子宫全切术并发泌尿道损伤的预防及处理

<正>子宫全切术是妇科最常见的手术之一,因子宫与膀胱后壁及输尿管下段解剖关系紧密,术中存在泌尿道损伤(urinary tract injury,UTI)的风险。术前积极预防相关损伤的发生,术中及时识别损伤并适当处理有利于患者术后康复。而迟发性UTI往往需二期手术处理,不仅增加患者术后并发症发生率、住院时间及治疗费用,其治疗亦给患者带来一定痛苦,影响生活质量并容易导致医     

婴幼儿肛周脓肿及肛瘘治疗研究进展

肛周脓肿及肛瘘均属于肛腺感染,是婴幼儿常见的疾病之一,如果治疗不及时极易导致败血症而危及生命。目前临床对肛周脓肿及肛瘘的治疗以西医手术治疗和中医为主,均可以取得较好的成效。本文重点从中药熏洗、药物外涂、中西医联合治疗等方面对婴幼儿肛周脓肿及肛瘘的中医治疗研究进展做系统的分析综述,并拓展性地介绍中医理念在婴幼儿肛周脓肿及肛瘘护理干预中的应用。     

影响宫颈癌患者根治术后尿路感染的危险因素分析

目的分析宫颈癌患者根治术后尿路感染(UTI)的危险因素。方法回顾性分析2015年1月-2018年1月间于我院行根治术治疗240例宫颈癌患者的临床资料,统计其术后UTI情况,并分析术后UTI危险因素。结果 (1)240例患者中共51例发生UTI,感染率为21.25%。(2)细菌培养结果提示UTI患者尿液培养细菌谱以革兰氏阴性菌为主,占比最高的为大肠埃希菌(39.22%),其次肺炎克雷伯菌(15.69%)。(3)将术后UTI感染者纳为感染组(n=51),未感染者纳为对照组(n=189),单因素分析提示,感染组与对照组年龄、糖尿病史、尿梗阻史、高血压史、术前是否行放化疗、手术切除范围、留置尿管方式、术后留置尿管时间、重插尿管次数、术后是否尿潴留及住院时间均存在显著差异(P0.05),两组病理类型及术中出血量无显著性差异(P0.05)。(4)Logistic回归分析提示,年龄≥60岁、术前放化疗、手术切除范围、术后留置尿管时间≥14 d、重插尿管≥2次以及术后尿潴留均是导致术后UTI的独立危险因素。结论术前提高老年患者机体免疫功能、严格控制术前放化疗、术后尽早拔除尿管并减少重复插管,术中注意保护盆腔神经,能有效预防宫颈癌根治术术后UTI,利于患者术后恢复。     

新生儿泌尿系统感染117例临床分析

目的探讨新生儿泌尿系统感染(UTI)的临床特点及致病菌的分布和耐药状况。方法对2005年1月至2010年12月成都市妇女儿童中心医院新生儿科病房收治的117例UTI新生儿,按照清洁尿培养结果,将其分为尿培养呈阳性组(A组,n=52)和尿培养呈阴性组(B组,n=65)(本研究遵循的程序符合本院人体试验委员会制定的伦理学标准,得到该委员会批准,分组征得受试对象监护人的知情同意,并与其签署临床研究知情同意书)。两组新生儿性别、胎龄、确诊时日龄及喂养方式等比较,差异无统计学意义(P>0.05)。采用回顾性分析方法,对其临床特点、实验室检查结果、治疗及转归进行统计学分析。结果 117例UTI新生儿的临床表现极不典型,缺乏UTI的局部症状,甚至无症状。52例尿培养呈阳性患儿中,革兰阴性(G-)杆菌检出率为71.15%,分别为大肠埃希菌、阴沟肠杆菌和肺炎克雷伯菌。这些G-杆菌对亚胺培南西司他丁及第三代头孢菌素中头孢哌酮舒巴坦、头孢曲松均敏感。结论 G-杆菌为导致新生儿UTI感染的主要致病菌,临床应重视尿培养以确定病原,合理选用抗菌药物治疗。此外,对患儿进行相应影像学检查以排除其他潜在病因,亦十分必要。     

