综合性医院405株细菌的分离鉴定及耐药性调查

[目的]调查综合性医院常见菌株对各种抗生素的耐药性，为合理使用抗生素控制感染提供依据。[方法]用纸片扩散法或微量稀释法测定塘沽医院临床分离细菌的体外药敏试验。[结果]分离菌株位于前六位的是：大肠埃希菌、金黄色葡萄球菌、铜绿假单胞菌、肺炎克雷伯菌、肠球菌和凝固酶阴性葡萄球菌。检测他们对11种抗生素的耐药性，结果显示：革兰阴性杆菌对丁胺卡那霉素、头孢他啶最为敏感，大肠埃希菌对环丙沙星的耐药率急剧上升，已达65％。革兰阳性球菌中肠球菌对万古霉素的耐药率为4．3％；耐苯唑西林的葡萄球菌对大多数抗生素的耐药率都在50％以上。未发现耐万古霉素的葡萄球菌出现。[结论]系统的耐药性检测对临床合理用药具有重要临床意义。     

763株病原菌鉴定及耐药性分析

目的 为临床合理应用抗生素提供依据。方法 对763株病原菌进行分类鉴定及耐药性分析。结果 临床常见菌依次为大肠埃希菌、肺炎克雷伯菌、金黄色葡萄球菌、铜绿假单胞菌、凝固酶阴性葡萄球菌、不动杆菌。四种革兰阴性菌对20种抗生素的耐药率依次为铜绿假单胞菌＞大肠埃希菌 ＞肺炎克雷伯菌＞不动杆菌。葡萄球菌耐药率最高的为罗红霉素87．5％、红霉素86．1％、阿奇霉素83．7％。结论 耐药性监测，减少耐药菌株的产生，指导临床合理应用抗生素。     

住院患者病原菌的耐药性分析

目的：调查2001年7月—2002年7月天津某三级甲等医院住院患者病原菌耐药性。方法：采用K—B法测定住院患者临床分离株的药物敏感性。结果：住院患者最常见的临床分离株为大肠埃希菌(13．7％)、铜绿假单胞菌(9．2％)、肺炎克雷伯菌(7．5％)、不动杆菌(5．1％)和金黄色葡萄球菌(5．8％)。革兰阴性杆菌占68．6％。亚胺培南、头孢吡肟、头孢哌酮一舒巴坦和阿米卡星对革兰阴性杆菌抗菌活性好。大肠埃希菌对左氧氟沙星等氟喹诺酮类耐药率超过60％，对头孢噻肟等部分药物耐药率已接近或超过30％。金黄色葡萄球菌对苯唑西林耐药率达43．6％，且均为多重耐药菌株，未发现对万古霉素耐药的金黄色葡萄球菌。结论：住院患者广谱抗菌药物使用广泛，临床医师应关注细菌耐药性变化，合理使用抗菌药物。     

1072例伤口感染病原菌分布及耐药分析

[目的]研究患者伤口感染的常见病原菌及对抗生素耐药情况。[方法]对2006～2008年度我院住院患者感染伤口分泌物标本进行细菌培养及药物敏感试验。[结果]1072份伤口分泌物标本中分离出致病菌663株,分离率为61．8％。2006年伤口感染病原菌排在前4位为大肠埃希菌、金黄色葡萄球菌、表皮葡萄球菌、不动杆菌属。2007年伤口感染病原菌排在前4位为金黄色葡萄球菌、铜绿假单胞菌、表皮葡萄球菌、肺炎克雷伯菌属。2008年伤口感染病原菌排在前4位为金黄色葡萄球菌、铜绿假单胞菌、表皮葡萄球菌、大肠埃希菌。对常用抗牛素如青霉素、红霉素等均有较高的耐药性。革兰阴性杆菌对二三代头孢菌素的耐药率正在逐年增加。[结论]进行伤口感染分泌物细菌培养及耐药性检测对指导临床合理应用抗生素具有重要意义。     

氟喹诺酮类药物对大肠埃希菌耐药性分析

目的 分析大肠埃希菌对氟喹诺酮类药物耐药性变化,为临床合理使用抗生素提供依据.方法 用常规方法分离鉴定细菌,采用K-B纸片扩散法对临床分离的大肠埃希菌进行药物敏感性测定.结果 在统计年限内共检出大肠埃希菌312株,分离率逐年上升,大肠埃希菌对氟喹诺酮类药物的耐药率有普遍上升的趋势并呈多重耐药,对诺氟沙星、环丙沙星、氧氟沙星、左氧氟沙星、加替沙星耐药率均达到10％以上,最高达43.9％.其中产超广谱β-内酰胺酶的大肠埃希菌分离率为38.5％.结论 大肠埃希菌临床分离率逐年增加,耐药性逐年增强,应加强其耐药性监测,合理用药,以控制和减缓细菌耐药性的增长.     

