重症监护室机械通气患者发生呼吸机相关肺炎的危险因素分析及护理策略

目的 探讨重症监护室（ICU）机械通气患者发生呼吸机相关肺炎（VAP）的危险因素及护理策略。方法 选取86例ICU机械通气患者,根据是否合并VAP分为VAP组（n=41）和非VAP组（n=45）。比较两组的临床特征,采用Logistic回归分析ICU机械通气患者发生VAP的影响因素。结果 VAP组机械通气时间≥10 d、意识障碍、留置胃管、未预防性应用抗生素占比均高于非VAP组（P <0.05）。Logistic回归分析显示,VAP组机械通气时间≥10 d、意识障碍、留置胃管是ICU机械通气患者发生VAP的独立危险因素（OR>1, P <0.05）,而预防性应用抗生素是ICU机械通气患者发生VAP的保护因素（OR<1, P<0.05）。结论 ICU机械通气患者发生VAP的影响因素较多,临床应针对危险因素制定相应干预措施,以降低VAP发生风险。     

综合重症监护病房呼吸机相关性肺炎危险因素调查分析

目的 调查分析综合重症监护病房(ICU)呼吸机相关性肺炎(VAP)的危险因素.方法 采用前瞻性的调查方法,对2008年2-12月在综合ICU住院并行机械通气的233例患者发生VAP情况进行调查.结果 233例患者中发生VAP72例,感染率为30.9%;VAP发生率:住ICU时间>7d者为51.9%(56/108),机械通气时间>14d者为68.6%(24/35).气管切开、留置胃管者的VAP发生率与气管未切开、未留置胃管者之间的差异有统计学意义(P<0.05),而使用糖皮质激素、制酸剂及昏迷者与未使用者及未昏迷者VAP发生率差异无统计学意义(P>0.05).结论 综合ICU VAP的高发生率与多种临床因素,如住ICU时间、机械通气时间、气管切开、留置胃管有关.     

52例ICU呼吸机相关性肺炎危险因素及病原学分析

目的 探讨ICU呼吸机相关性肺炎(VAP)的危险因素、病原菌分布及耐药性.方法 回顾性分析医院呼吸科重症监护病房和外科重症监护病房2010年5月-2011年8月收治的进行机械通气138例患者临床资料,并对所有患者进行APACHEⅡ评分和CPIS评分.结果 单因素分析表明,气管切开、昏迷、住ICU≥5d、机械通气≥4 d、使用镇静剂、使用激素、留置胃管与VAP相关,logistic回归分析显示,住ICU≥5d、留置胃管和昏迷是发生VAP的独立危险因素;VAP组APACHEⅡ评分(21.8±7.4)明显高于非VAP组(14.5±4.8),差异有统计学意义(P＜0.05),两组间CPIS评分比较差异无统计学意义;52例VAP患者中共分离出164株病原菌,其中革兰阴性菌104株占63.4％,革兰阳性菌35株占21.3％,真菌25株占15.2％,鲍氏不动杆菌、铜绿假单胞菌、金黄色葡萄球菌是VAP的主要致病菌.结论 住ICU≥5d、留置胃管和昏迷是发生VAP的危险因素,APACHEⅡ评分可作为预测VAP感染的指标,导致VAP的各种病原菌普遍耐药性较强.     

改进鼻饲方法对控制呼吸机相关性肺炎的应用研究

目的:探讨应用改进鼻饲方法对ICU内行机械通气(MV)患者呼吸机相关性肺炎(VAP)发生情况的影响.方法:将桐庐县中医院近年来收治的行机械通气治疗48h以上,且行肠内营养的104例患者随机分为观察组(53例)和对照组(51例),对照组采用普通胃管,用常规的方法留置胃管;观察组采用改进鼻饲方法,并结合声门下负压吸引.之后观察、比较两组患者的VAP发生率及机械通气时间.结果:观察组患者VAP发生率低于对照组(P＜0.05,差异有统计学意义);观察组患者的通气时间较对照组缩短(P＜0.05,差异有统计学意义).结论:MV患者改进鼻饲方法能有效地预防VAP的发生,值得在基层医院ICU推广应用.     