脑卒中患者并发泌尿系感染的相关因素及护理(综述)

在脑卒中患者中泌尿系感染的发生率仅次于呼吸道感染，且是导致患者死亡的主要原因之一。泌尿系感染（Urinary Tract Infection，UTI）是指致病微生物侵袭泌尿系统而导致的炎症，根据感染部位可分上、下尿路感染。其病情反复发作，迁延不愈，可由无症状细菌尿至严重的毒血症。脑卒中患者合并泌尿系感染不仅增加治疗费用，而且增加脑卒中的治疗难度，并增加患者的痛苦。     

碘伏膀胱冲洗防治留置尿管尿路感染探讨

目的探讨0.5%碘伏(聚维酮碘)膀胱冲洗(IB)防治重症监护患者尿管相关医院泌尿道感染(UTI)的效果及方法. 方法预防组:碘伏组以0.5%碘伏做IB,3次/d;对照组不做IB;治疗组:碘伏组及对照组处理同预防组. 结果预防组:0.5%碘伏IB可显著减少尿管相关医院UTI的发生率(P<0.05);治疗组:0.5%碘伏IB治疗尿管相关医院UTI的治愈率显著高于对照组(P<0.05). 结论 0.5%碘伏IB可有效防治尿管相关医院UTI.     

中药柴柏味前汤加味治疗尿路感染40例临床观察

尿路感染(Urinary Tract Infection,UTI)是临床上常见的泌尿系统疾病,以尿急、尿频和尿道灼热刺痛等为主要临床表现。UTI因多种微生物侵入而患病,最常见的是肠道革兰氏阴性菌,其中以大肠杆菌最为常见,占70%以上。西医治疗主要以抗生素为主,但随着耐药菌株对西药不敏感的情况日益增多和对西药的过敏反应与毒副作用的频繁发生,治疗     

乌司他丁对急性胰腺炎患者炎性细胞因子的调节作用

目的 探讨乌司他丁(UTI)治疗急性胰腺炎的作用机制和临床疗效.方法 将52例急性胰腺炎患者采用随机数字表法分为UTI组和对照组,每组各26例.对照组予以禁食、制酸、胃肠减压、生长抑素、抗感染及营养支持等治疗.UTI组在对照组基础上,给予UTI 10万U静脉滴注,2次/d,共5 d.结果 治疗前,两组白细胞介素(IL)-6、IL-8、肿瘤坏死因子(TNF)-α含量基本一致(P>0.05);治疗后,UTI组IL-6、IL-8和TNF-α下降速度均明显快于对照组(P<0.05).UTI组痊愈率65.4%(17,26),明显高于对照组的34.6%(9,26)(P<0.01);UTI组痊愈率+显效率为92.3%(24,26),明显高于对照组的76.9%(20/26)(P<0.01).结论 UTI对急性胰腺炎患者IL-6、IL-8、TNF-α的分泌、释放有一定的调节作用,治疗急性胰腺炎临床疗效确切,有一定的临床推广价值.     

门诊泌尿系感染病原菌分布及耐药性分析

目的分析门诊泌尿系感染(UTI)患者分离病原菌的分布及耐药性。方法收集门诊尿常规阳性的UTI患者的清洁中段尿标本,进行细菌培养,采用纸片扩散法进行体外药敏试验,用WHONET软件分析药敏结果。结果引起门诊UTI感染主要病原菌是大肠埃希菌占74.2%,大肠埃希菌对氨苄西林的耐药率最高为69.6%,超广谱β-内酰胺酶(ESBLs)检出率为24.7%,未检测到对亚胺培南、美罗培南、阿米卡星、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦耐药的菌株。结论了解门诊泌尿系感染的病原菌分布及耐药性至关重要,可以为临床医师提供经验治疗UTI的病原学依据。     

