青岛地区鲍曼不动杆菌的临床分布及耐药性分析

①目的 了解青岛地区鲍曼不动杆菌的临床分布特点及耐药性趋势，指导临床合理使用抗菌药物。②方法 采用Microscan MA-40全自动细菌鉴定系统或API系统对本地区临床标本进行鲍曼不动杆菌分离培养并使用K—B法检测其耐药性。③结果 共分离鲍曼不动杆菌626株，主要来源于呼吸内科(36．9％)和ICU病房(31．0％)，其次为神经内科病房(12．1％)、肿瘤科病房(11．0％)和其他病房(8．9％)；该菌广泛耐药，除对亚胺培南、特治星等少数抗菌药物敏感外，对临床常用抗菌药物的耐药率较高。④结论 鲍曼不动杆菌是呼吸内科和ICU病房医院感染的主要病原菌，且对常用抗菌药物呈现多重耐药，须引起临床高度重视。     

我院ICU病区2009年鲍曼不动杆菌检出率及耐药性分析

目的了解我院2009年重症监护病房（ICU）患者鲍曼不动杆菌感染的临床特点及耐药趋势,指导临床正确面对鲍曼不动杆菌感染,合理使用抗生素。方法做细菌培养及鉴定,并以MIC法测定1年来235株鲍曼不动杆菌对19种抗菌药的耐药率。结果共分离鉴定鲍曼不动杆菌235株;鲍曼不动杆菌多重耐药,耐药率最低的是粘菌素及多粘菌素B（0％）,其次是美满霉素（10．2％）。结论鲍曼不动杆菌已成为医院感染尤其是ICU感染的主要致病菌,在抗生素治疗过程中极易变异而形成多重耐药;对多重耐药的鲍曼不动杆菌感染的患者应以亚胺培南和B一内酰胺酶抗菌抑制剂作为第一线抗菌药物;ICU病房应加强消毒隔离措施,避免鲍曼不动杆菌的交叉感染和院内感染的扩张。     

2002～2005年我院临床分离的鲍曼不动杆菌的分布与耐药性分析

目的：了解临床分离的鲍曼不动杆菌分布及对各种药物的耐药性，为临床感染治疗提供依据。方法：采用纸片扩散法（Kirby—Bauer）对我院2002年～2005年临床分离的鲍曼不动杆菌进行抗菌药物的敏感性实验。结果：2002～2005年我院共分离309株鲍曼不动杆菌，分离率逐年上升，主要分布在呼吸科病房（占32．6％），其次为外科监护病房（26．2％）、外科（23．9％）、内科（8．7％）和急诊科（6．1％）、儿科（2．2％）。鲍曼不动杆菌对常用抗菌药的耐药率有普遍上升的趋势，并呈多重耐药。其中，对亚胺培南耐药率最低，从3％上升到9．7％，对氨曲南、头孢噻肟耐药率最高，分别为80．1％和90．2％。对阿米卡星、左氧氟沙星、头孢哌酮／舒巴坦、头孢吡肟、哌拉西林等抗菌药物耐药率均在50％以上。结论：鲍曼不动杆菌临床分离率逐年增加，耐药性逐年增强，应加强其耐药性监测，合理使用抗菌药物。     

鲍曼不动杆菌的耐药性分析

目的对在本单位检出的鲍曼不动杆菌的耐药情况进行分析,为指导合理使用抗生素提供依据。方法应用法国梅里埃公司ATB细菌鉴定仪及配套的革兰阴性杆菌鉴定板（ID32GN）对检出疑似菌株进行鉴定,并对分离出的鲍曼不动杆菌作药敏试验分析。结果2005年7月-2007年7月二年间,在分离出的167株不动杆菌中检出鲍曼不动杆菌94株,占56.3％。药敏结果亚胺培南的耐药率最低（3.2％）,其次为头孢哌酮舒巴坦（12.7％）和阿米卡星（13.9％）;头孢噻肟、头孢他啶和头孢吡肟的耐药率分别为38.3％、33.0％和26.6％。结论鲍曼不动杆菌耐药率较高且有多重耐药现象,应引起临床的高度重视。一旦发现感染耐药株,必须迅速采取控制措施,避免引起医院感染的流行。     

鲍曼不动杆菌387株临床分布特征及耐药性分析

目的分析医院感染常见非发酵菌鲍曼不动杆菌的分布特征及耐药情况,为临床合理用药提供依据。方法按常规方法进行细菌培养鉴定,琼脂纸片扩散（K-B）法检测鲍曼不动杆菌对12种抗菌药物的药敏结果。结果鲍曼不动杆菌最常出现于痰标本中,占75．0％,其次是尿液标本、分泌物标本和血液标本;鲍曼不动杆菌感染以院内为主,尤其重症医学科分布最多,其次是呼吸内科。该菌耐药现象严重,耐药率最低的抗生素是头孢哌酮一舒巴坦。结论鲍曼不动杆菌已成为医院感染的重要致病菌,对多种抗菌药物存在高耐药率,而且耐药率在逐年上升;药敏检测工作对于指导临床合理用药具有重要意义。     

