复发性尿路感染的临床治疗研究

目的：探讨复发性尿路感染临床治疗方法和效果。方法：选择2014年9月到2015年9月来我院接受治疗的100例复发性尿路感染患者作为研究对象，对其实施分期抗菌治疗，并对观察患者尿培养、尿常规数据和信息。结果：100例患者中治愈率为89%（89/100）；患者治疗前后差异具有统计学意义（P<0.05）。结论：选择规则抗菌疗法对复发性尿路感染患者进行治疗能够产生显著的效果，患者治愈率相对较高，未出现任何肝肾功能不良的症状，值得在临床治疗中进行使用和推广。     

开颅术后颅内感染持续灌注抗菌药物护理

目的 总结脑室内持续灌注抗菌药物治疗开颅术后颅内感染患者的护理方法,为颅内感染预防治疗提供参考.方法 对36例颅内感染患者实施脑室内持续灌注抗菌药物治疗,并提供病情观察、体位、引流管、药物治疗、不良反应等优质护理服务,观察护理效果.结果 36例患者引流管留置平均时间(52.3±4.8)d;33例颅内感染得到良好控制(91.67％),3例拔除引流管实施脑室腹腔分流术;平均随访(10.3±2.3)个月,治愈32例,治愈率为88.89％,死亡3例,死亡率为8.33％,1例放弃治疗,占2.78％.结论 脑室内持续灌注抗菌药物治疗开颅术后颅内感染疗效显著,在围术期提供优质护理服务可提高治疗成功率,缩短引流管留置时间,减少并发症.     

伏立康唑在肾移植术后侵袭性肺曲霉菌病中的应用

目的 观察伏立康唑在肾移植术后侵袭性肺曲霉菌病中的临床疗效和安全性,为临床治疗提供依据.方法 回顾性分析17例肾移植术后侵袭性肺曲霉菌病患者早期应用伏立康唑,同时辅以相关支持治疗.结果 3例确诊患者中,2例治愈;11例临床诊断患者9例治愈;3例拟诊患者2例治愈,平均治愈率为76.5％.结论 无论确诊、临床诊断或拟诊的肾移植术后侵袭性肺曲霉菌病,尽早应用广谱抗真菌药物-伏立康唑,均能改善症状并提高治愈率.     

老年糖尿病患者并发慢性骨髓炎保肢治疗的研究

目的 研究老年糖尿病患者并发慢性骨髓炎新的保肢临床疗法.方法 采用手术清创、术后放疗,应用抗菌药物和营养支持等新疗法治疗糖尿病并发慢性骨髓炎患者为试验组,共68例；对照组62例采用普通疗法.结果 试验组68例患者,其中临床治愈57例,3个月～5年内复发11例,5年治愈率达83.82％；对照组62例,其中临床治愈28例,1个月～5年内复发34例,5年治愈率达45.16％.结论 试验组新疗法对老年糖尿病并发慢性骨髓炎患者的保肢治疗是一种有益探索.     

老年髋部骨折患者术后感染的预防与控制

目的 探索老年髋部骨折患者术后感染的预防和控制措施,以预防与控制其术后感染,提高治愈率.方法 对医院2008年1月-2010年12月手术治疗的223例＞65岁髋部骨折患者进行回顾性调查分析.结果 223例髋部骨折患者中,167例合并有≥1种其他科疾病,以心血管疾病、糖尿病和呼吸系统疾病为主;入院后平均手术时间(4.29±2.45)d;手术方式为内固定或髋关节置换;术后感染共6例占2.7％,其中手术部位感染2例占0.9％,呼吸道感染1例占0.45％,尿路感染3例占1.35％.结论 对老年髋部骨折患者术后感染的预防和控制,除预防性应用抗菌药物外,应尽早请相关科室会诊,共同评估患者病情及制定围手术期治疗方案,重视围手术期镇痛和早期功能锻炼、离床活动.     

5-氨基酮戊酸-光动力(ALA-PDT)联合CO2激光治疗尖锐湿疣的疗效分析

目的 探讨5氨基酮戊酸光动力疗法(ALA PDT)联合治疗尖锐湿疣(condylomata acuminata)的疗效.方法 对102例患者随机分2组,其中男性62例,女性40例,A组为氨基酮戊酸-光动力(ALA-PDT)联合CO2激光治疗,B组为CO2激光治疗(对照).7～10 d治疗1次,根据病情不同共治疗2～6次,对每次治疗后的不良反应、疗效做出评价.结果 A组(治疗组)2次治愈为13.3％,4次治愈为70.0％,6次治愈为8.33％.B组(对照组)2次治愈为9.52％,4次治愈为42.8％,6次治愈为14.3％.A组总治愈率为91.6％,明显高于B组的66.6％,2种方法对尖锐湿疣的疗效比较,治疗组高与对照组,差异有统计学意义(x2 =3.93,P＜0.05).结论 5-氨基酮戊酸光动力疗法联合CO2激光选择性较高、清除率高、复发率低、治疗周期短、操作简便、术后无需特殊处理,优于单纯CO2激光治疗尖锐湿疣,临床值得推广.     