肾移植术后尿路感染的相关因素及预防措施

肾移植术后(PRT)并发尿路感染(UTI)是最常见的感染之一,近6年来,我们在肾移植后UTI的防治方面采取了积极有效的措施,使术后UTI的发生率逐年下降。1　相关因素及预防措施1.1　诱发因素与UTI　术前男性患者生殖器不洁,如包茎、包皮垢刺激;女性术前滴虫性阴道炎或真菌性阴道炎没有及时发现及根治,术后随着机体抵抗力的降低,从而引起感染症状。预防措施是做好术前检查及治疗。1.2　留置尿管与UTI　PRT患者发生UTI与保留尿管的时间呈正相关。术后留置尿管超过48h者,UTI的比例明显高于24h内拔除尿管者,并且尿道刺激症状明显。预防措施…     

婴儿泌尿系感染的临床特点及病原菌分布

目的 研究婴儿泌尿系感染的临床特点及病原菌分布.方法 对2012年1月至2016年12月近5年来在西安市儿童医院肾脏科住院并确诊为泌尿系感染的96例婴儿的临床资料进行回顾性分析.结果 泌尿系感染患儿中,1岁以下的婴儿和1岁以上患儿的男女构成比差异有统计学意义(χ2=10.971,P<0.01),婴儿泌尿系感染中男62例(占64.58%),女34例(占35.42%).起病形式以发热及肉眼血尿起病最多见,27例(28.13%)均提示泌尿系畸形,其中包括重复肾、肾积水、肾结石、肾发育不良及膀胱输尿管返流等.32例尿培养阳性(阳性率为33.33%),其中革兰阴性菌20例(62.50%),大肠埃希菌12例(37.50%),肺炎克雷伯杆菌7例(21.88%),革兰阳性菌中肠球菌12例(37.50%).所有患儿积极抗感染治疗后,除1例自动出院失访外,其余患儿均预后良好.结论 婴儿泌尿系感染以男孩多见,临床表现多不典型,易合并泌尿系畸形,对婴儿泌尿系感染应常规行泌尿系超声以排除泌尿系畸形.在治疗中应重视寻求病因的同时针对病因进行治疗.     

The struggle to diagnose UTI in children under two in primary care

BACKGROUND: The incidence of urinary tract infection (UTI) in childhood is highest in infancy and accounts for 5% of febrile infants. Reflux nephropathy following UTI in early childhood is the commonest preventable cause of chronic renal failure. Recent guidelines aim to improve the diagnosis and management of UTI in small children. OBJECTIVES: To assess management of febrile children and UTI in children under 2 years amongst GPs, and to identify some reasons for the difficulties in diagnosing UTI. METHOD: Questionnaire distributed by periodical journal. RESULTS: Eighty-two GPs responded, of whom 61 (74%) were unaware of the recent Royal College of Physicians guidelines on childhood UTI. Seventy-seven GPs (94%) would find guidelines helpful on when to send a urine sample for culture from a child under 2 years. Only 11 GPs (14%) regularly sent urine from febrile infants and toddlers; 48 GPs (63%) sent urine from only 0-10% of patients; 21 (26%) were unable to collect urine at all from these children. Several difficulties were identified by GPs regarding investigation for UTI in children. These related to practical difficulties in urine collection and culturing, lack of professional awareness of the importance of UTI and concerns about the costs of investigation. CONCLUSION: GPs frequently do not investigate for UTI in febrile children due to practical difficulties, lack of awareness and financial costs. National guidelines need to be disseminated and implemented effectively to reach target groups. Further scope for research into a simple, cheap method to collect and test urine has been highlighted as a priority to improve early diagnosis of UTI. Management of UTI in primary care can be improved with carefully evaluated strategies and this could lead to a reduction in the prevalence of renal scarring.      

