白三烯D4、白细胞介素6和肿瘤坏死因子α在成人分泌性中耳炎中耳积液中的表达及意义CSCD

目的探讨白三烯D4(leukotrieneD4,LTD4)、白细胞介素6(interleukin 6,IL-6)及肿瘤坏死因子α(tumour necrosis factorα,TNF-α)在成人分泌性中耳炎(secretory otitis media,SOM)患者中耳积液中的表达水平。方法采用酶联免疫吸附法测定32例(40耳)成人SOM患者中耳积液,其中28例患者(4例拒测)的外周血浆及20例健康人外周血浆中的LTD4、IL-6及TNF-α表达水平。结果 (1)LTD4、IL-6和TNF-α在所有标本中的检出率均为100%;(2)LTD4、IL-6在实验组表达显著高于对照组(t=2.436、2.596,P<0.05),TNF-α浓度表达与对照组比较,无统计学意义(P>0.05)。结论 LTD4和IL-6作为重要免疫介质,参与SOM的发生发展。     

溃疡性结肠炎的护理

对我院2001.01—2007.06收治溃疡性结肠炎患者的护理体会总结如下。1临床资料1.1一般资料本组68例,男32例,女36例,年龄18—75岁。均有溃疡性结肠炎的典型症状并经结肠镜检查确诊,     

面罩气道正压机械通气治疗慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭的疗效观察

慢性阻塞性肺疾病 (COPD)急性发作时常合并 型呼吸衰竭 ,能否纠正呼衰对患者预后起着关键作用。面罩机械通气已广泛应用于治疗呼吸衰竭。由于 COPD患者肺顺应性差 ,气道阻力高 ,故对面罩机械通气治疗 COPD合并 型呼吸衰竭的疗效仍有分歧 ,尤其对重症呼衰的疗效更不明确。本研究旨在观察面罩机械通气治疗 COPD 型呼吸衰竭的疗效 ,并进一步观察对重症呼衰的疗效。1　对象与方法1.1　对象　所选病例随机分为两组 ,治疗组 2 0例 ,其中男15例 ,女 5例 ;年龄 (6 3.1± 8.4)岁 ,病程 (18.3± 9.3)年。呼吸频率 >2 5次 / min 18例 ,神志不…     

预防性应用抗生素对气胸患者胸管定植菌的影响

目的 研究气胸患者闭式引流术后胸管定植菌的病原学特点以及预防性抗生素应用在减少病原菌定植方面的意义.方法 入组120例急诊留观的需接受胸腔闭式引流术治疗的气胸患者,随机(随机数字法)分为抗生素组(A组,n=60)和对照组(B组,n=60)完成胸腔置管术,术后A组给予甲磺酸左氧氟沙星氯化钠注射液0.6 g/200 mL·d-1静脉滴注,B组给予0.9%氯化钠注射液200 mL/d静脉滴注直至拔管后24 h.拔管后将胸管前端2 cm剪下行细菌培养.两组数据比较采用χ2检验或Fisher精确概率法.结果 两组120例有49例导管培养阳性,共检出病原菌57株,位于前四位的病原菌分别是凝固酶阴性葡萄球菌(57.9%)、白色假丝酵母菌(10.5%)、金黄色葡萄球菌(7%)和鲍曼不动杆菌(7%),所有细菌对β-内酰胺类抗生素都具有较高的耐药率.有基础疾病的患者的导管细菌检出率(50%)高于单纯气胸患者的31%,两者差异具有统计学意义(P＜0.05).置管时间超过14 d的患者的导管细菌检出率(70%)明显高于置管14 d以内的35%,两者差异具有统计学意义(P＜0.01).置管小于7 d时,A组导管的细菌检出率(8.3%)明显低于B组(52.9%),两者差异有统计学意义(P＜0.01);置管7～14 d时,A组导管的细菌检出率(21.4%)低于B组(68.8%),两者差异有统计学意义(P＜0.05);置管大于14 d时,两组导管的细菌检出率皆为70%,两者差异无统计学意义(P＞0.05).两组患者在疾病转归和住院天数上差异无统计学意义(P＞0.05).结论 气胸患者闭式引流术后常见的胸管定植菌为条件致病菌,细菌耐药现象十分严重.置管时间的延长、患者合并基础疾病都会增加感染的风险.预防性的应用抗菌药物有利于减少短期置管(小于14 d)患者的导管细菌检出率,降低感染的风险,但在缩短住院天数、影响疾病转归方面未证明有益.

