精神病人夏秋季肠道感染发生率及其预防措施

住院复退精神病人是一特殊群体，由于常年住院。加上封闭式管理，病员缺乏体力劳动和户外活动。社会功能严重受损，缺乏主诉。病区结构老化，病人活动范围小。人员密集，空气不流通，该群体较易患肠道感染。服用抗精神病药物，可能导致机体正常防御功能受损，同时。精神疾病本身演变会出现患者精神活动衰退，生活处理能力下降，从而增加了肠道感染的原因。本文对我院长期住院的330例复退军人精神病患者1997年及2000年夏秋季肠道感染情况进行了调查分析。并提出相应的预防措施。     

肠道感染导致腹膜透析相关性腹膜炎的相关因素分析

目的:探讨肠道感染导致维持性腹膜透析患者发生腹膜炎的发病诱因、营养状况、致病菌及其转归,为保护腹膜、制定有效防治措施及降低腹膜炎发生率提供临床依据。方法:回顾性分析我院肾脏内科腹膜透析中心2011年1月~2014年12月收治的306例患者,对其并发肠道感染发生腹膜炎的24例43例次患者的相关因素进行分析总结。结果:主要发病诱因:腹泻15例(62.50%),便秘9例(37.50%)。营养状况:通过对24例患者的血红蛋白、血清白蛋白、血清总蛋白的分析,显示低蛋白血症是导致腹膜炎的一个重要诱因,在我中心尤其当血清白蛋白低于25.73 g/L时更容易发生腹膜炎。主要致病菌:大肠埃希菌32例次(74.42%),阴沟肠杆菌7例次(16.28%),鲍曼不动杆菌4例次(9.30%),其中以大肠埃希菌为主。腹膜炎的转归及预后:首次治愈10例(41.67%),复发14例(58.33%),其中复发3次4例,复发2次8例;复发后导致拔管1例,死亡1例,再治愈率41.6%。结论:腹腔的防御功能随透析时间的延长而减退,肠道感染时细菌由肠壁或淋巴途径进入腹腔,并且腹膜透析液是细菌的良好培养基,因此肠道感染是导致腹膜炎的一个危险因素,本中心复发率高达58.33%,首次治愈率较低为41.67%,然而血清白蛋白低于25.73 g/L时更容易诱发腹膜炎,因此应以预防为主,重视腹膜透析患者便秘及腹泻情况,加强患者营养治疗,提前干预、及早处理,对患者积极进行教育,减少肠道感染导致腹膜炎发生,提高腹膜透析患者的生活质量。     

分子生物学技术在肠道感染诊断中的应用

肠道感染病原体由于培养条件的复杂常导致诊断和鉴定的困难。而核酸探针技术及PCR方法的出现为解决上述问题提供了技术保障。本文重点介绍年来DNA、rRNA探针、PCR在引发肠道感染的细菌、病毒及寄生虫等病原体诊断中的应用。     

脓毒症相关性脑病研究现状

脓毒症相关性脑病是脓毒症一种常见并发症,患者出现弥散性脑功能障碍,其严重程度从短暂的、可逆的脑病到严重的、不可逆的脑损伤不等.本文对其临床症状、可能的发病机制及治疗对策进行概述.     

肠道感染与儿童生长发育的研究进展

病原微生物引起的肠道感染是一类儿童常见临床感染性疾病,对儿童生长发育有不可忽略的消极影响。肠道病原微生物可进入宿主肠道内,破坏人体正常肠道微环境,打乱肠道内生态平衡。上述情况包括破坏肠道黏膜、增加/降低肠道通透性、抑制正常肠道微生物功能等,进而阻碍机体对营养的转化和吸收等。家长及临床工作者应提高对儿童生长环境中易出现的肠道感染微生物的防范意识。     