尿路感染病原菌分布及其耐药性分析

[目的]了解我院2004年1月～2005年12月尿路感染患者病原菌分布及其耐药状况，指导临床合理应用抗生素。[方法]按“全国临床检验操作规程”培养分离菌种，药敏试验采用K-B法。[结果]分离出420株细菌，G^＋球菌48．6％，G^-杆菌38．1％，真菌13．3％，分离数在前4位细菌分别为：大肠埃希菌24．8％；凝固酶阴性葡萄球菌21．0％；肠球菌18．6％；真菌13．3％。主要病原菌对部分抗生素多重耐药，但万占霉素对革兰阳性球菌保持100％敏感性。革兰阴性杆菌对亚胺培南敏感性率最高。[结论]大肠埃希菌、凝固酶阴性葡萄球菌是引起泌尿系感染的主要病原菌，因其对多种抗生素耐药，临床应根据药敏结果合理使用抗生素。     

10年临床分离菌的耐药性调查

目的：探讨1991—2000年10年间住院感染患病原菌及其耐药性变化。方法：采用回顾性调查分析方法，收集10年间临床标本分离病原菌及其药敏资料进行统计分析。结果：1991—2000年共分离出5332株病原菌，其中革兰阳性球菌994株(18．6％)，革兰阴性杆菌4338株(81．4％)。大肠埃希菌、铜绿假单胞菌、克雷伯菌属为临床最常见病原菌，凝固酶阴性葡萄球菌、不动杆菌属、肠球菌已成为临床主要病原菌，嗜麦芽窄食单胞菌、黄杆菌亦见增多。大肠埃希菌和克雷伯菌属对阿米卡星、多粘菌素B敏感，环丙沙星对铜绿假单胞菌、不动杆菌属、凝固酶阴性葡萄球菌、肠球菌具有较好的抗菌活性，临床常见病原菌对氨苄西林、羧苄西林、庆大霉素和氯霉索耐药严重。结论：临床常见病原菌在发生变化，耐药严重的条件致病菌已成为优势感染菌，临床应重视细菌学检查和耐药性监测，合理使用抗菌药物。     

2010年某院临床常见细菌分布及耐药性分析

目的 了解2010年临床分离菌株对抗菌药物的耐药情况.方法 细菌鉴定采用手工法,药敏试验采用纸片扩散法.结果 2010年各临床科室送检标本中,真菌、克雷伯菌、大肠埃希菌、假单胞菌、肠球菌、凝固酶阴性葡萄球菌、金黄色葡萄球菌为主要病原菌.革兰阴性菌中以假单胞菌耐药性最高,其次为大肠埃希菌、克雷伯菌.革兰阳性菌中金黄色葡萄球菌感染呈下降趋势,而凝固酶阴性葡萄球菌感染呈上升趋势,耐药率也随之增长.结论 临床科室应注意微生物实验室所提供的细菌耐药情况,合理使用抗生素.     

泌尿系感染常见病原菌分布及耐药性分析

[目的]了解我院泌尿系感染病原菌的分布及常见病原菌的耐药性，为临床合理用药提供依据。[方法]采用API鉴定系统进行病原菌鉴定，用琼脂纸片扩散法（K—B法）进行药敏试验。[结果]分离出病原菌282株，其中革兰阴性杆菌199株，占70．57％；革兰阳性球菌67株，占23．76％。检出率最高的是大肠埃希菌，其次为肠球菌和葡萄球菌等。大肠埃希菌对亚胺培南、头孢哌酮／舒巴坦、哌拉西彬他唑巴坦的耐药率较低，分别为1．32％、7．89％、11．18％；肠球菌及葡萄球菌对万古霉素耐药率最低，分别为3．33％和0。[结论]泌尿系感染主要由革兰阴性杆菌引起。临床医生应依据药敏试验结果合理使用抗生素。     

小儿下呼吸道感染的病原菌及耐药性调查

目的 调查温州地区小儿下呼吸道感染的病原菌及其耐药性。方法 标本经分离培养，做菌株鉴定和药敏试验。结果 1763份下呼吸道感染患儿的痰液培养共分离出病原菌715株，总阳性率为40．6％。其中革兰阴性菌448株，占62．7％；革兰阳性菌148株。占20．7％；真菌119株。占16．6％。革兰阴性菌以肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌和鲍曼不动杆菌为主。肺炎克雷伯菌和大肠埃希菌产超广谱β-内酰胺酶（ESBLs）的百分率分别为49．3％和46．5％。较敏感的抗生素为弧胺培南、丁胺卡那霉素、环丙沙星、哌拉西林／他唑巴坦和头孢哌酮／舒巴坦；除铜绿假单胞菌对复方新诺明的耐药率为100％外，铜绿假单胞菌和鲍曼不动杆菌对各种抗生素的耐药性均较低。革兰阳性菌中以肺炎链球菌和金黄色葡萄球菌为主。肺炎链球菌对青霉素的耐药率达到71．1％，对环丙沙星和万占霉素敏感，耐药率为0％。金黄色葡萄球菌中MRSA占18．0％，对环丙沙星、左旋氧氟沙星和万占霉素敏感。结论 小儿下呼吸道感染的病原菌以革兰阴性荫为主。肺炎克雷伯菌、大肠埃希菌、铜绿假单胞菌、鲍曼不动杆菌、肺炎链球菌、金黄色葡萄球菌为主要病原菌。对抗生素的耐药性较强，临床上应注意对这些菌株的检测，积极防治。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.