持续细管引流联合金黄色葡萄球菌滤液制剂治疗老年难治性复发性气胸28例

目的 评价持续细管引流联合金黄色葡萄球菌滤液制剂(恩格菲)治疗老年难治性复发性气胸的临床效果.方法 28例难治性复发性气胸患者,用14G中心静脉导管代替普通硅胶管行胸膜腔闭式引流,12例复发性气胸患者胸腔内注入恩格菲时机选在插管后第3～4天,16例插管后超过2周未愈患者也予注药.结果 18例于胸腔内注药后第1～3天肺复张,6例1周后肺仍未复张,再次注药治愈,2例重复3次注药治愈,2例经3次注药无效转外科手术治疗,治愈率达92.9%(26/28).结论 持续细管引流联合恩格菲治疗老年难治性复发性气胸的临床效果明显.不良反应轻,值得在内科普通病房推广应用.     

腰椎间盘突出症167例疗效分析

目的 探讨综合疗法治疗腰椎间盘突出症的疗效.方法 将167例腰椎间盘突出症患者随机分为综合疗法组92例和对照组75例,综合疗法组采用腰椎三维牵引、推拿、药酒内服和中药离子导入,配以腰围固定、腰背肌力训练等综合治疗.对照组采用药酒内服和直流电中药导入治疗.结果 综合治疗组92例中,治愈54例,好转36例,未愈2例,治愈率58.70% 对照组75例中,治愈24例,好转32例,未愈19例,治愈率32.00%.两组患者治愈率经统计学分析,差异有显著性意义（P〈0.01）.结论 综合疗法治疗腰椎间盘突出症能发挥各疗法的协同作用,疗效显著,适用于基层医院康复治疗.     

预见性护理管理在肾结石术后尿路感染患者中的应用效果

目的:探讨预见性护理管理在肾结石术后尿路感染患者中的应用效果.方法:选择2018年5月至2019年5月我院收治的肾结石术后尿路感染患者80例,根据盲抽法将其分为两组,各40例.对照组施行常规护理,观察组施行预见性护理管理,比较两组尿路感染发生率、治疗依从性.结果:干预后1周、2周,观察组尿路感染发生率比对照组低,差异具有统计学意义(P<0.05);护理干预后2周,观察组治疗依从性比对照组高,差异具有统计学意义(P<0.05).结论:预见性护理管理在肾结石术后尿路感染患者应用中效果明显,可提高患者治疗依从性.     

玉屏风散二联治疗复发性单纯疱疹病毒性角膜炎临床研究

目的 探讨玉屏风散二联治疗复发性单纯疱疹病毒性角膜炎临床效果,为临床防治复发性单纯疱疹病毒性角膜炎提供参考依据.方法 选取眼科2009年1月-2011年5月复发性单纯疱疹病毒性角膜炎患者140例140眼,随机分为两组,各70例70眼,其中对照组采用常规西医治疗,包括阿昔洛韦滴眼液、干扰素滴眼液及更昔洛韦眼用凝胶等,联合治疗组在对照组治疗基础上,加用玉屏风散,比较两组患者的治疗效果.结果 对照组与联合治疗组患者治愈率分别为52.9％、82.9％,而两组患者治疗总有效率分别为85.7％、98.6％,联合治疗组患者治愈率及治疗总有效率均明显高于对照组(P＜0.05);对照组与联合治疗组患者临床治愈时间分别为(29.7±5.2)d、(20.4±3.0)d,联合治疗组患者临床治愈时间明显少于对照组(P＜0.05);对照组与联合治疗组患者随访复发率分别为42.9％、7.1％,联合治疗组患者随访复发率明显低于对照组(P＜0.05).结论 玉屏风散二联治疗复发性单纯疱疹病毒性角膜炎较单纯西医治疗,能够有效提高临床治疗效果,缩短病程,降低复发风险.     

