医院肠球菌感染危险因素及其药敏分析

近年来，国内外均不断有耐万古霉素肠球菌的报道。为了解我院肠球菌的药敏及所致感染的概况，笔者对本院住院患者中肠球菌感染病例进行了调查，结果如下。     

虫草多糖预先给药对大鼠内毒素性急性肺损伤的影响

Objective To evaluate the effects of Cordyceps polysaccharide (CP) pretreatment on endotoxin-induced acute lung injury (ALI) in rats.Methods Forty adult male SD rats were randomly divided into 5 groups ( n = 8 each) : CP1-3 group, ALI group and control group (group C). Group CP1-3 received CP 1, 2 and 3 g/kg by intragastric gavage every 12 h for 6 times respectively, and then received LPS 5 mg/kg iv through the femoral vein 2 h after the last administration. Croup ALI received normal saline 1 ml/100 g instead of CP, and the rest methods were the same as those described in group CP. Group C received normal saline 1 ml/100 g instead of CP and LPS, and the rest methods were the same as those described in group CP. The animals were killed 6 h after injection of LPS. The lungs were removed for determination of W/D lung weight ratio, pulmonary permeability index (PPI), WBC and PMN counts in broncho-alveolar lavage fluid (BALF) , and levels of TNF-α in lung tissues and BALF, and microscopic examination.Results Compared with group C, W/D lung weight ratio, PPI, WBC and PMN counts in BALF, lung pathological scores and levels of TNF-α in lung tissues and BALF were significantly increased in group ALI and CP1-3 ( P < 0.05 or 0.01). No significant differences were found in the indices mentioned above between group CP1 and group ALI ( P > 0.05) . The indices mentioned above were significantly lower in group CP2,3 than in group ALI ( P < 0.05) . PMN counts in BALF, lung pathological scores and levels of TNF-α in lung tissues and BALF were significantly lower in group CP3 than in group CP2 ( P < 0.05) . Conclusion Cordyceps polysaccharide pretreatment can attenuate LPS-induced ALI in a dose-dependent manner through inhibition of inflammatory response in rats.     

北京与银川两家医院耐碳青霉烯类肠杆菌科细菌的流行特征研究#br#

目的 调查研究北京与银川两家医院耐碳青霉烯类肠杆菌(carbapenem-resistance Enterobacteriaceae, CRE)的流行病学特征，为CRE的临床诊治及其传播控制提供依据。方法 收集2008年1月至2017年12月间北京地区解放军302医院及银川地区宁夏医科大学总医院的临床标本中分离的CRE，分析其流行趋势、标本来源、病原特点及基因型组成，探讨CRE的流行病学特征。结果 两地区10年间分离鉴定出266株CRE，呈上升趋势，北京地区CRE检出率由2008年为0.45%上升到2017年的5.84%；银川地区CRE检出率由2008年的0.26%上升到2017年的3.1%。CRE感染患者以男性为主(159例，59.77%)，主要来自重症监护病房(intensive care unit，ICU)70例(26.31%)。北京与银川两家医院分离出CRE的主要标本为痰液(29.4%与26.3%)，血液(18.4%与6.5%)和尿液(10.5%与19.7%)，血液和尿液标本占比差异显著(P=0.015和0.045)。北京与银川两家医院CRE菌株以克雷伯菌属(66.32%和44.74%)、埃希菌属(20.00%和9.21%)及肠杆菌属(7.89%和36.84%)为主，差异均具有统计学意义(比较P值分别为0.0012、0.0340和0)。266株CRE总体对碳青霉烯类和头孢类抗生素的耐药率较高，对其他类抗生素包括磷霉素和左氧氟沙星的耐药率达到80%以上，对阿米卡星的耐药率近60%；对头孢他啶/阿维巴坦的耐药率为42.86%，耐药率较低的包括替加环素(4.51%)和多黏菌素B(4.14%)；北京地区CRE对阿米卡星和左氧氟沙星的耐药率显著高于银川地区。北京地区的blaKPC在克雷伯菌、埃希菌属和肠杆菌属中均占绝对优势(93.75%、61.9%和80%)，而blaNDM仅在埃希菌属中检测到；银川地区均以blaNDM基因为主，三个菌属中占比分别为36%、74%和85.71%，两地碳青霉烯酶耐药基因分布差异明显(P=0)。结论 北京与银川两地区的CRE菌株流行呈增长趋势，在标本来源、病原特点、碳青霉烯酶耐药基因分布等方面特征鲜明，临床应根据本地区的CRE流行特点采取针对性治疗。     

