目的 探讨脓毒症患者淋巴细胞亚群联合Th1/Th2细胞因子等相关指标的特征,为早期识别脓毒症生物标志物变化及判断预后提供思路.方法 收集脓毒症患者84例,根据疾病转归分为预后良好组和预后不良组,同期选取120名健康人作为对照组.流式细胞仪检测外周血淋巴细胞亚群(CD3+、CD4+T、CD8+T细胞、CD19+B细胞、NK细胞)及血清Th1/Th2细胞因子谱白介素2(IL-2)、白介素4(IL-4)、白介素6(IL-6)、白介素10(IL-10)、γ-干扰素(IFN-γ)和α-肿瘤坏死因子(TNF-α)水平;全自动血液分析仪检测白细胞、中性粒细胞、血小板、中性粒细胞和淋巴细胞的比值(NLR)等;全自动血浆蛋白分析仪检测C反应蛋白(CRP);免疫层析法检测降钙素原(PCT);全自动血凝分析仪检测PT、APTT;血气分析(氧分压、乳酸、二氧化碳分压等).Pearson方法分析细胞因子和淋巴细胞亚群的相关性,二元logistic回归分析评价各指标与脓毒症严重程度的关联,绘制受试者工作特征曲线(ROC)评价各指标对脓毒症的诊断价值.结果 与对照组相比,脓毒症组CD3+、CD3+CD4+、CD3+CD8+、CD3-CD16+56+、CD3-CD19+数量及CD4+/CD8+比值显著性下降,TNF-α、IL-6水平显著性升高(P＜0.05).脓毒症患者预后良好组和预后不良组相比,CD4/CD8比值及IL-6水平差异有统计学意义(P＜0.05).Pearson相关性分析显示,患者血清CD8+T细胞和IL-2水平间呈正相关(P＜0.05);二元logistic回归分析CD4/CD8比值为影响脓毒症的独立危险因素;ROC曲线结果显示,IL-6、TNF-α、CD4/CD8比值对于脓毒症病情的评估具有较好的临床价值.结论 脓毒症患者TNF-α、IL-6、CD4/CD8比值对脓毒症监测及预后判断具有较好的临床参考价值.

OBJECTIVE To understand the clinical distribution of Klebsiella pneumoniae and carbapenem-resistant K. pneumoniae（CRKP） strains and analyze the changes of drug resistance in 7 years so as to provide data for reasonable clinical use of antibiotics. METHODS The clinical isolates of K. pneumoniae and CRKP were collected from a hospital between 2015 and 2021. The specimens sources, department sources, result for drug susceptibility testing and changes of drug resistance to commonly used antibiotics were retrospectively analyzed by WHONET 5.6 software and SPSS 26.0 software. RESULTS Totally 8181 strains of non-repetitive K. pneumoniae were isolated from 2015 to 2021, the isolation rate was the highest（15.69%） in emergency department, and 51.83% of the strains were isolated from sputum specimens. The drug resistance rates of the K. pneumoniae strains to cefazolin, imipenem and amikacin were 64.36%, 3.97% and 3.31%, respectively. The drug resistance rates of the K. pneumoniae strains to the commonly used antibiotics were remarkably increased in 2015-2018, and the drug resistance rates to the commonly used antibiotics and carbapenems such as imipenem and meropenem began to decline from 2018. Totally 327 strains of CRKP were isolated between 2015 and 2021, the isolation rate showed upward trend and declined in recent two years. The CRKP strains showed highly drug resistance to the commonly used antibiotics like cephalosporins, the drug resistance rates to gentamycin and levofloxacin were decreased, and the strains were sensitive to polymyxin B and tigecycline. CONCLUSION The drug resistance rates of the clinical isolates of K. pneumoniae and CRKP to most of the antibiotics generally rise at the beginning and then go down. The overall status of drug resistance rate shows upward trend. Regular surveillance of the bacterial drug resistance may facilitate the understanding of change of the drug resistance and control of the occurrence and spread of CRKP strains.