Recurrent uncomplicated urinary tract infections in women: a review

Recurrent urinary tract infections most often present with symptoms of irritative voiding. In most cases, they are caused by reinfection with a previously isolated organism. Patients with one or more symptoms of uncomplicated recurrent urinary tract infection should undergo thorough examination and screening for underlying comorbidities that increase susceptibility. When frequent reinfections, empiric treatment relapse, persistent infections, or risk factors for complicated infections are encountered, patients may benefit from urodynamics, cystoscopy, renal ultrasound, intravenous urogram, or voiding cystourethrogram to evaluate for anatomic, functional, or metabolic abnormalities affecting the urinary tract (e.g., stones, stricture, obstruction, vesicoureteral reflux, lesions, detrusor underactivity). These patients may benefit from culture-guided empiric treatment and further evaluation by urology, nephrology, or infectious disease specialists. In patients with a history of uncomplicated urinary tract infections, empiric treatment guided by local antimicrobial resistance may efficiently treat a suspected recurrence. After successful treatment of the acute infection, postcoital prophylaxis, continuous prophylaxis, or self-start empiric treatment may be selected based on frequency of recurrent infections, temporal relation to intercourse, and patient characteristics. Ancillary measures such as probiotics, cranberry products, or local estrogen replacement may also be considered. This article will review the current definition, epidemiology, pathogenesis, diagnosis, work-up, treatment, treatment side effects, and prevention of recurrent urinary tract infections in women. A suggested algorithm for evaluation and treatment based on current literature is provided.     

Urethral overdilatation in females with lower urinary tract symptoms.

The long-term results of using the Otis urethrotome as a dilator only in females with lower urinary tract symptoms are reported. Out of 103 patients, 80% were symptomatically improved or cured at initial follow up and this was maintained at 18 months in 62% of cases. Optimal, long-term results (78% improvement or cure) were obtained in the subgroup of patients who had recurrent urinary tract infections. The results compare favourably with those reported following urethrotomy. The advantages of urethral overdilatation are discussed.     

经皮肾镜取石术治疗90例上尿路结石的体会

目的：探讨经皮肾镜取石术（PCNL）治疗上尿路结石治疗体会。方法：回顾性分析行B超引导下PCNL治疗上尿路结石90例患者的临床资料。结果：手术时间40～110min,平均（70.5±8.3）min。Ⅰ期手术86例,Ⅱ期手术4例。失血量与手术时间、穿刺路径呈正相关,与肾积水程度呈负相关。术后15例出现不同程度的发热,抗感染治疗后,均恢复正常。8例术后出现出血,予以夹闭肾造瘘管、止血剂、输血等治疗,7例获得成功,其中1例出血严重,行开放患肾切除。所有患者术中均无胸膜、肠管及肾邻近脏器损伤。结论：PCNL治疗上尿路结石安全有效,值得在临床上推广。     

输尿管上段结石合并尿路感染的微创治疗体会：附40例报告

目的总结输尿管上段结石合并尿路感染的微创治疗经验。方法回顾性分析2009年12月至2013年12月收治的40例输尿管上段结石合并尿路感染患者的临床病历资料,并结合文献进行总结。结果一期膀胱镜下逆行插管21例、B超引导下行经皮肾穿刺造瘘11例,2—6d后感染均得到控制,上述32例患者二期行体外冲击波碎石（ESWL）、经尿道输尿管镜碎石术（URL）或经皮。肾取石术（PCNL）治疗成功。其余8例在抗感染同时一期行URL成功。所有患者均无输尿管穿孔、撕裂、尿源性脓毒血症及严重出血等并发症,术后2～10周输尿管结石全部排净,平均住院时间13．4d。结石排净后随访1—12个月,平均6个月。其中3例术前肾功能不全接受URL患者肾功能改善,余肾功能均恢复正常。结论一期膀胱镜下逆行插管或经皮肾穿刺造瘘联合二期行ESWL、URL或PCNL治疗输尿管结石合并尿路感染,并发症少,可迅速控制感染,彻底清除结石,二者联合应用是输尿管上段结石合并尿路感染的理想治疗方法。     

Effects of magnesium hydroxide in renal stone disease.

Magnesium is a known inhibitor of the formation of calcium oxalate crystals in the urine and was proposed for prophylactic treatment in renal stone disease as early as the 17th and 18th centuries. We have treated 55 patients with recurrent renal calcium stone disease without signs of magnesium deficiency (normal serum magnesium, urinary magnesium, intracellular magnesium in muscle biopsies, gastrointestinal absorption of 28Mg, and magnesium loading test) from our outpatient stone clinic for up to four years with 500 mg Mg2+, in the form of Mg(OH)2, daily. The mean stone episode rate before therapy was 0.8 stones/year/patient. Forty-three recurrent renal calcium stone-formers without medical therapy served as controls. Serum magnesium increased initially but after one year returned to the pretreatment level. Urinary magnesium excretion increased promptly and remained elevated during the follow-up period. The urinary calcium excretion remained unchanged. The magnesium/calcium ratio in the urine increased and approached a value earlier found in healthy subjects without stone disease. Urinary citrate increased on therapy when analysed after three years of treatment. The mean stone episode rate decreased from 0.8 to 0.08 stones/year on treatment and 85% of the patients remained free of recurrence during follow-up, whereas 59% of the patients in the control group continued their stone formation. Side effects were few. Magnesium treatment in renal calcium stone disease is effective with few side effects. No clinical signs of magnesium excess were observed.     

