神经外科重症监护病房常见病原菌的分布与耐药性研究

目的调查珠江医院神经外科重症监护病房(ICU)病原菌的分布与耐药情况,分析ICU院内感染的发生原因,探讨防治对策。方法应用法国VITEKⅡ全自动细菌鉴定仪鉴定病原菌,用纸片扩散法检测药敏结果。结果神经外科ICU菌群主要以革兰阴性杆菌(71.6%)为主,鲍曼不动杆菌占16.7%,大肠埃希菌占15.7%,铜绿假单胞菌占13.7%,肺炎克雷伯菌占13.7%等。但葡萄球菌、粪肠球菌等阳性球菌(28.4%)也有增加的趋势。亚胺培南和头孢哌酮/舒巴坦仍保持最高抗菌活性,细菌的耐药率分别为15.3%和30.6%。结论我院神经外科ICU感染主要病原菌是革兰阴性杆菌,对常用抗菌药物耐药性较高,但革兰阳性球菌所占比例呈增高趋势。控制第二、三代头孢菌素以及制酸剂(质子泵抑制剂)的预防性用药,减少耐药菌株的产生,有针对性地使用抗生素是控制危重病人感染的有效措施。     

锁骨钩钢板内固定配合康复治疗锁骨远端骨折

目的探讨和分析应用锁骨钩钢板内固定配合康复治疗锁骨远端骨折的新方法。方法42例应用锁骨钩钢板配合术后早期康复治疗锁骨远端骨折的患者全部得到了随访,随访时间2～46个月(平均15.6个月),患者年龄36～57岁,平均45.6岁。术后2d患肩按照制定的康复训练方法进行功能训练,最终随访按Lazzcano评价标准〔1〕评价治疗结果。结果42例患者术后X线检查均达到满意复位与固定,局部Lazzcano功能评定关节功能恢复优良率97.6%。结论应用锁骨钩钢板治疗锁骨远端骨折手术操作简单,配合术后完善的康复治疗,可得到非常满意的结果。     

B细胞淋巴瘤TIL-T的IL-2Rα基因突变及蛋白表达检测

目的 :检测B细胞淋巴瘤 (B NHL)中肿瘤浸润T细胞 (TIL T)的活化标记IL 2Rα(CD2 5 )的基因及蛋白表达 ,寻找TIL T在B NHL肿瘤微环境中存在意义的实验依据。方法 :将 19例B NHL提取RNA ,采用RT PCR和SSCP检测其IL 2Rα的Ⅳ Ⅷ外显子基因突变与否 ;19例B NHL采用细胞免疫化学染色进行CD3、CD4、CD8、CD2 0、CD2 5细胞免疫表型的分析 ;2 9例B NHL和 2 0例良性淋巴组织 ,采用冰冻切片免疫组化方法进行IL 2Rα(CD2 5 )蛋白表达的检测。结果 :SSCP显示 19例TIL -T的IL 2Rα未发现异常泳动条带。细胞免疫化学染色示B NHL中 5 2 .6 3% (10 /19例 )的CD2 5 +细胞少于 10 % ,TIL T(CD3+)与CD4相关 (r =0 .5 7,P <0 .0 1)并与CD2 5相关 (r =0 .5 0 ,P <0 .0 5 )。免疫组化示 86 .2 % (2 5 /2 9例 )的B NHL中CD2 5表达 (+/- )和 (+) ,且主要表达在TIL T细胞上 ,呈散在分布 ,阳性细胞少于T标记细胞。结论 :19例TIL T的IL 2Rα在RNA水平未发现基因异常 ;CD2 5蛋白在B NHL中呈弱表达趋势。提示部分TIL T不表达CD2 5 ,推测TIL T的IL 2Rα的表达在转录后机制中可能出现异常或TIL T存在活化障碍。     

Twenty-four-hour intragastric acidity and clinical trial of bedtime enprostil 70 μg compared with ranitidine 300 mg in duodenal ulcer