早产儿肺及早产儿肺疾病的影像学评估价值

呼吸系统疾病已成为导致我国早产儿死亡的主要原因之一。由于产前糖皮质激素促胎肺成熟治疗、肺表面活性物质(PS)及各种类型呼吸支持技术等的应用,临床诊治该类疾病的策略日趋成熟,对于早产儿呼吸系统常见疾病的诊治,大多具备各自的指南和临床路径。目前临床对于该领域的研究热点,多集中于早产儿肺及其疾病的基因研究、早期干预方式的选择和精准化诊治等方面。笔者拟就早产儿肺及早产儿肺疾病的病理生理基础、影像学表现及其转归的最新研究进展进行阐述,以探讨影像学检查在早产儿肺及其肺疾病中的临床应用价值,辅助临床实现对早产儿肺疾病的精准化诊治。     

Parent's opinions on the diagnosis of children under 2 years of age with urinary tract infection

BACKGROUND: Urinary tract infection (UTI) in childhood can be diagnosed in 5% of febrile infants. Renal scarring is associated with increasing numbers of UTI episodes, and the incidence of renal scarring rises with each urinary infection. High levels of awareness of childhood UTI are important among both professionals and parents. Whilst problems for professionals in making the diagnosis have been explored, few data exist concerning parental understanding and perspectives. OBJECTIVES: The purpose of this study was to assess parental understanding of UTI in their child and identify any delay perceived in the diagnosis, along with identifying how helpful parents had found any information that they had been given. METHODS: Subjects were the parents of children aged <2 years being investigated in one out-patient department following proven UTI. A semi-structured questionnaire was given to parents at first attendance (quantitative data) and content analysis of qualitative data was carried out. RESULTS: Fifty-two out of 84 parents responded (response rate 64%), of whom 45 (86.5%) felt that they had been given a full explanation of the significance of UTI in childhood. Forty percent felt that clean catch was the easiest method of obtaining a urine sample from their child. Although the quantitative data were positive, several themes were identified in the qualitative data, relating to lack of awareness, delay in investigation by health professionals and issues regarding the information that had been imparted to parents. Parents would like more information about the illness that affects their child, and many would like this in leaflet form. CONCLUSIONS: Parents perceive low awareness levels and delays in investigation of UTI in childhood amongst health professionals. Increasing awareness about the importance of UTI in childhood, its incidence and management should be generated amongst health professionals who deal with young children. Parents need and would like more information about the disease and how to identify it, with guidance on urine collection. Further research is needed into whether educational strategies for either parents or health professionals are effective in identifying UTI earlier, and what the best methods of implementing these would be.     

Diarrhoeal disease and its control

The diarrhoeal diseases are an important cause of illness throughout the world and a leading cause of death among infants and young children. Unfortunately, the greatest wealth of clinical material is found where the facilities for its study are least available. This article deals with a number of the many problems which therefore arise. The etiology is multiple, and often obscure. The relationship between the diarrhoeal diseases and malnutrition is as yet far from being elucidated. Many epidemiological questions require an answer. There is no standard treatment. Prevention, it is universally agreed, depends largely upon improvement in environmental sanitation, especially upon the provision of a safe and adequate supply of piped water, but this apparently simple measure is fraught with difficulties. Much remains to be done before anything like satisfactory control of this group of diseases can be achieved.     

青海省儿童骨髓细胞形态学检查832例分析

目的分析骨髓细胞形态学检查结果,探讨骨髓细胞形态学在血液病中的诊断价值。方法选取2006～2010年在某院初次行骨穿检查的832例患儿,对其骨髓结果进行回顾性分析。结果 2006～2010年832例患儿中学龄期儿童比例最高占25.6%,其次为婴幼儿占21.4%。各年龄阶段均以原发性血小板减少性紫癜(ITP)构成比最高。骨髓细胞形态学检查诊断中常见的疾病依次为:ITP、感染骨髓象、增生性贫血、缺铁性贫血(IDA)、急性白血病(AL)、再生障碍性贫血(AA)。结论实验室骨髓细胞形态学检查是造血系统疾病诊断的基础,正确的血细胞计数以及血细胞形态学的详细观察仍然是最基本的诊断方法,具有重要价值,除血液系统疾病本身,其他如不明原因发热、肝脾、淋巴结肿大者也应尽早行骨髓检查,早期诊断早期治疗,以免延误最佳治疗时机。     

The Diagnosis of Urinary Tract Infection in Young Children (DUTY) Study Clinical Rule: Economic Evaluation

Objective

To estimate the cost-effectiveness of a two-step clinical rule using symptoms, signs and dipstick testing to guide the diagnosis and antibiotic treatment of urinary tract infection (UTI) in acutely unwell young children presenting to primary care.