Effects of magnesium hydroxide in renal stone disease

Magnesium is a known inhibitor of the formation of calcium oxalate crystals in the urine and was proposed for prophylactic treatment in renal stone disease as early as the 17th and 18th centuries. We have treated 55 patients with recurrent renal calcium stone disease without signs of magnesium deficiency (normal serum magnesium, urinary magnesium, intracellular magnesium in muscle biopsies, gastrointestinal absorption of 28Mg, and magnesium loading test) from our outpatient stone clinic for up to four years with 500 mg Mg2+, in the form of Mg(OH)2, daily. The mean stone episode rate before therapy was 0.8 stones/year/patient. Forty-three recurrent renal calcium stone-formers without medical therapy served as controls. Serum magnesium increased initially but after one year returned to the pretreatment level. Urinary magnesium excretion increased promptly and remained elevated during the follow-up period. The urinary calcium excretion remained unchanged. The magnesium/calcium ratio in the urine increased and approached a value earlier found in healthy subjects without stone disease. Urinary citrate increased on therapy when analysed after three years of treatment. The mean stone episode rate decreased from 0.8 to 0.08 stones/year on treatment and 85% of the patients remained free of recurrence during follow-up, whereas 59% of the patients in the control group continued their stone formation. Side effects were few. Magnesium treatment in renal calcium stone disease is effective with few side effects. No clinical signs of magnesium excess were observed.     

医院获得性真菌尿路感染的临床特点

目的了解我院真菌尿路感染现状. 方法回顾分析我院医院感染调查中73例真菌尿路感染的临床特点. 结果平均年龄54.49岁,≥60岁占42.47%,平均住院日54.76 d;与恶性肿瘤、长期卧床、危重疾病有关;发生真菌感染前抗生素使用率100%,78.08%联用≥2种抗生素,平均使用抗生素时间为(35±14)d;有导尿等泌尿系操作47.95%;临床表现不典型,抗真菌治疗效果欠佳,病死率24.66%. 结论年龄大、住院时间长、长期卧床及长期用抗生素者易发生真菌尿路感染,症状不典型,预后差.     

三聚氰胺致肾结石患儿的诊治

目的探讨三聚氰胺奶粉导致婴幼儿肾结石的临床诊断治疗效果。方法对该院2010年9月—2011年12月收治的43例三聚氰胺奶粉导致泌肾结石患儿的临床资料进行回顾性分析,患儿接受保守治疗,每日对患儿尿液pH值进行监测,观察尿结晶是否排出。结果 43例肾结石患儿超声检查结果显示大多数患儿结石大小为0.4～1.0cm,部分患儿伴有肾积水、输尿管扩张、集合系统分离。经过15～30d内科保守治疗后,患儿肾结石体积逐渐变小直至消失,患儿肾积水症状出现明显好转,肾功能恢复正常。结论采用内科保守治疗三聚氰胺奶粉导致泌肾结石患儿,溶石效果良好,临床治愈率高。     

Infection control in a skilled nursing facility: a 6-year survey

In 1981 an infection control programme was started in a 320-bed skilled nursing facility in The Netherlands. The programme consisted of recording the antimicrobial drugs prescribed and the site of infection, culture of urine from patients admitted from hospital and from residents with suspected symptomatic urinary tract infection, restriction of long-term indwelling urethral catheterization and restricted use of antimicrobial drugs. At a weekly staff meeting, these data were reviewed. As a result of the programme, the number of treatments for urinary tract infections decreased by 74% between 1981 and 1986, and the number of courses for recurrent urinary tract infections decreased from 18 to 6% of the total number given. The patients who did not require antimicrobial therapy increased from 51% in 1981 to 70% in 1986.     

不同年龄段女性复发性尿路感染的临床分析

目的:观察不同年龄段女性复发性尿路感染的临床特点,评价单用抗生素或联合中药治疗的疗效。方法:观察女性复发性尿路感染患者156例,其中育龄期组90例,更年期和老年期组66例。所有患者予以抗生素治疗,部分患者同时联用清热利湿复方中药治疗。观察治疗前后临床症状、体征和实验室检查结果,药物治疗结束后观察随访半年。结果:更年期和老年期女性较育龄期女性复发性尿路感染症状不典型,随访期复发率高。联合中药治疗能显著减少复发率,改善症状。结论:临床医生在诊治女性复发性尿路感染时应该考虑不同年龄段的临床特点,合理选择诊疗方案。