医院内获得性小儿肠道感染的调查与对策

为探讨医院获得性肠道感染发病规律 ,笔者对我院儿科病房 1 996～ 1 999年 6339份病历进行回顾性调查。1　临床资料根据国家卫生部医政司医院感染监控小组制定的医院感染诊断标准[1 ] 。我院儿科病房四年中共收治 6339例患儿 ,发生医院感染 346例 ,感染率 5 46% ,发生医院内获得性肠道感染 61例 ,占同期住院患者的 0 96% ,占医院感染性疾病的1 7 6% ,占医院感染首位。年龄最小 5ｄ ,最大 1 4岁。男 38例 ,女性 2 3例。患儿年龄越小 ,其发病率越高 (表 1 )表 1　各年龄组医院肠道感染发病率 (% )比较年龄组总例数肠道感染例数发病率 (% )5～…     

分子生物学技术在肠道感染诊断中的应用

肠道感染病原体由于培养条件的复杂常导致诊断和鉴定的困难。而核酸探针技术及ＰＣＲ方法的出现为上述问题提供了技术保障。本文重点介绍年来ＤＮＡ、ｒＲＮＡ控针、ＰＣＲ在引发肠道感染的细菌、病毒及寄生虫等病原体诊断中的应用。     

肠道感染后继发肠易激综合征的护理

目的总结肠道感染后继发肠易激综合征(irritable bowel syndrome,IBS)的护理经验。方法对191例肠道感染后的IBS患者做好心理护理、饮食护理、药物治疗的护理、症状的护理和健康教育。结果治疗前本组患者消化系统症状平均得分(9.21±1.35)分,治疗后(2.36±1.28)分,治疗前后比较,t=6.12,P<0.01,差异具有统计学意义。治疗后患者的消化系统症状得到明显的改善。结论有效的护理干预措施使患者情绪稳定,增强战胜疾病的信心;减轻消化道的不适症状,提高了治疗的效果。     

Haemorrhagic shock and encephalopathy syndrome: neurological course and predictors of outcome

The haemorrhagic shock and encephalopathy syndrome (HSES) is a devastating disease. The aetiology of this syndrome is unknown, and, despite intensive treatment, the outcome is often fatal or associated with severe neurological sequelae. Objective: To assess the neurological features and potential prognostic markers of the disease. Design: Retrospective study. Setting: Division of Neuropaediatrics in a children's university hospital. Patients and methods: Fourteen patients fullfilling the HSES criteria out of 42 children admitted with fever and shock to the Paediatric Intensive Care Unit between 1986 and 1994, were analysed for clinical, biological, neuroradiological, EEG and neuropathological findings. Results: The patients (age range from 2 to 33 months) were found at night or in the morning either comatous (n = 3) or convulsing (n = 11). All but one were healthy before admission, although eight had had a brief prodromal infectious disease. All were febrile (mean body temperature 39.9 °C ± 0.9 °). Seasonal clustering during the winter months was observed. Coma and seizures with frequent status epilepticus were the main neurological manifestations. All children recovered from their multiple organ failure within a few days. Seven died (50 %); four survivors had neurological sequelae (29 %) with a developmental quotient (DQ) of 50 % or less in three and a DQ of 75 % in one and three infants (21 %) had normal outcomes. Computed tomography (CT) displayed a diffuse area of low density mainly in the cerebral cortex and intraventricular and parenchymal haemorrhages. Magnetic resonance imaging (MRI) showed haemorrhagic cortical lesions. Post-mortem examination of the brain conducted in three patients showed necrotic and haemorrhagic lesions, mainly in cortical areas. Comparison of the children with adverse outcome (death or neurological sequelae) with those with normal outcome revealed that predictors of poor outcome were status epilepticus (p = 0.003) and coma for more than 24 h (p = 0.01). Infants without disseminated intravascular coagulation, without a biphasic course and without brain hypodensities or haemorrhages on CT scans performed at least 4 days after onset had a normal neurodevelopmental outcome. Conclusion: The central nervous system appeared to be the main target of the HSES lesions. The most common outcome was brain death or severe brain damage. Further studies with a larger sample are necessary to determine whether the prognostic indicators we identified are reliable. Received: 20 April 1998 Accepted: 13 November 1998     

