Hot topics on the diagnosis and antimicrobial therapy of ventilator-associated pneumonia, including clinical diagnostic criteria, evaluation of biomarkers, ventilator associated events, clinical pulmonary infection score, ventilator-associated tracheobronchitis, microbiological diagnosis and duration of therapy were discussed. The viewpoints in the guidelines of America, Europe and Japan were also reviewed.
【摘要】 目的 探討并分析導致肺曲霉病患者誤診的原因，為早期診斷并及時正確治療提供科學的依據。 方法 回顧性分析2010年1-4月間確診為肺曲霉病的3例患者在診治過程中被誤診的原因。 結果 3例患者均缺乏明顯的特異性臨床表現和影像學表現，最后確診均依據病理學活檢證實。 結論 肺部的曲霉菌感染缺乏特異性的臨床和影像學表現，及早行纖維支氣管鏡檢查或肺組織活檢可提高早期診斷率。【Abstract】 Objective To analyze the misdiagnostic causes of pulmonary aspergillosis. Methods The clinical data of three patients with pulmonary aspergillosis from January to April 2010 were retrospectively analyzed, and the misdiagnostic causes were analyzed. Result No specific clinical and imaging findings were found in the three patients, and pulmonary aspergillosis was finally diagnosed according to the pathological biopsy. Conclusion Pulmonary aspergillus lacks specific clinical and imaging manifestations; early fiberoptic bronchoscopy or pulmonary biopsy may improve the rate of accurate diagnosis.
目的 了解醫院內血源性職業暴露高風險人群，有針對性采取防護措施，降低血源性職業暴露的發生率。 方法 對2008年1月－2011年12月四川省婦幼保健院52例血源性職業暴露醫務人員，按照暴露人群、暴露方式、暴露病種、暴露地點的不同進行調查分析。 結果 52例職業暴露人群中護士27例（占51.9%）；產房和手術室為高發職業暴露場所，共32例，分別為17例（占32.7%）和15例（占28.8%）；職業暴露病種主要為乙型肝炎，共27例（占51.9%）；暴露方式主要為針刺傷，共37例（占71.2%）。 結論 提高醫務人員職業防護意識，規范操作流程，加強自身防護是減少職業暴露的根本所在。
Objective To explore the application effect of the four-dimensional teaching library model in the training of neuroinfection subspecialty continuing physicians, and compare it with traditional rotational training. Methods Continuing physicians who received training in the Department of Neurology of Xuanwu Hospital, Capital Medical University between March 2021 and February 2023 were selected. The continuing physicians who received traditional rotational training between March 2021 and February 2022 would serve as the control group, and the continuing physicians who received four-dimensional teaching library model training between March 2022 and February 2023 would serve as the experimental group. The Mini-CEX scale was used to evaluate the clinical comprehensive abilities of two groups of continuing physicians. At the same time, self-made questionnaires were used to evaluate the evaluation of two groups of continuing physicians on different teaching modes. Results A total of 55 continuing physicians were included. Among them, there were 27 people in the control group and 28 people in the experimental group. There was no statistically significant difference in the comparison of general information between the two groups (P＞0.05). At the time of graduation, all items on the Mini-CEX scale in the experimental group were higher than those in the control group (P<0.05). The survey questionnaire results showed that the experimental group scored higher than the control group in terms of improving learning interest, improving self-learning ability, improving clinical thinking, improving analysis and problem-solving ability, improving doctor-patient communication ability, and increasing teamwork (P<0.05). Conclusion The application effect of the four-dimensional teaching library model in the training of neuroinfection subspecialty continuing physicians is better than that of traditional rotational training, which can significantly improve the clinical comprehensive ability of continuing physicians and is worth promoting.
在過去二十年間，麻醉技術和手術技術的改進使肺部惡性腫瘤患者的手術死亡率大大降低，但術后并發癥仍是主要問題。肺切除術后的常見并發癥是肺部并發癥[1]，主要表現是低氧血癥，尤其在肺功能減退的肺切除患者中發病率更高[2]。目前國內對低氧血癥的診斷缺乏統一的診斷標準，一些作者采用Russell等[3]提出的標準，吸空氣氧的情況下，患者動脈血氧飽和度（SpO2）≤92%，大于30 s就可診斷為術后低氧血癥。也有作者建議[4]將一次或以上血氣檢查PaO2lt;8 kPa或PaO2/FiO2lt;300 mm Hg（1 mm Hg=0.133 kPa）作為診斷低氧血癥的標準。30%~50%的術后患者可發生低氧血癥，一般認為這樣的低氧血癥是一過性的，對大多數患者是無害的[5]。但如果合并心腦或其他器官動脈硬化或其他原因的血管阻塞，這種低氧血癥就是很危險的[6]。常見低氧血癥的原因是肺萎陷不張和誤吸、心源性肺水腫、靜脈輸入液體過量、通氣血流比例失調和急性肺損傷/急性呼吸窘迫綜合征（ALI/ARDS）[7]，其中ALI/ARDS是肺切除術后患者死亡的主要原因[8-10]。
目的 調查四川省婦幼保健院醫院感染發生情況及影響因素，以改進醫院感染發病率監測方法與醫院感染預防和控制措施。 方法 對2011年9月19日0：00～24：00所有住院患者進行調查，包括當日出院、轉院、死亡的患者，但不包括新入院患者，使用全國醫院感染監控網統一設計的調查表，采用床旁調查和查閱病歷相結合，對調查結果進行統計分析。 結果 應調查住院患者112例，實際調查109例，實查率為97.3%；發生醫院感染4例，現患率為3.7%。醫院感染部位以呼吸道為主，抗菌藥物使用率為64.2%。 結論 通過醫院感染現患率調查，可以在短期內全面了解醫院感染的現狀，針對性的制定醫院感染監控措施，預防和控制醫院感染的發生。
目的:比較充填式和平片式無張力疝修補術的臨床效果。方法:回顧分析用平片式及充填式無張力疝修補術治療246例腹股溝疝的臨床及隨訪資料。結果:246例患者尿潴留, 陰囊水腫和切口感染等并發癥無明顯差異(Pgt;0.05),隨訪6個月至2年,無1例復發。結論:同填充式無張力疝修補術比較,平片式無張力疝修補術具有簡單,手術時間短、費用低廉的特點,更適合基層推廣。