呼吸机相关性肺炎的危险因素与口腔护理预防效果分析

目的分析呼吸机相关性肺炎(VAP)的危险因素及其口腔护理预防效果,为降VAP提供参考依据。方法收集2012年12月-2015年5月医院心胸外科210例行机械通气患者临床资料,将其随机分为对照组和干预组,每组各105例,对照组患者给予常规口腔护理,干预组患者采用口腔生理盐水冲洗,记录两组患者VAP发生及预后;对机械通气患者发生VAP的危险因素进行多因素logistic回归分析,采用SPSS 16.0软件进行统计分析。结果干预组患者VAP发生率、病死率分别为14.29%、4.76%,显著低于对照组患者的44.76%、13.33%,差异均有统计学意义(P0.05);VAP患者共检出病原菌85株,其中革兰阴性菌、革兰阳性菌、真菌分别占63.53%、30.59%、5.88%;年龄≥65岁、住院时间≥21d、机械通气时间≥14d、APACHEⅡ评分≥18分、有侵入性操作、意识障碍、合并基础疾病、预防性应用抗菌药物是机械通气患者发生VAP的危险因素(P0.05);其中年龄≥65岁、机械通气时间≥14d、APACHEⅡ评分≥18分、侵入性操作是患者发生VAP的独立危险因素(P0.05)。结论口腔生理盐水冲洗可降低机械通气患者呼吸机相关性肺炎发生率,年龄、机械通气时间、APACHEⅡ评分、侵入性操作为机械通气患者发生VAP的危险因素。     

呼吸机相关性肺炎的危险因素分析及护理对策

目的 调查呼吸机相关性肺炎(VAP)发生的危险因素,探讨相应的护理对策.方法 回顾性分析226例行机械通气患者VAP发生率、病原菌特点、相关危险因素及护理措施,总结预防和控制VAP的有效护理干预对策.结果 226例行机械通气患者发生VAP 49例,发生率为21.7％,随年龄增长VAP发病率逐渐上升(P＜0.05)；基础疾病中慢性阻塞性肺疾病(COPD)并发VAP 20例,发生率40.8％；通气时间＞15 d患者VAP发生率明显增高(P＜0.05)；VAP患者共检出病原菌114株,革兰阴性菌占65.4％,革兰阳性菌占24.0％,真菌10.6％；鲍氏不动杆菌、铜绿假单胞菌、金黄色葡萄球菌、肺炎克雷伯菌是VAP主要致病菌；机械通气、原发基础疾病、抗菌药物不合理使用等因素是VAP的重要危险因素.结论 VAP发生与危险因素存在密切相关；严格护理操作,加强对危险因素控制及护理干预,减少VAP发生率.     

探讨重症监护室呼吸机相关性肺部感染的危险因素分析

目的:探讨重症监护室(ICU)呼吸机相关性肺部感染(VAP)的危险因素及防御对策.方法:选取我院2014年1月—2015年12月ICU实行机械通气治疗患者1024例作为研究对象,回顾性分析其临床资料,探讨相关性肺炎诱发危险因素及制定防御对策.结果:1024例患者的年龄、意识状态、机械通气时间、基础疾病、气管切开与VAP的发生密切相关,差异有统计学意义(P<0.05);多因素logistic回归分析结果提示:年龄≥60岁、气管切开、机械通气时间≥3 d、意识昏迷以及合并基础疾病等因素是ICUVAP发生的独立危险因素(P<0.05).结论:通过对VAP发生情况及其危险因素进行分析,医护人员需要加强对患者的监测并进行针对性的预防措施,降低VAP发生率,提高患者生活质量具有重要的意义.     

呼吸机相关肺炎相关因素分析及综合干预措施的预防效果

目的探讨呼吸机相关肺炎(VAP)的相关因素及综合干预措施对其预防效果。方法回顾性分析2015年12月-2016年12月本院重症监护室(ICU)内进行机械通气超过48h的患者132例为研究对象,分为试验组和对照组,各66例,对照组患者进行常规治疗,试验组患者在常规治疗的基础上给予综合干预措施,观察两组患者的VAP发生率、机械通气时间及住ICU时间,归纳患者发生VAP的相关因素。结果 132例患者VAP发生率为42.42%(56/132),试验组发生VAP 12例少于对照组((P0.001)),同时试验组患者机械通气时间及住ICU时间分别为(6.32±2.15)天及(10.23±2.13)天均低于对照组(P0.05);意识障碍、低蛋白血症、使用糖皮质激素、脱机失败再次插管、机械通气时间、急性生理与慢性健康评分(APACHEⅡ)是患者VAP发生的相关因素(P0.05)。结论 VAP的发生率较高,影响ICU患者VAP发生的因素较多,对机械通气患者给予综合干预措施能有效降低VAP发生率,减少患者机械通气时间及住ICU时间,具有一定临床价值。     

