综合重症医学科住院患者医院感染直接经济损失研究

目的评估某三级甲等医院综合重症医学科住院患者发生医院感染造成的直接经济损失。方法回顾性地分析该院综合重症医学科2013年1月至2014年12月发生医院感染患者32例,设为医院感染组,按1:1比例匹配患者为对照组。分析两组患者住院天数、住院费用及不同感染部位对住院天数的影响。结果对照组患者住院天数13.47(8.00,12.75)d,医院感染组患者住院天数48.91(14.25,74.25)d,两组间差异有统计学意义(z=4.165,P0.05)。对照组患者住院总费用41 855.62(24 684.55,460 26.74)元,医院感染组患者住院总费用160788.45(49123.11,223 523.13)元,其中西药费最高,其次是治疗费,两组间差异有统计学意义(P0.05)。多部位医院感染患者比单一部位感染患者住院天数增多[(75.00±60.93)vs(16.64±9.91)d],且差异有统计学意义(t=2.82,P0.05)。结论开展重症医学科医院感染经济学损失评估,可更科学和有效地对医院感染造成的经济损失做出评价,有助于医疗机构管理者增加对医院感染预防控制的经济投入,节约有限的医疗资源,从而减轻患者的经济负担。     

急性脑血管病并发医院感染经济损失的病例对照

目的探讨急性脑血管病住院后医院感染所造成的经济损失,使医务人员对急性脑血管病住院后医院感染的危害有更直观的认识,提高其感染预防控制意识。方法采用1∶1配对病例对照研究方法,唐山市协和医院2015年1月至2017年9月急性脑血管病患者住院后并发医院感染的64患者作为病例组,同期未发生感染的64例患者作为对照组,比较两组患者住院费用等差异。结果两组患者的平均总费用(中位数)差异有统计学意义(P0.05),平均每例患者由医院感染所造成的经济损失为7 965元,直接经济损失5 757元,间接经济损失2 276元,延长住院天数6 d;在直接分类费用中,两组监护费、治疗费、药品费、床位费、化验费、护理费、检查费比较,差异有统计学意义(P0.05),在间接分类费用中,两组伙食费、误工费、陪护费比较,差异有统计学意义(P0.05)。结论急性脑血管病后发生医院感染明显增加患者的直接费用、间接费用和住院时间,给患者造成巨大的经济损失,应采取有效管理方法,控制医院感染。     

糖尿病足患者临床特点及内科治疗住院费用分析

目的观察糖尿病足(DF)患者的临床资料特点,分析其内科治疗住院费用特点及不同支付方式的患者花费有无差别。方法选取该院内分泌科住院治疗的60例DF患者,非DF组60例患者选取与DF患者同时期住院、医保类型相同、合并≤2种糖尿病并发症、不合并DF的非感染糖尿病患者,收集临床资料及住院费用,统计各项费用占总花费的比例,对两组患者的临床资料特点、总费用及各项费用进行统计分析;将60例DF患者按支付方式不同,分为职工医保组和非职工医保组(包括新型农村合作医疗、城镇居民医保、自费),对两组住院总费用及各项费用进行统计分析。结果 DF组患者合并各项并发症及合并症的例数均高于非DF患者,其中糖尿病肾病、糖尿病周围神经病变、下肢动脉病变、心脑血管疾病、低蛋白血症、贫血方面差异有统计学意义(P0.05)。DF患者的平均住院总费用为(14502.06±8695.51)元,平均住院日(19.82±11.76)d,日均花费731.69元,其中药品费最高(6659.44±4918.11)元,占总费用45.92%),其次为治疗费(3125.83±2183.22)元,21.55%、检查费(1983.96±835.38)元,13.68%、耗材费(1253.18±961.03)元,8.64%、床位费(723.39±472.75)元,4.99%、护理费(560.31±67.51)元,3.86%。与非DF组比较,DF患者的住院总费用、药品费、检查费、治疗费、耗材费、床位费、护理费均较高,且住院天数长,差异有统计学意义(P0.05)。60例DF患者中职工医保32例,非职工医保28例,职工医保组、非职工医保组住院日分别为(22.47±13.16)d、(17.00±9.73)d,职工医保组患者住院日、住院总费用及各项费用均高于非职工医保组,但差异无统计学意义(P0.05)。结论 DF患者具有年龄大、糖尿病病程长、血糖控制差、文化水平低、男性多发、并发症及合并症合并率高的特点,住院天数长,内科治疗住院花费较高,其中药品费、治疗费、检查费占花费的绝大部分。     

