降钙素原测定指导呼吸道感染抗生素治疗

以降钙素原（PCT）测定为指导,在社区获得性肺炎（CAP）、慢性阻塞性肺疾病急性发作期（AECOPD）和急性支气管炎的抗生素治疗中,入院时抗生素处方显著减少、抗生素疗程显著缩短,且临床结果相似;在门诊对急性呼吸道感染患者的抗生素治疗中,预计抗生素处方率减少20％、抗生素疗程缩短20％、临床结果不差于标准抗生素治疗组。     

26例肺部感染患者降钙素原指导下抗生素应用分析

目的 探讨降钙素原(PCT)指导下抗生素治疗在肺部感染中的应用,为肺部感染患者抗生素的合理使用提供一个新的指导指标.方法 随机选取2010年12月～2011年12月在我科住院的肺部感染患者54例,并随机分为以下两组:常规治疗组28例,依据传统的临床诊断标准停用抗生素;PCT指导组26例,根据PCT值来确定抗生素的使用时间.并对两组患者的治疗结果进行比较.血清PCT水平的测定采用双抗体夹心法,血清白细胞介素(IL)-6水平的测定采用酶联免疫吸附法.结果 两组患者的治疗效果比较差异无统计学意义(P＞0.05),但PCT指导组患者抗生素使用天数、住院天数以及住院总费用明显优于常规治疗组(P＜0.05).PCT与IL-6呈正相关.结论 PCT指导组患者抗生素的使用时间、住院天数、抗生素使用费用以及住院总费用均明显优于常规治疗组,PCT可以作为确定继续使用或停用抗生素的预测指标之一.     

降钙素原水平检测在呼吸道感染性疾病诊治中的应用及预后评估

降钙素原在脓毒血症中的诊疗价值已得到公认,但在呼吸道不同致病原所致感染性疾病中的诊断及鉴别诊断价值仍在探讨中。本文就目前发表的部分文献中的实验结果作一简要概述,旨在进一步探讨降钙素原水平检测在呼吸道感染性疾病诊疗、预后评估及指导抗生素应用中的价值。     

阿奇霉素联合头孢类抗生素治疗社区获得性下呼吸道感染的疗效观察

目的 探讨阿奇霉素联合头孢类抗生素治疗下呼吸道感染的临床疗效。方法 随机选择下呼吸道感染164例分为三组：阿奇霉素联合头孢类组（A组）60例，单独阿奇霉素组（B组）46例，单独头孢类抗生素组（C组）58例，比较3组患者治疗后的临床疗效及不良反应。阿奇霉素0．5g，每131次静滴，连续7～10天；头孢噻肟钠2g，每132次静滴，连续7～10天。结果 A组显效率、总有效率均高于其他两组，差异有显著统计学意义（P〈0．01）。结论 阿奇霉素联合头孢类抗生素对治疗下呼吸道感染较单独应用阿奇霉素或头孢类抗生素有良好的疗效，不良反应发生率与单独用阿奇霉素相比差异无统计学意义（P〉0．05）。     

医院获得性MRSA下呼吸道感染58例耐药分析

近年来 ,由于抗生素的广泛应用 ,耐甲氧西林葡萄球菌( MRSA)成为院内感染的主要致病菌。2 0 0 1年 8月～ 2 0 0 2年 8月 ,我院收治获得性 MRSA下呼吸道感染 5 8例 ,现将其耐药情况分析如下。临床资料 :本组 5 8株 MRSA菌株均来自我院住院患者痰标本。5 8例患者均有发热、咳浓痰 ,少数有血痰。所有患者均符合卫生部制定的院内感染诊断标准。其中 3 0例来自神经外科ICU病房 ,5例来自呼吸内科病房 ,18例来自神经内科病房 ,4例来自烧伤病房 ,1例来自血液病房。5 6例患者均连续 2次以上痰培养 ,采用 M- H培养基琼脂扩散法作苯唑西林敏感实…     