352株鲍曼不动杆菌感染的分布特征及耐药性分析

目的了解临床标本中鲍曼不动杆菌的分布特征和耐药情况。方法回顾性分析南充市中心医院2009年1月-2010年12月鲍曼不动杆菌感染及耐药情况,采用MicroScan Neg Combo Panel Type 31对临床分离的352株鲍曼不动杆菌进行鉴定和药敏试验。结果痰中鲍曼不动杆菌检出率最高（80．4％）;临床分布以重症监护病房（ICU）最多（46．3％）,其次是神经外科（15．9％）;鲍曼不动杆菌对舒普深仍有较高的敏感性（95％）,对其它头孢菌素类的耐药性均〉60％。结论鲍曼不动杆菌已成为医院感染特别是ICU病区感染的主要致病菌之一,在抗生素治疗中形成多重耐药;对多重耐药的鲍曼不动杆菌复合菌群感染的患者应以舒普深作为第一线抗菌药物;重点是加强预防,防止鲍曼不动杆菌感染的发生。     

肇庆市鲍曼不动杆菌的分布及耐药特征

摘要：目的了解肇庆市第一医院鲍曼不动杆菌的临床分布特征和耐药变迁,以指导临床规范用药和流行感染控制提供可靠的依据。方法收集2007年1月至2012年12月临床分离非重复鲍曼不动杆菌1053株,用MicmScanautoScan4型分析仪进行细菌鉴定和药敏试验（头孢哌酮一舒巴坦彩用K—B法）。结果2007—2012年住院患者鲍曼不动杆菌临床分离株共1053株,最常见的分离部位为呼吸道占比84．5％;主要科室来源于ICU、呼吸内科和心血管内科等,依次占36．O％、10．5％和10．1％;鲍曼不动杆菌在非发酵菌属和革兰阴性菌属中所占比率均呈现逐年升高;鲍曼不动杆菌对头孢哌酮一舒巴坦敏感率较高,对其他抗菌药物耐药率均较高,对常用抗菌药物耐药率总体呈现上升趋势。结论鲍曼不动杆菌多重耐药现象严重,对常用抗菌药物耐药率逐年上升,应加强鲍曼不动杆菌耐药性监测,隔离感染者,防止医院内传播。     

鲍曼不动杆菌的临床分布及耐药分析

目的：探讨鲍曼不动杆菌的临床分布及其耐药性,为临床防治提供实验依据.方法：采用细菌培养、生化鉴定临床鲍曼不动杆菌,药敏实验分析其耐药性及临床分布特点.结果：从住院患者标本中分离出76株鲍曼不动杆菌,主要在痰液检出63株（83.0％）,脑脊液检出6株（7.9％）.菌株主要分布在重症监护病房（ICU）和外科病房,分别检出37株（48.7％）,和21株（27.6％）.鲍曼不动杆菌对头孢哌酮/舒巴坦、多黏菌素E和美罗培南等药物敏感;对头孢西丁、头孢呋辛和头孢噻肟等耐药.结论：鲍曼不动杆菌主要引起ICU患者下呼吸道感染,对多种抗生素耐药.     

呼吸科病房下呼吸道感染细菌分布及耐药性分析

目的：探讨呼吸科病房下呼吸道感染细菌分布及耐药性。方法获取诊断为下呼吸道感染患者的痰液,然后采用K‐B纸片琼脂扩散法和最小抑菌浓度法分离细菌种类,并进行药物敏感试验。结果共分离获得细菌529株,其中革兰阴性菌416株（78．8％）,革兰阳性菌88株（16．6％）,真菌25株（4．7％）,居前2位的是革兰阴性菌铜绿假单胞菌（25．0％）和鲍曼不动杆菌（13．0％）。最为常见的铜绿假单胞菌对不少常用药物已有不同程度耐药,但仍有部分药物可供选择。鲍曼不动杆菌除对头孢哌酮／舒巴坦耐药率较低外,其他常用药物均已明显耐药。头孢哌酮／舒巴坦对多种革兰阴性菌和阳性菌敏感率均高。结论呼吸科病房下呼吸道大多数感染菌是革兰阴性菌,其中最为常见的是铜绿假单胞菌和鲍曼不动杆菌,后者对大多常见药物已耐药,前者仅个别药物尚可选用。     

鲍曼不动杆菌医院感染分布及耐药性分析

目的探讨孝感市中心医院鲍曼不动杆菌医院感染的临床分布特点及耐药现状,为临床合理应用抗菌药物提供依据。方法对临床各科室分离出的鲍曼不动杆菌用ATB Expression半自动细菌鉴定仪进行菌种鉴定,采用纸片扩散法进行药物敏感试验。以中华人民共和国卫生部颁布的《医院感染的诊断标准(试行)》为医院感染诊断标准。结果鲍曼不动杆菌以呼吸道标本检出率最高,占67.8%;临床科室中以呼吸科病房及呼吸重症监护室检出率最高,占33.7%。鲍曼不动杆菌对亚胺培南的耐药率最低(2.0%);对头孢哌酮/舒巴坦、阿米卡星、头孢吡肟、米诺环素及头孢他啶有较好的抗菌活性,耐药率较低(≤40.0%);对第1、2代头孢菌素、头孢噻肟、头孢哌酮及氨曲南耐药率均较高(>60.0%);对头孢哌酮/舒巴坦的耐药率(20.0%)低于头孢哌酮(64.4%);对氨基糖甙类中阿米卡星的耐药率(29.3%)低于庆大霉素(73.7%)。结论鲍曼不动杆菌耐药十分严重,应引起临床高度重视。合理使用抗生素,加强医院感染管理,防止耐药菌株导致的爆发流行。     

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.