老年患者抗生素相关性腹泻的危险因素

目的了解老年患者发生抗生素相关性腹泻(AAD)的危险因素。方法从2008年1月～2009年1月入我科181例老年患者,年龄>60岁、抗生素应用超过1周,记录年龄、性别、合并症、血浆白蛋白、肌酐、质子泵抑制剂(PPI)、抗生素、腹泻等,进行回归分析。结果①AAD组(n=39)年龄明显高于非AAD组,(80.7±7.34)岁v(s77.8±7.62)岁。②单用一种抗生素致AAD发生率依次为三代头孢菌素/碳青霉烯28.8%、广谱青霉素18.2%、氟喹诺酮8.7%、头霉素8.3%。≥两种抗生素致AAD发生率明显高于单药组。③白蛋白低、肌酐高、联合抗生素和应用PPI是AAD发生的独立危险因素,OR值分别为0.879、1.006、3.994和8.732。结论关注老年患者自身因素(白蛋白和肌酐水平)、是否联用抗生素以及合用PPI,对于早期识别高危AAD患者非常重要。     

老年患者发生抗生素相关性腹泻的易感因素分析

目的 了解院内感染老年患者发生抗生素相关性腹泻(AAD)的易感因素.方法 选取2012年2月至2016年2月在该科诊断院内感染患者共192例,年龄均大于或等于60岁,其中发生AAD患者44例.记录两组年龄、性别、抗生素使用时间、清蛋白、是否糖尿病、抗生素应用种类、质子泵抑制剂(PPI)使用情况等,进行二元Logistic回归分析.结果 两组年龄、抗生素使用时间、清蛋白、抗生素应用种类、使用PPI情况比较,差异有统计学意义(P<0.05).二元Logistic回归分析显示,年龄、抗生素使用时间、PPI使用是AAD发生的独立危险因素.结论 对于发生院内感染的老年患者,年龄越大、抗生素使用时间越长、应用PPI,越容易发生AAD.     

呼吸内科住院患者抗生素相关性腹泻的临床特征及危险因素分析

目的分析呼吸内科住院患者抗生素相关性腹泻的临床特征及其危险因素。方法选择浙江省医疗健康集团杭州医院呼吸内科2018年1月至2019年12月应用抗生素治疗的1980例患者的临床资料,根据抗生素应用后是否出现抗生素相关性腹泻（AAD）分为AAD组和非AAD组,分析AAD的临床特征,并采用单因素和多因素logistic回归分析AAD的危险因素。结果1980例应用抗生素患者发生AAD者71例,发生率为3.59%。71例引起AAD的抗生素使用频率依次为：β-内酰胺类与酶抑制剂的复合制剂、第三代头孢、碳青霉烯类、第二代头孢。AAD临床表现主要为大便次数增多、大便性状改变。经单因素及多因素logistic回归分析,结果显示年龄、病重、住院时间、抗生素联合使用及使用时间是呼吸内科住院患者发生AAD的独立危险因素（均P＜0.01）。结论缩短住院时间,合理选用抗生素,减少多种类型抗生素联合使用及避免长时间使用抗生素是减少AAD发生的重要预防措施。     

影响感染科患者发生抗生素相关性腹泻的危险因素分析

目的:探讨感染科患者发生抗生素相关性腹泻(AAD)的发病机制及其危险因素,为临床早期预防提供依据。方法:选取2018年6月至2020年10月浙江省立同德医院感染科收治的283例患者进行随访调查,依据其住院期间是否发生AAD将其分为AAD组(77例)和非AAD组(206例);分析感染科患者住院期间的AAD发生率,比较两组患者间的各因素分布差异性,并采用逐步logistic回归法筛选影响感染科患者发生AAD的相关危险因素。结果:283例感染科患者住院期间AAD发生率为27.21%(77/283);影响感染科患者住院期间发生AAD的危险因素包括年龄(OR=3.117)、营养风险(OR=4.035)、病情危重(OR=4.586)、联用抗生素(OR=4.175)、抗生素使用时间(OR=2.807)、住院时间(OR=2.246),而使用微生态制剂(OR=0.483)则为保护性因素。结论:感染科患者住院期间的AAD发生率高达27.21%,应摸清AAD的发病机制及其相关高危因素,早期采取预防措施,降低感染科的AAD发生率,改善患者的预后。     

小儿细菌性重症肺炎并发抗生素相关性腹泻患儿的影响因素

目的:探讨小儿细菌性重症肺炎并发抗生素相关性腹泻患儿的影响因素。方法:选取细菌性重症肺炎患儿2 172例,入选患儿入院前均未经抗生素治疗且无腹泻症状。自抗生素治疗时起观察患儿大便情况,根据是否出现抗生素相关性腹泻(AAD)分为AAD组(798例)和非AAD组(1 374例)。记录并比较两组患儿机械通气、白细胞计数、C反应蛋白、抗生素种类和使用时间。结果:ADD组患儿发生率36.74%,患儿平均年龄明显低于非AAD组(P<0.05);两组患儿机械通气、抗生素使用≥5 d、抗生素联合使用、使用克林霉素、阿莫西林/克拉维酸钾、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦的比例之间差异有统计学意义(P<0.05)。多因素Logisitic回归分析显示:年龄≤2岁、有机械通气、抗生素联合使用、使用阿莫西林/克拉维酸钾、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦是AAD发生的独立危险因素。结论:细菌性重症肺炎患儿年龄≤2岁、有机械通气、抗生素联合使用、使用β内酰胺类/β内酰胺酶抑制剂均为并发AAD的影响因素。     