BACKGROUND:The Notch signaling pathway regulates various cellular processes, including cell growth, inflammation response, and autophagy, thereby participating in the occurrence and development of various diseases. The present study aimed to investigate the molecular mechanism of Notch signaling in regulating alveolar type II epithelial cell viability and autophagy after Klebsiella pneumonia (KPN) infection.METHODS:KPN-infected human alveolar type II epithelial cells A549 (ACEII) were constructed. The autophagy inhibitor 3-methyladenine (3-MA) and Notch1 signaling inhibitor (DAPT) were used to pretreat A549 cells for 24 hours, 48 hours, and 72 hours before KPN infection. Real-time fluorescent quantitative PCR (qRT-PCR) and western blot assays were applied to detect the mRNA and protein expressions of LC3 and Notch1, respectively. ELISA was used to detect the levels of INF-γ, TNF-α, and IL-1β in the cell supernatants.RESULTS:The results showed that KPN-infected A549 cells presented significantly upregulated Notch1 and autophagy-related protein LC3 levels, along with increased IL-1β, TNF-α, INF-γ levels in a time-dependent manner. Autophagy inhibitor 3-methyladenine (3-MA) counteracted the promotive effects of LC3 and inflammatory cytokine levels in KPN-infected A549 cells; however, 3-MA did not influence Notch1 level. Notch1 inhibitor DAPT could suppress Notch1 and LC3 levels, thereby inhibiting inflammation response in KPN-treated A549 cells in a time-dependent way.CONCLUSIONS:KPN infection can activate the Notch signaling pathway and induce autophagy in type Ⅱ alveolar epithelial cells. Inhibiting the Notch signaling pathway may restrain KPN-induced A549 cell autophagy and inflammation response, shedding new insights for the treatment of pneumonia.

目的 探讨领悟社会支持在肥胖症患者病耻感与生活质量间的中介作用.方法 对2019年12月—2020年11月在宁夏医科大学总医院肥胖门诊和胃肠外科就诊的132例未行减重手术的肥胖症患者应用一般资料调查表、领悟社会支持量表(PSSS)、体重自我病耻感问卷(WSSQ)和简明健康调查量表(SF-12)进行调查,并使用AMOS24.0软件进行验证分析.结果 肥胖症患者领悟社会支持、病耻感、生活质量总得分分别为50.48±8.56分、39.73±8.96分、37.08±6.23分.Pearson分析结果:肥胖症患者病耻感与生活质量、领悟社会支持呈负相关(r=-0.290,P<0.01、r=-0.352,P<0.01);生活质量与领悟社会支持呈正相关(r=0.154,P<0.01).中介效应结果:领悟社会支持在肥胖症患者病耻感与生活质量之间的中介效应为0.021,占总效应的15.67％.结论 医务工作者、教育者及大众传媒应采取有针对性的干预,降低病耻感水平,以其提高患者生活质量.

Objective To understand the molecular epidemiology and virulence characteristics of carbapenem-resistant Klebsiella pneumoniae （CRKP） in the General Hospital of Ningxia Medical University.Methods A total of 103 CRKP strains isolated from January 2015 to December 2019 were collected.Modified carbapenem inactivation method （mCIM） combined with EDTA-modified carbapenem inactivation method （eCIM） were used to detect the carbapenemase-producing phenotype.PCR technique was used to detect carbapenemase-resistant genes,capsule serotype,and virulence genes.The homology of carbapenem-resistant hypervirulent K.pneumoniae （CR-hvKP） was analyzed by multi-locus sequence typing （MLST） and pulsed-field gel electrophoresis （PFGE）.Results The 103 CRKP strains showed variable levels of resistance to commonly used antibiotics.Phenotyping based on mCIM and eCIM tests showed that 94 CRKP strains were carbapenemase producers,of which 67.0% produced metallo-beta-lactamase and 33.0% produced serine carbapenase.The prevalence of resistant genes was 50.5% （52/103） for bla NDM ,33.0% （34/103） for bla KPC ,22.3% （23/103） for bla OXA-48 ,and 10.7% （11/103） for bla IMP .MLST identified 18 ST types among the CRKP strains,mainly including ST11 （36/102,35.3%） and ST76 （23/102,22.5%） types.Ten CRKP strains were identified as CR-hvKP,all of which harbored fimbrial adhesion related gene fimH and siderophore enterobactin gene （entB）.Only 4 of the 10 CR-hvKP strains were capsular serotype K1.PFGE-based homology analysis showed that majority of the 10 CR-hvKP strains were clsoely related and belonged to cluster D.No outbreak was found in the same ward in the same time period.Conclusions The CRKP strains in this hospital mainly produce NDM-5 carbapenemase,and ST11 is the dominant prevalent strain.About 9.7% of the CRKP strains were hypervirulent strains,which should be addressed carefully in clinical settings to prevent a potential outbreak.