Recurrent urinary tract infections in children: Preventive interventions other than prophylactic antibiotics

Urinary tract infection (UTI) is one of the most common childhood infections. Permanent renal cortical scarring may occur in affected children, especially with recurrent UTIs, leading to long-term complications such as hypertension and chronic renal failure. To prevent such damage, several interventions to prevent UTI recurrences have been tried. The most established and accepted prevention at present is low dose long-term antibiotic prophylaxis. However it has a risk of break through infections, adverse drug reactions and also the risk of developing antibiotic resistance. The search is therefore on-going to find a safer, effective and acceptable alternative. A recent meta-analysis did not support routine circumcision for normal boys with no risk factors. Vaccinium Macrocarpon (cranberry), commonly used against UTI in adult women, is also effective in reducing the number of recurrences and related antimicrobial use in children. Sodium pentosanpolysulfate, which prevents bacterial adherence to the uroepithelial cells in animal models, has shown conflicting results in human trials. When combined with antibiotic, Lactobacillus acidophilus (LA-5) and Bifidobacterium, by blocking the in vitro attachment of uropathogenic bacteria to uroepithelial cells, significantly reduce in the incidence of febrile UTIs. Deliberate colonization of the human urinary tract of patients with recurrent UTI with Escherichia-coli (E. coli) 83972 has resulted in subjective benefit and less UTI requiring treatment. The non-pathogenic E. coli isolate NU14 DeltawaaL is a candidate to develop live-attenuated vaccine for the treatment and prevention of acute and recurrent UTI. Diagnosing and treating dysfunctional elimination syndromes decrease the incidence of recurrent UTI. A meta-analysis found the lack of robust prospective randomized controlled trials limited the strength of the established guidelines for surgical management of vesicoureteral reflux. In conclusion, several interventions, other than antibiotic prophylaxis, for the prevention of recurrent UTI have been tried and, although showing some promise, they do not provide so far a definitive effective answer. Finding suitable alternatives still requires further high quality research of those seemingly promising interventions.     

串联质谱技术在柳州地区高危儿的应用价值

目的 运用串联质谱技术(MS/MS)检测柳州地区临床高危儿氨基酸及酰基肉碱水平,了解本地区临床高危患儿群体遗传代谢疾病的发生情况。方法 选取2013年1月-2015年12月本院住院及门诊高危患儿共2 215例,串联质谱分别检测其氨基酸及肉碱水平。初筛阳性患儿结合临床表型,进一步经不同确诊手段检测分析后,确定确诊病例,并进行随访治疗。结果 在2 215例高危儿的检测结果中,初筛阳性为195例,占8.80%;确诊例数为30例为1.35%。确诊遗传代谢病14种共计30例患儿,其中疾病种类以肉碱缺乏症、希特林蛋白血症、戊二酸血症Ⅰ型为主,其余类型病种均有出现。结论 在广西柳州地区高危儿群体,遗传代谢疾病的比例及病种均有一定发生率,在高危儿遗传代谢疾病的诊疗过程中,运用串联质谱技术可以针对该群体进行早期筛查与疾病预防。     

温州市区婴幼儿食物过敏的临床特征研究

目的研究婴幼儿食物过敏的临床特征,为该病的诊治提供依据。方法以温州市区儿童消化科门诊就诊的0~36月儿童为研究对象。向家长询问病史并填写调查表,同时检测血清总IgE及牛奶、鸡蛋黄、鸡蛋清、大豆、海鱼、虾、螃蟹等7项特异性IgE(sIgE)。根据病史及sIgE检测结果定可疑病例,然后进行食物剔除试验并随访6月。结果本组食物过敏检出率为18.99%。最常见的过敏原为牛奶(55.56%)和鸡蛋清(15.56%)。本组患儿最常见临床表现为湿疹及便血。结论温州市区婴幼儿最常见的食物致敏原为牛奶和鸡蛋清,最常见临床表现为湿疹及便血,食物回避可有效治疗食物过敏。