头孢菌素致肾衰竭患者脑病的临床分析

目的探讨头孢菌素在肾功能衰竭患者中的合理应用。方法回顾性分析30例肾衰竭患者在使用头孢菌素（头孢菌素用量2～3g／d）过程中出现的神经精神症状及脑电图表现,探讨其可行的治疗方案。结果所有患者均停用头孢类抗生素,22例行血液透析治疗,2例行腹膜透析治疗,5例应用抗癫痫药物,2～5天后29例患者症状缓解,1例患者死亡;27例患者行脑电图检查,23例脑电图显示背景为广泛慢波伴有中到高波幅尖波或者尖慢波。结论肾衰竭患者使用常规剂量的头孢菌素可引起神经毒性,推测与患者血脑屏障的改变、药物的清除率降低以及游离药物浓度增高有关。肾衰竭患者在应用头孢菌素时需根据内生肌酐清除率调整剂量,一旦出现症状需及时停药。     

Posterior reversible encephalopathy syndrome in a pregnant patient without eclampsia or preeclampsia

Posterior Reversible Encephalopathy syndrome (PRES) is a rare neurologic disorder characterised by vasogenic edema in occipital and parietal lobes on MR. Patients usually complain about headache, visual disturbance, seizure and altered mental status. We repot a case of PRES seen in a pregnant patient. Although pre-eclampsia and eclampsia are among the common causes of this syndrome in this case patient was normotensive and no proteinuria was present. To our knowledge this is the first PRES case presented of a pregnant patient without eclampsia or pre-eclampsia.     

Posterior reversible encephalopathy syndrome in intensive care medicine

Background Posterior reversible encephalopathy syndrome (PRES) is a well-recognized clinico-neuroradiological transient condition. Early recognition is of paramount importance for prompt control of blood pressure or removal of precipitating factors and treatment of epileptic seizures or status epilepticus. Delay in the diagnosis and treatment may in fact results in death or in irreversible neurological sequelae. Discussion PRES is characterized by headache, altered mental status, seizures, and visual disturbances and is associated with a number of different causes, most commonly acute hypertension, preeclampsia/eclampsia, and immunosuppressive agents. Clinical symptoms and neuroradiological findings are typically indistinguishable among the cases of PRES, regardless of underlying cause. Magnetic resonance studies typically show edema involving the white matter of cerebral posterior regions, especially parieto-occipital lobes but frontal and temporal lobes, and other encephalic structures may be involved. Conclusions Intensivists and other physicians involved in the evaluation of patients with presumed PRES must be aware of the clinical spectrum of the associated conditions, the diagnostic modalities, and the correct treatment.     

Research progress of sepsis-related encephalopathy

【Abstract】 Sepsis associated encephalopathy (SAE) is one of the common encephalopathy in critically ill patients. It is a brain dysfunction caused by inflammatory reaction caused by non central nervous system infection. The pathogenesis of SAE is complex and unclear, and there is a lack of effective criteria for the diagnosis of SAE. SAE patients are often in critical condition with high mortality. At present, there is no specific method to treat SAE. The research on SAE treatment has a long way to go. This paper introduces the possible pathogenesis, diagnostic methods and treatment of SAE. © 2021, Chinese Medical Journals Publishing House Co.Ltd. All rights reserved.     

Research progress of sepsis-related encephalopathy

【Abstract】 Sepsis associated encephalopathy (SAE) is one of the common encephalopathy in critically ill patients. It is a brain dysfunction caused by inflammatory reaction caused by non central nervous system infection. The pathogenesis of SAE is complex and unclear, and there is a lack of effective criteria for the diagnosis of SAE. SAE patients are often in critical condition with high mortality. At present, there is no specific method to treat SAE. The research on SAE treatment has a long way to go. This paper introduces the possible pathogenesis, diagnostic methods and treatment of SAE. © 2021, Chinese Medical Journals Publishing House Co.Ltd. All rights reserved.     

