90例小儿重症支原体肺炎相关危险原因分析

选取2012年1月~2014年6月收治的90例小儿重症支原体肺炎患者设为观察组,另选90例小儿非重症支原体肺炎患者为对照组,比较两组性别、年龄、病程、病变部位、生活环境、血沉、C-反应蛋白、白细胞计数、人肺炎支原体抗体阳性率、大环内酯类药物使用时间等可能危险因素的差异。结果两组在病程、病变部位、血沉、C-反应蛋白、白细胞计数、人肺炎支原体抗体阳性率、大环内酯类药物使用时间等观察指标上的差异有统计学意义(P<0.05)。年龄、病程、病变部位、血沉、C-反应蛋白、白细胞计数、人肺炎支原体抗体阳性率、大环内酯类药物使用时间等是小儿重症支原体肺炎的相关危险因素,临床应注意检测相关指标,为疾病的诊断、防治提供参考。     

降钙素原和C反应蛋白联合检测在老年支原体肺炎及其合并细菌感染中的应用价值

目的探讨降钙素原(PCT)和C反应蛋白(CRP)联合检测在老年支原体肺炎及其合并细菌感染中的应用价值。方法回顾性分析117例临床确诊肺炎支原体特异性抗体(IgM)阳性的老年住院患者,其中单纯支原体肺炎(单纯感染组)87例,合并细菌感染(合并感染组)30例和40例健康老年人正常对照组资料,比较血清降钙素原和CRP结果,并应用受试者工作特征(ROC)曲线等统计方法分析处理。结果合并感染组PCT、CRP[0.94(0.176,2.19)、95.57(27.36,164.44)]高于单纯感染组[0.06(0.04,0.11)、16.84(5.71,47.05)]和对照组[(0.032(0.029,0.044)、2.11(1.51,4.75)];单纯感染组的PCT、CRP[0.06(0.04,0.11)、CRP16.84(5.71,47.05)]高于对照组[0.032(0.029,0.044)、2.11(1.51,4.75)],各组间差异有统计学意义(P0.05)。单纯感染组CRP的敏感度79.3%、特异度82.5%高于PCT的敏感度69%、特异度80%,合并感染组PCT的敏感度83.3%、特异度83.9%高于CRP的敏感度70%,特异度81.6%。结论 PCT和CRP可以作为早期诊断老年支原体肺炎及其合并细菌感染的有效指标,且两者联合检测具有更高的临床应用价值。     

红细胞分布宽度和C反应蛋白联合检测在早期儿童肺炎中的诊断价值

目的探讨红细胞分布宽度(RDW)和C反应蛋白(CRP)联合检测在儿童早期肺炎中的诊断价值。方法收集40例细菌性肺炎患儿(细菌性肺炎组)和41例支原体肺炎患儿(支原体性肺炎组)的临床资料及血液标本,同时收集41例健康体检儿童作为健康体检组。检测血常规及CRP,绘制受试者工作特征曲线(ROC曲线),计算灵敏度、特异度和曲线下面积(AUC)。结果细菌性肺炎组患儿RDW和CRP水平均显著高于支原体肺炎组患儿和健康体检组,差异有统计学意义(P0.05);支原体肺炎组患儿CRP水平均显著高于健康体检组,差异有统计学意义(P0.05)。支原体肺炎组患儿RDW水平与健康体检组比较,差异无统计学意义(P0.05)。ROC曲线分析显示,RDW和CRP联合检测时,诊断细菌性肺炎的灵敏度为82.5%,特异度为81.5%,AUC为0.868;诊断支原体性肺炎的灵敏度为73.2%,特异度为82.4%,AUC为0.839。结论 RDW和CRP的检测有助于细菌性肺炎及支原体肺炎患儿的鉴别诊断,两种指标联合检测可为儿童肺炎的早期诊断及类型判断提供一定的参考,以指导临床用药。     

肺炎支原体感染治疗的临床分析

目的 探讨大环内酯类药物治疗肺炎支原体感染的药效.方法 回顾性分析50例肺炎支原体感染患者的临床资料,这些患者均经大环内酯类治疗,分析治疗结果.结果 50例肺炎支原体感染患者中41例治疗有效,有效率82%;9例治疗无效.结论 在肺炎支原体感染治疗中正规应用大环内酯类无效时,要考虑有耐药的可能,可根据药敏结果用药.     

中性粒细胞/淋巴细胞计数比值在小儿支原体肺炎和支气管肺炎中的诊断和鉴别诊断意义

目的探讨中性粒细胞/淋巴细胞计数比值(NLR)在小儿支原体肺炎和支气管肺炎中的差异及其临床诊断价值。方法选择小儿支原体肺炎患者53例(支原体肺炎组)和支气管肺炎患儿40例(支气管肺炎组)作为研究对象,在患儿初次就诊时采集外周血,测定红细胞计数(RBC)、白细胞计数(WBC)、血小板计数(PLT)、红细胞平均分布宽度(RDW)、血小板平均分布宽度(PDW)、C反应蛋白(CRP)水平,对结果进行分析。结果支原体肺炎组NLR较支气管肺炎组明显增加,差异有统计学意义(P=0.028),其他指标两组间差异无统计学意义(P0.05)。支原体肺炎组NLR与RDW呈负相关关系(r=-0.392,P=0.004),与PDW、CRP和WBC呈正相关关系(r分别为0.274、0.427、0.530,P分别为0.047、0.001、0.001)。支气管肺炎组NLR与PDW呈负相关关系(r=-0.311,P=0.033),与其他指标均无相关性。ROC曲线分析结果表明,NLR的曲线下面积为0.787(95%CI:0.661~0.913),具有诊断价值(P0.001)。其他指标对支原体肺炎与支气管肺炎无鉴别诊断价值(P0.05)。结论 NLR对于支原体肺炎具有诊断意义,且在支原体肺炎和支气管肺炎的鉴别诊断中具有一定的应用前景。     

