不同病原菌感染早产儿败血症的临床特点和炎症指标及临床结局

目的分析不同病原菌感染早产儿败血症的临床特点、血液学指标及临床结局。方法依据感染病原菌不同将商丘市第一人民医院90例早产儿败血症患儿分为革兰阳性菌组、革兰阴性菌组、真菌组,分析各组患儿临床特点、炎症指标[白细胞计数(WBC)、血小板(PLT)、C-反应蛋白(CRP)]及临床结局。结果 90例早产儿败血症患儿根据检出病原菌分为革兰阳性菌组26例、革兰阴性菌组42例、真菌组22例;革兰阳性菌以表皮葡萄球菌为主,革兰阴性菌以肺炎克雷伯菌、大肠埃希菌为主,真菌以近平滑假丝酵母、白假丝酵母为主。真菌组出生体质量最低、胎龄最小(P0.05),革兰阳性菌组、革兰阴性菌组早发型比例较高(P0.05)。革兰阳性菌组和革兰阴性菌组首发症状中呼吸困难占比高于真菌组,腹胀占比低于真菌组(P0.05),革兰阳性菌组血培养转阴时间最短(P0.05),三组发病时WBC和PLT异常率比较差异有统计学意义(P0.05)。革兰阴性菌组感染前机械通气时间最长(P0.05),真菌组感染前抗生素使用时间、深静脉置管留置时间最长(P0.05),真菌组住院时间、住院费用最高(P0.05);革兰阴性菌组肺炎、支气管肺发育不良发生率最高,革兰阴性菌组、真菌组坏死性小肠炎发生率高于革兰阳性菌组(P0.05);革兰阴性菌组治愈或好转出院率最低(P0.05)。结论不同病原菌感染致早产儿败血症临床特点不尽相同,需结合临床症状、发病日龄及血液学指标等综合判断,并及早合理用药。     

新生儿败血症病原菌分布及耐药性分析

目的研究医院新生儿败血症病原菌的分布及耐药性,指导临床合理使用抗菌药物。方法采用病例对照研究的方法,对医院2006年1月-2011年5月新生儿重症监护病房121例败血症确诊患儿进行回顾性分析,按发病时间分为早发型及晚发型败血症,并根据发生感染的地点分为社区获得性感染及医院感染。结果新生儿败血症病原菌以革兰阴性菌为主,73株占60.33%,革兰阳性菌44株占36.36%,真菌4株占3.31%,早发型与晚发型败血症中大肠埃希菌、肺炎克雷伯菌、鲍氏不动杆菌、阴沟肠杆菌、金黄色葡萄球菌、白色假丝酵母菌、链球菌属与败血症比较,差异有统计学意义(P<0.05),社区与医院感染败血症中大肠埃希菌、肺炎克雷伯菌、嗜麦芽寡养单胞菌、金黄色葡萄球菌、白色假丝酵母菌比较,差异有统计学意义(P<0.05),产ESBLs大肠埃希菌、肺炎克雷伯菌检出率分别为15.79%、16.67%;革兰阴性菌、革兰阳性菌对青霉素、氨苄西林均耐药。结论早发型及晚发性败血症、社区获得性及医院感染败血症病原谱不同,均有多药耐药菌产生。     

