MICU老年住院患者痰标本分离细菌及耐药率变迁

目的分析我院MICU老年住院患者痰标本中分离出的主要病原菌种类及其耐药率变迁,为临床用药提供参考。方法收集我院2017年1月至2019年12月MICU年龄大于60岁老年住院患者的痰液标本,剔除同一患者的重复病原菌,进行菌株分离、培养鉴定及药敏试验,分析病原菌分布及耐药率情况。结果共分离出535株病原菌,其中革兰阴性杆菌502株,占93.8%,高于其他文献报道,革兰阳性球菌33例,占6.2%,常见病原菌前5位为鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌、嗜麦芽窄食单胞菌及金黄色葡萄球菌。结论我院MICU老年住院患者痰标本分离病原菌以革兰阴性菌为主,其中鲍曼不动杆菌感染情况最重,对多种药物耐药率偏高,应注意加强耐药菌耐药监测,根据药敏结果指导合理应用抗菌药物,加强医务人员掌握防控病菌感染的干预措施,有利于降低耐药菌感染率。     

Fresh-frozen plasma and platelet transfusions are associated with development of acute lung injury in critically ill medical patients

BACKGROUND: Transfusion has long been identified as a risk factor for acute lung injury (ALI)/ARDS. No study has formally evaluated the transfusion of specific blood products as a risk factor for ALI/ARDS in critically ill medical patients. METHOD: In this single-center retrospective cohort study, 841 consecutive critically ill patients were studied for the development of ALI/ARDS. Patients who received blood product transfusions were compared with those who did not, in univariate and multivariate propensity analyses. RESULTS: Two hundred ninety-eight patients (35%) received blood transfusions. Transfused patients were older (mean [+/- SD] age, 67 +/- 17 years vs 62 +/- 19 years; p < 0.001) and had higher acute physiologic and chronic health evaluation (APACHE) III scores (74 +/- 32 vs 58 +/- 23; p < 0.001) than those who had not received transfusions. ALI/ARDS developed more commonly (25% vs 18%; p = 0.025) in patients exposed to transfusion. Seventeen patients received massive RBC transfusions (ie, > 10 U of blood transfused within 24 h), of whom 13 also received fresh-frozen plasma (FFP) and 11 received platelet transfusions. When adjusted for the probability of transfusion and other ALI/ARDS risk factors, any transfusion was associated with the development of ALI/ARDS (odds ratio [OR], 2.14; 95% confidence interval [CI], 1.24 to 3.75). Among those patients receiving individual blood products, ALI/ARDS was more likely to develop in patients who received FFP transfusions (OR, 2.48; 95% CI, 1.29 to 4.74) and platelet transfusions (OR, 3.89; 95% CI, 1.36 to 11.52) than in those who received only RBC transfusions (OR, 1.39; 95% CI, 0.79 to 2.43). CONCLUSION: Transfusion is associated with an increased risk of the development of ALI/ARDS in critically ill medical patients. The risk is higher with transfusions of plasma-rich blood products, FFP, and platelets, than with RBCs.     

循证护理在内科ICU健康教育中的应用

目的 以最佳证据为基础开展护理工作,提高内科ICU患者及家属对疾病的诊断、治疗及护理的依从性及满意度,避免医患纠纷的发生.方法 确定问题;检索有关文献;评价相关实证,制定并实施护理计划.结果 实施循证护理后,我科的健康教育质量及患者满意度上升(达100%),无患者投诉事件发生.结论 循证护理的开展提高了护理服务质量,促进了护理事业的发展.     

Effects of combined alcohol and benzodiazepine: a review

Both human and animal studies relating to the combined effects of alcohol and benzodiazepine (BZD) are reviewed. Although the combination of alcohol and BZD is sometimes associated with drug-induced deaths, drug overdoses and traffic accidents or fatalities, epidemiological information is lacking on the true extent of the combined abuse and on the patterns and prevalence of use of these two drugs. Since BZD are widely used for the short- and long-term treatment of alcoholics, these patients are deemed more at risk of developing BZD or alcohol/BZD dependence than the general population. There is a dire need for large-scale controlled studies concerning the efficacy of BZD in the long-term treatment of alcoholics. Compared to men, women are at a higher risk as far as the potential for BZD addiction is concerned, since they tend to use BZD more often. Epidemiologic studies on the patterns of use of BZD, alcohol or alcohol/BZD in pregnant women are called for. Animal models are also needed to ascertain whether prenatal exposure to both alcohol and BZD can impart long-lasting behavioral changes in the progeny. It is possible that BZD can exacerbate the damaging prenatal effects of alcohol.     