支原体肺炎的临床特点及其危险因素分析

选取2013年9月~2014年3月我院确诊为支原体肺炎的58例患者进行回顾性分析,分析内容包括患者性别、临床表现、热型、肺部CT病变部位及影像特征、WBC、ESR、CRP、血清支原体Ig M抗体、发病持续时间和应用大环内酯类抗生素的时间因素。结果患者男女患病率比较无差异,患者以刺激性咳嗽和发热为首发症状较为多见,常伴肺外表现,如皮炎;热型不定;病变部位、ESR、CRP、发病持续时间、Mp-Ig M和应用大环内酯类抗生素的时间因素与支原体肺炎具有相关性,且具有统计学意义(P0.05)。病变部位、ESR、CRP、发病持续时间、Mp-Ig M和应用大环内酯类抗生素的时间是支原体肺炎的危险因素,对该病早诊断,尽早使用抗生素可以减轻症状和缩短病程。     

肺炎支原体IgM与CRP在支原体肺炎诊断中的应用

目的 探讨肺炎支原体IgM与C反应蛋白(CRP)在支原体肺炎诊断中的应用.方法 选择支原体肺炎患者150例,细菌性肺炎患者115例,健康体检者100例,用酶联法检测肺炎支原体IgM,用乳胶免疫比浊法测CRP,分析各组MP-IgM、CRP的阳性率.结果 MP-IgM在支原体肺炎组中阳性率明显高于其他组;CRP在细菌性肺炎组中阳性率明显高于其他组.结论 肺炎支原体IgM与CRP联合是支原体肺炎早期诊断较好指标.     

肺炎支原体感染诊治中存在的问题或误区

<正>肺炎支原体(Mycoplasma pneumoniae,MP)感染在全世界、特别是亚洲地区广泛存在,大环内酯类抗生素耐药的肺炎支原体(macrolide-resistant Mycoplasmapneumoniae,MRMP)感染也不断增加[1]。尽管对MP感染的诊治已取得了很大进展,但仍有许多不同观点、问题或误区,对其进行充分讨论和研究,将会使MP感染     

血清降钙素原预测慢性阻塞性肺疾病急性加重期患者合并肺炎的价值

目的探讨血清降钙素原(PCT)在预测慢性阻塞性肺疾病急性加重期(AECOPD)合并肺炎患者中的临床价值。方法选取2014年1月至2015年12月住院的140例AECOPD患者,根据相关检查将患者分为单纯AECOPD组65例,AECOPD合并肺炎组75例,记录两组患者的基本信息、病史、抗生素使用等相关情况,入院24 h内测定白细胞计数(WBC)、中性粒细胞百分比(NE%)、C反应蛋白(CRP)、PCT等并进行比较,对两组之间具有统计学意义的指标进行Logistic回归分析,回归分析后有意义指标绘制受试者工作特征(ROC)曲线,并计算曲线下面积(AUC)。结果两组患者间WBC、NE%、CRP、PCT差异有统计学意义(P0.05)。对上述5项指标进行Logistic回归分析,显示PCT能预测AECOPD患者是否合并肺炎。PCT预测AECOPD患者合并肺炎的ROC曲线下面积为0.892(95%CI:0.836~0.941)。ROC曲线的最佳截点值0.077 ng/ml,此截点值时预测AECOPD患者合并肺炎的敏感度为82.8%,特异度为93.6%。结论血清PCT可作为预测AECOPD患者是否合并肺炎的辅助检查指标。     

七肽TVNFKLY和LPQRLRT在儿童肺炎支原体肺炎中的诊断价值

目的探讨七肽TVNFKLY和LPQRLRT在儿童肺炎支原体肺炎中的诊断价值。方法选取2016年5月至2019年5月该院收治的儿童肺炎支原体肺炎患儿120例为支原体组、非儿童肺炎支原体肺炎患儿120例为非支原体组和体检健康儿童120例为对照组。酶联免疫吸附测定试验检测各组血清中七肽TVNFKLY和LPQRLRT水平。采用受试者工作特征曲线(ROC曲线)的曲线下面积(AUC)分析七肽TVNFKLY和LPQRLRT检测在儿童肺炎支原体肺炎中的诊断意义。结果儿童肺炎支原体肺炎患儿血清中七肽TVNFKLY和LPQRLRT水平高于非儿童肺炎支原体肺炎患儿和体检健康儿童,差异有统计学意义(P<0.05)。血清中七肽TVNFKLY和LPQRLRT单向诊断儿童肺炎支原体肺炎的灵敏度分别为95.00%和92.50%,特异度分别为87.08%和90.42%,准确度分别为89.72%和91.11%。血清中七肽TVNFKLY和LPQRLRT联合对儿童肺炎支原体肺炎的诊断的灵敏度为92.50%,特异度为90.83%,准确度为91.39%。结论血清中七肽TVNFKLY和LPQRLRT水平检测可作为诊断儿童肺炎支原体肺炎的潜在标志。     

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.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

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.     

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.     

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.