公立医院是医疗卫生服务体系的主力军,在保障人民健康特别是抗击新冠肺炎疫情中,承担了紧急、危险、艰苦的医疗救治工作,发挥了重要作用.笔者通过分析平急结合重要性及存在的问题,提出从构建良好的平急结合资源体系和提升重大疫情的救治能力等方面探讨可实现的路径,助力公立医院高质量发展.

Objective:To investigate the clinical characteristics, diagnosis, treatment and prognosis of infective endocarditis(IE)in elderly patients with cerebral infarction as the first presentation.Methods:The clinical data of 5 elderly infective endocarditis patients with cerebral infarction as the first presentation diagnosed and treated in Beijing Shijitan Hospital, Capital Medical University from October 2010 to December 2021 were retrospectively analyzed, and national and international reports from January 1998 to December 2021 on IE in the elderly with cerebral infarction as the first presentation were collected.The clinical characteristics, diagnosis and prognosis were analyzed and summarized.Results:A total of 18 IE cases with cerebral infarction as the first presentation were reviewed, including 5 cases from our hospital.The male to female ratio was 5∶1, and the median age was 70.5 years.IE was diagnosed several hours to 4 months after the onset of cerebral infarction.All the patients had speech impairment symptoms and most of them exhibited hemiparesis.The National Institute of Health Stroke Scale(NIHSS)scores ranged between 2-35.All 18 patients underwent blood culture, and streptococci were the most common pathogens.Most of the lesions were located in the blood supply area of the middle cerebral artery or the junction between the middle cerebral artery and the posterior cerebral artery.Echocardiography showed that mitral valve vegetations were the dominant features, followed by aortic valve vegetations.All 18 patients received antibiotic treatment, 2 underwent valve replacement and removal of vegetations, and 11 underwent intravenous thrombolysis or mechanical thrombectomy.50.0% of patients(9 cases)had a good prognosis and one third(6 cases)died.Conclusions:Cerebral infarction is the first presentation in some elderly IE patients, and misdiagnoses are common, but half of patients can have a good prognosis after timely anti-infection and surgical treatment.

新冠肺炎严重威胁人类生命安全和身体健康,广大医务工作者为拯救患者生命不懈努力,而医院后勤系统为医院正常运行提供保障.面对重大疫情,首都医科大学附属北京世纪坛医院后勤系统采取网格化管理,围绕患者就诊、医护诊疗、后勤服务3条主线,健全服务评价系统,抓好重点环节管控,制定启动应急预案,有效降低医院感染风险.通过抓住后勤保障工作中疫情防控重点,创新管理举措,统筹协调、责任到人,完善了“人流、物流、信息流”的全要素管理,为提高疫情防控工作处置效率奠定了坚实基础,取得了良好成效.

目的 了解居民新冠肺炎疫情防控的知识、技能和心理行为状况,为疫情防控的居民宣教和心理干预提供科学依据.方法 使用自制问卷,采用方便抽样法抽取调查对象,使用自制电子问卷进行调查.所有数据使用SPSS 21.0进行统计分析,定量资料进行方差分析和t检验.结果 收到447份有效问卷中,男性占51.90％,女性占48.10％.调查对象的平均年龄(38.20±13.00)岁.新冠肺炎防控知识和技能得分均为(5.31±1.56)分,女性得分高于男性(P<0.05),28岁～和38岁～年龄组高于其他年龄组(P<0.05);大专或大学组和医疗卫生人员组高于其他组(P<0.05),农民组低于其他组(P<0.05).91.50％的调查对象报告自己的防控知识和技能主要来源于新闻发布.调查对象阳性心理行为症状的总评分为(0.85±1.17)分.93.96％的调查对象认为最终会彻底控制此次疫情,但44.52％的调查对象过去两周出现阳性心理症状,出现焦虑、偏执、强迫、躯体化、恐怖、抑郁症状的分别占24.38％、24.83％、22.82％、3.36％、6.94％、2.24％.结论 居民中大多数已掌握新冠肺炎防控的基本知识和技能,文化程度较低者和农村居民应作为后续宣教的重点人群.应重视实施大众心理疏导和干预.疫情新闻发布工作和网络媒体较好地发挥了公众沟通的作用.