新生儿晚发型败血症病原菌及诊断方法

目的探究血小板计数(PLT)、未成熟中性粒细胞/成熟中性粒细胞比值(I/T)、C-反应蛋白(CRP)联合用于新生儿晚发型败血症的诊断价值。方法选择2015年3月-2019年5月上饶市人民医院收治的80例败血症晚发型足月新生儿及100例住院非感染新生儿作为研究对象,分别为败血症组及对照组。采集败血症患儿血标本进行病原菌检测及耐药性分析,测定两组患儿PLT、I/T、CRP水平,分析单独或联合检测诊断败血症的临床价值。结果 80例败血症患儿血培养共分离出82株病原菌,其中包括革兰阳性菌48株占58.54%,革兰阴性菌33株占40.24%,真菌1株占1.22%。革兰阴性菌中大肠埃希菌、肺炎克雷伯菌对亚胺培南、美罗培南等抗菌药物耐药率较低;革兰阳性菌中表皮葡萄球菌、溶血性葡萄球菌对万古霉素、利福平等抗菌药物耐药率较低。与对照组比较,败血症组患儿PLT计数显著降低,I/T比值及CRP水平均显著升高,两组比较差异有统计学意义(P0.05)。PLT计数、I/T比值、CRP水平诊断新生儿败血症的曲线下面积分别为0.750、0.667、0.718。3种指标联合检测诊断曲线下面积为0.842,均高于两指标联合及单独检测。结论晚发型败血症患儿血培养检出病原菌以革兰阳性菌为主,PLT计数、I/T、CRP指标联合检测诊断价值优于单一指标。     

血流感染所致脓毒症患者血清中炎症因子、凝血指标的水平变化及临床意义

目的 探讨细菌性血流感染所致的脓毒症患者血清中炎症因子、凝血指标的水平及其临床意义。 方法 收集2016年2月-2017年2月郑州大学第五附属医院ICU收治的103例细菌性血流感染导致的脓毒症患者为研究对象,并根据血培养结果将其分为革兰阳性菌血流感染组(革兰阳性菌组,n=37)和革兰阴性菌血流感染组(革兰阴性菌组,n=66),并于同期随机选取60例健康体检者为对照组。比较各组血清炎症因子包括降钙素原(PCT)、C反应蛋白(CRP)水平,以及凝血指标包括D-二聚体(D-D)、凝血四项(PT、APTT、TT、FIB)、抗凝血酶Ⅲ(ATⅢ)水平。 结果 革兰阳性菌组、革兰阴性菌组血清PCT、CRP、D-D、PT、APTT、TT水平高于对照组,FIB、ATⅢ水平低于对照组,差异均有统计学意义(均P＜0.05)。并且革兰阴性菌组血清PCT、CRP水平高于革兰阳性菌组,差异均有统计学意义(均P＜0.05),革兰阳性菌组、革兰阴性菌组FIB、ATⅢ水平差异无统计学意义(均P＞0.05)。革兰阳性菌组和革兰阴性菌组中,重症脓毒症患者血清炎症因子PCT、CRP、D-D、PT、APTT、TT水平均高于非重症患者,FIB、ATⅢ水平低于非重症患者,差异均有统计学意义(均P＜0.05)。 结论 细菌性血流感染所致脓毒症患者血清炎症因子以及凝血指标呈不同程度异常,并与细菌种类及病情严重程度密切相关,早期联合检测有助于诊断疾病及评估预后。     

早产儿院内感染所致败血症的临床特征、病原菌及炎症指标分析

目的：分析早产儿院内感染所致败血症的临床特征、病原菌分布及炎症指标。方法：回顾性分析2016年6月～2022年6月本院收治的87例院内感染所致败血症早产儿的临床资料，比较革兰氏阴性菌感染和革兰氏阳性菌感染患儿的临床特征及炎症指标。结果：早产儿院内感染所致败血症的发病率为1.07%(87/8146)。感染革兰氏阳性菌59例(67.8%),以表皮葡萄球菌为主(33.9%),感染革兰氏阴性菌28例(32.2%),以肺炎克雷伯杆菌为主(39.3%)。革兰氏阴性菌感染患儿早发型比例、严重并发症、白细胞下降、C反应蛋白升高和血小板下降等发生率明显高于革兰氏阳性菌感染患儿，胎龄、出生体重、机械通气、抗生素应用以及PICC留置时间大于革兰氏阳性菌感染患儿，住院费用高于革兰氏阳性菌感染患儿，差异具有统计学意义(P<0.05),革兰氏阴性菌感染患儿死亡率高于革兰氏阳性菌感染患儿(P<0.05)。结论：早产儿院内感染所致败血症以革兰氏阳性菌为主；革兰氏阴性菌感染者更易发生严重并发症、预后更差，白细胞、血小板下降及C反应蛋白升高对提示感染类型和治疗有帮助。     