目的 探讨以护士为主导的肠内营养支持对胃癌患者围术期的临床应用效果.方法 选取2020年1—10月在宁夏某三级甲等医院胃肠外科行胃癌手术的79例患者为研究对象,按组间基本特征具有可比性的原则分为对照组40例和观察组39例.对照组接受常规围术期管理;观察组在对照组基础上实施以护士为主导的肠内营养支持,即入院后由责任护士对患者进行营养风险筛查(NRS-2002),根据评分结果共同制订营养计划.实施过程中责任护士应用营养耐受评估表进行监测及处理.结果 观察组胃肠功能恢复时间、首次下床时间、住院时间短于对照组,总住院费用低于对照组,术后血红蛋白及白蛋白水平高于对照组,躯体功能、角色功能、认知功能、整体健康状况评分高于对照组,疲劳、恶心与呕吐、便秘、经济困难评分低于对照组,差异均有统计学意义(P<0.05),其中随着观察时间延长,术后血红蛋白水平组间差异逐渐增大,血白蛋白水平组间差异逐渐降低(P交互<0.05).两组患者情绪功能、社会功能、疼痛、气促、失眠、食欲下降、腹泻评分比较差异无统计学意义(P>0.05).结论 以护士为主导的肠内营养支持应用于胃癌患者围术期,可缩短胃肠功能恢复时间,提高其生活质量,加速其术后康复.

目的 调查宁夏某三甲医院加速康复外科理念下胃癌患者术后早期下床活动现状,分析影响因素,为完善胃癌术后患者早期下床活动方案提供理论指导和循证依据.方法 采用询问患者、查阅病历、现场调查方式对110名胃癌术后患者进行一般资料、疾病及手术相关情况、早期下床活动情况进行调查,对影响早期下床活动因素进行Logistic回归分析.结果 加速康复外科理念下胃癌患者术后早期下床活动完成率为30.91％,处于较低水平;活动前疲乏和疼痛是影响其早期下床活动的不利因素(P<0.05).结论 重视并采取有效措施对患者进行疲劳干预、加强疼痛管理,提高胃癌患者术后早期下床活动执行率,加速患者康复.

目的:构建肺癌术后患者延续护理评价指标体系.方法:采用德尔菲法初步构建并确立肺癌术后患者延续护理评价指标体系,采用层次分析法确定各级指标权重.结果:初步构建的肺癌术后患者延续护理指标评价体系包括4个一级指标,14个二级指标,36个三级指标.两轮专家函询,有效回收率分别为100. 00％和96.15％,专家意见提出率分别为84.62％和92.00％,专家的权威系数分别为0.87和0.91,两轮专家函询中各指标的肯德尔协调系数在0.396～0.424之间.结论:肺癌术后患者延续护理效果评价指标体系各级指标专家意见协调集中,专家权威性和积极性较高,可为肺癌术后患者延续护理服务评价提供依据.

调查胃癌术后患者对早期肠内营养认知现状.以60例胃癌术后患者为研究对象,通过问卷调查方式对患者营养认知现状进行统计.目前胃癌术后患者对早期肠内营养认知水平普遍偏低,我们在进行早期肠内营养时,要加强患者营养管理相关知识的培训教育,解决患者对EEN认知上的曲解,培养患者积极主动参与营养支持中.

肥胖症是体内营养物质过多导致脂肪堆积的复杂疾病.同时肥胖症也与2型糖尿病、高血压、血脂异常、睡眠呼吸暂停低通气综合征、多囊卵巢综合征等慢性疾病的发病密切相关[1].超重和肥胖已成为威胁大众健康的社会公共卫生问题.目前,减重代谢手术是治疗病态性肥胖唯一长期有效的方式[2].从上世纪50年代世界范围内第一台减重代谢手术开始至今,减重代谢外科不断发展,已经形成了一门科学的、规范的、严谨的、全方位发展的独立学科[3].减重代谢手术总量也逐年升高,我国减重代谢手术从2008年的百余例增长到2018年的10000多例,十年间增长了近百倍,开展减重代谢手术的医院或中心也快速增长[4,5].笔者所在的医院科室从2015年开始关注减重代谢外科,并于2015年底完成了第一例减重代谢手术,也是宁夏地区第一例减重代谢手术.与发达地区相比,经济欠发达地区减重代谢外科的发展困难重重.经过近五年的发展,虽然我们接诊的患者数量及手术例数不断增长,但宁夏及周边地区减重代谢外科发展仍较滞后.回顾近五年的发展历程,本文总结了宁夏地区减重代谢外科发展的历程和特点.

