护理干预在预防重症监护病房患者铜绿假单胞菌感染中的应用

目的探讨护理干预在预防重症监护病房患者铜绿假单胞菌感染中的应用效果。方法选择2009年1月至2010年12月我院重症监护病房80例患者作为对照组,2011年1月至2012年12月我院重症监护病房入住的80例患者作为观察组。对照组患者实施常规护理,观察组患者给予预防性护理,观察两组患者铜绿假单胞菌感染率和患者满意度。结果观察组患者铜绿假单胞菌感染感染率明显低于对照组,患者满意度明显优于对照组,差异均有统计学意义。结论在重症监护病房内给予预防性护理可以有效减少铜绿假单胞菌的感染,提高患者满意度。     

ICU铜绿假单胞菌感染的危险因素分析及应对对策

目的研究ICU铜绿假单胞菌感染的危险因素,并对相应对策进行分析。方法选择2009年4月至2011年4月我院接诊的200例重症监护室（ICU）患者,进行研究。将200例患者按照是否感染铜绿假单胞菌,分为实验组和对照组两组。每组各100例。实验组100例患者均在治疗过程中发生铜绿假单胞菌,对照组患者未出现铜绿假单胞菌。通过对两组患者治疗过程中危险因素进行单因素和多因素分析,研究ICU铜绿假单胞菌感染的危险因素。结果对实验组和对照组两组患者治疗过程中的各项危险因素进行分析。发现实验组患者平均住院时间明显长与对照组垆〈0．01）;实验组进行气管插管（或切开）和机械通气的病例数明显多与对照组（P〈0．01）;实验组患者亚胺培南、大环内酯类、喹诺酮类等抗生素的使用的病例数明显多与对照组（P〈0．01）。结论ICU铜绿假单胞菌感染的危险因素有平均住院时间、进行气管插管（或切开）和机械通气的病例数及亚胺培南、大环内酯类、喹诺酮类等抗生素的使用,需采取恰当的护理应对措施才能减少ICU铜绿假单胞菌感染的发生率。     

心理护理干预对传染病患者负性情绪的影响效果观察

目的研究心理护理干预对传染病患者负性情绪的影响效果。方法 66例存在负性情绪的传染病患者,随机分为对照组与干预组,每组33例。对照组病患采取常规护理,干预组病患在其基础之上采取心理护理干预。观察并比较两组临床效果。结果干预组病患的抑郁、焦虑评分下降度及患者护理满意度均比对照组高,心理护理效果优良,两组比较差异具有统计学意义(P<0.05)。结论科学的心理护理干预措施能够有效消除传染病患者的负性情绪,降低其抑郁、焦虑的程度,促进疾病恢复。     

强化护理管理对ICU患者泌尿系统感染的影响分析

目的对强化护理管理对ICU患者泌尿系统感染的影响进行分析。方法选取2010年10月至2012年10月在我院重症监护室内治疗患者80例,随机分为两组患者,常规组患者40例,应用常规护理干预措施;强化组患者40例,进行强化护理管理,对比两种护理干预对控制和降低泌尿系统感染效果。结果强化护理管理组患者泌尿系统感染率、护理满意度、住院时间均显著优越于常规组患者,差异性明显,具有统计学意义(P<0.05)。两组患者均未发生因护理干预措施不当导致的严重不良后果。结论针对ICU患者进行强化护理管理措施可显著降低重症监护室内患者泌尿系统感染率、缩短重症监护室治疗时间、提高患者满意度,安全可靠,适宜进行临床广泛应用和推广。     

罗红霉素干预治疗铜绿假单胞菌肺部感染的临床研究

目的:探讨罗红霉素干预治疗铜绿假单胞菌肺部感染的疗效。方法:64例铜绿假单胞菌肺部感染患者随机分为两组,试验组口服罗红霉素0.15 g,bid,同时静滴一种药敏试验对铜绿假单胞菌敏感的抗菌药;对照组仅给予一种药敏试验对铜绿假单胞菌敏感的抗菌药静滴。两组疗程均为2周。结果:试验组的临床痊愈率、有效率显著高于对照组,症状、体征好转及中性粒细胞比例恢复正常的平均天数也明显低于对照组,细菌清除率明显高于对照组(P均<0.05)。结论:罗红霉素联合敏感抗菌药治疗铜绿假单胞菌肺部感染的疗效优于单用敏感抗菌药。     

