摘要:目的:探討老年耐亞胺培南銅綠假單胞菌(IRPA)感染的危險因素以指導臨床救治。 方法:采用病例對照研究,選取四川省人民醫院干部科2006年1月~2008年12月IRPA院內感染老年患者32例,并隨機選擇同時期敏感銅綠假單胞菌院內感染48例作為對照,采用單因素(t檢驗,χ2檢驗)及多因素Logistic回歸進行分析。結果:IRPA分離率為34.8%,IRPA對抗生素的耐藥性遠遠高于敏感銅綠假單胞菌組,但對阿米卡星敏感率達81.3%。單因素分析發現,下列因素與IRPA感染有關:高齡、住院時間≥4周、高急性生理和慢性健康狀況(APACHEⅡ)評分、慢性肺部疾病(慢性阻塞性肺疾病COPD/支氣管擴張)、分離出IRPA前2周用過亞胺培南/美羅培南、早期聯用抗生素、院內獲得性肺炎(HAP)。多因素Logistic回歸分析表明:長程住院［比值比(OR)= 14.887］,APACHEⅡ評分≥16分(OR=38.908)以及分離出IRPA前2周用過亞胺培南/美羅培南(OR =12.945)是IRPA感染的獨立危險因素。結論:長程住院、APACHEⅡ評分≥16分以及亞胺培南/美羅培南的使用是IRPA感染的危險因素。IRPA對阿米卡星敏感率相對較高,但治療難度大。Abstract: Objective: To study the infection status and risk factors of nosocomial infection caused by imipenemresistant Pseudomonas aeruginosa (IRPA) in elderly patients. Methods: By a casecontrol study, the data of 32 cases of IRPA nosocomial infections were analyzed from Jan. 2006. to Dec. 2008 in cadres Ward of Sichuan Provincial People’s Hospital; 48 cases of Imipenemsensitive pseudomonas aeruginosa infection were randomized as control. Univariate analysis (T test and chisquare test )and multivariate logistic regression analysis were used for statistics. Results: The resistance to antibiotics of IRPA is much higher than the sensitive group.81.3％ of IRPA were sensitive to amikacin. According to univariate analysis,the factors associated with the infection caused by IRPA were age, length of stay in hospital more than 4 weeks, high score of APACHEⅡ, chronic pulmonary disease (COPD/bronchiectasis),imipenem/meropenem used 2 weeks before isolation of IRPA, early combination therapy of antibiotics and hospital acquired pneumonia (HAP). Multivariate logistic regression analysis identified three independent factors: Length of stay in hospital more than 4 weeks, APACHEⅡ score≥16 and imipenem/meropenem used 2 weeks before isolation of IRPA. Conclusion: Long length of stay in hospital, APACHEⅡ score ≥16 and previous imipenem/meropenem use were independent risk factors for IRPA infection. Although the sensitivity of IRPA to amikacin was relatively high, it was difficult to treat in clinical practice.
Objective To summarize the characteristic manifestations in the middle and old aged people with meniscus injury and the outcome of the treatment under the arthroscope. Methods Fifty-two patients, aged 52-58 years, with meniscus injury to a total of 57 knee joints, were diagnosed and treated under the arthroscope. The history of their knee diseases was 1-21 years. Horizontal tearsoccurred in 19 knee joints, degenerative tears in 13 knee joints, complex tears in 9 knee joints, longitudinal tears in 5 knee joints, oblique tears in 4 knee joints, radial tears in 4 knee joints, and flap tears in 3 knee joints. Three meniscus tears were sutured and 54 meniscus tears were cut fully or partly under thearthroscope. Results All the postoperative patients were followed up for 6-15 months, and the average follow-up period after operation was 9 months. According to the DONG Tianxiang’s standards for the therapy under the arthroscope, the excellent result was achieved in 39 knee joints, good in 12 knee joints, and fair in 6 knee joints, with no failure. The excellent and good rate was 89.5%. Conclusion The clinical manifestations of meniscus injury are not typical in the middle and old aged people. The therapeutic effect with the help of the arthroscope is satisfactory with an advantage of minimal traumatic invasiveness to the knee joint.