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臨床肺部感染評分評估呼吸機相關性肺炎預后的研究

目的 探討臨床肺部感染評分( CPIS) 對呼吸機相關性肺炎( VAP) 患者早期病情演變及預后評估的價值。方法 將42 例符合納入標準的VAP 患者根據其預后分為存活組和死亡組, 采用方差分析及獨立t 檢驗, 對兩組患者的一般情況, VAP 起病前、起病后1 d 及5 d 的CPIS 分值進行分析比較。結果 42 例患者中, 存活18 例, 死亡24 例, 死亡率57. 14% 。存活組平均年齡明顯低于死亡組[ ( 43. 0 ±14. 58) 歲比( 64. 75 ±14. 19) 歲, P lt; 0. 001] 。兩組患者的平均機械通氣時間均gt;10 d。存活組CPIS 分值在VAP 起病后1 d 較起病前明顯升高[ ( 5. 78 ±0. 94) 分比( 3. 0 ±1. 81) 分,P lt;0. 001] , 起病后5 d 則明顯下降[ ( 3. 72 ±1. 36) 分, P lt; 0. 001] ; 死亡組CPIS 分值在VAP 起病后1 d較起病前也有明顯升高[ ( 6. 41 ±1. 21) 分比( 3. 75 ±1. 67) 分, P lt;0. 001] , 但起病后5 d 仍維持于較高水平[ ( 7. 08 ±1. 10) 分] 。結論 CPIS 評分在評估VAP患者病情及預后上有一定臨床價值。

Clinical Research on Correlation Factors of Concurrent Fungal Infections in Old Patients with Pulmonary Diseases: 49 Case Reports

摘要:目的: 探討我院呼吸內科病房老年肺部疾病患者并發真菌感染發病的相關因素,分析其易患因素、臨床特征和治療。 方法 : 采用回顧性調查方法對2002年1月至2008年6月收住內科的經微生物檢查證實49例繼發真菌感染的患者進行分析,并與同期無真菌感染的肺部疾病患者(對照組)比較。 結果 : 在呼吸內科病房中,老年患者院內肺部真菌感染發生率為378%,主要感染部位為泌尿系(218%),呼吸道(269%),消化道(409%)。慢性阻塞性肺疾病(498%)是繼發院內肺部真菌感染最常見的基礎疾病,其感染因素為長期使用廣譜抗生素(962%)和糖皮質激素(332%)、營養狀況不良(583%)出現低蛋白血癥及合并糖尿病、白細胞減少和侵襲性診療操作等。肺部真菌感染的臨床表現無特異性,確診需結合痰培養,組織病理學和臨床表現來確定,感染菌種以白色念珠菌為主,占626%。氟康唑治療有效率914%。研究組與同期無真菌感染的肺部疾病患者(對照組)比較:病死率分別為612%和082%,兩組治療無效的病例(惡化和死亡病例)比較差異有顯著性。 結論 : 院內真菌是呼吸系統疾病繼發感染的重要病原體,而白色假絲酵母菌是院內肺部真菌感染的主要致病菌,宿主免疫狀態、感染播散和疾病嚴重程度是影響預后的因素。該研究認為老年肺部疾病患者并發真菌感染的相關因素和影響預后的因素對其預防、診斷、治療、改進預后和生存質量有重要的臨床意義。除有效的抗真菌治療外,積極的綜合治療有助于提高真菌感染的治愈率。Abstract: Objective: To study the susceptible factors,clinical features and treatments of nosocomial pulmonary fungal infection in the ward of respiratory department.〖WTHZ〗Methods : The chart files of 49 patients with nosocomial pulmonary fungal infection admitted from January 2002 to June 2008 in the ward of Respiratory Department were reviewed. Results : The incidence rate of nosocomial pulmonary fungal infection was 378%.COPD(498%)was the main predisposing disease,and candidiasis(626%) was the most common pathogen. The main susceptible factors associated with nosocomial pulmonary fungal infection are longterm use of broadspectrum antibiotics(962%),hypoalbuminemia(583%),longterm use of adrenocortical steroid(332%),and diabetes mellitus.There is no specific clinical feature.Fluconazole(914%)is more efficient in the treatment.〖WTHZ〗Conclusion : Nosocomial pulmonary fungis are important pathogenin the secondary infection in respiratory disease.The most common pathogen is candida albicans.Combined therapy as well as treating fungus infection are important measures to increase the cure rate of nosocomial pulmonary fungal infection.

