鹿茸多肽对胎大鼠脑神经干细胞体外诱导分化的实验研究

目的　探讨鹿茸多肽对胎大鼠脑神经干细胞体外分化的影响。　方法　从E12～ 14d的Wistar大鼠脑中分离扩增获得大量神经干细胞后 ,加入不同浓度的鹿茸多肽 ,观察其对胚胎神经干细胞分化的影响 ,并通过免疫组织化学染色检测神经干细胞分化为神经元和星形胶质细胞的状况。　结果　 5 0 μg L组分化细胞总数与对照组相比有显著性差异 (P <0 0 1) ;5 0 μg L、10 0 μg L、2 0 0 μg L组神经元特异烯醇化酶 (NSE)阳性率与对照组相比有显著性差异 (P <0 0 1) ,并呈一定的剂量依赖性。　结论　鹿茸多肽在体外可明显促进神经干细胞向神经元分化 ,为鹿茸多肽应用于神经系统损伤性疾病的治疗提供了实验依据。     

临床肺部感染评分干预对VAP患者的疗效观察

目的 探讨临床肺部感染评分对VAP患者抗生素选择策略进行干预后对预后的影响.方法 采用随机、对照、临床研究.连续入选符合诊断标准的VAP患者56例,随机分为2组:A组(评分干预组,28例)临床肺部感染评分大于6分者抗生素选择策略采用降阶梯治疗方案,小于6分者采用常规升级治疗方案.B组(常规组,28例)按常规自然决定抗生素的选择和疗程.比较两组患者抗生素使用疗程、病死率及真菌定植发生率等.结果 A组抗生素使用疗程、病死率显著低于B组,B组真菌定植发生率高于A组.结论 临床肺部感染评分干预抗生素选择策略对改善VAP的疗效、预后具有良好效果.     

镀银气管导管对呼吸机相关性肺炎影响的荟萃分析

目的 评价镀银气管导管,对预防机械通气患者呼吸机相关性肺炎(VAP)的效果.方法 电子检索Cochrane图书馆、PubMed、EMbase、ScienceDirect、中国生物医学文献数据库(CBM)、中国期刊全文数据库(CNKI)、万方数据库等,各数据库检索时间均从创建到2011年8月；纳入镀银气管导管对预防机械通气患者VAP效果的随机对照试验(RCT);采用RevMan5软件进行荟萃分析,对于无法转换合并的数据,采用描述性分析.结果 共纳入3个RCT、2127例患者,文献异质性较小；荟萃分析结果表明,镀银气管导管可显著降低VAP的发生率[固定效应模型,OR=0.59,95 ％CI(0.41,0.84),P=0.005]、死亡率和负面事件等方面两组差异无统计学意义;住院时间、住ICU时间、气管插管时间、临床肺感染指数及呼吸道细菌浓度等指标,由于数据难以转换及难以获取完整数据等原因未能做荟萃分析,只进行描述性分析,显示两组在上述指标方面差异无统计学意义.结论 与标准非镀银气管导管相比,镀银气管导管能显著降低机械通气患者VAP的发生率,而对患者死亡率及负面事件发生率等指标无明显改善；需要进行更多设计严格的、多中心、大样本随机对照试验,对镀银气管导管的综合效果进行验证.     

静脉输注免疫球蛋白对呼吸机相关肺炎疗效的系统评价

目的 系统评价免疫球蛋白(IVIG)治疗呼吸机相关性肺炎(VAP)相关研究,分析其有效性,为临床治疗策略提供依据。方法 系统检索CNKI、万方、CBM、Pubmed、Embase、ISI及Cochrane数据库中相关文献,采用Cochrane标准评价纳入研究偏倚风险,Meta分析结合描述性分析研究数据。结果 ①纳入6个随机对照研究,435例低体质量儿、早产儿及婴儿VAP患者,质量一般。②Meta分析结果显示IVIG组死亡率低于非IVIG组[RR=0.33,95%CI(0.18~0.60),P=0.0002];IVIG组血液免疫球蛋白浓度比对照组高3.19 mg/L [MD=3.19,95%CI(3.02~3.37),P<0.05];③IVIG组败血症[RR=0.14,95%CI(0.04~0.51),P=0.003]和多器官功能衰竭发生率[RR=0.51,95%CI(0.30~0.88),P=0.02]低于对照。结论 IVIG主要用于早产儿及低体质量儿VAP患者,可能提高体液免疫,降低败血症和多器官功能衰竭发生率,减少患者病死率,改善预后。     

静脉输注免疫球蛋白对呼吸机相关肺炎疗效的系统评价

目的：系统评价免疫球蛋白( IVIG)治疗呼吸机相关性肺炎( VAP)相关研究,分析其有效性,为临床治疗策略提供依据。方法系统检索CNKI、万方、CBM、Pubmed、Embase、ISI及Cochrane数据库中相关文献,采用Cochrane标准评价纳入研究偏倚风险,Meta分析结合描述性分析研究数据。结果①纳入6个随机对照研究,435例低体质量儿、早产儿及婴儿VAP患者,质量一般。②Meta分析结果显示IVIG组死亡率低于非IVIG组[RR=0．33,95%CI(0．18~0．60),P=0．0002];IVIG组血液免疫球蛋白浓度比对照组高3．19 mg/L [MD=3．19,95%CI(3．02~3．37),P<0．05];③IVIG组败血症[RR=0．14,95%CI(0．04~0．51),P=0．003]和多器官功能衰竭发生率[RR=0．51,95%CI(0．30~0．88),P=0．02]低于对照。结论 IVIG主要用于早产儿及低体质量儿VAP患者,可能提高体液免疫,降低败血症和多器官功能衰竭发生率,减少患者病死率,改善预后。     

