封闭式负压引流治疗软组织感染

目的探讨封闭式负压引流治疗软组织感染的疗效。方法应用封闭式负压引流治疗开放性骨折发生软组织感染18例。结果18例均获随访,时间6个月-1年6个月。软组织感染均愈合,骨折正常愈合12例,延迟愈合6例,无慢性骨感染发生。结论封闭式负压引流治疗软组织感染,可短期控制感染,为进一步治疗创造条件,尤其适用于深部软组织感染患者。手术简单,疗效可靠,适合基层医院应用。     

Effectiveness of a hospital-wide selective screening programme for methicillin-resistant Staphylococcus aureus (MRSA) carriers at hospital admission to prevent hospital-acquired MRSA infections

Screening of potential MRSA-positive patients at hospital admission is recommended in German and international guidelines. This policy has been shown to be effective in reducing the frequency of nosocomial MRSA transmissions in the event of an outbreak, but the influence of screening on reducing hospital-acquired MRSA infections in a hospital setting where MRSA is endemic is not yet well-documented. This study describes the effect of hospital-wide screening of defined risk groups in a 700-bed acute care hospital during a period of 19 months. In a cohort study with a 19-month control period, the frequencies of hospital-acquired MRSA infections were compared with and without screening. In the control period, there were 119 MRSA-positive patients, of whom 48 had a hospital-acquired MRSA infection. On the basis of this frequency, a predicted total of 73.2 hospital-acquired MRSA infections was calculated for the screening period, but only 52% of the expected number (38 hospital-acquired MRSA infections) were observed, i.e., 48% of the predicted number of hospital-acquired MRSA infections were prevented by the screening programme. The screening programme was performed with minimal effort and can therefore be recommended as an effective measure to help prevent hospital-acquired MRSA infections.     

鱼腥草注射液佐治下呼吸道感染的疗效观察

目的观察鱼腥草注射液佐治下呼吸道感染的疗效及安全性.方法将76例急性下呼吸道感染患者随机分为治疗组和对照组,两组均予内科常规治疗,治疗组则另予鱼腥草注射液治疗.结果治疗组的总有效率为94.7%,显著优于对照组的73.7%(x2=6.33,P＜0.05),且未见明显副作用.结论鱼腥草注射液佐治急性下呼吸道感染安全、有效,值得推广.     

Effects of seawater immersion combined with open abdominal injury on the expression of NF-κB,and IκBαof small intestine in rats

Objective To observe effects of seawater immersion combined with open abdominal injury on the expression of NF-κB,and IκBαas well as the change pattern in rats. Methods Ninety-one Wistar rats were randomly divided into 3 groups: the control group (n =7), the open abdominal injury group(n =42) and open abdominal injury combined with 1-hour seawater immersion group ( n =42). The expression of NF-κB,andIκBαin small intestine tissues was measured by Western blot and statistical analyses were also made in the study. Results The expression of NF-κB,in the seawater immersion combined with open abdominal injury group increased significantly 3 hours after injury, when compared with that of the open abdominal injury group(P<0. 05), whereas the expression of NF-κB, of the pure injury group was slightly lower than that of the control group, but no statistical differences could be seen between them(P>0.05). The change pattern in the expression of IκBαwas quite the opposite to that of NF-κB. Conclusions NF-κB seemed to be rapidly and persistently involved in the whole inflammatory response to trauma induced by opened abdominal injury and seawater immersion, when a comparison was made with the pure open abdominal injury group. Injuries for the rats in the open abdominal injury combined with seawater immersion group were serious, and the feedback mechanism for NF-κB was not established for quite a long time.     

慢性肝病合并细菌感染临床特点分析

目的 :分析慢性肝病合并细菌感染的特点。方法 :对 1997～ 2 0 0 2年住院的慢性重度、重症肝类及肝硬化合并细菌感染患者 52例进行回顾性分析。结果 :其中医院内感染占 2 9 8%。感染的部位 :腹腔感染 40 4% ,血液感染17 3 % ,呼吸道感染 18 1% ,肠道感染 9 6% ,胆道感染 7 7% ,口腔感染占 6 3 % ,其他感染占 3 3 % ,重型肝炎的感染率最高 ,其次为肝硬化和慢性重度肝炎。结论 :肝病患者免疫力低下 ,易于合并细菌感染 ,感染使病情加重 ,影响肝病的愈后 ;提高患者免疫力 ,增强控制医院感染的措施 ,重视潜伏感染状态病灶的处理 ,早期诊治感染可提高肝病患者的生存率     

