临床抗感染决策对NICU新生儿败血症心肌损害的影响

目的 研究临床首选不同抗生素的抗感染决策对NICU新生儿败血症心肌损害发生率的影响.方法 采用前瞻性临床研究方法,分析了入住NICU的112例新生儿败血症患儿心肌损害的发生率与首选不同的抗生素及其抗感染治疗效果的关系.结果 治疗有效者88例,心肌损害的发生率为43%,显著低于无效者(79%,P＜0.05).抗感染疗效差,5 d内需更换抗生素者心肌损害的发生率显著高于不需更换者(P＜0.05).头孢地嗪(CDZ)组43例,心肌损害的发生率为33%,显著低于首选其他抗生素组,即复方抗生素组和单方抗生素组(70%,56%,P＜0.05).结论 尽早选择安全、有效的抗生素,减少抗生素的更换率,可降低新生儿败血症心肌损害的发生率.CDZ治疗新生儿败血症临床疗效好.     

本院90例新生儿败血症病原菌和耐药性研究

对我院90例新生儿败血症的阳性菌株的构成比以及新生儿败血症对抗生素耐药情况进行分析总结,探究新生儿败血症病原菌和耐药性,为其临床治疗提供参考指导。结果经过对我院90例新生儿败血症患儿进行血培养,发现有76例病原菌呈阳性,阳性率为84.44%(76/90),有14例病原菌呈阴性,阴性率为15.56%(14/90);新生儿败血症对抗生素(红霉素、青霉素、克林霉素、头孢唑林等)的耐药率均在65%以上。阳性病原菌是新生儿败血症最为突出的细菌形式,且新生儿败血症对临床常用的青霉素、红霉素等抗生素具有普遍的耐药性,在临床治疗中,应该根据患儿的病原菌药敏结果,来选取最佳、最合理的抗生素进行临床治疗,有效的降低耐药菌株的产生,从而提高临床治疗效果,改善患儿的生活质量。     

PCT、hs-CRP及二者联合检测对新生儿败血症的诊断价值

目的探讨血清降钙素原(PCT)及高敏C反应蛋白(hs-CRP)联合检测在新生儿败血症临床诊断中的应用价值。方法选取新生儿细菌性败血症患儿(病例组)156例(日龄≤3 d者88例、日龄4~28 d者68例)及新生儿呼吸窘迫综合征、新生儿窒息患儿(对照组)245例(日龄≤3 d者162例、日龄4~28 d者83例)。按预设的时间段对研究对象采血,分别进行PCT、hs-CRP、血培养及血常规检测,并对资料进行统计分析。结果以血培养结果为金标准,PCT诊断新生儿败血症的敏感性、特异性、阳性预测值、阴性预测值、约登指数≤3 d组分别为94.3%、39.5%、45.9%、92.7%、0.34,4~28 d组分别为85.3%、86.7%、84.1%、87.8%、0.72。hs-CRP诊断新生儿败血症的敏感性、特异性、阳性预测值、阴性预测值、约登指数≤3 d组分别为85.2%、83.3%、73.5%、91.2%、0.69,4~28 d组分别为83.8%、83.1%、80.3%、86.2%、0.67。PCT与hs-CRP联合诊断新生儿败血症的敏感性、特异性、阳性预测值、阴性预测值、约登指数≤3 d组分别为80.7%、90.1%、81.6%、89.6%、0.71,4~28 d组分别为77.9%、90.4%、86.9%、83.3%、0.72。结论在新生儿败血症诊断中,应优先采用PCT和hs-CRP双指标联合检测。     

