综合医院重症监护病房医院感染目标性监测分析

目的：了解综合医院重症监护病房（ICU）医院感染现状及病原菌分布,为制定医院感染预防控制措施提供科学依据。方法：采用目标性监测方法, 对2017年1-12月入住ICU患者进行医院感染目标性监测,统计医院感染发病率、器械相关感染发病率、医院感染病原菌及多重耐药菌分布情况。结果：共监测ICU患者4 593例,发生医院感染258例,296例次,例次感染率6.44%;住院总日数37 905天,千日例次感染率为7.81‰。感染部位以呼吸系统感染为主（占47.64%）,其次为血流感染（占23.65%）、泌尿系感染（占13.18%）。呼吸机相关性肺炎日发病率3.31‰;中心静脉导管相关血流感染日发病率0.34‰;导尿管相关泌尿系感染日发病率1.08‰。检出病原菌319株,其中革兰氏阴性菌221株（占69.28%）,革兰氏阳性菌76株（占23.82%）,真菌22株（占6.90%）。检出多重耐药菌137株（占42.95 %）。结论：ICU医院感染发病率高,主要为呼吸系统感染,病原菌以革兰氏阴性菌为主,器械相关感染发生率高,细菌耐药现象明显。开展目标性监测,能及时发现感染隐患,采取干预措施,降低医院感染发生率。     

重症监护病房医院感染目标性监测结果分析

目的目标性定期监测ICU感染数据,了解危险因素,控制医院感染的发生。方法采用目标性监测方法对2014年10月60例ICU患者的医院感染情况进行分析,并对侵入性操作相关感染进行研究分析。结果 60例患者中共发生医院感染为23.33%,日感染率为24.21‰,调查日感染率为6.43‰;3种侵袭性操作相关性感染率分别为:呼吸机相关肺炎感染率发生9.69‰,中心静脉插管相关血流感染率8.19‰,导尿管插管相关泌尿道感染率2.05‰,共检出21株致病菌株,以革兰阴性菌为主。结论 ICU医院感染发生率高与各种导管应用相关,以呼吸机相关性肺炎为主,应注意多重耐药菌的监控与防护,做好隔离与手卫生。     

综合三级甲等医院ICU目标性监测分析与控制研究

目的了解综合三甲医院ICU医院感染特点,评价目标性监测效果,为持续质量改进和提高ICU医院感染管理水平提供科学依据。方法对本院ICU近4年住院患者感染情况进行回顾性分析,目标性监测医院感染发病情况,并对监测结果进行统计分析,主要包括医院感染率,患者导管相关感染,病原菌监测情况。结果综合ICU患者发生医院病例感染率31.1%,例次感染率4.4%,平均病情严重程度4.3分,调整患者感染率为1.04%,操作使用率由高到低依次为尿管、中心静脉置管和呼吸机,相关感染发病率最高为呼吸机相关性肺部感染(33.5‰);病原菌以革兰阴性杆菌为主(74.8%)。结论采用目标性监测方法,有利于及时掌握ICU患者医院感染发生的动态变化,为医院感染预防与控制措施的制定提供科学依据。     

新疆医科大学附属肿瘤医院重症监护病房医院感染目标性监测

目的了解分析肿瘤专科医院重症监护病房(ICU)医院感染目标性监测结果及特点,为制定医院感染预防控制措施提供科学依据。方法对2013年1-12月入住ICU的患者进行目标性监测,采用患者平均病情严重程度评分(ASIS)调整法调整医院感染发病率,监测3种侵袭性操作相关感染及多重耐药菌分布情况。结果共监测住院患者443例,总住院2 483 d,发生医院感染52例,感染率为11.7%,日感染率为20.9‰,经ASIS调整后日感染率为6.3‰。感染诊断以呼吸系统感染最多,占55.7%,其次为泌尿系统;发生呼吸机相关性肺炎12.1‰,导管相关性血流感染0.9‰,导管相关性尿路感染4.1‰。共检出病原菌181株,其中革兰阴性杆菌135株(74.6%),革兰阳性球菌33株(18.2%),真菌13株(7.2%),检出多重耐药菌33株(18.2%)。结论 ICU是医院感染的高发科室,应开展目标性监测,合理使用抗生素,监测病原菌及其耐药性,对危险因素进行监控,制定切实有效科学的防控措施,减少医院感染的发生。     

重症监护病房2013年医院感染目标性监测分析

目的通过对综合重症监护病房(ICU)开展目标性监测,了解综合ICU医院感染的状况,为控制综合ICU医院感染提供建议。方法采取目标性监测的方法,对2013年1—12月入住综合ICU的374例患者进行调查分析。结果 2013年入住ICU患者共374例,发生医院感染62例82例次,累计住院日数为2 724 d,医院感染发病率为16.6%,日感染发病率为22.8‰。感染部位主要是肺部感染,占75.6%,其次是血流感染、尿道插管相关泌尿道感染、皮肤软组织感染。呼吸机相关肺炎(VAP)、血管导管相关血流感染(CLABSI)、导管相关尿路感染(CAUTI)日感染率分别为33.3‰、2.8‰、2.3‰。检出的病原菌中,革兰阴性杆菌占93.2%,革兰阳性球菌占5.4%,真菌占1.4%。检出数量前3位的细菌是:铜绿假单胞菌、肺炎克雷伯菌、鲍曼不动杆菌。结论综合ICU医院感染发病率为16.6%,以肺部感染为主,器械相关感染占62.2%,控制器械相关感染是控制ICU医院感染的工作重点。ICU医院感染病原菌以革兰阴性菌为主,提示临床治疗时宜选择覆盖革兰阴性杆菌的抗菌药物。     