目的 评价"六步起床法"在胃肠道手术后患者首次下床活动中的效果.方法 将100例患者纳入研究,采用序列分组,对照组采用常规口头督促法进行护理指导,试验组采用"六步起床法"进行护理指导.观察两组病人首次下床活动时出现切口疼痛、头晕、引流管脱落发生率、肠蠕动恢复时间.结果 试验组较对照组下床活动出现切口疼痛、晕厥、引流管脱落发生率明显减少(P＜ 0.05),肠蠕动恢复时间明显提前(P＜ 0.01).结论 "六步起床法"可明显降低胃肠道手术后患者首次下床活动时不良现象的发生,有利于术后机体功能恢复.

目的 探讨不同胃管置入深度应用于肠梗阻的效果和临床研究.方法 本次研究选取2017年4月～2018年6月我院收治的90例肠梗阻患者.观察组45例患者以耳垂-鼻尖+发际-剑突体表长度行胃肠减压治疗,其长度低于70 cm,高于55 cm.对照组45例患者以耳垂-鼻尖-剑突体体表长度行胃肠减压治疗,其长度不超过55 cm.观察治疗结局.结果 观察组45例患者胃液引流量及腹胀评分明显优于对照组,对比差异有统计学意义(P<0.05).观察组45例患者炎症因子水平明显优于对照组(P<0.05).结论 采取70 cm以下、55 cm以上长度的胃管长度更有利于加强引流效果.值得临床推广和广泛应用.

目的:研究住院期间卧床患者发生压疮的相关因素.方法:采用南京军区南京总医院依据欧洲MDS、美国WOCN工具包及国际IAD和Tears指南,并应用Delphi法制成的调研工具对该院的1816位住院患者进行回顾性问卷调查.结果:其中280位卧床患者压疮发生率为6.43%,医院获得性压疮发生率为3.57%.住院期间卧床患者发生压疮的主要原因有外力作用、皮肤过度潮湿、营养不良、感知能力丧失、高龄等.结论:住院期间卧床患者压疮发生率较高,识别压疮高危人群有助于医务人员提高对该类人群压疮与治疗的重视程度,从而有利于开展有针对性的干预措施,以降低压疮发生率,减少压疮相关并发症及医疗费用等.

腹腔感染、肠外瘘是外科常见重症,抑制感染是此类重症治愈的关键.我科采用双腔管低负压持续冲洗引流的方法用于腹腔感染、肠瘘患者引流漏液,避免了漏液对周围皮肤的损伤,取得了较好的效果.

目的探讨不同氧疗法减少食管癌患者术后低氧血症的效果。方法将60例患者分成观察组和对照组,观察组30例给予面罩吸氧10 h,氧流量6 L/min,再改用鼻导管吸氧3 d,氧流量为2 L/min;对照组30例患者仅给予鼻导管吸氧3 d,氧流量为4～6 L/min,分别于术前、术后返回病房(术后当天)和术后的第l、2 d进行动脉血气分析,比较2组患者各个时间点的PaO2和PaCO2及术后并发症发生情况。结果 2组患者术前PaO2、PaCO2均正常,术后当天PaO2均低;观察组与对照组比较术后1、2 d PaO2明显提高,观察组发生低氧血症并发症明显少于对照组。结论合理氧疗可以预防和减少食管癌患者术后低氧血症的发生。

<正>急性胰腺炎的治疗原则是尽量减少胰液分泌,即胰腺休息疗法。持续胃肠减压可减少胃液进入十二指肠后刺激十二指肠黏膜分泌促胰酶素,从而减少胰酶分泌。对急性胰腺炎患者进行肠内营养支持能为肠道黏膜直接提供营养物质,减少机械刺激,保持黏膜的完整性,维持肠屏障结构与功能,更

<正> 近年来,随着老年人口数量明显上升,其发生肺癌的风险较低年龄人群明显增加,老年肺癌的治疗日益受到关注。外科手术仍是老年肺癌的首选治疗措施。老年人由于重要器官功能减退,术中和术后对手术创伤可能出现与年轻患者不同的反应,术

目的:总结老年腹主动脉瘤围手术期的护理体会,探讨相应的护理及护理措施。方法:术前监测生命体征,控制血压警惕瘤体破裂,做好健康宣教及心理护理;术后加强循环及呼吸系统的护理,密切观察术后出血、及血压、心功能、下肢血运的变化,注意饮食与营养的护理。