个性化护理在儿科护理中的应用分析

目的探讨个性化护理应用于新生儿败血症的临床效果和护理满意度。方法选取2015年1月~2017年1月期间在本院救治的90例新生儿败血症患儿为研究对象,采用随机数字表法分为观察组和对照组,每组45例。对照组患儿仅接受普通的常规护理,观察组患儿在实施与常规护理的基础上,加施个性化护理。分析比较两组患儿治疗效果和患儿家属对护理的满意度。结果观察组患儿治疗有效率高达97.78%,远远高于对照组73.33%,差异有统计学意义(P0.05);观察组患儿家属护理满意率为100.00%,高于对照75.56%,差异有统计学意义(P0.05)。结论个性化护理应用于新生儿败血症护理中,治疗效果显著,患儿家属满意。     

新生儿早发型与晚发型败血症临床特征及病原学研究

目的探讨新生儿早发型与晚发型败血症临床特征、病原菌分布及耐药情况,为临床采取有效的感染防控措施提供参考依据。方法选取2014年1月-2018年12月血培养阳性的97例新生儿败血症患儿,根据发病时间分为早发型(日龄≤3d)和晚发型(日龄3d),对新生儿早发型与晚发型败血症的临床特征、病原菌分布和耐药情况进行分析。结果早发型败血症36例(37.1%,36/97),其中早产儿20例(55.6%,20/36),低出生体重儿18例(出生体重2500g,50.0%,18/36);革兰阴性菌感染69.4%(25/36),革兰阳性菌感染27.8%(10/36),真菌感染2.8%(1/36);前三位主要病原菌分别为大肠埃希菌(69.4%,25/36)、B组链球菌(16.7%,6/36)、牛链球菌Ⅱ型(8.3%,3/36)。晚发型败血症61例(62.9%,61/97),其中早产儿50例(82.0%,50/61),低出生体重儿49例(80.3%,49/61);革兰阴性菌感染68.9%(42/61),革兰阳性菌感染24.6%(15/61),真菌感染6.6%(4/61);前三位主要病原菌分别为肺炎克雷伯菌(45.9%,28/61)、葡萄球菌(19.7%,12/61)、大肠埃希菌(13.1%,8/61)。早发型败血症中早产、低出生体重儿比例显著少于晚发型;其大肠埃希菌、B组链球菌感染显著多于晚发型;而其肺炎克雷伯菌、葡萄球菌、多重耐药菌感染显著少于晚发型(P 0.05)。共检出35株多重耐药菌,大肠埃希菌、肺炎克雷伯菌、凝固酶阴性葡萄球菌、金黄色葡萄球菌中多重耐药菌株比例分别为7/33、21/28、6/6、1/6。结论晚发型败血症多见于早产儿、低出生体重儿。大肠埃希菌和B组链球菌是早发型败血症的主要病原菌;肺炎克雷伯菌和葡萄球菌是晚发型败血症的主要病原菌。多重耐药菌感染多见于晚发型败血症,使控制医院感染和选用合适的抗生素成了临床难题。     

口服抗生素治疗儿童社区获得性非重症肺炎

目的：探讨口服抗生素治疗儿童社区获得性非重症肺炎的临床疗效。方法：选择门诊临床诊断为小儿非重症肺炎的患儿228例,随机分为口服抗生素组（116例）与静脉用抗生素组（112例）,比较2组疗效和不良反应发生情况。结果：口服抗生素组治愈103例,有效8例,有效率为95.7%,无效5例,占4.3%;静脉用抗生素组治愈102例,有效7例,有效率占97.4%,无效3例,占2.6%,经比较2组疗效差异无统计学意义。结论：口服抗生素治疗小儿非重症肺炎是安全有效的,可以作为治疗小儿非重症肺炎的首选方法。     