血清降钙素原在老年下呼吸道感染中的临床意义

目的探讨血清降钙素原对老年下呼吸道感染患者的诊断、病情评估、疗效监测及预后判断的价值。方法将老年下呼吸道感染患者80例（感染组）分为预后良好及预后不良组;另设立正常对照组;于入院后24 h内测感染组及正常对照组血清降钙素原（PCT）、超敏C反-应蛋白（hs-CRP）、WBC、中性粒细胞百分比（N）及第8天感染组以上各项指标,动态观察各项炎性指标的变化;并记录感染组入院24 h内及经抗感染治疗后第8天急性简化生理学评分（SAPSⅡ评分）,对病情进行评定。结果感染组患者第1天血清PCT水平高于正常对照组（P〈0.05）;PCT指标的灵敏度（85%）和特异度（90%）均较高,PCT的ROC曲线下面积高于hs-CRP、WBC、N;预后不良组第1天及第8天PCT值明显高于预后良好组,预后良好组第1天PCT明显高于第8天（P均〈0.01）;PCT水平与SAPSⅡ评分明显正相关（r=0.404,P〈0.01）。结论血清PCT水平可反映老年下呼吸道感染患者病情严重程度及预后,是其诊断的一个较好指标。     

降钙素原、C反应蛋白对下呼吸道感染的临床意义分析

目的 研究降钙素原（PCT）与C反应蛋白（CRP）联合检测在在下呼吸道感染病原诊断及病情评估的临床应用价值.方法 以50例下呼吸道感染患者为研究对象,比较不同病因及不同病情严重程度支气管肺炎患者CRP、PCT检测情况.结果 细菌组、病毒组、支原体组CRP两两比较均存在统计学差异（P＜0.05）,PCT细菌组与其他两组比较均存在统计学差异（P＜0.05）,细菌组CRP、PCT呈正相关（r=0.724,P＜0.05）,病毒组、支原体组CRP、PCT无相关性;细菌性组中随病情严重程度加深,CRP、PCT血清水平进行性增高.结论 CRP、PCT对下呼吸道感染病原体的早期诊断、病情评判及预后评估有重要的临床应用价值.     

新喹诺酮在社区获得性呼吸道感染中的应用价值

环丙沙星、氧氟沙星等传统喹诺酮药物对革兰阳性细菌的抗菌活性不够强 ,因而在以肺炎链球菌为重要致病原的社区呼吸道感染中的应用受到限制。近年来新开发的莫西沙星、加替沙星、吉米沙星、左氧氟沙星等 ,在抗菌活性与药物动力学方面有更多的优点 ,已成为治疗社区获得性呼吸道感染的重要药物之一。一、喹诺酮类药物的一般特点1.作用机制 :除曲伐沙星与吉米沙星外 ,所有氟喹诺酮类都拥有喹诺酮核作为其基本结构。喹诺酮类药物是新一代具有特殊作用机制的抗菌药物 ,它通过与细菌的ＤＮＡ特异性靶位点相结合来发挥抗菌作用。所以 ,细菌细胞内氟…     

加替沙星注射剂治疗下呼吸道和泌尿系统细菌性感染临床随机对照研究

目的　评价国产加替沙星注射剂治疗下呼吸道和泌尿系统感染的临床疗效与安全性。方法　采用随机对照盲法平行试验设计 ,入选病例 2 0 6例 ,剔除 1例 ,中辍 5例 ,可评价的病例2 0 0例。试验组应用加替沙星注射剂 40 0mg/次 ,每 2 4小时 1次静滴 ;对照组应用左氧氟沙星注射剂 2 0 0mg/次 ,每天 2次静滴 ,疗程均为 7～ 14天。 结果　试验组和对照组的有效率分别为 91.18% ( 93 /10 2 )和 88.78% ( 87/98) ;试验组细菌清除率为 94.3 2 % ( 83 /88) ,略高于对照组的 93 .5 1%( 72 /77) ;试验组临床不良反应发生率为 8.74% ( 9/10 3 ) ,高于对照组的 6.80 % ( 7/10 3 ) ,两组细菌清除率和不良反应发生率比较差异均无显著性 (P >0 .0 5 )。结论　加替沙星注射剂治疗临床常见致病菌引起的下呼吸道和泌尿系统感染 ,临床疗效好 ,使用安全、方便 ,有较高的临床应用价值。     

