目的 分析重症监护室(ICU)老年脓毒症患者耐碳青霉烯类肺炎克雷伯菌(CRKP)感染的危险因素及预后.方法 选取125例肺炎克雷伯菌阳性老年脓毒症患者,根据是否碳青霉烯类耐药,将其分为耐药组和非耐药组,统计分析2组患者的一般临床资料、标本来源构成、单因素及多因素危险因素及预后.结果 2组患者性别、年龄及感染指标差异无统计学意义(P＞0.05);2组患者主要标本来源均为痰液及肺泡灌洗液;2组使用碳青霉烯类药物时长≥3 d、中心静脉导管留置天数和感染前30 d内抗生素使用,这3个单因素分析差异有统计学意义(P＜0.05);多因素logistic回归分析显示,以上3个危险因素也是预测CRKP感染的独立危险因素;耐药组患者的预后差、28 d病死率高,差异有统计学意义(P＜0.05).结论 控制碳青霉烯类抗生素使用,缩短中心静脉导管留置时间,可降低CRKP感染的发生,从而降低老年脓毒症患者病死率,改善预后.

目的:为了解决高流量加温加湿氧疗设备有限不能满足病患救治需求的问题,设计一种在重症监护病房能够实现的高流量加温加湿氧疗装置.方法:该装置由压缩氧气终端、压缩空气终端、气体连接管路、氧气流量计、空气流量计、医用加温湿化器组成,利用医院压缩气体源终端提供的恒定且较高流速的空气和氧气,实现高流量、空氧混合及加温加湿功能.在同一医用吊塔安装费雪派克高流量氧疗仪及该装置,在同一时间段设定相同的混合气流速及混合气体氧浓度,测定两组装置实际的吸入气氧浓度,计算吸入气氧浓度绝对误差值,并进行统计学分析.结果:该装置与费雪派克高流量氧疗仪相比,在设定提供相同流速、氧浓度的混合气体时,实际吸入气氧浓度绝对误差值无统计学差异(P>0.05).结论:该项氧疗装置的设计及临床应用,可以为临床实现高流量加温加湿氧疗技术提供另一途径,提高医疗资源利用率,有一定的临床应用及研究价值.

目的 研究白藜芦醇(resveratrol,RSV)缓解脂多糖(LPS)诱导的急性肺损伤的机制.方法 随机选择40只8周龄雄性ICR小鼠,将其随机分成5组,对照组、模型组、实验组(100、300、500 mg/kg),分别用生理盐水或白藜芦醇灌胃预处理2周.用4％ 水合氯醛麻醉小鼠,经气道滴入2.5 mg/kg LPS复制急性肺损伤模型,对照组滴加生理盐水.构建模型后6 h,处死成功诱发急性肺损伤的小鼠,取其肺组织进行肺湿重与干重(W/D)比测定,进行组织病理学观察;利用NADP+/NADPH检测试剂盒检测烟酰胺腺嘌呤二核苷酸磷酸(NADPH)氧化酶活性,利用qRT-PCR与免疫印迹法对NADPH氧化酶亚基p47phox、p22phox表达水平进行检测.结果 通过气道滴入LPS成功构建急性肺损伤小鼠模型;通过病理学观察、测定肺W/D,证明白藜芦醇以剂量依赖的方式有效缓解了L PS诱导的肺损伤;与模型组相比,实验组NADP+/NADPH比值显著降低;qRT-PCR和Western blot实验结果显示,与模型组相比,白藜芦醇显著降低了NADPH氧化酶亚基p22phox、p47phox的表达水平.结论 白藜芦醇通过降低NADPH氧化酶亚基p22phox、p47phox的表达水平,降低肺组织NADP+/NADPH比值,缓解LPS诱导的急性肺损伤.

Objective To evaluate the effect of peripheral perfusion index（PI） combined with traditional resuscitation index on elderly sepsis patients.Methods 71 elderly patients with sepsis in ICU of our hospital（patients after resuscitation with arterial blood lactic acid ＞ 2.0 mmol/L at the completion of early resuscitation） were divided into two groups according to PI,PI≥1.4 group and PI＜1.4 group. The changes of central venous pressure（CVP）,mean arterial pressure（MAP）,central venous blood oxygen saturation（ScvO 2 ）,Pv-aCO 2 /Ca-vO 2 ratio, and lactic acid clearance rate at 0 h and 6 h after resuscitation were analyzed.Results There was no significant difference in the general clinical data of 71 elderly patients with sepsis. Immediately after resuscitation, there was no significant difference in MAP,CVP,ScvO 2 ,Pv-aCO 2 /Ca-vO 2 ratio, and lactic acid clearance rate between the two groups（P＞0.05）;6 hours after resuscitation, the Pv-aCO 2 /Ca-vO 2 ratio, and lactate clearance rate of patients in PI≥1.4 group were better than those in PI＜1.4 group（P＜0.05）. The 28-day mortality of patients with PI ≥ 1.4 was lower than that of patients with PI＜1.4（P＜0.05）.Conclusion In the resuscitation treatment of elderly patients with sepsis, the traditional resuscitation index combined with PI,Pv-aCO 2 /Ca-vO 2 ,and lactate clearance rate can refine the guidance, optimize the resuscitation goal and improve the prognosis.