Combination of ventilator care bundle and regular oral care with chlorhexidine was associated with reduction in ventilator associated pneumonia

BackgroundVentilator associated pneumonia (VAP) is an important source of morbidity and mortality in patients receiving mechanical ventilation. VAP is associated with prolongation of mechanical ventilation, ICU and hospital stay and increases in costs.MethodsQuality improvement project. Mechanically ventilated patients received oral care every 8 h with chlorhexidine 2%. A formal process was developed to evaluate compliance with the following ventilator bundle initiatives: head of the bed elevation to 30–45°, daily sedation vacation and assess the readiness to extubate, providing peptic ulcer disease prophylaxis and providing deep vein thrombosis prophylaxis (unless contraindicated).ResultsThe rate of VAP before starting the project, in the first 6 months of year 1431H, was 16.2 cases/1000 ventilator days. Six month after inception of the quality improvement project, the VAP rates decreased to 5.6 cases/1000 ventilator days at the end of 1431H, and at the end of 1432H, it was 5.5 cases/1000 ventilator days. This leads to significant reduction in mortality (adjusted according to APACHE II) from 23.4% to 19.1% (p value 0.024) and the length of stay in ICU from 9.7 to 6.5 days (p value 0.00002).ConclusionThe combination of regular oral hygiene with chlorhexidine 2% and rigorous implementation of ventilator care bundle was associated with significant reduction in VAP rate in mechanically ventilated patients. This has led to reduction in length of stay in ICU from 9.7 to 6.5 days and reduction in mortality from 23.4% to 19.1%.     

呼吸机相关性肺炎的预防及护理策略

目的总结呼吸机相关性肺炎的预防及护理经验。方法术后加强机械通气管理,除常规观察外,还从视、听、测3方面加强观察,掌握吸痰指征,遵循科学吸痰的原则与方法,良好而有效地湿化。结果该组病人中31例治疗好转,成功脱机。结论呼吸机相关性肺炎对肺功能状态有明显的负面影响,术后全面预防、加强监护及管理非常重要。     

儿童重症监护病房呼吸机相关性肺炎病原菌分布及耐药性分析

目的 分析儿童重症监护病房(PICU)呼吸机相关性肺炎(VAP)病原菌及耐药情况,为临床合理选用抗菌药物提供依据.方法 回顾性分析2008年1月至2010年6月武汉市儿童医院PICU收治的46例合并VAP患儿下呼吸道分泌物所分离出的细菌、真菌及其耐药性情况.结果 共分离出病原菌119株,革兰氏阴性(G-)杆菌、革兰氏阳性(G+)球菌和真菌分别占65.55%、13.45%和21.01%;前5位病原菌分别为鲍氏不动杆菌、大肠埃希氏菌、肺炎克雷伯氏菌、白色念珠菌及凝固酶阴性葡萄球菌.药敏结果显示,G-杆菌和G+球菌对临床常用抗菌药物均存在不同程度耐药性,多重耐药现象严重.G-杆菌对阿米卡星、环丙沙星、亚胺培南、美罗培南、头孢哌酮/舒巴坦、派拉西林/他唑巴坦较为敏感;G+球菌均对万古霉素、替考拉宁和利奈唑胺敏感;真菌普遍敏感.结论 VAP病原菌以G-杆菌为主且呈多重耐药性.临床上应对VAP进行规范性、连续性耐药性监测,并依据细菌病原学及耐药性合理选择抗菌药物,同时加强机械通气管理以及医院环境消毒,降低VAP发生率.

Abstract：

Objective To study the pathogenic bacteria strains with drug-resistance prevailing in patients with ventilator-associated pneumonia(VAP)in Pediatric Intensive Care Unit(PICU)in order to provide a reasonable guidance to the clinical use of suitable antibiotics.Method A retrospective clinical study in 46 patients with VAP was carried out in PICU of Wuhan Children's Hospital between January 2008 and June 2010.The prevalent strains of the pathogenic bacteria with drug-resistance isolated from lower respiratory tract by aspiration were analyzed.Results In total,119 pathogenic microbial strains were isolated including Gram-negative bacilli(G-,65.55%),fungi(21.01%)and Gram-positive cocci(G+,13.45%).Among pathogens,the most common pathogenic strains were Acinetobacter baummannii, Escherichia coli,Klebsiella pneumoniae,candida albicans and coagulase-negative staphylococci.Antibiotic susceptibility tests indicated that the situation of the multiple drug-resistances to antibiotics found in G- and G+ Was serious. Most of G- were sensitive to ciprofloxacin, amikacin, imipenem, meropenem,cefoperazone-sulbaetam and piperacillin-tazobactam.The G+ cocci were 100% susceptibility to vancomycin, teicoplanin and linezolid.Fungi were almost sensitive to all the anti-funaus agents. Conclusions The oredominant oathogens of VAP were G- bacilli,and their multiple drug-resistances to antibiotics were the serious problems.The monitoring of the drugresistance should be emphasized, and the option of antibiotics should depend on the antibiotic sensitivity test.