虫草多糖预先给药对大鼠内毒素性急性肺损伤的影响

Objective To evaluate the effects of Cordyceps polysaccharide (CP) pretreatment on endotoxin-induced acute lung injury (ALI) in rats.Methods Forty adult male SD rats were randomly divided into 5 groups ( n = 8 each) : CP1-3 group, ALI group and control group (group C). Group CP1-3 received CP 1, 2 and 3 g/kg by intragastric gavage every 12 h for 6 times respectively, and then received LPS 5 mg/kg iv through the femoral vein 2 h after the last administration. Croup ALI received normal saline 1 ml/100 g instead of CP, and the rest methods were the same as those described in group CP. Group C received normal saline 1 ml/100 g instead of CP and LPS, and the rest methods were the same as those described in group CP. The animals were killed 6 h after injection of LPS. The lungs were removed for determination of W/D lung weight ratio, pulmonary permeability index (PPI), WBC and PMN counts in broncho-alveolar lavage fluid (BALF) , and levels of TNF-α in lung tissues and BALF, and microscopic examination.Results Compared with group C, W/D lung weight ratio, PPI, WBC and PMN counts in BALF, lung pathological scores and levels of TNF-α in lung tissues and BALF were significantly increased in group ALI and CP1-3 ( P < 0.05 or 0.01). No significant differences were found in the indices mentioned above between group CP1 and group ALI ( P > 0.05) . The indices mentioned above were significantly lower in group CP2,3 than in group ALI ( P < 0.05) . PMN counts in BALF, lung pathological scores and levels of TNF-α in lung tissues and BALF were significantly lower in group CP3 than in group CP2 ( P < 0.05) . Conclusion Cordyceps polysaccharide pretreatment can attenuate LPS-induced ALI in a dose-dependent manner through inhibition of inflammatory response in rats.     

虫草多糖预先给药对大鼠内毒素性急性肺损伤的影响

Objective To evaluate the effects of Cordyceps polysaccharide (CP) pretreatment on endotoxin-induced acute lung injury (ALI) in rats.Methods Forty adult male SD rats were randomly divided into 5 groups ( n = 8 each) : CP1-3 group, ALI group and control group (group C). Group CP1-3 received CP 1, 2 and 3 g/kg by intragastric gavage every 12 h for 6 times respectively, and then received LPS 5 mg/kg iv through the femoral vein 2 h after the last administration. Croup ALI received normal saline 1 ml/100 g instead of CP, and the rest methods were the same as those described in group CP. Group C received normal saline 1 ml/100 g instead of CP and LPS, and the rest methods were the same as those described in group CP. The animals were killed 6 h after injection of LPS. The lungs were removed for determination of W/D lung weight ratio, pulmonary permeability index (PPI), WBC and PMN counts in broncho-alveolar lavage fluid (BALF) , and levels of TNF-α in lung tissues and BALF, and microscopic examination.Results Compared with group C, W/D lung weight ratio, PPI, WBC and PMN counts in BALF, lung pathological scores and levels of TNF-α in lung tissues and BALF were significantly increased in group ALI and CP1-3 ( P < 0.05 or 0.01). No significant differences were found in the indices mentioned above between group CP1 and group ALI ( P > 0.05) . The indices mentioned above were significantly lower in group CP2,3 than in group ALI ( P < 0.05) . PMN counts in BALF, lung pathological scores and levels of TNF-α in lung tissues and BALF were significantly lower in group CP3 than in group CP2 ( P < 0.05) . Conclusion Cordyceps polysaccharide pretreatment can attenuate LPS-induced ALI in a dose-dependent manner through inhibition of inflammatory response in rats.     

虫草多糖预先给药对大鼠内毒素性急性肺损伤的影响

Objective To evaluate the effects of Cordyceps polysaccharide (CP) pretreatment on endotoxin-induced acute lung injury (ALI) in rats.Methods Forty adult male SD rats were randomly divided into 5 groups ( n = 8 each) : CP1-3 group, ALI group and control group (group C). Group CP1-3 received CP 1, 2 and 3 g/kg by intragastric gavage every 12 h for 6 times respectively, and then received LPS 5 mg/kg iv through the femoral vein 2 h after the last administration. Croup ALI received normal saline 1 ml/100 g instead of CP, and the rest methods were the same as those described in group CP. Group C received normal saline 1 ml/100 g instead of CP and LPS, and the rest methods were the same as those described in group CP. The animals were killed 6 h after injection of LPS. The lungs were removed for determination of W/D lung weight ratio, pulmonary permeability index (PPI), WBC and PMN counts in broncho-alveolar lavage fluid (BALF) , and levels of TNF-α in lung tissues and BALF, and microscopic examination.Results Compared with group C, W/D lung weight ratio, PPI, WBC and PMN counts in BALF, lung pathological scores and levels of TNF-α in lung tissues and BALF were significantly increased in group ALI and CP1-3 ( P < 0.05 or 0.01). No significant differences were found in the indices mentioned above between group CP1 and group ALI ( P > 0.05) . The indices mentioned above were significantly lower in group CP2,3 than in group ALI ( P < 0.05) . PMN counts in BALF, lung pathological scores and levels of TNF-α in lung tissues and BALF were significantly lower in group CP3 than in group CP2 ( P < 0.05) . Conclusion Cordyceps polysaccharide pretreatment can attenuate LPS-induced ALI in a dose-dependent manner through inhibition of inflammatory response in rats.     

