儿童重症监护病房鲍氏不动杆菌临床分布及耐药性变化趋势分析

目的调查儿童重症监护病房(PICU)鲍氏不动杆菌(ABA)临床分布特点及耐药情况,为合理选用抗菌药物提供依据。方法采用VITEK-32微生物全自动鉴定系统鉴定细菌,以纸片扩散法进行药敏试验,按CLSI标准操作。结果 2007-2009年共检出329株,其中2007年45株、2008年74株、2009年210株,分别占当年总检出率的9.57%、12.67%和24.33%;大部分菌株来源于痰液及支气管吸出物标本,占89.36%;基础疾病以肺炎最多,占80.24%;药敏结果显示,常用抗菌药物耐药性普遍较高,呈逐年上升趋势,其中青霉素类、头孢菌素类(头孢哌酮/舒巴坦除外)抗菌药物耐药率均>70.0%,亚胺培南、美罗培南平均耐药率>60.0%;阿米卡星、左氧氟沙星、环丙沙星耐药率最低,分别为0.45%、1.97%、2.48%。结论 ABA感染在PICU不断增加,常用抗菌药物表现多药耐药性,且呈逐年上升趋势;临床上应进行规范的连续耐药监测,依据病原学及耐药性资料,合理选择抗菌药物;同时加强医院环境和人员消毒,控制ABA在PICU定植与播散。     

MRI findings in 6 cases of children by inadvertent ingestion of diphenoxylate-atropine

Purpose

Compound diphenoxylate (diphenoxylate-atropine) poisoning can cause toxic encephalopathy in children, and magnetic resonance imaging (MRI) of the brain in this condition has not been reported. This study is to analyze brain MRI findings and to investigate the relations between MRI features and possible pathophysiological changes in children.

Methods

Six children accidentally swallowed compound diphenoxylate, 4 males, 2 females, aged 20-46 months, average 33 months. Quantity of ingested diphenoxylate-atropine was from 6 to 30 tablets, each tablet contains diphenoxylate 2.5 mg and atropine 0.025 mg. These patients were referred to our hospital within 24 h after diphenoxylate-atropine ingestion, and underwent brain MRI scan within 24-72 h after emergency treatment. The characteristics of conventional MRI were analyzed.

Results

These pediatric patients had various symptoms of opioid intoxication and atropine toxicity. Brain MRI showed abnormal low signal intensity on T1-weighted images (T1WI) and abnormal high signal intensity on T2-weighted images (T2WI) and fluid-attenuated inversion recovery (FLAIR) imaging in bilateral in all cases; abnormal high signal intensity on T1WI, T2WI and FLAIR in 4 cases. Encephalomalacia was observed in 3 cases during follow-up.

Conclusion

In the early stage of compound diphenoxylate poisoning in children, multiple extensive edema-necrosis and hemorrhagic-necrosis focus were observed in basic nucleus, pallium and cerebellum, these resulted in the corresponding brain dysfunction with encephalomalacia. MRI scan in the early stage in this condition may provide evidences of brain impairment, and is beneficial for the early diagnosis, treatment and prognosis assessment.     

Associations of Participation-Focused Strategies and Rehabilitation Service Use With Caregiver Stress After Pediatric Critical Illness

Objective(s)

Determine the associations between having participation-focused strategies and receiving rehabilitation services in the pediatric intensive care unit (PICU) with caregiver stress over 6 months post-PICU discharge.

头低足高俯卧位降低儿科ICU呼吸机相关性肺炎的效果

目的探讨合理的体位管理方案以降低儿科ICU机械通气患儿呼吸机相关性肺炎(VAP)的发生率。方法选取2013年6月-2017年6月收治于华中科技大学同济医学院附属同济医院儿童重症医学科行机械通气的460例患儿为研究对象。按使用机械通气的前后顺序交替分为观察组(n=230)和对照组(n=230)。两组患儿在对症支持治疗和机械通气常规护理的基础上给予不同的体位管理方案,每2~3小时改变体位1次。观察组给予头低足高倾斜俯卧位与其他体位交替进行,对照组则给予常规仰卧位与侧卧位交替进行。比较两组患儿机械通气前5天痰液引流量、两组患儿胸片改善时间、机械通气持续时间、VAP发生率以及相关并发症发生率。结果观察组患儿机械通气前5天内痰液引流量较对照组更多,观察组患儿胸片改善时间及机械通气持续时间均少于对照组,且VAP发生率均低于对照组(均P<0.05),两组患儿并发症发生率无明显差异(P>0.05)。结论在儿科ICU机械通气患儿中采取头低足高倾斜俯卧位可以显著提高患儿的通气效果,降低机械通气持续时间和VAP发生率,且不会增加相关并发症风险。     