神经内科重症感染患者感染的原因、临床特点及其护理对策

目的分析探讨神经内科重症感染患者的感染原因、临床特点及其护理对策。方法选择2013年4月至2014年5月我院收治的80例神经内科重症感染患者作为研究对象,随机将其分成两组,对照组40例,对其进行常规护理,实验组40例,在常规护理的基础上进行护理干预,并分析对比两组患者的临床资料。结果 1年龄、住院时间、创伤性操作、抗生素使用时间是导致神经内科重症患者感染的主要原因;2主要感染部位为呼吸道感染,共31例,占总比的38.75%,主要感染病菌原为铜绿假单胞菌,共39例,占总比的48.75%;3实验组患者护理后的临床护理满意度为92.50%,共37例患者表示满意,对照组患者护理后的临床护理满意度为72.50%,共29例患者表示满意(P<0.05),差异具有统计学意义。结论年龄、住院时间、创伤性操作、抗生素使用时间是导致神经内科重症患者感染的主要原因;神经内科重症感染患者的主要感染部位为呼吸道,铜绿假单胞菌为主要感染病菌,故应该采取有效的临床护理干预措施对患者进行临床护理。     

外科重症监护病房中铜绿假单胞菌耐药性及同源性分析

目的 研究外科重症监护室(ICU)临床分离铜绿假单胞菌的耐药性及遗传相关性.方法 收集本院于2007年3月至2008年3月的外科ICU住院病人非痰标本中的铜绿假单胞菌2l株,采用琼脂2倍稀释法,测定铜绿假单胞菌对15种抗菌药物的敏感性;利用脉冲场凝胶电泳技术分析其遗传同源性.结果 21株铜绿假单胞菌对其中8种抗菌药物耐药率较高,耐药率均在57%以上;并且有2株对所测15种抗菌药物均耐药,属泛耐药细菌;21株铜绿假单胞菌中大多具有很高的同源性.结论 外科ICU分离的铜绿假单胞菌对常用抗菌药物耐药率高,耐药情况严重,且大多来源于同一克隆.     

外科重症监护病房铜绿假单胞菌耐药性分析

目的了解南京军区南京总医院外科重症监护病房(ICU)标本中分离的铜绿假单胞菌的耐药情况,并与普通病房比较。方法采用K-B纸片扩散法,用8种抗菌药物对分离的786株铜绿假单胞菌进行药敏试验。结果外科ICU与普通病房铜绿假单胞菌对8种抗菌药物的耐药率,有非常显著性差异(P<0.001)。结论外科ICU铜绿假单胞菌耐药严重,应及时进行耐药性检测,采取严格的隔离措施,防止交叉感染。     

综合医院ICU感染的临床研究

目的加强我院综合ICU医院感染的管理,降低细菌的耐药率,减少医院感染的发生。方法对我院综合ICU进行为期1年的医院感染管理干预,比较干预前后综合ICU两种常见菌株(即铜绿假单胞菌、鲍曼不动杆菌菌株)的耐药率变化。结果干预后铜绿假单孢菌及鲍曼不动杆菌对各抗菌药物的耐药率均明显降低,差异具有统计学意义(P<0.05)。结论我院综合ICU的细菌耐药率较高,加强医院感染的管理可以有效降低细菌耐药率,控制医院感染的发生与播散。     

护理干预对ICU医院感染的影响

目的探讨通过护理干预降低ICU医院感染率的对策。方法护理干预组的护理人员强化院内感染知识培训,加强病房管理、基础护理,合理应用抗生素等护理措施。结果常规护理医院感染19例,感染率7.2%;护理干预组医院感染12例,感染率4.6%,两组之间感染率差异有显著性(P<0.05)。结论通过有效的护理措施可以降低医院院内感染率,ICU院内感染是可以防止的。     

Role of glutathione in reduction of arsenate and of gamma-glutamyltranspeptidase in disposition of arsenite in rats