目的 探索综合医院新型冠状病毒肺炎(COVID-19)防控体系的建立与应用,制定行之有效的防控策略,为综合性医院建立科学的疫情防控体系提供可借鉴的经验,成为长效机制.方法 以管理传染病三个环节"传染源、传播途径、易感人群"为原则,加强人员培训、健康监测、消毒防护、物资调配及健康科普工作,优化诊疗区域及通道,建立应急预案及督导机制,强化重点科室管理及人工智能应用,结合医院实际情况,制定科学有效的防控策略,注重细节,保障防控措施落地.结果 医院诊疗活动有序开展,防控措施有效可行,医患传染病防控意识明显增强,防控知识知晓率达到100.00％,医务人员手卫生依从性提高,穿脱防护用品及消毒灭菌规范合理,医院工作人员、门急诊及住院患者均未感染COVID-19.结论 科学的医院感染防控体系的建立与应用,可以有效控制综合医院新型冠状病毒肺炎的传播与感染.

目的 分析食管癌根治术后患者院内感染病原菌分布特点及耐药性情况,为临床诊治提供依据.方法 回顾性分析2014年4月 ～2019年4月180例发生院内感染的食管癌根治术后患者的一般临床资料,总结病原菌培养结果 及多重耐药性情况.结果 食管癌根治术后患者在院治疗期间发生的最常见的院内感染是下呼吸道感染(32.8％),其次是手术切口(21.1％)、胸腔(15.0％)和上呼吸道感染(13.3％).180个标本共分离出276株病原菌,其中革兰阴性菌164株(59.4％),以大肠埃希菌(11.6％)最多;革兰阳性菌78株(28.3％),主要为金黄色葡萄球菌(8.3％);真菌34株(12.3％),以白色念珠菌为主(5.1％).药敏试验显示几种主要革兰阴性菌对头孢唑林、氨苄西林、阿莫西林-克拉维酸及复方新诺明具有较高耐药性,对头孢哌酮-舒巴坦、亚胺培南和美罗培南较为敏感;几种主要革兰阳性菌对青霉素、红霉素、阿奇霉素和头孢唑林具有较高耐药性,对万古霉素和利奈唑胺较敏感;几种主要真菌对氟康唑、两性霉素B具有较高耐药性,对酮康唑、咪康唑较为敏感.结论 食管癌根治术后患者最易发生院内感染的部位是下呼吸道,最常见的病原菌类型是革兰阴性菌,且耐药严重,存在多重耐药菌,临床上应该做好相应的预防工作及合理选择抗菌药物.

目的 分析老年肺癌患者术后发生院内肺部感染的病原菌分布特点及耐药性情况,为临床诊治提供一定参考依据.方法 回顾性分析2016年8月—2019年8月收治的496例老年肺癌手术患者的临床资料,统计术后发生院内肺部感染的情况,总结肺部感染痰培养的细菌分离株及多重耐药性情况.结果 496例老年肺癌患者术后发生院内肺部感染者117例(23.6％);共分离出162株病原菌,以革兰阴性菌(103株,63.58％)为主,其次为革兰阳性菌(38株,23.46％)和真菌(21株,12.96％).药物敏感(药敏)试验结果显示革兰阴性菌、革兰阳性菌及真菌对常用抗菌药物的耐药率均较高.结论 老年肺癌患者术后院内肺部感染发生率较高,最常见的病原菌是革兰阴性菌,且细菌耐药严重,甚至出现较多的多重耐药菌,临床上要加强病原菌的培养和药敏试验,合理选择抗菌药物.