集束化护理方案预防呼吸机相关性肺炎的效果观察

目的 探讨集束化护理方案在预防呼吸机相关性肺炎(VAP)的效果,为临床治疗提供参考.方法 选取2010年1-12月收住ICU的176例机械通气≥48 h患者为集束化组,患者均采取抬高床头30～45度、持续声门下吸引、密闭式吸痰、人工鼻的应用、加强口咽部管理、严格洗手等集束化护理干预措施,选取2009年1-12月ICU收治的163例机械通气≥48 h患者为对照组,比较两组患者VAP发生率、机械通气时间、ICU住院时间及痰病原学检查结果.结果 与对照组相比,采用集束化护理方案后VAP发生率由25.15％降至15.91％,差异有统计学意义(P＜0.05);机械通气时间由(13.5±5.6)d缩短至(8.5±4.2)d,差异有统计学意义(P＜0.05),ICU住院时间由(21.17±17.62)d缩短至(13.42±9.23)d,差异有统计学意义(P＜0.01);两组患者病原菌均以革兰阴性菌为主,差异无统计学意义.结论 集束化护理方案对预防VAP有着重要的意义,加强对医护人员的培训,提高集束化护理方案的依从性和完善的质量控制是降低VAP的关键.     

重症患者呼吸机相关性肺炎的危险因素及预防策略

目的 探讨重症患者呼吸机相关性肺炎(VAP)的发病危险因素和预防策略.方法 对医院2009年6月-2011年5月ICU收治的入科时无肺部感染且进行机械通气＞48 h患者的临床资料进行回顾性调查分析.结果 183例患者发生VAP83例,发生率45.4％,所有VAP患者共检出病原菌165株,其中革兰阴性杆菌最常见,占69.70％,革兰阴性杆菌中以乙酸钙鲍氏复合不动杆菌最多,占39.39％;其他病原菌革兰阳性球菌占25.45％和真菌占4.85％;年龄≥60岁、机械通气时间≥5d、意识障碍、曾使用制酸剂、白蛋白＜30 g和侵入性操作为VAP发生的危险因素.结论 重症患者VAP的发生与上述危险因素有关,应采取严密监控、规范洗手、加强保护性护理、严格呼吸道管理、改进营养支持方法等针对性的非药物干预措施,以减少VAP的发生.     

Investigation and Control of Anthrax Outbreak at the Human–Animal Interface,Bhutan, 2010

In 2010, we investigated anthrax outbreak in Bhutan. A total of 43 domestic animals died, and cutaneous anthrax developed in 9 persons, and 1 died. All affected persons had contact with the carcasses of infected animals. Comprehensive preparedness and response guidelines are needed to increase public awareness of anthrax in Bhutan.     

Risk for Travel-associated Legionnaires’ Disease,Europe, 2009

Legionnaires’ disease is underreported in Europe; notification rates differ substantially among countries. Approximately 20% of reported cases are travel-associated. To assess the risk for travel-associated Legionnaires’ disease (TALD) associated with travel patterns in European countries, we retrieved TALD surveillance data for 2009 from the European Surveillance System, and tourism denominator data from the Statistical Office of the European Union. Risk (number cases reported/number nights spent) was calculated by travel country. In 2009, the network reported 607 cases among European travelers, possibly associated with 825 accommodation sites in European Union countries. The overall risk associated with travel abroad was 0.3 cases/million nights. We observed an increasing trend in risk from northwestern to southeastern Europe; Greece had the highest risk (1.7). Our findings underscore the need for countries with high TALD risks to improve prevention and control of legionellosis; and for countries with high TALD risks, but low notification rates of Legionnaires’ disease to improve diagnostics and reporting.     

Travel-associated Diseases,Indian Ocean Islands, 1997–2010

Data collected by the GeoSentinel Surveillance Network for 1,415 ill travelers returning from Indian Ocean islands during 1997–2010 were analyzed. Malaria (from Comoros and Madagascar), acute nonparasitic diarrhea, and parasitoses were the most frequently diagnosed infectious diseases. An increase in arboviral diseases reflected the 2005 outbreak of chikungunya fever.     