新生儿败血症的临床表现及病原学分析

目的 探讨新生儿败血症(N S)的危险因素、临床表现、并发症、病原学分布及耐药情况,为提高疾病的诊断、早期合理运用抗生素提供依据.方法 选择2017年1月至2020年6月就诊于贵阳市妇幼保健院的285例新生儿败血症患儿为研究对象,依据症状出现的时间分为早发型组(日龄≤3天,n=141)和晚发型组(日龄>3天,n=144),比较两组临床资料及病原学特点.结果 早发型组中小于胎龄儿、羊水污染、生后窒息的发生率高于晚发型组,差异均有统计学意义(χ2值分别为22.592、4.372、4.419,P<0.05);早发型组中黄疸的发生率高于晚发型组,而发热、咳嗽、鼻塞、腹泻的发生率低于晚发型组,差异均具有统计学意义(χ2值分别为58.549、51.173、11.203、6.460、4.501,P<0.05);早发型组中白细胞(WBC)、C反应蛋白(CRP)及血小板(PLT)均低于晚发型组,差异具有统计学意义(Z值分别为-2.087、-2.618、-6.102,P<0.05);早发型组中糖代谢紊乱、颅内出血、消化道出血的发生率高于晚发型组,差异均有统计学意义(χ2值分别为22.167、12.185、4.262,P<0.05);285例血培养共培育出289株病原菌,在早发型组中以革兰阴性菌为主(66.06％),而在晚发型组中以革兰阳性菌为主(68.97％).结论 对于小于胎龄儿、早产、羊水污染、生后窒息等围产高危因素的患儿,需警惕早发型NS的发生;对于发热、咳嗽、鼻塞、腹泻等症状,需警惕晚发型NS的发生;对于抗生素的选取,应结合药敏试验及当地病原菌特点综合分析.     

早产儿重症监护病房实验室确诊败血症病原分布及临床特点

目的调查重症监护病房败血症早产儿病原菌分布及其临床特点。方法回顾性分析2016年1月—2018年12月某院早产儿重症监护病房收治的血培养阳性,实验室确诊败血症155例,对不同病原菌早产儿败血症临床特点进行比较。结果 155例早产儿败血症中,革兰阴性(G~-)杆菌组76例(占49.03%),以肺炎克雷伯菌败血症为主;革兰阳性(G~+)球菌组42例(占27.10%),以表皮葡萄球菌败血症为主;真菌组37例(占23.87%),以近平滑假丝酵母菌、白假丝酵母菌败血症为主。G~-菌组和真菌组早产儿胎龄、出生体重小于G+菌败血症组;真菌败血症组早产儿起病日龄大于G~-菌组、G~+菌组,深静脉置管比例高于G-菌组、G~+菌组;真菌组早产儿血小板计数低于G~-菌、G~+菌组;G~-菌组C反应蛋白(CRP)高于G~+菌组和真菌组,差异均有统计学意义(均P0.05)。155例早产儿治愈好转率94.84%,病死率5.16%。G~-菌组患儿病死率高于G~+菌组、真菌组,真菌败血症组治疗日数长于G~-菌、G~+菌组,差异均有统计学意义(均P0.05)。结论早产儿败血症致病菌主要为G~-菌,G~-菌组、G~+菌组及真菌组败血症早产儿临床表现不同、实验室指标及预后不同。     

