120株鲍曼不动杆菌临床分布及耐药分析

目的了解本院2012年感染鲍曼不动杆菌患者的科室分布及耐药情况。方法对2012年1月～2012年12月间医院住院患者送检的各类标本进行分离培养出120株鲍曼不动杆菌，用K-B法对其进行药敏试验。结果鲍曼不动杆菌主要分布在ICU，对头孢哌酮／舒巴坦耐药率为50．8％，其余抗生素如三代头孢、四代头孢、碳青霉烯类、酶抑制剂类抗生素类耐药率均大于80％。结论鲍曼不动杆菌的耐药率日益严重，临床应及时检测和掌握区域性鲍曼不动杆菌的耐药特点，合理使用抗生素，及早控制鲍曼不动杆菌引起的医院感染。     

鲍曼不动杆菌在ICU与非ICU分离率及耐药性的比较

目的:比较ICU与非ICU鲍曼不动杆菌的分离率及耐药率,为临床合理选择抗菌药物提供依据.方法:分析2005年6月至2007年6月痰标本中鲍曼不动杆菌分离率及其对15种抗菌药物耐药状况.结果:(1)ICU鲍曼不动杆菌分离率近似或高于非ICU,但无统计学差异.(2)鲍曼不动杆菌对亚胺培南敏感率约98%, 对头孢西丁,头孢噻吩,氨苄西林,呋喃妥因100%耐药,对头孢三代,氨基糖甙类,喹诺酮类,复方新诺明耐药率均＞ 50%,但ICU与非ICU无统计学差异.结论: 在ICU与非ICU均可发生鲍曼不动杆菌医院内感染,其耐药情况严重,各地区各医院差异很大,医务人员需根据本地区本医院用药习惯,鲍曼不动杆菌耐药特点合理选择有效的抗菌药物.     

鲍曼不动杆菌感染分布及耐药性分析

目的了解鲍曼不动杆菌的感染分布及其耐药性变化。方法对达州市中心医院2007年1月至2009年12月从临床患者标本中分离的377株鲍曼不动杆菌进行耐药性分析,并用WHONET软件进行数据处理。结果分离的鲍曼不动杆菌主要分布在重症监护病房(ICU)(38.5%),痰标本中分离的鲍曼不动杆菌最多见(74.3%)。鲍曼不动杆菌除对亚胺培南和多黏菌素敏感率较高外,对临床常用的头孢3代和氟喹诺酮类抗菌药物的耐药率大于55.0%。ICU分离株耐药率明显高于普通病房。结论鲍曼不动杆菌对多种抗菌药物耐药,且以ICU分离株最为明显,应加强细菌耐药性监测,合理使用抗菌药物,有效预防和控制感染。     

危重症患者560株鲍曼不动杆菌的临床分布及药敏结果

目的了解ICU患者鲍曼不动杆菌的检出率、分布及耐药状况,为临床ICU患者合理用药提供参考。方法对四川省人民医院急诊ICU、老年ICU、呼吸ICU、神经内科ICU、外科ICU送检的各类临床标本中分离的鲍曼不动杆菌进行系统分析。应用VITEK-2全自动细菌鉴定药敏仪并参照2013年美国临床实验室标准化委员会(CLISI)标准判断药敏结果,以WHONET5. 6及GRAPHPAD6. 0统计软件进行数据分析。结果 5年间5个ICU共检出560株鲍曼不动杆菌;鲍曼不动杆菌的检出率为急诊ICU36. 8%、老年ICU 20. 4%、呼吸ICU 12. 1%、神经内科ICU 8. 0%、外科ICU 22. 7%;痰液鲍曼不动杆菌检出率为70. 9%,血液12. 1%、其他17. 0%;抗菌药物敏感试验共检出耐碳青霉烯类鲍曼不动杆菌(CRAB) 236株,占42. 1%;老年ICU的耐碳青霉烯类鲍曼不动杆菌(CRAB)检出率为57. 9%,高于其他科室(P 0. 05)。共检出泛耐药鲍曼不动杆菌(XDRAB) 64株,占11. 4%,各科室标本中XDRAB检出率差异无统计学意义(P 0. 05);对头孢他啶耐药率为40. 7%,头孢哌酮/舒巴坦耐药率为45. 0%,哌拉西林/他唑巴坦30. 5%,左旋氧氟沙星的耐药率为30. 1%,对替加环素耐药率为16. 8%。结论不同重症监护室因病人来源不同,其鲍曼不动杆菌检出率有明显差别,耐药率亦有较大差异。     

重症监护病房革兰阴性杆菌感染的分布与耐药性

目的 :研究重症监护病房 (ICU)革兰阴性杆菌感染的分布及耐药性特征。方法 :对我院ICU 2 0 0 0年 1月— 2 0 0 0年12月各类感染标本所分离的 399株革兰阴性杆菌分布及耐药性进行回顾性分析。结果 :占前 5位的革兰阴性杆菌为不动杆菌属 (2 2 .3% )、铜绿假单胞菌 (18.3% )、阴沟肠杆菌 (16 .2 % )、肺炎克雷伯菌 (8.8% )和大肠埃希菌 (8.8% )等。不动杆菌属对所监测的抗生素多数耐药 ,对亚胺培南的耐药率也达 15 .4 % ;铜绿假单胞菌呈多重耐药 ,对亚胺培南的耐药率也达 4 0 .5 % ;阴沟肠杆菌对头孢他啶、头孢吡肟的耐药率达 4 2 .9%、31.9% ,但亚胺培南对阴沟肠杆菌保持较高的抗菌活性。结论 :ICU中感染的革兰阴性杆菌均有严重的耐药性 ,加强耐药性监测 ,指导临床合理使用抗生素十分重要。     