Association between Chlamydia Pneumoniae Infection and Cerebral Infarction: A Meta-analysis

Objective　To review the association between chlamydia pneumoniae (CP) infection and cerebral infarction. Methods　We electronically searched MEDLINE, BIOSIS, VIP database, and China Full Text Journal Database from Jan. 1990 through Dec. 2007 to identify case-control studies about the association of CP and cerebral infarction. The quality of the included studies was assessed and the RevMan 4.2 software was used for meta-analyses. Results　A total of 22 studies were included. The results of meta-analyses showed: ① When the microimmunofluorescence (MIF) method was used to examine CP antibody in serum, the positive rate of the cerebral infarction group was higher than that of the control group when the positive infection was defined by IgA≥1?16 [n=8, OR=2.18, 95%CI (1.49 to 3.49), Plt;0.0001]; but when positive infection was defined by IgA≥1?32 (n=3), IgG≥1?32 (n=6), or IgG≥1?64 (n=5), there were no significant differences in the positive rate between the two groups [OR (95%CI) were 1.47 (0.97 to 2.24), 1.24 (0.82 to 1.86), and 1.23 (0.98 to 1.55), respectively]; ② When the ELISA method was used to examine CP-IgG antibody in serum, the positive rate of the cerebral infarction group was higher than that of the controlled group [n=8, OR=2.40, 95%CI (1.42 to 4.06), P=0.000 2]. ③ The acute and chronic CP infections were associated with the incidence of cerebral infarction [n=4, OR=7.22, 95%CI (2.68 to 19.49); n=4, OR=4.30, 95%CI (3.40 to 7.40)]. Conclusion　① The association between CP infection and cerebral infarction is determined by the positive criterion. IgA antibody is more sensitive than the IgG antibody. When the positive infection is determined by IgA≥1?16, CP infection is associated with cerebral infarction. ② The results of ELISA for examining CP-IgG support the association between CP infection and cerebral infarction. ③ Both acute and chronic CP infections are associated with cerebral infarction, but these associations needed to be proven by more scientific studies.

Prophylactic Effect of Lamivudine Monotherapy Against Hepatitis B Recurrence Following Liver Transplantation

【Abstract】ObjectiveTo investigate the prophylactic effect of lamivudine monotherapy on the recurrence of hepatitis B after liver transplantation. MethodsThirtyone patients with hepatitis B related benign decompensated cirrhosis who underwent liver transplantation between February 1999 to June 2002 and survived more than 3 months were analyzed retrospectively. Lamivudine was administered to each patient after operation and some patients before operation for the prophylaxis of HBV recurrence. The HBV markers and HBV DNA in serum and bioptic liver tissues in all patients were evaluated before and after operation. ResultsTotal HBV recurrence rate was 19.4％（6/31） during average 38.2 months (3.2-70.2 months) follow up. HBV recurrence rate was 7.1％(2/28), 16.0％(4/25), 26.1％(6/23) and survival rate was 87.1％(27/31), 80.6％(25/31), 66.1％(20.5/31) after 1-, 3-and 5-year, respectively. One hundred milligram lamivudine administration peroral daily for 2 weeks prior to transplantation enable HBeAg 54.5％(6/11) and HBV DNA 50.0％(5/10) positive patients convert to negative respectively. ConclusionPreoperative administration of lamivudine monotherapy can effectively prevent allograft from HBV re-infection after liver transplantation. Lamivudine should be used to convert HBV DNA and HBeAg to negative.

Logistic Regression Analysis of Risk Factors for Surgical Site Infection after Hepatobili-ary and Pancreatic Surgery

Objective To study the influence factors of surgical site infection (SSI) after hepatobiliary and pancreatic surgery. Methods Fifty patients suffered from SSI after hepatobiliary and pancreatic surgery who treated in Feng,nan District Hospital of Tangshan City from April 2010 and April 2015 were retrospectively collected as observation group, and 102 patients who didn’t suffered from SSI after hepatobiliary and pancreatic surgery at the same time period were retrospectively collected as control group. Then logistic regression was performed to explore the influence factors of SSI. Results Results of univariate analysis showed that, the ratios of patients older than 60 years, combined with cardiovascular and cerebrovascular diseases, had abdominal surgery history, had smoking history, suffered from the increased level of preoperative blood glucose , suffered from preoperative infection, operative time was longer than 180 minutes, American Societyof Anesthesiologists (ASA) score were 3-5, indwelled drainage tube, without dressing changes within 48 hours after surgery, and new injury severity score (NISS) were 2-3 were higher in observation group (P＜0.05). Results of logistic regression analysis showed that, patients had history of abdominal surgery (OR=1.92), without dressing changes within 48 hours after surgery (OR=2.07), and NISS were 2-3 (OR=2.27) had higher incidence of SSI (P＜0.05). Conclusion We should pay more attention on the patient with abdominal surgery history and with NISS of 2-3, and give dressing changes within 48 hours after surgery, to reduce the incidence of SSI.