重症监护病房与普通病房铜绿假单胞菌感染的耐药性对比研究

目的 通过对比重症监护病房（ICU）与普通病房铜绿假单胞菌（PA）的细菌耐药性,为临床合理用药提供依据.方法 对2003年7月～2004年12月ICU与普通病房233株PA（ICU81株、普通病房152株）的体外药敏活性进行分析.结果 ICU较普通病房耐药率明显升高（P〈0.005）.PA对8种常用抗生素的耐药率ICU为：亚胺培南16.25%、环丙沙星18.18%、阿米卡星44.73%、氨曲南57.74%、头孢他啶61.03%、头孢哌酮-舒巴坦64.06%、左氧氟沙星71%、哌拉西林-三唑巴坦73%、哌拉西林77.94%.普通病房为：亚胺培南5.36%、环丙沙星9.75%、氨曲南16.86%、头孢哌酮-舒巴坦17.02%、头孢他啶20%、阿米卡星26.86%、哌拉西林-三唑巴坦39%、哌拉西林40.97%、左氧氟沙星46%.ICU与普通病房中PA株对亚胺培南的耐药率R〈10%.对亚胺培南耐药的PA株对其他多种抗生素也表现较高的耐药率（R〉38.00%）,但对其他多种抗生素耐药的PA株尚保留了对亚胺培南的敏感性（R〈24.3%）.结论 PA对多种抗生素耐药,尤其在ICU,PA耐药性明显高于普通病房.针对PA,亚胺培南在ICU和普通病房都是一可靠而有效的抗生素.     

A rapid, safe, and low-cost technique for the induction of mild therapeutic hypothermia in post-cardiac arrest patients

Aim of study

The benefits of inducing mild therapeutic hypothermia (MTH) in cardiac arrest patients are well established. Timing and speed of induction have been related to improved outcomes in several animal trials and one human study. We report the results of an easily implemented, rapid, safe, and low-cost protocol for the induction of MTH.

Methods

All in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA) patients admitted to an intensive care unit meeting inclusion criteria were cooled using a combination modality of rapid, cold saline infusion (CSI), evaporative surface cooling, and ice water gastric lavage. Cooling tasks were performed with a primary emphasis on speed. The main endpoints were the time intervals between return of spontaneous circulation (ROSC), initiation of hypothermia (IH), and achievement of target temperature (TT).

Results

65 patients underwent MTH during a 3-year period. All patients reached target temperature. Median ROSC-TT was 134 min. Median ROSC-IH was 68 min. Median IH-TT was 60 min. IH-TT cooling rate was 2.6 °C/h. Complications were similar to that of other large trials. 31% of this mixed population of IHCA and OHCA patients recovered to a Pittsburgh cerebral performance score (CPC) of 1 or 2.

Conclusion

A protocol using a combination of core and surface cooling modalities was rapid, safe, and low cost in achieving MTH. The cooling rate of 2.6 °C/h was superior to most published protocols. This method uses readily available equipment and reduces the need for costly commercial devices.     

Non-circadian signals in the intensive care unit: Point prevalence morning,noon and night

Background: Intensive care unit (ICU) sleep disturbance is severe and potentially related to abnormal light and sound exposure.Objectives: To assess the prevalence of measures of light and sound disturbance in ICU patient rooms, and whether these could be modified by a sleep-promotion intervention.Methods: This observational study with a before and after design for a quality improvement initiative surveyed environmental factors in ICU rooms at 01:00 08:00, and 12:00. Surveys assessed light usage, television usage, window shade position, and room door/curtain position. Factors were compared before and after an ICU sleep-promotion intervention.Results: 990 (pre-intervention) and 819 (post-intervention) occupied rooms were surveyed. Pre-intervention, the prevalence of night-time factors included: bright lights on (21%), television on (46%), and room door open (94%). Post-intervention, more rooms had all lights off at night (41% v 50%, p = 0.04), and fewer rooms had open door curtains (57% v 42%, p = 0.001) and window shades (78% v 62%, p = 0.002).Conclusions: Disruptive environmental factors are common in the ICU. Some factors improve with sleep-promotion interventions.