10861例住院患者医院感染调查与分析

目的　了解我院住院患者医院感染发病情况 ,确定今后监测的方向和重点。方法　采用回顾性调查 ,对本院 2 0 0 3年上半年 10 861份住院病历进行调查分析。结果　共有 62 7例发生医院感染 ,总感染率 5 .77% ,医院感染部位前三位为下呼吸道 ( 4 9.3 % ) ,上呼吸道 ( 12 .0 % ) ,泌尿道 ( 11.8% ) ,医院感染病原菌主要是革兰阴性杆菌 (占5 9.7% )、革兰阳性球菌 (占 2 5 .7% )及真菌 (占 14 .6% )。结论　落实医院感染控制措施是降低医院感染率的重要手段。     

慢性肾脏病住院患者医院感染的危险因素

目的 探讨慢性肾脏病患者医院感染的发病率和危险因素.方法 回顾性调查2005年3月-2009年2月在我院肾内科住院的1 355例慢性肾脏病患者医院感染的发生情况及危险因素.结果 1 355例慢性肾脏病患者中有67例发生医院感染,感染率为4.9%.原发病为慢性肾功能不全、自身免疫性疾病、肾病综合征的患者医院感染率较高,分别为9.02%,7.89%和6.35%.年龄较大或者住院时间较长的患者医院感染率较高.医院感染的部位以下呼吸道(31.34%)、上呼吸道(26.87%)、泌尿道(13.43%)、胃肠道(11.94%)及深静脉插管(11.94%)为主.医院感染病原体以革兰阳性球菌为主.结论 慢性肾脏病患者住院期间发生医院感染的危险因素包括患者基础疾病种类、年龄大、住院时间长等.应加强预防措施,有效控制和降低慢性肾脏病患者医院感染率.     

7914例住院病例医院感染浅析

目的为了解本院医院感染发病率,掌握医院感染发病的规律.方法对1998年住院患者7914例进行了回顾性的调查.结果医院感染率为3.77%,其中老干科为12.93%,其余依次为肿瘤科、内Ⅱ科、外科.感染率最低的是综合科,为2.93%.感染部位以呼吸道最高,其构成比是34.56%,其次是胃肠道(19.13%),再其次是术后切口(14.42%).结论医院感染率与患者年龄、住院时间、气候特点有密切关系.     

老年住院患者医院感染的临床调查

1990～2000年,我院内科综合病房共收治老年患者20例,为了解长期住院的老年患者医院感染状况及其影响因素,将住院60天左右的20例老年患者的临床资料进行医院感染回顾性分析,结果报告如下。1临床资料本组20例中,男15例,女5例;年龄59～76岁,平均65岁。住院时间51～95天,平均66天。2结果2.1医院感染发病率及发病时间医院感染发病率为80%,发生时间为住院后5～38天,医院感染持续时间为5～20天。2.2医院感染部位分布见表1。表120例患者医院感染部位分布感染部位感染次数感染率(%)上呼吸道感染1575.0下呼吸道感染1260.0肺炎525.0泌尿系感染525.0消化…     

70例老年患者医院感染的临床分析

目的:了解老年患者医院感染的发生情况,为预防医院感染的发生提出依据.方法:对70例老年患者医院感染进行回顾性分析.结果:老年患者医院感染发病率7.11%,病死率8.57%,明显高于非感染组病死率2.3%(P＜0.005),感染多发生在冬春季(65.86%),其中以呼吸道为主(46.34%),它与住院时间长、长期联用多种抗生素、免疫力低下、侵入性操作有关.结论:通过控制抗生素的应用、缩短住院时间、提高机体抵抗力、减少侵入性操作等诱发因素降低老年患者医院感染发生率.     

186例老年患者医院感染的分析

目的为了解我院老年患者医院感染情况,采取有效措施降低医院感染率。方法对我院急诊内科(2000～2004年)60岁以上的186例老年患者进行回顾性调查。结果186例中有83例发生医院感染,其感染率为44.6%,呼吸道感染占首位,为61.4%,其次为泌尿道感染占27.7%,皮肤软组织感染占0.82%。结论老年患者免疫功能低下,气候原因、住院时间长及不合理使用抗生素等多种因素造成。     

老年糖尿病患者医院感染的特点分析

目的探讨老年糖尿病患者医院内感染的临床特点,以指导临床有效防治.方法回顾性调查326例老年糖尿病患者的临床资料,分析其医院感染的特点及易感染因素.结果老年糖尿病患者医院感染的发生率为19.9%,明显高于同期我院老年患者总医院感染率的8.9%(P＜0.05).老年糖尿病患者死亡率医院感染组(18.5%)明显高于非感染组(5.4%)(P＜0.05).高龄、血糖控制不佳及合并症等均为老年糖尿病患者医院感染的易感因素.感染易发部位以下呼吸道、泌尿系多见.病原菌以革兰阴性杆菌为主,占73.6%.结论老年糖尿病患者医院感染发生率及死亡率高.良好控制血糖、治疗基础病及糖尿病并发症,提高机体抵抗力,合理应用抗生素是防治老年糖尿病患者医院感染的有效措施.     

住院患者医院感染223例分析

目的:分析医院感染情况,为预防与控制医院感染提供科学依据.方法:对2008～2010年住院患者医院感染情况进行回顾性调查.结果:发生医院感染223例,感染率1.2%.感染部位以呼吸道为主(49.8%).医院感染较高的科室外科2.2%、内科2.1%.年龄≥60岁的患者医院感染率(2.9%)高于＜60岁的患者(0.9%).结论:加强医护人员医院感染知识的培训,合理使用抗生素药物,积极治疗基础疾病,严格执行无菌操作,减少侵入性操作等是降低医院感染的有效措施.     

1848例老年患者医院感染的临床分析

目的：探讨老年患者医院内感染的诱发因素及其预防和控制;方法：1996－1998年间60岁以上1848例老年住院患者医院内感染病例的回顾性调查分析;结果：1848例老年住院患者发生院内感染病例192例,感染率为10.39％,比全院总感染率7.9％明显增高,并且随年龄的增长而增高。老年患者院内感染部位以呼吸道最为常见,其次为泌尿道,而且感染率与住院时间呈正相关。对常见的分离菌做药敏试验,普遍耐药。结论：对老年住院患者,医院应提供良好的住院环境,入院后应及时诊断,抓紧治疗,避免减少侵袭性治疗与重复操作,尽可能缩短住院时间。     

老年患者医院感染的流行病学调查分析

目的:调查分析老年患者医院感染的特点及相关影响因素,为控制医院感染提供依据.方法:选择2000年1月至2006年12月在广西医科大学第一附属医院老干部保健中心住院的60岁以上老年患者7 085例作为研究对象,统计医院感染的发生情况,并收集相关流行病学资料.结果:老年患者医院感染发生率为7.34%,随年龄的增加呈上升趋势.原发基础疾病中以呼吸系统疾病、消化系统疾病、神经系统疾病的患者更容易发生医院感染;感染部位以下呼吸道最高,上呼吸道、泌尿道分列第二、三位;2000～2006年发生率大致呈现逐年上升的特点;病原菌以革兰阴性杆菌为主,其次是真菌;老年患者医院感染的发生与广谱抗生素使用、泌尿道插管、动静脉插管、使用呼吸机显著相关(P<0.01).结论:预防和控制老年患者医院感染应采取加强基础疾病治疗,重视无菌操作技术和抗生素的合理使用,加强常见病原菌感染的监测等综合措施.     

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.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

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.     

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.