浅谈手卫生与儿童重症监护病房医院感染率及三管感染率的相关性

目的探讨手卫生与儿童重症监护病房(PICU)医院感染率及三管感染率的相关性。方法选择2017年4月至2019年9月我院儿内二科PICU医护人员与所有患儿为研究对象。观察调查期间各季度医院感染、三管感染发生情况及医护人员手卫生依从率、正确率与合格率;分析医护人员手卫生与PICU医院感染率、呼吸机相关肺部感染率的相关性。结果我院2017年4月至2019年9月PICU医院感染率在0~9.91%,2017年第三季度、2018年第一季度医院感染率最突出;呼吸机相关肺部感染在2017年第三季度明显增加;PICU医护人员手卫生依从率在68.57%~92.83%,正确率在81.98%~92.95%,合格率在79.07%~91.67%。相关性分析结果显示,医护人员手卫生依从率与PICU医院感染率、呼吸机相关肺部感染率均有显著的负相关性(P<0.001)。结论医护人员手卫生依从性与PICU医院感染率、呼吸机相关肺部感染率有显著的负相关性,严格执行手卫生可明显降低医院感染率与三管感染率。     

依据儿童早期预警评分配置PICU护理人力的临床实践研究

目的 探讨根据儿童早期预警评分进行护理人力资源配置在PICU护理工作中的应用效果.方法 根据儿童早期预警评分的结果判断患儿病情危重程度及护理需求情况,进行护理人力资源的调配,对实施前后的各项护理质量指标、医生对护理工作满意度、护士对护理人力资源配置满意度、患儿或家属对护理工作满意度对比.结果 使用儿童早期预警评分进行动...     

高频通气在肺抢救监护病房(PICU)中应用(附25例分析)

我们对PICU中25例危重患儿行高频通气(HFV)32例次(占同期机械通气病人的18.6％)。其中混合高频通气(CHFV)6例次,高频喷射通气(HFJV)10例次,高频正压通气(HFPPV)2例次,经鼻塞高频喷射给氧14例次。年龄范围:1天～10岁,主要原发病:重症肺炎伴呼衰、心衰,心肺复苏后,重症支气管哮喘,呼吸窘迫综合征等。经鼻气管内插管为高频通气主要途经。应用结果显示:经鼻塞高频给氧与普通给氧(口罩或头罩)相比,PaO_2和PaO_2/Fio2值明显上升(P<0.01),PaCO_2和PH无明显变化(P>0.05),混合高频通气组均无CO_2潴留,并提示其所需平均气道压(Paw)和吸气峰压值(PIP)较单纯常频通气时为低。本文对高频通气适应症、高频呼吸器参数的调节略加讨论。并指出:CO_2潴留和呼吸道湿化不足仍是高频喷射通气应用中存在的主要问题,为此可采取与常频通气交替使用,注意调节驱动力和频率等参数和加强气道管理等方法加以解决。     

Association between anemia and postoperative complications in infants undergoing pyloromyotomy

BackgroundAlthough preoperative anemia has been suggested to predict postsurgical morbidity and mortality among infants < 1 year of age, the data were drawn from heterogeneous patient cohorts including severely ill infants undergoing complex, high-risk procedures. We aimed to determine whether untreated preoperative anemia was associated with increased risk of postoperative complications in infants < 1 year of age who underwent pyloromyotomy, a common and relatively simple surgery.MethodsInfants < 1 year of age undergoing pyloromyotomy were identified from the American College of Surgeons (ACS) National Surgical Quality Improvement Program-Pediatric database. Preoperative anemia was defined as a hematocrit ≤ 40% for infants 0–30 days of age and ≤ 30% for infants more than 30 days of age. Patients who received pre- or postoperative blood transfusions were excluded.ResultsWe identified 2948 patients who met our inclusion criteria, of whom 843 were anemic (29%). The overall rate of complications in this cohort was 6%. The most common postoperative complications were readmission (97 cases), surgical site infection (43), reoperation (39), prolonged hospital stay (24), urinary tract infection (3), 30-day mortality (3) and cardiac arrest (2). We found no differences in the incidence of complications in anemic versus nonanemic patients on bivariate analysis or multivariable logistic regression (adjusted odds ratio = 1.2; 95% confidence interval: 0.8–1.7; P = 0.319).ConclusionsIn relatively healthy infants undergoing pyloromyotomy, untreated preoperative anemia was not associated with postoperative compilations and should not be considered a significant risk factor.Level of evidence III.