快速细菌鉴定药敏对下呼吸道感染抗生素应用的价值

我院使用美国EADE公司 Walk Away 40全自动微生物分析仪对痰液进行快速细菌鉴定药敏,为临床合理应用抗生素提供了科学依据。现就56例下呼吸道感染患者的痰菌培养、药敏鉴定与治疗进行分析。 1 资料与方法 1.1 一般资料本院呼吸内科1999年9月至2000年2月收治下呼吸道感染56例,其中男性36例,女性20例,年龄21～84岁,56例中包括肺炎10例、急性支气管炎4例、慢性支气管炎急性发作23     

The effect of curcumin supplementation on circulating adiponectin: A systematic review and meta-analysis of randomized controlled trials

ObjectiveOur objective was to perform a systematic review and meta-analysis on randomized controlled trials (RCTs) assessing the effect of curcumin on serum adiponectin concentration.MethodsWe searched PubMed/Medline, Scopus, ISI Web of Science, Cochrane Library, and Google scholar databases up to April 2019. RCTs conducted among human adults studied the effects of curcumin on serum adiponectin concentrations as an outcome variable was included. The weighted mean differences (WMD) and standard deviations (SD) of change in serum adiponectin levels were calculated. The random effects model was used for deriving a summary of mean estimates with their corresponding SDs.ResultsOut of 313 records, 6 trials that enrolled 652 subjects were included. The pooled results showed that curcumin supplementation significantly increased adiponectin concentrations in comparison with placebo (WMD: 0.82 Hedges' g; 95% confidence interval (CI): 0.33 to 1.30, P˂0.001). Greater effects on adiponectin were observed in trials lasting ≤10 weeks (WMD: 1.05 Hedges’ g; 95% CI: 0.64 to 1.45, P˂0.001).ConclusionCurcumin significantly improves adiponectin concentrations. However, due to some limitations in this study, further studies are needed to reach a definitive conclusion about the effect of curcumin on the levels of adiponectin.     

Exercise therapy in patients with constipation: a systematic review and meta-analysis of randomized controlled trials

Background: Exercise therapy has shown significant efficacy as a means of treating various intestinal diseases, but its role in the treatment of constipation is still unclear. The purpose of this study was thus to analyze the effects of exercise on constipation by means of a systematic review and meta-analysis.

Methods: PubMed, Web of Science, EMBASE, Cochrane Library and three Chinese databases [Wanfang Database, Chinese Biomedical Literature (CBM) and China National Knowledge Infrastructure (CNKI)] were searched for relevant studies published through June 2018. Eligible studies were selected in accordance with the PRISMA statement. The main results of interest were changes in gastrointestinal symptoms.

Results: A total of nine randomized controlled trials involving 680 participants were included. Eight studies involved aerobic exercise and only one study involved anaerobic exercise. The aerobic exercises included were Qigong, walking and physical movement. The results of this systematic review and meta-analysis indicated that exercise had significant benefits as a means of improving the symptoms of constipation patients [relative risk (RR)?=?1.97; 95% CI: 1.19, 3.27; p?=?.009; I²=91.3%]. Subgroup analyses showed that aerobic exercise (RR = 2.42; 95% CI: 1.34, 4.36; p?=?.000; I²=88%) similarly had a positive effect on constipation. However, these results were associated with a high risk of bias.