Acute diverticulitis – clinical presentation and differential diagnostics

Objective To describe the clinical presentation of acute diverticulitis in an emergency department and to characterize the natural history of diverticulitis in the short perspective. Comparisons are made with an important differential diagnosis, nonspecific abdominal pain (NSAP). Method Patients admitted to our hospital with abdominal pain of up to 7 days’ duration were registered prospectively using a detailed schedule for history, symptoms and signs, from 1 February 1997 to 1 June 2000. Of 3349 patients initially included, 3073 (92%) were eligible for follow up after 1–3 years. Results Acute diverticulitis was the final diagnosis in 145 patients and NSAP in 1142 patients. The incidence of hospitalized patients with diverticulitis was 47 per year and 100 000 population, with a mean hospital stay of 3.3 days. Patients with diverticulitis, more frequently than NSAP, had a longer history and laboratory signs of inflammatory activity. Isolated left abdominal tenderness was more common in diverticulitis, whereas isolated right abdominal tenderness was more common in NSAP. Duration of symptoms on arrival was independent of age and was not correlated to C‐reactive protein, leucocytes or body temperature. Sensitivity of diverticulitis as primary diagnosis was 64% and specificity 97%. Corresponding figures for NSAP were 43% and 90% respectively. Age and gender did not influence diagnostic accuracy or risk of surgery. Conclusion Diverticulitis differs significantly from NSAP in clinical presentation and laboratory parameters. Sensitivity of primary diagnosis for diverticulitis and NSAP was low.     

鼻胃管胃肠减压在择期腹部手术中的应用价值

鼻胃管胃肠减压曾被常规应用于择期和急诊的腹部手术后，目的是预防急性胃扩张的发生、治疗梗阻、降低吻合口压力等。但是，鼻胃管置入也会带来一些副作用，如呼吸道并发症、胃-食道反流、体液和电解质的丢失、声带的损伤，以及越来越被重视的患者的不适感。近年来的研究结果也对择期的腹部手术后常规应用鼻胃管胃肠减压提出不同的看法。现重新评价应用鼻胃管胃肠减压的理论基础及相关临床研究的结果，并对鼻胃管胃肠减压在择期腹部手术中的价值作一综述。     

3261例老年患者医院感染分析及对策

目的　探讨老年人医院感染状况 ,以采取有效措施降低医院感染率。方法　对我院 3 2 61例老年住院患者进行回顾性调查分析。结果　 3 2 61例中 2 1 2例发生医院感染 ,感染率为 6 .5 % ,以下呼吸道感染为多 ,占 49.5 % ;其次为泌尿道感染 ,占 2 2 .0 % ;胃肠道感染占 1 6 .5 % ;皮肤感染占 6 .6 % ;其他感染占 5 .2 %。结论　老年患者抵抗力低下 ,不合理使用抗生素以及住院时间延长 ,是造成医院感染的主要因素 ,因此应加强老年患者的护理 ,提高其自身防御能力 ,严格加强感染管理制度及医院感染监测 ,合理使用抗生素 ,以有效地降低医院感染的发生。     

湖南省洪涝灾害高发地区钩端螺旋体病流行因素的研究

目的研究湖南省洪涝灾害高发地区钩端螺旋体病的流行因素。方法选择洞庭湖区6个县研究传染源密度、带茵情况和自然人群、病人与动物抗体水平，按国家有关标准进行实验室和现场工作。结果(1)传染源：灭鼠前、后和钩体病流行后期鼠密度分别为7．02％、2．31％和4．64％，优势鼠种为黑线姬鼠，灭鼠后鼠密度下降了67．09％：村民家庭家畜饲养以圈养形式占99．15％，喂商品混合饲料的占72．33％。(2)病原学：对鼠、猪、犬和病人的标本进行钩体培养，分离出82株钩体，黄疸出血群占70．73％，1株国内新型茵，黑线姬鼠分离率高达11．03％。(3)血清学：检测1263名自然人15个群钩体抗体，一群以上抗体阳性率未接种钩体苗为50．88％，接种一针四价钩体为72．55％，人群抗体有14群之多；检测85例病人双份血清抗体，确诊63例，符合率74．11％，黄疸出血群感染比例最高；流行季节牛、犬和出栏猪抗体分别有14、8和7个群，牛阳性率最高。结论流行前灭鼠效果好，不仅降低了鼠密度，还降低了带茵率；主要传染源是鼠和牛，牛作为传染源的意义大于猪和犬；人群接种一针四价钩体菌苗亦有效；病人感染黄疸出血、澳洲和秋季群为多。