Abstract： Objective To compare minimally invasive technique with multiple short incisions and traditional open technique for great saphenous vein (GSV) harvesting in coronary artery bypass grafting (CABG). Methods Fortyseven patients underwent first time CABG between November 2007 to January 2009. These patients included 37 males and 10 females with their age ranged from 43 to 78 years and their average age was 61.3±84 years old. The patients were prospectively randomized into the minimally invasive harvesting group (group A,n=21) and the traditional open harvesting group (group B, n=26). For group A, we adopted the method of minimally invasive technique with multiple short incisions, while for group B, the traditional long incisions were adopted. The incision length, GSV harvesting time, lower limbs suture time and incision complications were compared between the two groups. Results During harvesting, no injury to the saphenous vein trunk or complications related to the quality of venous grafts occurred in both groups. There were no significantly differences in the number of venous grafts and the GSV length between the two groups. Group A had significantly longer GSV harvesting time than group B (51.9±11.5 min vs. 40.3±7.6 min,P=0.000). However, incision length (16.1±4.1 cm vs. 49.2±7.2 cm, P=0.000), incision suture time (11.0±3.0 min vs. 33.6±4.8 min,P=0.000) and lower limbs total operation time (62.6±14.9 min vs.73.8±11.6 min,P=0.006) in group A were much shorter than those in group B. Fortyseven patients were followed up (100%) and the followup time ranged from 3 to 26 months. The rate of leg wound complications such as serous exudates, hematomas and wound infection was 4.8% (1/21) in Group A and 34.6% (9/26) in Group B. These complications were all cured with additional treatments. Group A had lower leg wound complication rate than Group B (Plt;0.05). Conclusion Our study demonstrates that minimally invasive technique for GSV harvesting can be performed at a satisfactory speed and helpful in decreasing the lower limb incision complication rate.
ObjectivesTo understand the current situation of the nosocomial infection management system in maternal and child health care institutions at all levels in Sichuan province, and provide a feasible policy basis for strengthening the nosocomial infection management.MethodsThe expert group members of Sichuan Maternal and Child Health Association Academy Association designed a unified questionnaire, and distributed the questionnaire through “Questionnaire Star” to carry out on-site online survey.ResultsA total of 159 maternal and child health care institutions participated in the survey. Most secondary and below maternal and child health care institutions had not set up professional hospital infection monitoring system. A few secondary and below maternal and child health care institutions did not independently set up a hospital infection management committee, hospital infection management department, full-time hospital infection department head, the inspection team of infection control, monitoring system, and nosocomial infection management system and special supervision had not been established in special departments. There were statistical differences in some jobs in the construction of nosocomial infection management system in different levels of maternal and child health care institutions (P<0.05).ConclusionsThe organizational system construction of hospital infection managemen are at a low level in the second level and below maternal and child health care institutions in Sichuan province. The tertiary maternal and child health care institutions should give full play to the leading role in promoting the standard construction of nosocomial infection management system of maternal and child health care institutions in Sichuan province, and carry out nosocomial infection management of maternal and child health care institutions orderly.
Objective To investigate the genetic polymorphism of methicillin resistant Staphylococcus aureus ( MRSA) isolated from hospital acquired pneumonia. Methods Seventy-four hospitalized patients were diagnosed as noscomial MRSA pneumonia from January 2007 to January 2008 in Xinhua Hospital, Shanghai Jiaotong Univesity. The genes of MRSA were amplified by random amplified polymorphic DNA typing ( RAPD) assay in 82 clinical isolates from these patients. Results Two to 15 amplified DNA fragments were observed in agarose gel and they were classified into 11 genotypes. Genotypes Ⅲ, Ⅵ and Ⅶ ( 32. 56% , 30. 23% and 13. 95% , respectively) were mainly isolated from the ICU. Both independent genotypes and overlapping genotpyes with those from ICU were identified in isolates from the departments of geriatrics, emergency and respiratory medicine. Outbreak or cluster cases ( 48. 65% ) were found in 36 of the 74 patients while all outbreak cases occurred in the ICU. Conclusions Noscomial MRSA pneumonia is easy to disseminate and small-scale outbreak may occur especially in ICU. RAPD is valuable for identification and prevention of the spread of MRSA in hospital.