血培养阳性患者降钙素原、白细胞介素6的差异性分析

目的分析血培养阳性患者降钙素原(PCT)、白细胞介素6(IL-6)的变化情况。方法回顾性分析2015年1月-2016年6月184例血培养阳性住院患者的临床资料,比较革兰阴性菌(104例)、革兰阳性球菌(69例)、真菌(11例)血流感染患者PCT及IL-6检测结果的差异。结果将革兰阴性菌、革兰阳性菌、真菌血流感染后患者PCT、IL-6进行均值比较,PCT、IL-6的升高情况为革兰阴性菌高于革兰阳性菌;将革兰阴性菌、革兰阳性菌、真菌血流感染后患者PCT、IL-6进行对数转换后为lgPCT、lgIL-6,进行独立样本t检验,革兰阴性菌与革兰阳性菌血流感染后患者lgPCT比较差异有统计学意义(P<0.05);lgPCT在革兰阴性菌与可疑污染菌(凝固酶阴性葡萄球菌及酿脓链球菌)、阳性致病菌(除外凝固酶阴性葡萄球菌及酿脓链球菌的其他革兰阳性菌)的比较中有显著性差异(P<0.05);lgIL-6在革兰阴性菌、真菌与可疑污染菌的比较中有显著性差异(P<0.05),而与阳性致病菌的比较并无显著性差异;lgPCT与lgIL-6存在正相关性,相关系数r=0.422(P<0.01)。结论 IL-6和PCT的联合检测可及早发现感染,辨识感染与污染,为临床菌血症的诊疗、抗菌药物的应用提供依据。     

降钙素原在败血症中的诊断意义

目的通过分析血清降钙素原(PCT)在由革兰阴性菌和革兰阳性菌引起败血症患者中的血清浓度,明确PCT对不同菌引起败血症的诊断意义,为早期治疗提供理论依据。方法搜集医院发热患者145例,血培养阳性患者74例,阴性患者71例;血培养阳性患者中革兰阴性菌和革兰阳性菌各37例,比较不同组间PCT血清浓度。结果革兰阳性菌引起败血症以表皮葡萄球菌为主占21.62%,革兰阴性菌引起败血症以肺炎克雷伯菌为主占18.92%;通过比较3组间PCT表达水平,发现革兰阴性菌组PCT血清浓度明显高于革兰阳性菌组和血培养阴性组患者,而革兰阴性菌或革兰阳性菌不同菌间PCT表达差异无统计学意义;通过ROC曲线分析发现PCT诊断革兰阴性菌引起败血症的灵敏度为81.0%、特异性为93.0%、曲线下面积为92.0%。结论 PCT对于革兰阴性菌引起败血症具有较高的诊断价值,而对于非败血症及革兰阳性菌引起的败血症诊断意义不大。     

血流感染患者血清中氨基末端脑利钠肽前体的分布特征

目的分析疑似血流感染(BSI)患者血清中N末端脑利钠肽前体(NT-proBNP)在革兰阳性菌、革兰阴性和真菌血流感染对心脏负荷的影响。方法选择2012年12月-2016年9月于解放军总医院海南医院就诊的疑似败血症或血流感染,且同一天进行静脉血培养和NT-proBNP检测的全部样本,共174例。按照血培养结果分四组,分别为革兰阳性菌感染、革兰阴性菌感染、真菌感染和阴性对照组,比较四组中NT-proBNP的差异。结果革兰阳性菌感染、革兰阴性菌感染、真菌感染和阴性对照组在年龄、性别差异无统计学意义。四组间NT-proBNP两组间比较,仅革兰阴性菌感染组NT-proBNP为871(301,3 688)pg/ml和真菌感染组的4 398(1 283,8 436)pg/ml与阴性对照组的NT-proBNP 485(146,1 716)pg/ml差异有统计学意义,且均高于对照组(P<0.05),其余组间比较差异无统计学意义。结论革兰阴性菌感染和真菌感染更易出现NT-proBNP的增高,增加心脏的负荷,在临床血流感染治疗过程中,对于革兰阴性菌和真菌感染的血流感染患者应注意心脏负荷的监测。     

有性才会有健康

性是基本的人权。根据我国著名的性学家史成礼教授的研究,性有“三大功能”:生育功能、享乐功能和健康功能。     

Communicating with people with dementia

It can be very difficult to communicate with people with dementia. Each case requires its own unique handling. Not every scenario is covered, as many times your own judgment is what will work, best according to the circumstances. These can change from dawn to evening and from day to day. Never assume things will be the way they were the last time you communicated. Be on your guard. Be adaptable. The article will help get you started to think of your own ways to communicate.     