目的 分析血必净注射液联合高流量氧疗(HFNC)对老年急性呼吸窘迫综合征(ARDS)患者肺功能的影响.方法 选取老年ARDS患者88例,利用随机数字表抽样分为研究组与对照组,每组44例.两组均采取常规对症治疗,对照组在此基础上实施HFNC治疗,研究组在对照组的基础上联合血必净注射液治疗,两组连续治疗7 d.比较两组治疗前后动脉血气〔氧分压(PaO2)、二氧化碳分压(PaCO2)、血氧饱和度(SpO2)〕、炎症反应〔白细胞介素(IL)-6、肿瘤坏死因子(TNF)-α、C反应蛋白(CRP)〕、肺功能〔用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、FEV1/FVC〕变化及预后情况.结果 治疗后,研究组PaO2、PaCO2、SpO2、FEV1、FVC和FEV1/FVC明显高于对照组,血清IL-6、CRP、TNF-α水平明显低于对照组(均P<0.05);治疗后7 d研究组急性生理学及慢性健康状况评分系统(APACHE)-Ⅱ评分和序贯器官衰竭检测(SOFA)评分低于对照组.结论 血必净注射液联合HFNC对老年ARDS患者肺功能具有积极作用,可有效减轻炎症反应程度,改善血流动力学指标及肺功能,临床效果显著.

目的 研究老年慢性心力衰竭患者血清胱抑素C(Cys C)及N端B型尿利钠肽原(NT-proBNP)水平变化与心室重构的关系.方法 选取老年慢性心力衰竭患者125例为观察组,选取30例同期老年健康体检者为对照组.观察组按照美国纽约心脏病协会(NYHA)标准分为Ⅰ级组(25例)、Ⅱ级组(53例)、Ⅲ级组(29例)和Ⅳ级组(18例);依据左心室射血分数(LVEF)＞50％为射血分数保留心力衰竭组(HFpEF),(LVEF)＜40％为射血分数减少心力衰竭组(HFrEF).入院后空腹采血测定Cys C和NT-proBNP等;利用心脏彩色多普勒超声记录左心室舒张末容积(LVEDD)和LVEF,对上述资料进行相关分析.结果 与对照组比较,HFpEF组和HFrEF组血清Cys C和NT-proBNP水平有统计学差异(P＜0.05).与对照组、NYHA Ⅰ级组、NYHA Ⅱ级组和NYHA Ⅲ组比较,NYHA Ⅳ级组血清Cys C和LVEDD值明显增加,差异有统计学意义(P＜0.05).结论 老年慢性心力衰竭患者血清Cys C水平与心室重构相关.

目的:探讨重症监护病房(ICU)脓毒症患者细菌分类特点及与炎症指标表达水平的相关因素分析.方法:选取我院ICU收住的脓毒症患者80例,所有患者在收住后送检相关标本进行细菌培养,了解细菌标本来源及菌种分布情况,根据细菌培养结果将患者分为革兰氏阴性菌组(G-组)及革兰氏阳性菌组(G+组),比较分析两组患者血清降钙素原(PCT)及超敏C反应蛋白(hs-CRP)表达水平是否有差异.结果:80例培养阳性的脓毒症患者中,痰液为主要培养来源,G-菌占主要分布,G+菌分布较少,G-组患者血清PCT及hs-CRP较G+组表达水平高,具有统计学差异(P<0.05),两组患者28天病死率无明显区别(P>0.05).结论:ICU脓毒症患者需尽早送检标本进行细菌培养,G-菌阳性患者PCT及hs-CRP表达水平高,在初期可对患者经验性抗生素治疗.