Conclusion: Our results suggest that exercise may be a feasible and effective treatment option for patients with constipation. However, due to methodological shortcomings, the real effect of this intervention cannot be definitively determined. Researchers should, therefore, design more rigorous studies in order to evaluate the effect of exercise on constipation.     

左氧氟沙星静脉／口服序贯治疗老年社区获得性下呼吸道感染

目的 观察左氧氟沙星静脉／口服序贯治疗老年下呼吸道感染的疗效和安全性。方法 100例老年下呼吸道感染患者分成两组，分别予左氧氟沙星500mg／d静脉／口服序贯治疗或全程静脉治疗。结果 序贯治疗有效率84％，菌清除率69．2％。全程静脉治疗有效率86％，菌清除率72．7％。两组不良反应均轻微。结论 左氧氟沙星静脉／口服序贯治疗老年社区获得性下呼吸道感染有效，安全。     

奈替米星与阿米卡星临床疗效观察

目的以阿米卡星为对照评价奈替米星治疗下呼吸道感染的临床有效性及安全性。方法共人选病例132例，可评价疗效者102例，其中试验组（奈替米星）与对照组（阿米卡星）分别为52例与50例。安全性评价人选病例113例，两组分别为56例与57例。给药方法试验组每次200mg，每日1次，对照组每次200mg，每日2次，两组疗程均为7～14天。结果试验组与对照组的临床有效率分别为84．61％与64．00％，细菌清除率分别为90．91％与66．67％，敏感菌百分率分别为93．18％与71．43％，听力下降发生率分别为1．79％与15．79％。以上结果经统计学处理两组差异有显著性。结论奈替米星为治疗下呼吸道感染的安全、有效的抗菌药物。     

Indwelling catheter increases the risk of urinary tract infection in total knee arthroplasty: A meta-analysis of randomized controlled trials

Background:The purpose of this meta-analysis was to assess whether a urinary catheter is necessary for all patients in primary total knee arthroplasty (TKA).Methods:PubMed, EMBASE, the Cochrane Library, Web of Science, and China National Knowledge Infrastructure were systematically searched for randomized controlled trials (RCTs). All RCTs were compared with receive either an indwelling urinary catheter or no urinary catheter in TKA. Primary outcomes were urinary retention and urinary tract infection. Secondary outcomes were the length of stay, duration of the surgery, and the first urination time.Results:A total of 6 RCTs involving 1334 patients were included in the meta-analysis. No significant difference between the 2 groups was found in urinary retention (P = .52), length of stay (P = .38), duration of the surgery (P = .55). However, patients with an indwelling catheter were associated with a higher risk of urinary tract infections and longer time for the first urination than patients without indwelling catheters (P = .009 and P = .004).Conclusion:The available evidence indicates that patients without using the indwelling catheters could reduce urinary tract infections and the time for the first urination, without increase in the incidence of urinary retention in primary TKA.Level of Evidence:Level I, therapeutic study.     

加替沙星治疗急性下呼吸道感染的疗效评价

目的　评价加替沙星治疗急性下呼吸道感染的疗效和安全性。方法　35 例患者接受加替沙星200mg静脉滴注治疗,每日两次;36例患者接受左氧氟沙星 200mg静脉滴注治疗,每日两次;32 例患者接受环丙沙星200 mg静脉滴注治疗,每日两次,疗程均为 7~14 天。结果　加替沙星组、左氧氟沙星组痊愈率和有效率分别为77.14%、72.22%与91.43%、77.78%(P>0.05),加替沙星组和环丙沙星组痊愈率和有效率分别为77.14%、53.13%与91.43%、65.63%(P<0.05)。加替沙星组和左氧氟沙星组细菌清除率分别为87.88%、85.29%(P>0.05),加替沙星组和环丙沙星组细菌清除率分别为87.88%、65.62%(P<0.05)。结论　国产加替沙星抗菌谱广,抗菌活性强,副作用小,且疗效明显优于环丙沙星,能安全有效地治疗急性下呼吸道感染,有较高的临床应用价值。     