目的 通过对北京某三甲医院骨科清洁手术部位感染情况进行调查,对可能的清洁手术部位感染危险因素进行筛选,找出清洁手术部位感染的独立危险因素.方法 回顾性分析北京某三甲医院2010年-2019年骨科清洁手术病例,采用病例对照法研究,将术后发生清洁手术部位感染患者与同期未发生手术部位感染的患者,按1:2频数配比法,匹配因素为手术科室、年份,对清洁手术感染可能的影响因素予以多因素分析.结果 2010-2019年骨科共59例清洁手术部位感染病例.感染病例微生物标本送检率为61.0％(36/59),病原体检出率为77.8％(28/36);28例病例共分离到34株病原菌,其中6例病例为混合感染(2种及以上病原菌);病原菌培养结果,革兰氏阳性菌22株(64.7％):其中金黄色葡萄球菌13例(38.2％),表皮葡萄球菌7例(20.6％);革兰氏阴性菌12株(35.3％).多因素分析后得出,清洁手术部位感染的独立危险因素为糖尿病、术前贫血、手术时间≥180 min、术中出血>1000 ml、超重和肥胖、心功能Ⅲ级(P<0.05).结论 控制清洁手术部位感染,建议采取如下措施:加强医务人员手卫生管理;术前积极控制各种危险因素,如调整血糖,纠正贫血,针对超重肥胖和心功能差的患者,积极进行术前评估,完善手术计划,对患者进行预防手术部位感染的健康宣教;术者应提高手术技巧,充分止血,缩短手术时间.

目的 分析重症医学科建立人工气道机械通气患者碳青霉烯类抗菌药物耐药铜绿假单胞菌(Carbapenemresistant Pseudomonas aeruginosa,CRPA)肺部感染的危险因素及耐药性.方法 选择2016年1月-2019年12月首都医科大学附属北京世纪坛医院重症医学科铜绿假单胞菌(Pseudomonas aeruginosa,PA)感染患者388例,其中CRPA肺部感染患者251例为研究组,碳青霉烯类抗菌药物敏感铜绿假单胞菌(Carbapenem-sensitive Pseudomonas aeruginosa,CSPA)肺部感染患者137例为对照组,比较两组患者年龄、合并基础疾病、抗菌药物使用及炎症因子指标等临床资料,分析人工气道机械通气患者CRPA肺部感染的危险因素,分析两组患者对常用抗菌药物的耐药性,并对PA常见耐药基因进行检测.结果 两组患者年龄、APACHEⅡ评分、入院前卧床时间、炎症因子水平、合并慢性阻塞性肺病(COPD)、铜绿假单胞菌检出前使用碳青霉烯类抗菌药物、低蛋白血症比较差异有统计学意义(P＜0.05);其中合并COPD、机械通气时间＞10 d、铜绿假单胞菌检出前使用碳青霉烯类抗菌药物是人工气道患者CRPA感染的独立危险因素(P＜0.05);研究组对常用抗菌药物的耐药率均高于对照组;研究组除对阿米卡星耐药率为16.33％,头孢他啶25.50％外,其余耐药率均高于55.00％.碳青霉烯类抗菌药物耐药铜绿假单胞菌含有IMP、VIM、OXA-23、OXA-51等多种耐药基因.结论 CRPA肺部感染与合并COPD、铜绿假单胞菌检出前使用过碳青霉烯类抗菌药物、机械通气等多种因素相关,CRPA含有多种碳青霉烯类抗菌药物耐药基因,耐药率较高,预后差.

目的:了解综合医院普外科开展患者健康教育的现状和医护人员对患者健康素养的期望.方法:选取北京市4所三级综合医院的普外科医护人员作为调查对象,采用资料查阅和个人深入访谈法进行调查.结果:4所医院普外科平均健康教育兼职人员数(4.5±3.9)名,平均占医护人员总数的8.1％.各院普外科年均举办健康讲座(4±1.4)次,年均受益患者(257.5±96.1)人次.各医院普外科年均发放健康教育平面材料(8155.8±6349.3)份,播放健康科普视频(2095±660.4)小时,开展面对面患者教育(525.8±382.9)人时.医护人员希望患者知晓医学词汇7个,分别是胆石症、胰腺炎、疝气、腹股沟疝、肝癌、肠癌和甲状腺疾病;希望患者知晓相关知识点21个.结论:普外科患者健康教育状况不理想,应进一步加强常见外科疾病诊治的健康教育,提升患者健康素养.