新生儿肺炎克雷伯菌败血症的病原菌分布特征及耐药性研究

目的 探讨肺炎克雷伯菌（KP）败血症患儿的临床表现、治疗转归情况、KP来源、分布构成比及其对抗生素的耐药情况,为临床提供参考。方法 选取2010年1月至2019年12月聊城市人民医院收治的85例KP败血症患儿为研究对象进行回顾性分析,根据不同的日龄分为新生儿组（55例,出生≤28 d）和非新生儿组（30例,出生>28 d）;再根据发病日龄的不同将新生儿组分为早发型败血症组（35例,出生≤3 d）和晚发型败血症组（20例,3 d<出生≤28 d）。比较各组患儿的临床表现、治疗转归情况及KP的标本来源、分布构成比及对抗生素的耐药情况。结果 晚发型败血症组患儿发热、循环系统症状占比高于非新生儿组、早发型败血症组,早发型败血症组患儿呼吸系统、皮肤黏膜、神经系统症状占比高于晚发型败血症组、非新生儿组（P<0.05）,分离出的85株KP中有20株产超广谱β-内酰胺酶（ESBLs）菌、65株非产ESBLs菌均主要来自于痰液及尿液。85株KP中,早发型败血症组和晚发型败血症组氨苄西林钠耐药率最高,其次是头孢唑林钠、头孢曲松钠、氨苄西林钠舒巴坦;阿米卡星、喹诺酮类（环丙沙星、左氧氟沙星...     

血清IL-8和CRP联合测定对诊治新生儿细菌感染效果观察

选取本院2013年7月~2015年7月NICU收治新生患儿90例,将其中30例符合新生儿败血症、肺炎标准的新生儿设为临床感染组,将30例具有1项以上"可疑感染指证"的患儿设为疑似感染组,另将其余30例非感染和非疑似感染的患儿设为对照组;所有患儿通过股静脉采集血样行IL-8和CRP及常规检测,并结合IL-8和CRP检查结果制定相应的抗生素治疗计划。临床感染组和疑似感染组在治疗前的IL-8和CRP水平均高于对照组,感染组患儿治疗7d后IL-8和CRP水平较治疗前明显下降,但仍明显高于疑似感染组未治疗前水平(P0.05),治疗14d时,指标水平与对照组相接近(P0.05)。疑似感染组患儿治疗7d后,其指标水平接近对照组。感染组患儿在14d后、疑似感染组患儿在7d后,其根据抗生素应用指证用药率明显高于根据IL-8≥70pg/ml和(或)CRP10mg/L指标用药时的抗生素使用率。血清IL-8和CRP联合测定可作为早期诊断新生儿细菌感染重要指标,而IL-8≥70pg/ml和(或)CRP10mg/L则可作为新生儿感染抗生素用药的指导指标,以防止过度应用抗生素。     

免疫球蛋白治疗新生儿败血症体会

目的：观察应用丙种球蛋白治疗新生儿败血症的疗效。方法：将60例新生儿败血症患儿随机分为两组,治疗组30例确诊后立即予以静脉注射丙种球蛋白治疗,对照组30例采用常规治疗,联合应用抗生素积极控制感染。结果：治疗组和对照组总有效率分别为93%和80%,两组比较差异有显著性（P〈0.05）。结论：应用丙种球蛋白治疗新生儿败血症,可提高患儿的免疫功能,提高机体的抗病能力,有助于减少并发症,尽快恢复健康。     

小剂量红霉素治疗新生儿胃食管返流的疗效观察

观察小剂量红霉素治疗新生儿胃食管返流的临床效果。纳入140例患儿作为研究对象,随机分为对照组和观察组各70例,2组患儿均采取体位疗法,常规营养支持,早产儿暖箱复温,对照组予以5%葡萄糖20~30ml中加入西沙比利0.8~1.0mg·/(kg·d)静滴,观察组予以5%葡萄糖15~20ml中加入小剂量红霉素3~5mg·/(kg·d)缓慢静滴。治疗3~5d,对比2组返流次数、体重增加、大便情况及肝肾功能变化。观察组有效率高于对照组,差异有统计学意义(P0.05);治疗后,返流次数减少,观察组体重增加明显优于对照组,差异明显(P0.05)。小剂量红霉素治疗新生儿胃食管返流,疗效确切,无明显副作用,可推广使用。     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.     

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.