The effects of bedtime 70 micrograms and twice daily 35 micrograms doses of enprostil on 24-hour intragastric acidity were investigated in nine duodenal ulcer patients in remission. Median nocturnal acidity decreased significantly by 30% with 35 micrograms twice daily, and by 48% with 70 micrograms at bedtime. In a clinical trial using bedtime dosing, 102 duodenal ulcer patients randomly received either ranitidine 300 mg or enprostil 70 micrograms. More ulcers healed after 4 and 8 weeks treatment with ranitidine than with enprostil (76% ranitidine vs 52% enprostil, at 4 weeks p = 0.0065 and 94% vs 68%, respectively at 8 weeks, P = 0.0007). However, 6 months after cessation of treatment there was no material difference in overall outcome. Despite combining mucosal protection with acid inhibition enprostil treatment conferred no advantage over simple acid inhibition.     

烧伤病人耐甲氧西林金黄色葡萄球菌及其肠毒素的检测和耐药性分析

目的:评价乳胶结合实验,检测重症监护病房(ICU)耐甲氧西林金黄色葡萄球菌(MRSA)及其肠毒素(SE),并进行耐药性分析。方法:收集260株金黄色葡萄球菌临床分离株,通过药敏试验将其分为耐甲氧西林金黄色葡萄球菌和甲氧西林敏感金黄色葡萄球菌(MSSA),用反向间接血凝试验(RPHA)检测金黄色葡萄球菌肠毒素。结果:MRSA产肠毒素为134株,MSSA产肠毒素为38株,MRSA产肠毒素率为100％,MSSA产肠毒素率为30％。结论:重症监护病房应重视MRSA的检测和金黄色葡萄球菌肠毒素的检测,合理使用广谱抗菌药物。     

匹罗卡品致(癎)大鼠海马中表达生长抑素的中间神经元数目变化及其轴突出芽

Objective To investigate the roles of somatostatin(SS)positive intemeurons in the development and compensation of temporal lobe epilepsy.Methods Piloearpine-induced epilepsy rat model was established.Immunohistochemistry method was used to detect number changes and axonal sprouting of SS positive intemeurons in different domains of the hippocampus at difierent time points.Degeneration of SS positive interneurons and their neurophils were detected by the double immunofluorescence staining with SS and Fluoro-Jade B(FJB)at 7 and 60 days after status epilepticus (SE).Results In the exoerimental rat group,the number of SS positive neurons decreased in each hippocampal domain,and it reached the lowest at 7 days post-SE(There were 11.1±3.3 in hilus,2.8±0.9 in CA1region and 1.8±0.7 in CA1region,t=13.519,9.644 and 8.808,all P<0.01).In chronic phase,the number of SS neurons gradually recovered,and exceeded the control group in CA1 area at 60 days post-SE(12.8±1.5 vs 8.8±1.3,t=-4.506,P<0.01),however,the number of SS neurons in the hilus(25.5±4.6)and CA1 area(4.8±0.8)remained significantly less than normal levels(t value were 4.691 and 3.953.both P<0.01).Increased SS positive fibers were found in the lacunosum-molecular (1m)layer and outer molecular layer of dentate gyrus after 30 days post-SE,and numerous SS positive fibers were seen threnghout the layers of area CA1 at 60 days post-SE.Double immunofluuorescence revealed that a few SS positive interneurons and fibers were also labeled by FJB in area CA1 at 7 days post-SE and in CA domain/hilus at 60 days post-SE.Conclusions SS intemeurons loss plays an important role in the development of temporal lobe epilepsy.The loss is partially caIlsed by the degeneration and death of neurons;SS positive neurophils increase within area CA1 in chronic phase may play a significant role in the generation and compensation of temporal lobe epilepsy.     