抗菌药联合针灸治疗慢性阻塞性肺疾病急性加重期患者临床研究

目的探讨抗菌药联合针灸治疗慢性阻塞性肺疾病急性加重期患者的临床效果。方法选择住院治疗的慢性阻塞性肺疾病急性加重期患者60例为研究对象,按随机数字表法随机分为研究组和对照组,每组30例。对照组患者在常规治疗基础上注射用头孢哌酮舒巴坦钠治疗,研究组患者在同对照组治疗的基础上联合针灸治疗,比较两组患者的临床治疗效果、平均住院天数、药物利用指数(DUI)、抗菌药使用强度、30日再住院率、住院总费用及总药费。结果研究组患者治疗总有效率为96.7%,对照组为90.0%,研究组患者的临床疗效优于对照组患者,差异有统计学意义(P0.05);研究组患者住院天数、DUI、抗菌药使用强度、住院总费用及总药费均明显低于对照组,差异具有统计学意义(P0.05)。两组患者治疗期间均未发生严重不良反应。结论抗菌药联合针灸治疗COPD急性加重期患者,临床疗效确切,可有效减少患者抗菌药物的使用量,缩短住院时间,降低治疗费用,值得临床推广应用。     

合并糖尿病对下肢烧伤患者创面愈合的影响研究

目的探析合并糖尿病对下肢烧伤患者创面愈合的影响。方法 2017年1月—2019年1月间从该院择取50例合并糖尿病的下肢烧伤患者作为研究组,并择取50例未合并糖尿病的下肢烧伤患者作为对照组,所选患者均行以常规疗法治疗,同时研究组患者行以降糖治疗,治疗后7 d通过酶联免疫吸附试验法对两组纤维细胞生长因子2(FGF2)蛋白及mRNA表达水平、血管内皮生长因子(VEGF)蛋白及mRNA表达水平进行测定,对两组测定结果、隔离治疗时间、总住院时间以及并发症发生情况进行对照分析。结果经对照分析,研究组FGF2蛋白及mRNA表达水平、VEGF蛋白及mRNA表达水平、糖化血红蛋白均高于对照组,差异有统计学意义(P0.05);两组隔离治疗时间对比差异无统计学意义(P0.05),研究组总住院时间也比对照组长,差异有统计学意义(P0.05);从并发症发生率上来看,研究组为32.0%,对照组为12.0%,研究组高于对照组差异有统计学意义(P0.05)。结论对于下肢烧伤患者来说,合并糖尿病会影响创面愈合,不仅会延长住院时间,还容易出现并发症,对患者康复有不良影响。     

整合素连接激酶在大鼠烧伤创面中的表达及对创面愈合的影响

目的探讨整合素连接激酶(ILK)在大鼠烧伤创面中的表达及对创面愈合的影响。方法建立大鼠烧伤模型,免疫组化法测定大鼠烧伤创面愈合过程ILK的表达情况,将烧伤大鼠分为ILK转染组、阴性对照组和空白对照组,ILK转染组大鼠创面注射ILK过表达慢病毒,阴性对照组大鼠创面注射空质粒慢病毒,空白对照组大鼠创面注射等量生理盐水;免疫组化法测定各组大鼠烧伤创面愈合过程ILK的表达情况,观察各组大鼠创面愈合时间和愈合率。结果烧伤组烧伤后1 w和2 w后烧伤创面ILK的光密度值高于对照组(P0.05),烧伤后3 w烧伤创面ILK光密度值和对照组比较差异无统计学意义(P0.05)。ILK转染创面后,荧光显微镜下见绿色荧光蛋白主要在皮肤基底层表达,部分毛囊中也可见绿色荧光蛋白表达。烧伤后1 w和2 w,ILK转染组创面组织ILK光密度值高于空白对照组和阴性对照组(P0.05);烧伤后3 w,三组创面组织ILK光密度值比较差异无统计学意义(P0.05)。烧伤后1 w和2 w,ILK转染组创面愈合率高于空白对照组和阴性对照组(P0.05);烧伤后3 w,三组创面愈合率比较差异无统计学意义(P0.05);ILK转染组创面愈合时间短于空白对照组和阴性对照组(P0.05)。结论大鼠烧伤创面中ILK表达量增加,大鼠烧伤创面转染ILK过表达慢病毒后创面中ILK表达量增加,并促进烧伤创面的愈合。     