目的 了解某医院重点科室多重耐药菌(MDRO)的分布及耐药性,为临床抗菌药的使用提供科学依据.方法 收集2016—2017年首都医科大学附属北京世纪坛医院重点科室收治患者的痰液、尿液等各类标本,按照《全国临床检验操作规程》进行标本的接种分离与鉴定,并进行药物敏感性实验.结果 共分离出病原菌2080株.其中,泛耐药鲍曼不动杆菌(PDR-ABA)最多,为969株,占46.59％;其次为泛耐药铜绿假单胞菌(PDR-PAE)、大肠埃希菌(ECO)和耐甲氧西林金葡菌(MRSA).病原菌主要分布在重症监护室(ICU)、呼吸内科和急诊科病区,其中,ICU占52.45％,呼吸内科和急诊科病区分别占11.92％、9.95％.检出的病原菌分布以G-菌为主,共1652株,占79.42％,G+菌428株,占20.58％.G-菌对青霉素G、红霉素、克林霉素和万古霉素敏感性较高,余均有不同程度的耐药;G+菌对头孢类、哌拉西林、厄他培南、亚胺培南药物素敏感性较高,余均有不同程度的耐药,检出耐万古霉素肠球菌(VRE).结论 MDRO主要为条件致病菌,其中,以G-菌较为多见,且无论是G+菌还是G-菌对常用抗生素均广泛存在不同程度的耐药.

Endoplasmic reticulum (ER) stress is involved in inflammation-induced neurotoxicity. Mitofusin 2 (Mfn2), a member of the GTPase family of proteins, resides in the ER membrane and is known to regulate ER stress. However, the potential role and underlying mechanism of Mfn2 in inflammation-induced neuronal dysfunction is unknown. In our study, we explored the potential of Mfn2 to attenuate inflammation-mediated neuronal dysfunction by inhibiting ER stress. Our data show that Mfn2 overexpression significantly ameliorated tumor necrosis factor alpha (TNFα)-induced ER stress, as indicated by the downregulation of the ER stress proteins PERK, GRP78 and CHOP. Mfn2 overexpression also prevented the TNFα-mediated activation of caspase-3, caspase-12 and cleaved poly (ADP-ribose) polymerase (PARP). Cellular antioxidant dysfunction and reactive oxygen species overproduction were also improved by Mfn2 in the setting of TNFα in mouse neuroblastoma N2a cells in vitro. Similarly, disordered calcium homeostasis, indicated by disturbed levels of calcium-related proteins and calcium overloading, was corrected by Mfn2, as evidenced by the increased expression of store-operated calcium entry (SERCA), decreased levels of inositol trisphosphate receptor (IP3R), and normalized calcium content in TNFα-treated N2a cells. Mfn2 overexpression was found to elevate Yes-associated protein (Yap) expression; knockdown of Yap abolished the regulatory effects of Mfn2 on ER stress, oxidative stress, calcium balance, neural death and inflammatory injury. These results lead us to conclude that re-activation of the Mfn2–Yap signaling pathway alleviates TNFα-induced ER stress and dysfunction of mouse neuroblastoma N2a cells. Our findings provide a better understanding of the regulatory role of Mfn2–Yap–ER stress in neuroinflammation and indicate that the Mfn2–Yap axis may be a focus of research in terms of having therapeutic value for the treatment of neurodegenerative diseases.

目的:分析"互联网+"技术对公立医院健康教育质量的影响情况,为改进健康教育服务模式提供借鉴.方法:选择2016年1月至2018年6月期间在首都医科大学附属北京世纪坛医院就诊的588例患者进行健康知识及素养问卷调查,对相关数据进行分析.结果:"互联网+"技术应用前后,患者健康知识知晓率、健康行为养成率和医院健康教育满意率有显著性差异(均P<0.05).结论:借助"互联网+"技术,尤其是策划拍摄科普微电影及精品微视频等方式,能更有效发挥医院专家优势资源,能更好开展科普信息传播,提高患者的健康知识知晓率,改变其行为.