蒙古族地區不同年齡組幽門螺桿菌感染臨床研究

目的　對蒙古族聚集地區不同年齡組幽門螺桿菌（Hp）感染情況進行臨床研究。 方法　2009年2月－2011年9月采用深圳市中核海得威生物科技有限公司生產的尿素14C呼氣試驗檢測儀檢測，共檢測3 705例，年齡5～80歲。根據年齡分成6個組，受試者在早上空腹或進食2 h以上，先漱口，然后進行檢測。 結果　5～14歲Hp感染率37%，15～30歲Hp感染率45%，31～40歲Hp感染率44%，41～50歲Hp感染率45%，51～60歲感染率46%，60歲以上感染率46%，共檢測3 705例，平均Hp感染率43%。 結論　Hp感染率兒童低于成人，成人組間人群Hp感染率無明顯差異。蒙古族地區人群Hp感染率與國內其他地區人群感染率相似，無明顯差異。

Pathogenesis of Immune Dysfunction in Surgical Infection

Clinical Investigation of Severe Acute Pancreatitis Complicated with Infection

摘要:目的:探討重癥急性胰腺炎(SAP)繼發感染的臨床特點。方法:將我院20039~20053收治的SAP140例,按是否感染,分成感染組和對照組,對比分析其臨床資料。結果:感染組病死率高于對照組(P=0023);感染組入院初期,Ranson評分、CT評分、APACHE Ⅱ評分、血糖、ARDS和腸麻痹發生率、感染前手術率及呼吸機輔助呼吸率高于對照組(Plt;005);以G感染胰腺、胰周圍及肺部為主;肺部感染時間為107±25d,胰腺或胰周為176±29d。結論:急性期全身反應輕重及胰腺壞死程度是SAP繼發感染的基礎;臨床有創治療措施是促進因素。

Hot topics in the prevention and control of healthcare-associated infections

Healthcare-associated infection management has advanced rapidly in recent years. With the development of more standards and guidelines, infection control measures become more standardized and evidence-based. Evidence-based measures are increasingly applied in infection control, which promote more studies on the prevention and control of healthcare-associated infections. Furthermore, more new ideas of infection control have emerged, with old ones being challenged. The hand hygiene reform, multidrug-resistant organisms, and surgical site infections become the hot topics in recent years. In addition, whole-genome sequencing also provides more bases for understanding pathogen transmission in hospitals. Based on the high-quality studies published in recent years, this opinion review discusses these hot topics in the prevention and control of healthcare-associated infections.

Analysis of thrombotic events and mortality in patients with sever pneumonia in intensive care unit

Objective To explore the thromboembolic events and mortality in patients with different types of severe pneumonia, and to analyze the related high-risk factors. Methods A total of 161 severe pneumonia patients who admitted in intensive care unit from January 2018 to February 2023 were included in the study. The patients were divided into a COVID-19 group (n=88) and a community-acquired pneumonia (CAP) group (n=73) according to the type of pneumonia, and divided into a thrombosis group and a non-thrombosis group according to the occurrence of thrombosis. The patients were followed-up until discharge or in-hospital death, registering the occurrence of thrombotic events. Results During the in-hospital stay, 32.9% of CAP and 36.4% of COVID-19 patients experienced thrombotic events (P>0.05). In CAP group all the events (including 24 paitents) were venous thromboses, while in COVID-19 group 31 patients were venous and 3 were arterial thromboses (2 were cerebral infarction, and 1 with myocardial infarction). There were statistically significant difference in gender, age, venous thromboembolism score (VTE score), activated partial thromboplastin time (APTT), and procalcitonin (PCT) between the TE group and the Non-TE group. Logistic regression analysis showed that thrombotic events was associated with sex, age and APTT; gender (female: OR=2.47, 95%CI 1.13 - 5.39, P<0.05) and age (OR=1.04, 95%CI 1.01 - 1.07, P<0.05) were positively associated with thrombotic events. During the in-hospital follow-up, 44.3% of CAP patients and 42.5% of COVID-19 patients died (P>0.05). Receiver operator characteristic (ROC) curve analysis showed that APACHEⅡ score was more accurate in predicting mortality of severe pneumonia, and the area under the ROC curve (AUC) was 0.77 (95%CI 0.70 - 0.84, sensitivity 74.3%, specificity 68.1%), the AUC of the VTE score was 0.61 (95%CI 0.53 - 0.70, Sensitivity 31.4%, specificity 81.7%); the AUC of the creatinine was 0.64 (95%CI 0.56 - 0.73, sensitivity 72.9%, specificity 51.2%). While the Kappa value for kidney disease was 0.409 (P<0.05) presenting moderate consistency. Conclusions The incidence of thromboembolic events and mortality are high in patients with different types of severe pneumonia. Thrombophilia was associated with sex, age, and APTT. APACHEⅡ score, VTE score, and creatinine value were independent risk factors for predicting death from severe pneumonia.