老年深度烧伤行负压引流对创面修复的影响

目的探讨老年深度烧伤行负压引流对创面修复的影响。方法收集老年深度烧伤患者56例作为研究对象,随机分为负压引流组和对照组,对照组采用传统的换药治疗,负压引流组采用负压封闭引流技术治疗。观察负压引流组和对照组细菌培养阳性率和术后白细胞值情况、首次植皮存活率和平均愈合时间、住院时间和住院费用、疼痛评分情况。结果负压引流组的细菌培养阳性率明显低于对照组(P0.05),负压引流组术后白细胞值明显低于对照组(P0.05),负压引流组的首次植皮存活率明显高于对照组(P0.05),负压引流组术后平均愈合时间明显低于对照组(P0.05)。负压引流组的住院时间明显短于对照组(P0.05),负压引流组的住院费用高于对照组,但两者之间比较差异无统计学意义(P0.05)。负压引流组的疼痛评分明显低于对照组(P0.05)。结论负压封闭引流治疗老年深度烧伤可以降低细菌感染率和术后白细胞值,提高首次植皮存活率,降低愈合时间,缩短住院时间,降低患者疼痛,促进深度烧伤患者的创面愈合,住院费用虽有所增加,但和传统换药治疗没有差异。     

护理干预对肛周脓肿合并糖尿病手术前后治疗效果的影响

目的探讨护理干预对肛周脓肿合并糖尿病手术前后治疗效果的影响。方法选择该院2015年1月—2015年12月期间收治的76例肛周脓肿合并糖尿病患者,利用双盲法随机分为对照组和观察组,每组38例,对照组给予常规护理,观察组给予整体护理干预手段,对两组患者并发症发生几率和创面愈合时间进行对比分析。结果一方面,观察组患者脓肿消失时间、创面愈合时间、住院天数均优于对照组,P0.05,差异有统计学意义;另一方面,观察组患者的护理满意度(94.87%vs71.79%)和并发症发生几率(7.69%vs25.64%)也优于对照组,P0.05,差异有统计学意义。结论通过整体护理干预手段的实施,患者并发症发生几率和创面愈合时间都得到优化,值得临床推广。     

快速康复外科在结直肠癌患者中的应用

目的:对比应用快速康复外科(f a s t t r a c k surgery,FTS)治疗方案和传统治疗方案的结直肠癌患者在医疗效率指标和费用方面进行对照研究.方法:对2013-01/2013-12在青海大学附属医院胃肠外科收治的经肠镜病理诊断确诊为结直肠癌60例患者,随机分组,30例应用FTS方案为FTS组,30例应用常规治疗方案为对照组,比较两组患者的恢复胃肠排气时间,术后住院天数、总住院天数、住院总费用和并发症.结果:FTS组患者术后恢复胃肠排气时间明显低于对照组(P=0.000).FTS组患者术后住院天数明显短于对照组(P=0.000).FTS组患者住院天数亦明显短于对照组(P=0.002).FTS组患者住院费用也远低于对照组(P=0.013).两组患者并发症的发生率差异无统计学意义(P=0.306).结论:结直肠癌患者经FTS方案治疗,加速术后康复,缩短术后住院时间及总住院时间,减少医疗费用产生,并不增加肺部感染,切口感染,泌尿系感染等并发症的发生.     

烧伤膏治疗烧伤患者的中医护理分析

目的观察烧伤患者烧伤膏治疗期间应用中医护理的效果。方法以海南省中医院门诊2015年11月—2017年4月间接诊的100例烧伤患者为研究对象,并将之利用电脑随机双盲法分成试验组和对照组,每组50例。所有入选者在烧伤膏治疗期间都接受常规护理,实验组同时加用中医护理方案。综合分析两组烧伤创面的恢复情况,比较SAS评分、SDS评分等指标,综合评价两组患者的创面愈合效果,并比较其护理满意度。结果经过一段时间的护理之后,实验组中轻度以及重度烧伤患者的创面恢复时间明显比对照组缩短,组间差异有统计学意义(P0.05)。实验组护理后的SDS与SAS评分依次是(30.15±4.62)分、(31.72±4.83)分,明显比对照组的(41.83±5.17)分、(39.61±4.84)分低,组间差异有统计学意义(P0.05)。实验组患者创面愈合效果评价的优良率明显比对照组高,组间差异有统计学意义(P0.05)。实验组患者对护理服务的满意度(98.00%)明显比对照组(84.00%)高,组间差异有统计学意义(P0.05)。结论对接受烧伤膏治疗的病患施以中医护理,可有效缩短其烧伤创面恢复的时间,帮助减轻心理压力,提高创面愈合效果及临床护理质量,值得推行。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.