目的 探討延髓腫瘤的治療策略，以達到最佳預后。 方法 回顧分析2007年1月－2010年12月19例延髓腫瘤患者的臨床資料，其中18例經外科手術治療和病理證實，1例通過影像學確診。 結果 12例血管網狀細胞瘤中，11例手術全切，1例手術次全切；2例室管膜瘤均手術全切；2例海綿狀血管瘤分別手術全切及伽馬刀治療；3例膠質瘤均手術部分切除。18例手術治療患者術后神經功能障礙明顯好轉者13例，無明顯變化者3例，2例因術后嚴重并發癥死亡；1例伽馬刀治療患者癥狀好轉。術后隨訪6～48個月，平均24個月。11例恢復工作，4例生活可自理，2例因腫瘤復發死亡。結論 術前通過MRI檢查、術中神經電生理監測及熟練的顯微外科技術是外科治療優勢，伽馬刀治療延髓較小腫瘤有著損傷小的優點，因此制定合理的治療策略有利于提高患者生存質量。
ObjectivesTo identify the clinical characteristics and prognosis for CRKP (Carbapenem-resistant Klebsiella pneumonia, CRKP) infection among ICU patients in the Second Affiliated Hospital of Anhui Medical University. MethodsWe conducted a retrospectively analysis in which 19 patients infected by CRKP with another 21 CSKP (Carbapenem-sensitive Klebsiella pneumoniae, CSKP) infected patients from January 2017 to April 2018. Risk factors for CRKP infection were assessed. ResultsThe lower respiratory tract is the most common site of CRKP infection in our department. CRKP infection was associated with several clinical symptoms, particularly a higher incidence of sepsis shock (χ2=8.338, P=0.004), more application of the combined medicine (χ2=26.3, P<0.001), prolonged hospital stays (χ2=–2.217, P=0.027) and more expenses on antibiotics (χ2=12.855, P=0.005), and the declined survival rates in 14 days (χ2=4.269, P=0.039) and 21 days (χ2 =5.647, P=0.017). The resistance rate of CRKP strains was high, however no resistance to tegafycline was found. The risk factors of CRKP infection included three generations of cephalosporin and/or hydrocarbonase antibiotics exposure (χ2 =6.388, P=0.041), exposure time of three generations of cephalosporin (U=–2.187, P=0.029), exposure time of hydrocarbonase antibiotics (U=–2.103, P=0.035), tracheal intubation (χ2=6.352, P=0.012), tracheotomy (χ2 =4.821, P=0.028), SOFA score (t=4.505, P<0.001) and Charlson comorbidity index (t=3.041, P=0.004). The SOFA score was the only factor independently associated with CRKP bacteremia (P=0.02). ConclusionsCRKP infections in ICU directly affect the course of disease, survival time and treatment expenses of patients. Therefore, monitoring bacterial resistance, rational use of antibiotics, and protection of the immune function are of great significance for prevention and treatment of CRKP infection.