肾功能不全头孢菌素脑病16例临床分析

目的总结肾功能不全头孢菌素脑病的诊治经验,指导肾功不全患者的抗感染治疗。方法回顾性分析我科16例肾功能不全患者应用头孢类抗生素时引起的神经精神症状及相关临床资料。结果使用头孢菌素到出现神经精神症状时间间隔（4.26±1.85）天（2～6天）,临床表现为神志恍惚、谵妄、幻觉、嗜睡、口齿不清、记忆力障碍、肌肉震颤、抽搐等。所有患者停药并血液净化治疗后好转。结论 肾功能不全患者使用常规剂量的头孢菌素可造成神经毒性,因此应根据肌酐清除率调整剂量,一旦出现症状需立即停药。     

海洛因脑病的MRI表现

目的探讨海洛因脑病的MRI表现.方法回顾性分析22例有海洛因吸食史患者的MRI资料,检查序列包括T1WI、T2WI及FLAIR序列.结果 2例患者MRI表现未见异常,其余20例患者幕上或(及)幕下脑实质有不同程度的受累, 17例有灰质受累, 病变双侧对称,均表现为T1WI低信号,T2WI及FLAIR序列高信号,2例有轻度占位效应,1例轻度脑萎缩.结论海洛因所致脑病既可侵犯白质也可侵犯灰质,称之为海洛因脑病更恰当;海洛因脑病具有典型的MRI表现,结合临床病史可与其他脑病鉴别.     

Steroid pulse therapy in patients with encephalopathy associated with severe fever with thrombocytopenia syndrome

Severe fever with thrombocytopenia syndrome (SFTS) is a tick-borne infectious disease caused by the SFTS virus (SFTSV). Clinical symptoms of SFTS often involve encephalopathy and other central neurological symptoms, particularly in seriously ill patients; however, pathogenesis of encephalopathy by SFTSV is largely unknown. Herein, we present case reports of three patients with SFTS, complicated by encephalopathy, admitted to Tokushima University hospital: one patient was a 63-year-old man, while the other two were 83- and 86-year-old women. All of them developed disturbance of consciousness around the 7th day post onset of fever. After methylprednisolone pulse therapy of 500 mg/day, all of them recovered without any neurological sequelae. SFTSV genome was not detected in the cerebrospinal fluid of 2 out of the 3 patients that were available for examination. In these patients, disturbance of consciousness seemed to be an indirect effect of the cytokine storm triggered by SFTSV infection. We propose that short-term glucocorticoid therapy might be beneficial in the treatment of encephalopathy during early phase of SFTSV infection.     

Analysis of the risk factors and prognosis for severe fever with thrombocytopenia syndrome associated encephalopathy

ObjectiveSevere fever with thrombocytopenia syndrome (SFTS) is frequently associated with neurological injury, but there are currently few relevant studies. The goal of this study was to look at the risk factors for SFTA-associated encephalopathy (SFTSAE) and the short- and long-term prognosis of such patients.MethodsWe retrospectively studied 145 patients with SFTS who were treated at our hospital between May 2019 and November 2021. Clinical characteristics were collected, and patients were divided into two groups based on whether there was neurological injury during the disease: SFTSAE group and non-SFTSAE group. Univariate analysis was used to compare the differences in clinical data and outcomes between two groups, and multivariate Logistic regression analysis was used to reveal the independent risk factors for SFTSAE, and the predictive efficacy was assessed using the receiver operating characteristic (ROC) curve. Furthermore, survivors of SFTSAE were contacted by phone 6 months after discharge to assess the case fatality rate and quality of life.ResultsThe prevalence of SFTSAE was 22.7% (33/145). Bleeding symptoms, D-dimer level and blood amylase level were all independent risk factors for SFTSAE (P < 0.05). The combined AUC of these three factors was 0.969. Patients with SFTSAE had a 45.4% in-hospital mortality rate, and survivors had a largely normal quality of life after discharge.ConclusionPatients with SFTSAE frequently have multiple organ dysfunction, a high mortality rate, and a favorable long-term prognosis for survivors. Clinical manifestations of bleeding symptoms, elevated serum amylase, and elevated D-dimer were all independent risk factors for SFTSAE.