Objective To investigate the correlation of serum angiotensin Ⅱ level with the severity of depression and anxiety in patients with Parkinson's disease (PD) and its clinical significance.Methods Sixty patients with PD at the Department of Neurology in our hospital and 60 healthy individuals who underwent physical examination were included from January 2014 to December 2016.Depression and anxiety were evaluated by Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA),respectively.The serum ANG Ⅱ level was also assayed and its association with depression and anxiety in PD patients was examined.Results Depression and anxiety in the PD group were more severe than in the healthy group (HAMD score:23.0±5.9 vs.4.7±2.2,t=22.23,P＜0.0001;HAMA score:22.3±9.7 vs.5.2±3.3,t=11.71,P＜0.01),while serum ANG Ⅱ level of PD patients was significantly lower than in the healthy individuals [343.4 (230.0,470.2) ng/L vs.793.5 (440.9,2 087.1) ng/L,U =701.5,P ＜ 0.01].Spearman's rank correlation analysis suggested that serum ANG Ⅱ level was negatively related with the severity of depression and anxiety (HAMD:r =-0.5468,P ＜ 0.01;HAMA:r =-0.4146,P =0.001) in PD patients.Conclusions The serum ANG Ⅱ level which is significantly associated with the severity of depression and anxiety in PD patients might become a new clinical biomarker in predicting and diagnosing depression and anxiety in PD patients.

睡眠是每个人生命必需的过程,是一种生物节律,约占人一生中的三分之一时间.3月21日是“世界睡眠日”,据中国睡眠研究会全国调查问卷统计显示:高达38.2％的中国城市居民存在着不同程度的失眠,女性失眠率是男性的1.4～2倍. 怎样就算失眠呢?躺下后15至30分钟内入睡是正常,若超过1小时仍然不能入睡,就是失眠.引起失眠的情况很多,比如患上精神心理类疾病、有烦心事、工作压力过大、患有相关器质性疾病或是吃了导致兴奋的药物等.

提升人群健康素养是医院健康教育的目标.如何弥补医院传统健康教育模式的不足,满足人群对健康的需求是各医院需要思考和解决的问题.本文主要介绍了北京世纪坛医院积极利用新媒体进行创新模式的健康教育的一系列探索,包括网络直播医院健康大课堂、整合医院传统宣教工作、利用新媒体开展面向公众的健康教育等.这些方法也提高了医务人员科普工作的积极性,有助于构建和谐的医患关系.

Objective To explore the relationship of post-stroke depression (PSD) with neurological function deficits and activities of daily living. Methods A total of 160 patients with stroke from August 2012 to September 2013 in Department of Neurology in our hospital were enrolled. Self-Rating Depression Scale (SDS), Hamilton Depression Rating Scale-17 Items (HAMD-17), National Institutes of Health Stroke Scale (NIHSS) and Barthel Index (BI) were used to assess depression, neurological function deficits and activities of daily living of stroke patients. Results A total of 65 patients (40.63%) appeared depression after stroke. Compared with non-PSD group, patients in PSD group presented more serious neurological function deficits (P = 0.045) and less activities of daily living (P = 0.000). The PSD group was further divided into 3 subgroups: mild, moderate and severe depression. Along with the increase of severity of PSD, NIHSS score increased (P = 0.000, 0.000, 0.000) while Activities of Daily Living (ADL) score decreased (P = 0.000, 0.000, 0.000). Pearson correlation analysis suggested that HAMD score was positively correlated with NIHSS score (r = 0.534, P = 0.005), and negatively correlated with ADL score (r = -0.645, P = 0.002). Conclusions PSD is closely related with the degree of neurological function deficits and activities of daily living. Curing the primary disease, reducing neurological dysfunction, taking early rehabilitation therapy, and improving the patients' activities of daily living will be helpful to alleviate the degree of PSD. DOI: 10.3969/j.issn.1672-6731.2016.05.005