Working with patients with physical disabilities

Medical practices need to make a number of adaptations to ensure that their facilities and staff are accessible to patients and other office visitors with physical disabilities. This article describes 10 specific strategies for preparing your medical practice for patients with disabilities, both inside and outside your office. It describes minimum standards for office doorways, sidewalk inclines, ramps, reception areas, and other adaptations medical offices need to make. The article also describes specific do and don't advice for communicating with patients with physical disabilities. It suggests strategies for preparing written materials for disabled patients, for communicating verbally, and for providing healthcare education. Finally, it suggests an appropriate role for medical practice staff in the delivery of healthcare services to patients with physical disabilities.     

经方汗证治验

临床上汗证病情复杂,分自汗、盗汗、黄汗和但头汗出,治疗汗证方药诸多,有益气固表、养阴清热和清热除湿等方法,疗效不一。受恩师刘健主任教导和《伤寒论》《金匮要略》病脉证并治启发,以脉证并治、方证对应思想,浅谈桂枝加附子汤、黄芪芍药苦酒汤、柴胡桂枝干姜汤和三物黄芩汤治疗汗证的经验,为经方治疗汗证提供新思路。     

Coping with Children with ADHD: Coping Styles of Mothers with Children with ADHD or Challenging Behaviours

Parents of children with Attention Deficit Hyperactivity Disorder (ADHD) can experience significant levels of stress in their parenting roles, however, little is known about the specific coping strategies used by these parents. This pilot study Investigated the coping strategies used by mothers of children with ADHD. A 34 item questionnaire was developed to identify maternal coping strategies. A cohort of 38 mothers of children with ADHD and a control group of 30 mothers of children without ADHD or any other disability/illness completed the questionnaire. Factor analysis of responses produced three factors: Aggressive/Confrontive Coping, Rational Coping, and Indirect Coping. These factors are similar to coping dimensions proposed by Folkman and Lazarus. Comparisons between the two groups of mothers revealed that mothers of children with ADHD used significantly more Indirect Coping.     

Problems with measuring satisfaction with social care

The measurement of customer satisfaction has become widespread in both healthcare and social care services, and is informative for performance monitoring and service development. Satisfaction with social care services is routinely measured with a single question on overall satisfaction with care, comprising part of the Adult Social Care Survey. The measurement of satisfaction has been problematised, and existing satisfaction measures are known to be under‐theorised. In this article, the process of making an evaluation of satisfaction with social care services is first informed by a literature review of the theoretical background, and second examined through qualitative interviews conducted in 2012–2013 with 82 service users and family carers in Hampshire, Portsmouth and Southampton. Participants in this study were from white British and South Asian backgrounds, and the influence of ethnicity in the process of satisfaction evaluation is discussed. The findings show that the majority of participants selected a positive satisfaction rating even though both positive and negative experiences with services were described in their narratives. It is recommended that surveys provide opportunity for service users and family carers to elaborate on their satisfaction ratings. This addition will provide more scope for services to review their strengths and weaknesses.     

Ending clinical relationships with people with schizophrenia

The potential for the social worker-client relationship to contribute to therapeutic outcomes is not always apparent with clients who have schizophrenia. Their cognitive impairments often make it difficult for these clients to regulate interpersonal boundaries and for social workers to connect with them. Clinical practice is enhanced, however, by recognizing that severely impaired clients have the capacity and desire for relationships with service providers and others. The manner in which the clinical relationship ends is important for maintaining clinical gains and determining whether the client will risk investing in future relationships. The purpose of this article has been to sensitize social workers to the delicate nature of managing the endings of those relationships.