Haemophilus ducreyi Associated with Skin Ulcers among Children,Solomon Islands

During a survey of yaws prevalence in the Solomon Islands, we collected samples from skin ulcers of 41 children. Using PCR, we identified Haemophilus ducreyi infection in 13 (32%) children. PCR-positive and PCR-negative ulcers were phenotypically indistinguishable. Emergence of H. ducreyi as a cause of nongenital ulcers may affect the World Health Organization’s yaws eradication program.     

Long-Term Survival Among Histological Subtypes in Advanced Epithelial Ovarian Cancer: Population-Based Study Using the Surveillance,Epidemiology, and End Results Database

BackgroundActual long-term survival rates for advanced epithelial ovarian cancer (EOC) are rarely reported.ObjectiveThis study aimed to assess the role of histological subtypes in predicting the prognosis among long-term survivors (≥5 years) of advanced EOC.MethodsWe performed a retrospective analysis of data among patients with stage III-IV EOC diagnosed from 2000 to 2014 using the Surveillance, Epidemiology, and End Results cancer data of the United States. We used the chi-square test, Kaplan–Meier analysis, and multivariate Cox proportional hazards model for the analyses.ResultsWe included 8050 patients in this study, including 6929 (86.1%), 743 (9.2%), 237 (2.9%), and 141 (1.8%) patients with serous, endometrioid, clear cell, and mucinous tumors, respectively. With a median follow-up of 91 months, the most common cause of death was primary ovarian cancer (80.3%), followed by other cancers (8.1%), other causes of death (7.3%), cardiac-related death (3.2%), and nonmalignant pulmonary disease (3.2%). Patients with the serous subtype were more likely to die from primary ovarian cancer, and patients with the mucinous subtype were more likely to die from other cancers and cardiac-related disease. Multivariate Cox analysis showed that patients with endometrioid (hazard ratio [HR] 0.534, P<.001), mucinous (HR 0.454, P<.001), and clear cell (HR 0.563, P<.001) subtypes showed better ovarian cancer-specific survival than those with the serous subtype. Similar results were found regarding overall survival. However, ovarian cancer–specific survival and overall survival were comparable among those with endometrioid, clear cell, and mucinous tumors.ConclusionsOvarian cancer remains the primary cause of death in long-term ovarian cancer survivors. Moreover, the probability of death was significantly different among those with different histological subtypes. It is important for clinicians to individualize the surveillance program for long-term ovarian cancer survivors.     

Dengue Virus Transmission by Blood Stem Cell Donor after Travel to Sri Lanka; Germany, 2013

Three days after donation of peripheral blood stem cells to a recipient with acute myeloblastic leukemia, dengue virus was detected in the donor, who had recently traveled to Sri Lanka. Transmission to the recipient, who died 9 days after transplant, was confirmed.     

大龄单身女性寻求生育力保存的伦理问题探析

近年来,在肿瘤和卵巢相关疾病发生率逐年增加、不少大龄单身女性渴望为自己购买一份“生殖保险”等社会及个人因素催化下,人类对于生育力保存的需求急剧增加,满足这一需求正在或将成为重大挑战。对于寻求进行生育力保存的大龄单身女性来说,在合适的年龄应用玻璃化冷冻技术将其卵母细胞冻存是目前可采用的最佳生育力保存手段。而单身女性卵子冷冻将面临来自伦理道德、社会乃至法律的巨大挑战。本文概述国内外大龄单身女性卵子冷冻的现状,并对其可能涉及的相关伦理问题及解决途径进行综述,以促进理性正视单身女性卵子冷冻问题。     

Outbreak of Panton-Valentine Leukocidin–Associated Methicillin-Susceptible Staphylococcus aureus Infection in a Rugby Team,France, 2010–2011

Staphylococcus aureus strains that produce Panton-Valentine leukocidin are known to cause community infections. We describe an outbreak of skin abscesses caused by Panton-Valentine leukocidin–producing methicillin-susceptible S. aureus (clonal complex 121) in a professional rugby team in France during July 2010–February 2011. Eight team members were carriers; 7 had skin abscesses.     

Reemergence and Autochthonous Transmission of Dengue Virus,Eastern China, 2014

In 2014, 20 dengue cases were reported in the cities of Wenzhou (5 cases) and Wuhan (15 cases), China, where dengue has rarely been reported. Dengue virus 1 was detected in 4 patients. Although most of these cases were likely imported, epidemiologic analysis provided evidence for autochthonous transmission.