铜绿假单胞菌高活性β内酰胺酶检测及其耐药性分析

目的:研究临床分离铜绿假单胞菌(PA)持续高产AmpC酶和超广谱β内酰胺酶(ESBLs)的发生率及对耐药性的影响。方法:用改良三维试验法检验持续高产AmpC酶和ESBLs,用K—B法检测细菌耐药性。结果:我院2001年3月-2002年10月临床分离241株PA中,产生高活性β内酰胺酶共83株,检出率为34.4％,其中高产AmpC酶28株(11.6％),产ESBLs69株(28.6％),ESBLs与高产AmpC酶均阳性21株(8.7％),非AmpC酶、非ESBLs 7株(2.9％)。83株产酶PA主要分离自痰液(56株,67.5％)和烧伤创面分泌物(23株,27.7％)。易感人群以重症肺炎(34例,41.0%)、烧伤(23例,27.7 %)和肿瘤患者(10例,12.0%)为主。产酶株呈多重耐药性,对亚胺培南耐药率为10.8％,对受试的其他11种抗菌药物耐药率在49.4％～86.7％;除亚胺培南外,产酶株耐药率均明显高于非产酶株(X2≥16.1,P<0.005)。结论:我院PA临床株产ESBLs为主(约28.6％),其次是持续高产AmpC酶(约11.6％)。产酶株主要分离自重症肺炎、烧伤和肿瘤患者,其耐药率高,治疗用药应参考药敏试验结果。     

胸骨肿瘤CT诊断(附22例报告)

目的探讨胸骨肿瘤临床CT诊断和检查意义。方法搜集分析经临床病理证实的22例胸骨肿瘤CT资料,其中转移瘤17例(肺癌转移15例;乳腺癌转移2例)、骨髓瘤2例、软骨肉瘤1例、骨肉瘤1例、骨化性纤维瘤1例。结果局部骨质破坏(囊状膨胀性、溶骨性和混合性骨破坏3种),其中囊状膨胀性骨破坏1例(骨化性纤维瘤),溶骨性骨破坏16例(肺癌转移15例、骨肉瘤1例),混合性骨破坏5例(软骨肉瘤1例、骨髓瘤2例、乳腺癌转移2例)。胸骨处软组织肿块18例,胸骨前胸壁肌、皮下脂肪和胸骨后脂肪间隙浸润13例。结论胸骨肿瘤以转移瘤多见,CT检查对胸骨肿瘤有较高的诊断价值。     

匹罗卡品致(癎)大鼠海马中表达生长抑素的中间神经元数目变化及其轴突出芽

Objective To investigate the roles of somatostatin(SS)positive intemeurons in the development and compensation of temporal lobe epilepsy.Methods Piloearpine-induced epilepsy rat model was established.Immunohistochemistry method was used to detect number changes and axonal sprouting of SS positive intemeurons in different domains of the hippocampus at difierent time points.Degeneration of SS positive interneurons and their neurophils were detected by the double immunofluorescence staining with SS and Fluoro-Jade B(FJB)at 7 and 60 days after status epilepticus (SE).Results In the exoerimental rat group,the number of SS positive neurons decreased in each hippocampal domain,and it reached the lowest at 7 days post-SE(There were 11.1±3.3 in hilus,2.8±0.9 in CA1region and 1.8±0.7 in CA1region,t=13.519,9.644 and 8.808,all P<0.01).In chronic phase,the number of SS neurons gradually recovered,and exceeded the control group in CA1 area at 60 days post-SE(12.8±1.5 vs 8.8±1.3,t=-4.506,P<0.01),however,the number of SS neurons in the hilus(25.5±4.6)and CA1 area(4.8±0.8)remained significantly less than normal levels(t value were 4.691 and 3.953.both P<0.01).Increased SS positive fibers were found in the lacunosum-molecular (1m)layer and outer molecular layer of dentate gyrus after 30 days post-SE,and numerous SS positive fibers were seen threnghout the layers of area CA1 at 60 days post-SE.Double immunofluuorescence revealed that a few SS positive interneurons and fibers were also labeled by FJB in area CA1 at 7 days post-SE and in CA domain/hilus at 60 days post-SE.Conclusions SS intemeurons loss plays an important role in the development of temporal lobe epilepsy.The loss is partially caIlsed by the degeneration and death of neurons;SS positive neurophils increase within area CA1 in chronic phase may play a significant role in the generation and compensation of temporal lobe epilepsy.