Arsenate (AsV), the environmentally prevalent form of arsenic, is converted sequentially in the body to arsenite (AsIII), monomethylarsonic acid (MMAsV), monomethylarsonous acid (MMAsIII), and dimethylarsinic acid (DMAsV) and some trimethylated metabolites. Although the biliary excretion of arsenic in rats is known to be glutathione (GSH)-dependent, involving transport of arsenic-GSH conjugates, the role of GSH in the reduction of AsV to the more toxic AsIII in vivo has not been defined. Therefore, we studied how the fate of AsV is influenced by buthionine sulfoximine (BSO), which depletes GSH in tissues. Control and BSO-treated rats were given AsV (50 micromol/kg, i.v.) and arsenic metabolites in bile, urine, blood and tissues were analysed by HPLC-HG-AFS. BSO increased retention of AsV in blood and tissues and decreased appearance of AsIII in blood, bile (by 96%) and urine (by 63%). The biliary excretion of MMAsIII was also nearly abolished, the appearance of MMAsIII and MMAsV in the blood was delayed and the renal concentrations of these monomethylated arsenicals were decreased by BSO. Interestingly, appearance of DMAsV in blood and urine remained unchanged and the concentrations of this metabolite in the kidneys and muscle were even increased in response to BSO. To test the role of gamma-glutamyltranspeptidase (GGT) in arsenic disposition, the effect of the of the GGT inhibitor acivicin was investigated in rats injected with AsIII (50 micromol/kg, i.v.). Acivicin lowered the hepatic and renal GGT activities and increased the biliary as well as urinary excretion of GSH, but failed to alter the disposition (i.e. blood and tissue concentrations, biliary and urinary excretion) of AsIII and its metabolites. In conclusion, shortage of GSH decreases not only the hepatobiliary transport of arsenic, but also reduction of AsV and the formation of monomethylated arsenic, while not hindering the production of dimethylated arsenic. While GSH plays an important role in the disposition and toxicity of arsenic, GGT, which hydrolyses GSH and GSH conjugates, apparently does not influence the fate of the GSH-reactive trivalent arsenicals in rats.     

微透析取样技术在中药体内分析中的应用研究进展

本文综述了微透析取样技术在中药体内分析中的应用,介绍微透析取样技术的原理、组成、探针类型、特点,重点阐述了微透析取样技术在测定脑、血液、皮肤等组织器官中中药有效成分浓度的应用实例。表明微透析取样技术在中药药效研究中具有广阔的前景。     

应用PASS系统分析我院2010年住院医嘱

目的:了解我院2010年住院患者的合理用药情况,探讨如何利用合理用药监测系统( PASS)提高合理用药水平.方法:利用PASS对我院2010年15 966例住院患者的1 184 997条用药医嘱进行监测,以黑色警示医嘱为依据,收集不合理用药信息,并对监测结果进行统计、分析.结果:不合理用药医嘱50 261条,发生率为4.24％.绝对禁止黑色医嘱5441条,主要为药物相互作用(66.54％)、注射液体外配伍(17.86％)、用法用量(15.46％)、儿童警告(1.14％).结论:应用PASS系统能有效监测医嘱中的不合理用药情况,有利于提高临床合理用药水平,但PASS系统尚存在局限性,有待进一步完善.     

Changes in levels of dependency and predictors of mortality in elderly people in institutional care in Dunedin

The 1983 study of dependency of subjects in institutional care in Dunedin was repeated two years later. A significant increase in levels of dependency in residential homes, particularly in the Religious and Welfare sector was found. In 1983 there were 29 high dependency residents and 73 medium dependency residents in residential homes. In 1985 these numbers had increased to 55 and 86 respectively. There was no change in the number of low dependency residents. In 1983, 6 high dependency residents had been admitted to residential home care in the year prior to the study. In 1985 the number of high dependency residents recently admitted had increased to 23. There had also been a significant increase in the dependency of patients in Religious and Welfare continuing care hospitals. Of the 933 subjects in institutional care in 1983 who were able to be followed, 354 (37.9%) died in the following 2 years. Mortality rate was higher for those in hospital care (48.1%) than for those in residential home care (29.6%). Mortality rates were higher in more dependent subjects and this was evident for each measure of dependency.     

应用PASS系统对我院2008年住院医嘱的分析

目的监测分析2008年我院住院患者用药情况。方法将PASS系统嵌入医生工作站、临床药学工作站等子系统,构建合理用药计算机网络系统,对住院医嘱进行及时监测,将监测结果向医生反馈,并对其进行统计、分析。结果2008年共监测医嘱3 620 241条,不合理医嘱908条,占0.02%。不合理医嘱中,配伍禁忌(381条)占41.96%,用法用量(381条)占41.96%,药物相互作用(108条)占11.89%,儿童用药(38条)占4.19%。经与医生沟通后,更改不合理医嘱856条,占94.27%。结论PASS系统可有效监测医嘱中的不合理用药,通过与医生交流,大大减少药物不良事件的发生,值得临床推广应用,也为临床药师开展工作带来了极大的便利。但PASS系统尚存在局限性,有待进一步完善。     

Role of desacetylation in the detoxification of cephalothin in renal cells in culture

