸道感染急性加重的致病菌     

老年患者下呼吸道感染病原菌分布和耐药性分析

目的：了解我院老年患者下呼吸道感染病原菌分布及其耐药性。方法：对2005年1月～2006年1月老年患者深部痰细菌培养及药敏试验结果进行回顾性分析。结果：472例痰标本中376例培养阳性，阳性率为79．7％：376例阳性标本中检出病原菌396株，其中革兰阴性杆菌270株（68．2％），革兰阳性球菌71株（17．9％），真菌55株（13．9％）；铜绿假单胞菌居首位（30．8％）；肺炎克雷伯菌和大肠埃希菌的ESBLs阳性率分别为14．7％和20．8％；药敏试验结果显示．亚胺培南对肠杆菌科细菌保持100．0％的抗菌活性；铜绿假单胞菌对多种抗菌药物敏感性下降，出现20．0％对亚胺培南耐药株；葡萄球菌属对万古霉素一致敏感。结论：老年患者下呼吸道感染以革兰阴性杆菌为主，而且耐药性较强．临床微生物室应加强病原菌及其耐药性的监测，以指导临床合理使用抗菌药物。     

铜绿假单孢与不动杆菌混合肺感染42例临床分析

目的 了解铜绿假单孢菌与不动杆菌混合肺感染的致病特点和对抗生素的敏感性。方法 对42例铜绿假单孢菌与不动杆菌混合肺感染的患者的临床特点、痰细菌培养及药敏试验进行性分析。结果 铜绿假单孢菌与不动杆菌混合肺感染多发生于年老、有慢性肺部疾患及机械通气者,病死率高（45．2％）,对两种细菌的敏感率保持在90％以上的有亚胺培南及美洛配能,在80％左右的有丁胺卡那,罗咪沙星及舒氨西林。头孢类抗菌素的敏感率均低于55％以上。结论 铜绿假单孢菌与不动杆菌混合肺感染的病死率高,应依据药敏试验或选择强有力的抗菌素治疗。     

下呼吸道感染患者237株细菌分析

目的：总结和分析下呼吸道感染致病菌的构成和药物敏感性。方法：回顾性分析住院患者下呼吸道感染痰培养种类，药物敏感性试验。结果：下呼吸道感染主要细菌为铜绿假单孢菌，肺炎克雷伯菌，表皮葡萄球菌，醋酸钙不动杆菌。分别占20．3％、11．8％、10．5％、8．4％。其中革兰氏阴性菌占61．6％，对第三代头孢菌素、氟喹诺酮、氨基甙类抗生素敏感。革兰氏阳性菌38．4％，对β-内酰胺类抗生素敏感。结论：(1)铜绿假单孢菌感染主张以β-内酰胺和氟基甙类抗生素联合治疗。(2)革兰氏阳性菌对氨苄西林耐药。     

慢性阻塞性肺疾病急性加重期病原学分析

目的:总结我院慢性阻塞性肺疾病急性加重期患者痰培养及药敏结果。方法:回顾并分析2009年7月-2011年3月我院178例住院AECOPD患者痰培养及药敏试验结果。结果:178例患者痰培养样本中分离出病原菌150株,其中革兰氏阴性菌112株,占74.7%;革兰氏阳性菌26株,占17.3%;真菌12株,占8.0%。主要为铜绿假单孢菌、鲍曼不动杆菌、肺炎克雷伯菌、金黄色葡萄球菌以及大肠埃希氏菌。药敏结果显示,革兰氏阴性菌对美洛培南、新喹诺酮类、阿米卡星等抗生素敏感;革兰氏阳性菌对万古霉素敏感。结论:AECOPD的细菌感染以革兰氏阴性菌为主,且耐药性较高。临床上应加强药敏测定,合理应用抗生素,减少耐药菌株的产生。     

慢性阻塞性肺疾病急性加重期痰培养及药敏结果分析

目的：了解本地慢性阻塞性肺疾病（COPD）急性加重期痰培养病原菌及对抗菌药物敏感及耐药情况。方法：对太原市太钢总医院呼吸科2011年10月至2013年10月收治的 COPD 急性加重期患者,随机抽取191例,其中68例痰培养结果阳性,对其进行回顾性分析。结果：68例痰培养结果阳性者中有革兰阴性细菌51例（75．00％）,革兰阳性细菌14例（20．59％）。真菌3例（4．41％）。COPD 患者细菌感染以肺炎克雷伯杆菌、大肠埃希菌、铜绿假单胞菌、肺炎链球菌、鲍曼不动杆菌、普通变形杆菌、白色念珠菌、金黄色葡萄球菌等高检出率为主。结论：对 COPD 急性加重期患者,呼吸道感染以革兰阴性细菌为主,痰细菌学培养结果与患者病情严重程度关系密切,应合理选择抗菌药物。     

热带海岛环境下烧伤病人的细菌学调查

目的：调查热带海岛环境下烧伤病人细菌感染性药敏情况以指导有效的抗感染治疗。方法：回顾我院1990年1月至2000年12月住院病人创面和血液细菌培养及药敏情况进行分析。结果：从送检标本中检出13个菌属，28个菌种的细菌687株，其中创面培养细菌593株，血液培养细菌94株，细菌检出率排前五位的是铜绿假单孢杆菌，金黄色葡萄球菌，恶臭假单孢杆菌，表皮葡萄和不动杆菌。结论：铜绿假单孢杆菌，金黄色葡萄球菌，恶臭假单孢杆菌，表皮葡萄等仍是最主要的感染菌种，条件致病菌有逐步上升为烧伤病人主要致病菌的潜在危险，而霉菌感染仍不是烧伤感染的主导菌种，动态了解热带环境下烧伤病人感染菌及药敏情况，以便选择价廉，毒性小而有效的抗菌药物治疗，避免因滥用抗菌药物诱发新的耐药菌株形成有主要意义。     

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.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

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.