Abstract：

Objective To investigate the feature of the microorganisms colonization of the thoracic catheter-related infection and evaluate the clinical significance of prophylactic antibiotics administration in patients with pneumothorax treated with closed thoracic drainage. Method A total of 120 patients with pneumothorax treated with closed thoracic dramage in emergency department wore enrolled. The patients were randomized (random number) into group A (n =60) and group B (n =60). In group A, the patients received levofloxacin mesylate injection and in group B, patients received physiological saline injection instead after closed thoracic drainage. The tip of catheter was cut off to get a 2-cm long segment after catheter removal and this segment was dipped into a bottle filled with liquid culture medium for microorganism culture. Statistical analysis carried out by using χ2 test or Fisher exact test. Results Of all 120 patients, microorganisms were found in 49 segments of catheter and 57 strains of microorganisms were found. The four most common microorganisms were Coagulase-negative staphylococci (57.9%), Candida albicans (10. 5%),Staphylococcus aureus (7%) and Acinetobacter baumanii (7%). All of them were highly drug-resistant to β-1actam antibiotics. The difference in the positive rate of microorganism culture was distinct in pneumothorax patients with underlying diseases (50%) in comparison to the patients without underlying diseases (31%) (P ＜ 0.05). The positive rate of microorganism culture increased significantly as the duration of drainage was longer than 14 days (P ＜ 0.01). The positive rate of culture in group A was lower than that in group B if the duration of drainage was less than 7 days (8.3% vs 52.9%, P ＜ 0.01). The positive rate of culture after drainage for 7 days was 21.4% in group A and 68.8% in group B (P ＜0.05), and that after drainage for over 14 days was 70% in both groups (P ＞ 0.05). There were no significant differences in outcome and days of hospital stay between two groups (P ＞ 0. 05). Conclusions The common colonized microorganisms of thoracic catheter-related infection are conditional pathogens and highly resistant to antibiotics. Lengthening the duration of drainage and having underlying diseases increase the risk of infection. Although prophylactic antibiotics administration is beneficial to decrease the risk of thoracic catheter-related infection, it has no effects on shortening hospital stay and outcome of disease.     

以颈部肿块为惟一临床表现的隐性鼻咽癌1例

颈部肿块的处理有时极具挑战性,一是体现在对肿块性质的判定,二是体现在对原发灶的搜寻,三是体现在能否有效的切除,后两者有时更具挑战性.在临床医疗活动中我们不时会遇到棘手的病例,在施治措施经讨论又难以统一的情况下,"施治策略"的制定的确是一大难题.     

唾液SIgA含量与慢性咽炎关系初探

分泌性免疫球蛋白A(SIgA)为外分泌中的主要免疫球蛋白,是机体粘膜表面重要的防御因素之一,在局部免疫中起着重要作用。慢性咽炎是一种常见病,可由多种因素引起。为了观察是否是由于诸多病因导致咽部局部免疫能力下降而致慢性咽炎,我们自1992年以来应用放射免疫法(RIA)对100例正常人和100例慢性咽炎患者的唾液SIgA进行了测定,并作对照观察,现报道如下。1　资料与方法1.1　临床资料　对照组:为大学生和参加健康体检的正常人,均排除鼻病、口腔病、咽喉部疾病等可能影响唾液SIgA含量的疾病,其中男性50人,女性50人,年龄17～56岁,平均27.4岁…     

2型糖尿病膀胱大鼠模型的制作及尿流动力学变化

目的 探讨2型糖尿病膀胱大鼠模型的制作方法及其尿流动力学变化情况.方法 将40只雌性大鼠体 (200250) g分为2组:A组为对照组 (22只) , B组为实验组 (18只) .实验组经高糖高脂喂养四周后腹腔内注射链脲佐菌素 (STZ) (30 mg/kg一次性腹腔注射) 诱导建立大鼠2型糖尿病膀胱模型;对照组常规饲养4周后腹腔注射相同剂量枸橼酸缓冲液.2组均采用尾静脉测定大鼠血糖, 每周1次, 连续4周.12周时2组大鼠进行膀胱容量、膀胱压及漏尿点压测定, 连续记录3次.结果 与对照组相比较, 实验组血糖明显升高, STZ建模成功率100%;尿动力学结果显示实验组充盈期膀胱容量明显高于对照组, 膀胱压和漏尿点明显低于对照组.结论 STZ用于建立糖尿病大鼠膀胱模型成功率高, 其膀胱尿道功能发生显著改变.     

中山市河涌水面垃圾的管理

在分析中山市市域水面垃圾污染源及治理现状的基础上，结合中山市社会经济发展与自然条件，提出了河涌水面垃圾污染治理的对策以及措施。     

小儿支气管特殊异物成功取出1例报告

我科近来收治1例较为罕见的小儿左侧支气管特殊异物,现报道如下。患儿男,3岁。在玩耍时将一枚钢珠吸入,遂呛咳,流泪,面色青紫,但不久即恢复平静．家长未予重视。翌日凌晨再度发生一过性呛咳,家长即携小儿来院就诊。来诊时患儿呼吸尚平稳,左侧肺部呼吸音低,X胸片示左肺中上近肺门处一圆形异物。立即在无麻醉但心电监护下,行支气管镇检查,于左支气镜开口下约Zcm处窥见异物,试用异物钳钳央数次未能成功,此时将支气管镜满退出,使支气管镜开口与异物之间约呈Icm的里高,据人异物钳,充分张口错叶,缓缓伸向异物,手感钳叶已包绕…