Objective: The aim of this study was to develop and validate a risk score for predicting combined extracranial and intracranial artery stenosis (EICAS) in acute ischemic stroke patients.Methods: Patients with acute ischemic stroke were consecutively and prospectively enrolled in this study. Eligible patients were randomly divided into derivation and validation cohorts.Variables collected at presentation were used for predicting EICAS after acute ischemic stroke. Multivariable logistic regression was used to identify independent risk factors. Points for EICAS were generated by beta-coefficients. Sensitivity and specificity of the risk score was assessed by the area under the receiver operating characteristic curve (AUROC). Cutoff value for predicting EICAS was determined by maximum Youden index.Results: There were 629 patients with EICAS and 352 patients without cranial artery stenosis. Among EICAS, 321 patients were in the derivation cohort and 308 in the validation cohort. Five independent predictors including age, diabetes mellitus, hypertension, Low density lipoprotein (LDL) and heart disease were used to develop a 10-point score. The score was termed ADLH2 (age, diabetes mellitus, hypertension, LDL, heart disease). The ADLH2 showed good discrimination in the derivation (AUROC 0.695; 95% confidence interval, 0.656-0.735) and validation (AUROC 0.672; 95% confidence interval, 0.631-0.712) cohort. The cutoff value at maximum Youden index was 4 with the sensitivity 0.479 and specificity 0.719. Stroke patients with ADLH2 score >= 4 need further examination and therapy for EICAS.Conclusions: The ADLH2 score is a valid risk score to identify high-risk EICAS individuals who need further investigation and treatment. (C) 2016 Elsevier B.V. All rights reserved.

Objective To explore the association of post stroke depression (PSD) with the scale of stroke deficit and serum brain-derived neurotrophic factor levels in the elderly.Methods A total of 150 elderly stroke patients from the department of neurology of our hospital were recruited from August 2010 to September 2013.Patients were assessed by the Hamilton depression rating scale (HAMD),the National Institutes of Health Stroke Scale (NIHSS),and the Activitics of Daily Living Scale (ADL).In addition,serum BDNF levels were determined by ELISA.Results 42.0％ of the 150 elderly patients suffered depression after stroke (63/150).There were significant differences in neurological function impairment and ADL scores between the PSD group and the non-PSD group [(14.72±4.06) vs.(5.51±1.93) and (40.63±17.06) vs.(79.66±29.31),t=18.49 and 9.47,respectively,P＜0.0001 for both].HAMD and NIHSS scores showed positive correlations with the degreeof depression (r=0.998 and 0.962,P=0.0012 and 0.0375,respectively).ADL scores and serum BDNF levels decreased as the degree of depression increased,and were negatively correlated with the degree of depression (r=-0.985 and-0.995,P=0.0149 and 0.0049,respectively).Conclusions The degree of post-stoke depression is positively correlated with the scale of neurological dysfunction and negatively correlated with the activities of daily living scale and serum BDNF levels in the elderly.The primary disease should be properly treated,and improvement in brain metabolism and micro circulation should be attempted to alleviate neurological dysfunction.In addition,rehabilitation therapy should be performed early in elderly stroke patients in order to improve physical activity and self-care ability,thus reducing the degree of disability and depression.

目的 探讨急性脑梗死患者病灶大小与血清超敏C-反应蛋白(hsCRP)、血浆纤维蛋白原(FIB)水平的相关性及其临床意义.方法 选取2011-01-2013-12在作者医院神经内科诊治的急性脑梗死患者120例,根据入院CT/MRI扫描显示的病灶大小,按照Adama分类标准将患者分为腔隙性脑梗死组(41例)、小面积梗死组(58例)、大面积梗死组(21例).随机选取健康体检者40名作为对照组.分别测定各组患者血清hsCRP和血浆FIB水平.结果 急性脑梗死组血清hsCRPh和血浆FIB水平显著高于健康对照组(P＜0.01);大面积脑梗死组血清hsCRP和血浆FIB水平显著高于小面积脑梗死组(P＜0.01)和腔隙性脑梗死组(P＜0.01);小面积脑梗死组血清hsCRP和血浆FIB水平显著高于腔隙性脑梗死组(P＜0.01);腔隙性脑梗死组血清hsCRP和血浆FIB水平高于健康对照组(P＜0.01,P＜0.05).ACI病灶大小与血清hsCRP、血浆FIB水平呈正相关(r2分别为0.9354、0.9902).结论 急性脑梗死患者血清hsCRP和血浆FIB水平显著增高;血清hsCRP和血浆FIB水平与ACI患者病灶大小呈正相关;血清hsCRP和FIB可作为预防和治疗脑梗死的辅助观测指标.