脓毒症患者并发抗生素相关性腹泻的危险因素分析

目的 探讨脓毒症患者抗生素相关性腹泻（antibiot-associated diarrhea,AAD）的发生情况及危险因素。方法 选取2021年7月至2023年7月浙江大学医学院附属金华医院重症医学科收治的126例脓毒症患者为研究对象,根据是否发生AAD分为AAD组和非AAD组。对比两组患者的临床资料和抗生素使用情况,采用Logistic回归分析探讨影响脓毒症患者并发AAD的危险因素。结果 126例脓毒症患者呼吸系统感染72例,泌尿系统感染18例,血流感染15例,胸腹腔感染12例,其他感染9例;32例（25.4%）并发AAD。Logistic多因素回归分析显示年龄≥60岁、血乳酸（lactic acid,Lac）及白蛋白（albumin,ALB）水平、应用碳青霉烯类及酶抑制剂类抗生素、抗生素联用、使用激素、住院时间是影响脓毒症患者并发AAD的危险因素（95%CI分别为0.847~0.983、0.074~0.527、1.147~2.034、0.624~1.687、2.132~5.220、0.439~0.882、0.411~0.853、0.478~0.848,P<0.05）。结论 重症医学科脓毒症患者并发AAD的风险较高。年龄≥60岁、Lac水平、ALB水平、应用碳青霉烯类及酶抑制剂类抗生素、抗生素联用、使用激素、住院时间是影响脓毒症患者并发AAD的危险因素。     

布拉氏酵母菌与小儿抗生素相关性腹泻的临床研究

目的 分析真菌类微生态制剂--布拉氏酵母菌对小儿抗生素相关性腹泻 (AAD)的预防作用.方法 将2009年1月-2010年1月在我院住院治疗的46例支气管炎和肺炎患儿随机分为治疗组和对照组,每组23例,治疗组患儿自开始使用抗生素起口服布拉氏酵母菌散剂,250 mg/次,2次/d;对照组仅使用抗生素,出现腹泻后两组患儿均加用蒙脱石散剂和补液治疗.比较两组患儿AAD发生率、大便次数及腹泻持续时间.结果 治疗组3例(13.04%)患儿发生AAD,对照组9例(34.62%)患儿发生AAD,两组患儿AAD发生率差异有统计学意义(P<0.05).服药第4 d治疗组日平均大便次数(3.01±0.72)次,对照组(3.84±1.13)次,两组比较差异有统计学意义(P<0.05).治疗组AAD患儿腹泻持续时间(2.7±1.3)d,对照组AAD患儿腹泻持续时间(4.1±2.1)d,两组比较差异有统计学意义(P<0.05).结论 布拉氏酵母菌能有效预防AAD,但临床上规范抗生素的应用,严格控制广谱抗生素的使用和补充微生态制剂,是预防和控制AAD的关键措施.     

抗生素相关性腹泻296例流行病学及临床分析

目的了解住院患者抗生素相关性腹泻(AAD)的罹患率、危险因素、潜伏期、临床特点及预后。方法对我院普通病区及老年病区1234例抗生素应用者,自抗生素应用之日起,进行为期30 d的前瞻性追踪观察。结果抗生素应用者的AAD罹患率为24.00%(296/1234例);老年病区为29.46%,明显高于普通病区的17.30%(P<0.01);老年患者为27.97%,明显高于中青年患者的11.03%(P<0.01)。AAD主要危险因素是广谱抗生素、高龄和危重症。AAD的潜伏期为0.5~28.0 d,平均为(8.49±5.36)d(中位数7.0 d),中青年患者平均为(10.25±5.19)d(中位数8.5 d),明显长于老年患者的(8.28±5.34)d(中位数7.0 d,P<0.05)。大多数患者病情较轻,预后良好;重症病例较少见,均为老年病例,病情凶险,死亡率高。296例AAD患者经停用或换用抗生素,应用微生态剂、甲硝唑或万古霉素等处理,痊愈178例(60.14%),好转72例(24.32%),无效40例(13.51%),死亡6例(2.03%)。结论AAD是一种常见的抗生素治疗的并发症,在老年病区和老年患者中发病率较高,绝大多数患者经适当处理预后良好;重症病例较少见,但死亡率高。     

婴幼儿及儿童发生抗生素相关性腹泻的危险因素分析

目的:探讨导致婴幼儿及儿童发生抗生素相关性腹泻(AAD)的临床危险因素。方法:选择抗生素使用患儿122例为研究对象,对患儿的抗生素相关性腹泻发生率、年龄、性别、住院使用抗生素种类、疗程、营养状态、免疫情况等进行调查,并利用单因素、多因素分析患儿的抗生素相关腹泻的危险因素。结果:单因素方差分析显示,患儿年龄、营养状况、免疫功能、抗生素联用及使用时间存在统计学意义(P<0.05);多因素Logistic分析显示,抗生素联用、抗生素使用时间≥1周、患儿年龄<1岁、营养不良及免疫力低下是婴幼儿及儿童发生AAD的独立危险因素。结论:婴幼儿及儿童抗生素相关腹泻与多种因素有关,年龄较小、联合使用抗生素、抗生素使用时间过长、种类过多、营养不良及免疫力低等均会引起腹泻,需要进行综合干预。     

儿科病房抗生素相关性腹泻危险因素分析

目的 分析患儿抗生素相关性腹泻(AAD)的临床特点,探讨不同患儿年龄、抗生素使用时间及抗生素种类对腹泻病的影响,并提出预防措施.方法 围绕抗生素应用与腹泻的关系,对我院儿科近3年来住院的抗生素相关性腹泻患儿进行临床分析,并采用SPSS 12.0对数据进行分析.结果 1岁以内的婴儿使用抗生素、抗生素使用时间7d以上、联合应用二种以上抗生素的患儿AAD的发病率高于对照组(P均<0.05).结论 感染性患儿不恰当使用抗生素是AAD的危险因素.     

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.