2013年内蒙古自治区28所医院ICU医院感染目标性监测报告

目的了解内蒙古自治区部分医院重症监护病房(ICU)医院感染情况,为采取实时防控措施提供参考。方法采取前瞻性目标监测方法,对该自治区所属28所医院ICU住院患者医院感染状况进行监测与分析。结果2013年度共监测28所医院ICU住院患者7 255例,发生医院感染357例,感染率为4.92%。血管导管相关血流感染、导管相关泌尿道感染和呼吸机相关肺炎日感染率分别为1.56‰、2.26‰和10.02‰。从357例医院感染患者送检标本中共分离病原菌473株,以鲍曼不动杆菌、铜绿假单胞菌、金黄色葡萄球菌和肺炎克雷伯菌为主要优势菌。结论内蒙古自治区医院ICU住院患者医院感染率明显高于同地区医院平均值,侵入性操作,无菌操作和护理是关键防控环节。     

某综合医院专科重症监护病房医院感染目标性监测

了解医院各专科重症监护病房（ICU）医院感染实际状况,为制定有效防控措施提供依据。采取前瞻性目标性监测方法,对某综合医院临床专科ICU住院患者医院感染实际发生率进行监测与分析。结果 2013年全年该医院各专科ICU和综合ICU共入住重症患者3 841例,发生医院感染111例、147例次,感染率为2.89%、例次感染率为3.83%;日感染率为4.77‰,调整日感染率为1.36‰。患者感染部位以呼吸道感染率最高,构成比为55.78％,其次为泌尿道感染。在各专科ICU中,以神经内科ICU患者医院感染率最高,为11.93%;其次是神经外科ICU,为3.40%;综合ICU感染率为4.75%。不同专科ICU医院感染发生率之间差异有统计学意义（P＜0.01）。结论 该医院各专科ICU患者医院感染发生率差异明显,应加强对神经内外科和综合ICU医院感染防控措施,调整防控策略和重点。     

ICU前瞻性目标性监测结果分析应用

目的:通过对重症监护病房(ICU)目标性监测及结果分析,了解ICU医疗器械的使用率、感染率、感染部位、病原菌分布特点、细菌耐药情况、相关危险因素等,探讨其防控措施。方法:对2012年ICU收治的360例患者进行前瞻性的目标性监测。结果:本组患者(例次)感染发病率16.94%,调整感染发病率4.02%,患者(例次)日感染发病率14.76‰;呼吸机相关性肺炎发病率12.92‰;导尿管相关尿路感染发病率2.87‰;导管相关血流感染发病率3.20‰。院内感染部位主要分布在:下呼吸道、血液系统、泌尿系统;引起院内感染的耐药菌以多重耐药的鲍曼不动杆菌为主(39.53%),其次铜绿假单胞菌及肺炎克雷伯君(16.28%),排名第三为MRSA(11.63%)。结论:ICU发生的院内感染主要为医疗器械相关的感染,致病菌多为多重耐药菌株,感染途径以外源性感染为主。通过加强对ICU患者目标性监测及侵入性操作的管理和护理干预,提高手卫生依从性,降低医院感染的发生率。     

重症监护室病人医院感染现状调查

目的了解重症监护室(ICU)医院感染现状,制定医院感染防控措施。方法采用目标性监测的方法,对某医院重症监护病房ICU患者医院感染情况进行调查。结果 2009年全年12个月内,该医院重症监护病房共入住患者867例,发生医院感染73例、158例次,感染发病率为8.42%,例次感染率为18.22%。平均病情严重程度ASIS评分为3.68分,调整病人日感染率为4.14‰,日医院例次感染率为8.94‰。在发生医院感染的病人中,呼吸机相关性肺炎占25.4‰,留置导尿管相关尿路感染占7.7‰,动静脉插管相关血流感染占7.4‰。结论重症监护病房病人医院感染发病率较高,感染部位以下呼吸道为主,应加强呼吸机相关肺炎的控制措施。     

神经外科重症监护病房医院感染目标性监测分析

目的分析神经外科重症监护病房（ICU）医院感染目标性监测结果,了解其医院感染特点,为干预措施的制定提供参考。方法对2013年1月-12月期间每例入住神经外科ICU≥2 d的患者及转神经外科ICU 2 d内的患者,监测其医院感染发病情况、侵入性操作使用及感染情况和多重耐药菌筛查及耐药性情况。结果共纳入1 178例患者,住院总时间4 144 d,医院感染率为4.92%,患者日感染率为13.75‰,1月、7月-12月的医院感染发病率与其他几月比较明显偏高;呼吸机使用率为9.75%,呼吸机相关性肺炎发病率为14.85‰;中心静脉导管使用率为28.40%,中心静脉导管相关性血流感染发病率为0.85‰;导尿管使用率为97.90%,导尿管相关性尿路感染发病率为0.25‰。结论神经外科ICU医院感染发病呈现明显季节性,需要医院感染控制专（兼）职人员提高警惕,及时发出风险预警,强化医院感染风险管理。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.