The toxicity of three cephalosporin antibiotics to rabbit kidney cells in culture was compared to their known nephrotoxic potential in vivo (cephaloridine greater than cefazolin greater than cephalothin). While cephalothin is considered to be a relatively nonnephrotoxic cephalosporin when administered to many species including humans and rabbits, in several in vitro systems involving rabbit renal tissue, cephalothin was comparatively more toxic than anticipated based on in vivo data. Cephalothin is extensively desacetylated in rabbits to a less microbiologically active metabolite, desacetylcephalothin. When a microsomal S9 fraction from rabbit kidney was added to the in vitro assay in cultured rabbit renal cells, cephalothin was desacetylated and its toxicity to kidney cells was reduced. The addition of S9 in vitro provided a toxicity ranking of the cephalosporins that correlated with their known in vivo nephrotoxic potentials (cephaloridine greater than cefazolin greater than cephalothin). The in vitro detoxification of cephalothin by S9 was blocked by the coadministration of the esterase inhibitor, aminocarb. Desacetylcephalothin was relatively nontoxic to rabbit renal tissue in vitro. These results suggest that the desacetylation of cephalothin in vivo represents a previously unrecognized mechanism of detoxification of this cephalosporin antibiotic. Furthermore, this mechanism of detoxification may be applicable to other acetylated cephalosporins.     

2009年某院住院患者抗真菌药用药调查

目的:分析讨论某院抗真菌药使用的合理性,为临床安全有效地使用抗真菌药提供参考。方法:回顾性统计分析某院2009年住院患者抗真菌药用药信息。结果:2009年某院住院患者抗真菌药DDDs排名前3名分别为:氟康唑、制霉菌素和伊曲康唑;使用金额排名前3名分别为:氟康唑、米卡芬净及卡泊芬净;更换一种抗真菌药进行治疗的患者数为176人,在全部患者中占13.4%。结论:应进一步强化用药指征的意识,提高标本送检率,同时改善某些抗真菌用药不合理更换的现象,以避免耐药性发生,从而更好更长远地体现抗真菌药的治疗价值。     

Kinetics of in vitro metabolism of methoxyphenamine in rats

1. Methoxyphenamine (MP) was metabolized in vitro by rat liver preparations to O-desmethylmethoxyphenamine (O-desmethyl-MP), N-desmethylmethoxyphenamine (N-desmethyl-MP) and 5-hydroxymethoxyphenamine (5-hydroxy-MP). These metabolic pathways were inhibited by SKF 525-A and carbon monoxide, which indicates that these reactions were mediated at least partly by an NADPH-dependent cytochrome P-450 system. 2. Strain differences in the metabolism of this drug in vitro were observed in female Lewis and Dark Agouti (DA) rats, which are proposed models for human debrisoquine phenotypes. Methoxyphenamine O-demethylase and 5-hydroxylase activity in DA rats were lower than those in Lewis rats. 3. The metabolic transformation of methoxyphenamine in vitro to O-desmethyl-MP was inhibited competitively by debrisoquine and sparteine. This indicates that the cytochrome P-450 isoenzyme mediating the metabolism of MP to O-desmethyl-MP is similar to that mediating metabolism of debrisoquine and sparteine. However, no inhibition was observed with methenytoin.     

Comparison of in vitro cell models in predicting in vivo brain entry of drugs

Although several in vitro models have been reported to predict the ability of drug candidates to cross the blood-brain barrier, their real in vivo relevance has rarely been evaluated. The present study demonstrates the in vivo relevance of simple unidirectional permeability coefficient (P(app)) determined in three in vitro cell models (BBMEC, Caco-2 and MDCKII-MDR1) for nine model drugs (alprenolol, atenolol, metoprolol, pindolol, entacapone, tolcapone, baclofen, midazolam and ondansetron) by using dual probe microdialysis in the rat brain and blood as an in vivo measure. There was a clear correlation between the P(app) and the unbound brain/blood ratios determined by in vivo microdialysis (BBMEC r=0.99, Caco-2 r=0.91 and MDCKII-MDR1 r=0.85). Despite of the substantial differences in the absolute in vitro P(app) values and regardless of the method used (side-by-side vs. filter insert system), the capability of the in vitro models to rank order drugs was similar. By this approach, thus, the additional value offered by the true endothelial cell model (BBMEC) remains obscure. The present results also highlight the need of both in vitro as well as in vivo methods in characterization of blood-brain barrier passage of new drug candidates.