虫草多糖预先给药对大鼠内毒素性急性肺损伤的影响

Objective To evaluate the effects of Cordyceps polysaccharide (CP) pretreatment on endotoxin-induced acute lung injury (ALI) in rats.Methods Forty adult male SD rats were randomly divided into 5 groups ( n = 8 each) : CP1-3 group, ALI group and control group (group C). Group CP1-3 received CP 1, 2 and 3 g/kg by intragastric gavage every 12 h for 6 times respectively, and then received LPS 5 mg/kg iv through the femoral vein 2 h after the last administration. Croup ALI received normal saline 1 ml/100 g instead of CP, and the rest methods were the same as those described in group CP. Group C received normal saline 1 ml/100 g instead of CP and LPS, and the rest methods were the same as those described in group CP. The animals were killed 6 h after injection of LPS. The lungs were removed for determination of W/D lung weight ratio, pulmonary permeability index (PPI), WBC and PMN counts in broncho-alveolar lavage fluid (BALF) , and levels of TNF-α in lung tissues and BALF, and microscopic examination.Results Compared with group C, W/D lung weight ratio, PPI, WBC and PMN counts in BALF, lung pathological scores and levels of TNF-α in lung tissues and BALF were significantly increased in group ALI and CP1-3 ( P < 0.05 or 0.01). No significant differences were found in the indices mentioned above between group CP1 and group ALI ( P > 0.05) . The indices mentioned above were significantly lower in group CP2,3 than in group ALI ( P < 0.05) . PMN counts in BALF, lung pathological scores and levels of TNF-α in lung tissues and BALF were significantly lower in group CP3 than in group CP2 ( P < 0.05) . Conclusion Cordyceps polysaccharide pretreatment can attenuate LPS-induced ALI in a dose-dependent manner through inhibition of inflammatory response in rats.     

虫草多糖预先给药对大鼠内毒素性急性肺损伤的影响

Objective To evaluate the effects of Cordyceps polysaccharide (CP) pretreatment on endotoxin-induced acute lung injury (ALI) in rats.Methods Forty adult male SD rats were randomly divided into 5 groups ( n = 8 each) : CP1-3 group, ALI group and control group (group C). Group CP1-3 received CP 1, 2 and 3 g/kg by intragastric gavage every 12 h for 6 times respectively, and then received LPS 5 mg/kg iv through the femoral vein 2 h after the last administration. Croup ALI received normal saline 1 ml/100 g instead of CP, and the rest methods were the same as those described in group CP. Group C received normal saline 1 ml/100 g instead of CP and LPS, and the rest methods were the same as those described in group CP. The animals were killed 6 h after injection of LPS. The lungs were removed for determination of W/D lung weight ratio, pulmonary permeability index (PPI), WBC and PMN counts in broncho-alveolar lavage fluid (BALF) , and levels of TNF-α in lung tissues and BALF, and microscopic examination.Results Compared with group C, W/D lung weight ratio, PPI, WBC and PMN counts in BALF, lung pathological scores and levels of TNF-α in lung tissues and BALF were significantly increased in group ALI and CP1-3 ( P < 0.05 or 0.01). No significant differences were found in the indices mentioned above between group CP1 and group ALI ( P > 0.05) . The indices mentioned above were significantly lower in group CP2,3 than in group ALI ( P < 0.05) . PMN counts in BALF, lung pathological scores and levels of TNF-α in lung tissues and BALF were significantly lower in group CP3 than in group CP2 ( P < 0.05) . Conclusion Cordyceps polysaccharide pretreatment can attenuate LPS-induced ALI in a dose-dependent manner through inhibition of inflammatory response in rats.     

低氧与膈肌疲劳

膈肌疲劳是导致呼吸衰竭发生的重要的病理生理机制之一,低氧对膈肌疲劳的发生发展起着重要的作用。对低氧造成膈肌疲劳的机制和机体对低氧后的适应性改变进行简要的介绍。