C-reactive protein testing to reduce antibiotic prescribing for acute respiratory infections in adults: a systematic review and meta-analysis

BackgroundAntimicrobial resistance (AMR) has become a worldwide public health problem. Abuse of antibiotic in acute respiratory tract infections (ARI) contributes to the increasing AMR. C-reactive protein (CRP) testing may help reduce antibiotic overprescribing, but the available evidence quality varies widely. There is no meta-analysis of CRP testing to guide the antibiotic prescribing for adult ARI. Therefore, we conducted this meta-analysis to determine the effectiveness of CRP testing to guide antibiotic prescribing in adult ARI.MethodsWe searched the Cochrane Library, PubMed, and EMBASE databases for randomized controlled trials (RCTs) involving our meta-analysis from the establishment of these databases until January 16, 2021. Two reviewers extracted the data separately and pooled the data using RevMan5.3. The evidence quality was appraised strictly with GRADE system.ResultsSeven studies included with 3,614 patients. Compared with routine care, CRP testing reduced antibiotic prescribing rate at the index consultation significantly [risk ratio (RR) =0.76; 95% confidence interval (CI): 0.68–0.85; P<0.00001], and during 28 days follow-up (RR =0.77; 95% CI: 0.73–0.81; P<0.00001). There were no significant differences between CRP testing and routine care in clinical recovery of patients within 7 days (RR =0.95; 95% CI: 0.90–1.01; P=0.08). Moreover, adverse events were not significantly different between CRP testing and routine care.DiscussionCRP testing can reduce the antibiotic prescribing rate at index consultation and during 28 days
follow-up. These findings support the conclusion that CRP testing is valuable to guide the antibiotic prescribing for adult ARI.     

2012年中国成人社区获得性呼吸道感染主要致病菌耐药性的多中心研究

目的 调查2012年我国11家医院成人社区获得性呼吸道感染病原菌的耐药性.方法 收集2012年1-12月全国11家中心分离的599株成人社区获得性呼吸道感染病原菌,其中肺炎链球菌381株,流感嗜血杆菌137株,卡他莫拉菌81株.采用琼脂稀释法测定抗菌药物的MIC值.结果 50％(300/599)的菌株分离自60岁以上的患者,16.2％(97/599)的菌株分离自40岁以下的患者.按照肺炎链球菌口服青霉素的折点判定标准,56.7％(216/381)的肺炎链球菌为青霉素不敏感菌株(PNSSP),肺炎链球菌对大环内酯类的耐药率超过90％(345/381),对口服头孢菌素的耐药率为39.9％ ～50.7％(152 ～ 193株).肺炎链球菌对左氧氟沙星和莫西沙星的敏感度分别为97.8％(372/381)和99％(377/381).PNSSP对头孢曲松、阿莫西林/克拉维酸、头孢克洛、头孢呋辛的耐药率显著高于青霉素敏感菌株(PSSP).流感嗜血杆菌对除氨苄西林(71.5％,272/381)和头孢克洛(75.2％,286/381)外的抗菌药物的敏感度均超过90％.流感嗜血杆菌中β-内酰胺酶阳性率为21.9％(30/137),且β-内酰胺酶阳性菌株对氨苄西林、头孢克洛、氯霉素和四环素的耐药性显著高于β-内酰胺酶阴性菌株.氟喹诺酮类药物对流感嗜血杆菌的作用效果明显.除克林霉素、阿奇霉素和克拉霉素对卡他莫拉菌作用较差外,其他药物对卡他莫拉菌均具有较高的抗菌活性.结论 大环内酯类和口服头孢菌素类药物对肺炎链球菌、流感嗜血杆菌和卡他莫拉菌的抗菌活性有限,左氧氟沙星和莫西沙星对肺炎链球菌、流感嗜血杆菌和卡他莫拉菌仍具有较高的抗菌活性.