目的 分析鲍曼不动杆菌感染的分布特征、耐药性及与临床抗菌药物使用强度的相关性.方法 选取重症医学科收住的感染患者为研究对象,采集患者不同部位标本进行细菌培养,了解鲍曼不动杆菌细菌标本来源的分布情况,进行药物敏感分析试验,同时分析患者抗菌药物使用强度和耐药性的相关关系.结果 2016年、2017年及2018年分别检出检出鲍曼不动杆菌为125、112及101株,共338株鲍曼不动杆菌培养阳性标本,标本来源主要为呼吸道分泌物;采取严格院感措施后,鲍曼不动杆菌临床分离株有减少趋势;鲍曼不动杆菌对多种抗生素均有不同程度的耐药,且系多重耐药;头孢他啶、亚胺培南的使用强度与鲍曼不动杆菌的耐药率呈正相关性(P＜0.05).结论 院内鲍曼不动杆菌临床分离菌株分布广泛,多重耐药明显,抗生素选择需要联合用药,加强院感是减少鲍曼不动杆菌感染的有效措施.

目的 探讨血清降钙素原(PCT)和急性生理和慢性健康状态评分(APACHEⅡ)对脓毒症患者预后的评估价值.方法 根据脓毒症诊断标准,选取60例脓毒症患者,每位患者在入住ICU后的第1、4、8天及转出ICU时或死亡前检测血清PCT水平,同时计算APACHEⅡ;根据治疗至第28天时患者存活还是死亡,将患者分为生存组和死亡组;比较分析两组患者治疗不同时间血清PCT和APACHEⅡ评分的变化.结果 两组患者在治疗过程中血清PCT水平和APACHEⅡ评分均呈下降趋势,各时间点差异均有统计学意义(P均<0.05).生存组和死亡组患者治疗第1天血清PCT水平和APACHEⅡ评分均高于第4、8天和死亡或转出时(P均<0.05);两组患者入ICU第1天时血清PCT及APACHEⅡ评分差异均无统计学意义(P均>0.05),在第4、8天及死亡或转出这3个时点,死亡组血清PCT水平和APACHEⅡ评分均高于生存组(P均<0.05).结论 动态检测血清PCT水平和APACHEⅡ评分对脓毒症预后有很好的评估作用.

目的 血清降钙素原(PCT)联合血培养对脓毒症患者诊疗及预后的评估观察.方法 选取符合脓毒症诊断标准的血培养阳性患者59例,在收住ICU后检测血清PCT并送检血培养;根据血培养阳性结果将患者分为革兰氏阴性菌组(G-组)及革兰氏阳性菌组(G+组),比较分析2组患者血清PCT联合血培养对患者诊疗的指导价值.结果 59例脓毒症患者中,G-组患者血清PCT水平较G+组表达水平高,差异具有统计学意义(P＜0.05);以28 d是否存活为依据,G-组患者至28 d时共有9例死亡,病死率为28.13％ (9/32);G+组患者至28 d时共有8例死亡,病死率为29.63％(8/27),2组患者病死率比较差异无统计学意义(P＞0.05).结论 检测血清PCT联合血培养对脓毒症患者的诊疗及预后更有指导意义.

Objective To analyze the correlation of changes in serum retinal binding protein( RBP) level and their prognosis in critically ill patients,and investigate the impact of nutrition on prognosis in critically ill patients. Methods 90 severe cases were divided into the survival group and death group according to 28 Day's survival rate. Blood RBP and APACHEⅡ were measured at the first day, the third day and the seventh day among all cases,RBP level and APACHEⅡ score were compared separately at the same time point between the two groups,then the relationship and regression analysis were performed between the death rate and RBP,and APACHEⅡ on each time point. Results RBP level was lower in the nonsurvivors than survivors on the third day and the seventh day( P < 0. 05). A- PACHEⅡ scores in the nonsurvivors were higher than survivors throughout the ICU course( P < 0. 05),but there was no difference in RBP at admission between the two groups. Dead rate was negatively with RBP level at the third day and the seventh day( P < 0. 05), positively with APACHEⅡ scores throughout the ICU course( P < 0. 05),irrelevantly with RBP at admission( P > 0. 05). Logistic regression analysis with hospital mortality was as dependent variable,RBP level on the third and the seventh day was still significantly related with hospital mortality of critically ill patients( OR = 14. 132,3. 957; P = 0. 000,0. 047). Conclusion Nutritional status of patients can impact on prognosis in critically ill patients,and the nutritional therapy is expected to improve prognosis of critically ill patients.

Objective To explore the significance of anti-cyclic citrullinated peptide antibody in diagnosing rheumatoid arthritis.Methods Anti-CCP in patients with the chief complaint of joint pain or swelling was measured by ELISA.Results The sensitivity of anti-CCP and RF in diagnosing of RA was 75.0% and 53.2% respectively The specificity was 92.3% and 76.1%.The sensitivity and specificity of anti-CCP was significantly higher than that of RF(P0.01).Anti-CCP had greater diagnostic value than RF in early diagnosis of RA.Conclusion The anti-CCP presents a good sensitivity and specificity in diagnosis of RA.