某大学附属医院患者感染鲍曼不动杆菌临床分布及其耐药性调查

目的了解医院住院患者鲍曼不动杆菌感染的临床分布与耐药特点,为控制感染提供依据。方法通过回顾性分析方法,对某大学附属医院临床送检标本鲍曼不动杆菌检测结果及其药敏检测报告进行统计分析。结果在2011-2014年期间,从该医院住院患者送检标本中共检出鲍曼不动杆菌145株,标本主要来自综合ICU、新生儿ICU和神经外科,其次是泌尿外科和呼吸内科。鲍曼不动杆菌分离率居前3位的是呼吸道标本、尿液和粪便标本。在145株鲍曼不动杆菌中,多重耐药菌株和泛耐药菌株分别占37.24%和4.83%。临床分离的鲍曼不动杆菌对青霉素类、头孢菌素、β-内酰胺类、氨基甙类抗菌药的耐药率均在60%以上,对碳青霉烯类抗菌药物耐药率也接近50%。结论该医院分离的鲍曼不动杆菌临床分布主要集中在ICU,其耐药现象比较普遍,加强监测和按药敏试验选用抗菌药物成为重点防范措施。     

基层医院ICU鲍曼不动杆菌的感染现况及耐药性分析

目的 了解基层医院ICU鲍曼不动杆菌(Acinetobacter baumannii,Ab)的感染现状和评价《抗菌药物临床应用专项整治活动方案》的实施效果,为临床医生合理应用抗菌药物提供科学依据。方法 用VITEK2微生物分析系统对小榄医院2012年1月～2013年12月ICU患者标本中分离的鲍曼不动杆菌进行药敏分析,比较分析《抗菌药物临床应用专项整治活动方案》2012年(干预前)和2013年(干预后)ICU鲍曼不动杆菌的耐药性。结果 2012年(干预前)和2013年(干预后)从小榄医院ICU标本分离的鲍曼不动杆菌分别为71株和57株,其主要来源于呼吸系统感染,分别占94.4%和84.2%。该项方案干预后,多重耐药鲍曼不动杆菌的检出率由77.5%降为66.7%; 鲍曼不动杆菌对头孢吡肟、头孢他啶、头孢曲松、妥布霉素和复方新诺明等的耐药率显著降低(χ²＞3.84,P＜0.05)。结论 该项方案干预后,ICU患者标本分离的鲍曼不动杆菌对常用14种抗菌药物的耐药率低于干预前,其中有5种抗菌药物的耐药率显著降低。     

重症监护病房病原菌感染的分布与耐药性

目的　研究重症监护病房 (ICU)患者感染的病原菌分布及耐药性特征。方法　对我院ICU 2 0 0 2年 6月～ 2 0 0 3年12月各类感染标本所分离的细菌菌株分布及耐药性进行回顾性分析。结果　分离出的 5 4 0株细菌中仍以革兰阴性杆菌为主占 76 .7% ,其次为真菌 12 .4 % ,革兰阳性球菌 10 .9%。G-杆菌中铜绿假单胞菌占第一位 (31.2 % ) ,其次为克雷伯菌属和不动杆菌属 ,各占 15 .4 %和 14 .5 %。铜绿假单胞菌呈多重耐药 ,对亚胺培南的耐药率达 78%。不动杆菌属对所监测的抗生素多数耐药 ,对亚胺培南的耐药率较低。G 菌中以金黄色葡萄球菌为主 ,其中耐甲氧西林的金葡菌 (MRSA)占金葡菌的 96 .7%。真菌以白假丝酵母菌为主 ,占 5 7.8%。结论　ICU的感染及多重耐药情况严重 ,加强耐药性监测 ,指导临床合理使用抗生素十分重要     

神经外科ICU患者鲍曼不动杆菌感染和耐药性

目的探讨神经外科ICU患者鲍曼不动杆菌感染情况以及对抗菌药物的耐药情况,为临床抗菌药物使用及医院感染控制提供依据。方法回顾性分析2016年1月至2016年12月本院神经外科ICU患者不同标本分离出的鲍曼不动杆菌分布情况及对18种抗菌药物耐药情况,并进行统计分析。结果 936例标本共检出鲍曼不动杆菌251株,占26.8%;251株鲍曼不动杆菌中多重耐药菌211株,占84%;药敏结果显示,所分离出的鲍曼不动杆菌对替加环素的耐药率最低2%,对其它抗菌药物耐药率较高。结论神经外科ICU患者的标本中分离出的鲍曼不动杆菌对大多数抗菌药物耐药,多重耐药鲍曼不动杆菌占有比例极高,临床应加强抗菌药物合理使用,加强病原学检测,重视消毒隔离,尽量减少侵入性操作,以减少鲍曼不动杆菌交叉感染及耐药菌产生。     

鲍曼不动杆菌医院感染的临床分布及耐药性研究

目的研究住院患者鲍曼不动杆菌医院感染的临床分布及耐药性,为提出有效防控策略提供依据。方法通过回顾性分析,对某医院住院患者送检标本分离的鲍曼不动杆菌检验结果进行调查与分析。结果该医院2年时间内,从住院患者送检标本中共分离出鲍曼不动杆菌66株,主要分离自病人痰标本,构成比为81.82%。鲍曼不动杆菌感染标本主要来自重症监护病房,构成比占69.70%。临床分离的鲍曼不动杆菌对阿米卡星和头孢哌酮/舒巴坦尚比较敏感,但对氨苄西林和头孢替坦耐药率达到88.0%~100%。结论该医院鲍曼不动杆菌感染患者主要分布在ICU,痰标本分离率最高,其耐药率呈上升趋势。     

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.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.