目的 了解某医院重症监护病房(ICU)患者多重耐药菌(MDRO)医院感染情况与环境消毒质量关系.方法 通过回顾性分析方法,研究2016年1月-2020年12月9个病区ICU患者医院感染率和MDRO感染率;采用环境卫生学采样和细菌培养方法,分析环境消毒效果监测合格率.结果 该医院临床ICU连续5年住院患者医院例次感染率为7.26％,MDRO医院例次感染率为4.11％,环境消毒质量平均总合格率为94.88％.科室间医院感染率、例次感染率和MDRO医院例次感染率,环境消毒合格率均有统计学差异(P＜0.05);年度间的MDRO医院例次感染率和环境消毒合格率差异均无统计学意义;不同项目消毒效果的年度间差异无统计学意义.结论 环境消毒合格率越高的ICU,其科室的MDRO感染风险越低.该医院环境消毒质量较好,临床ICU住院患者MDRO感染率在可控范围,仍需要加强监督监测及管理.

目的 了解医院重症监护病房(ICU)住院患者感染耐碳青霉烯类铜绿假单胞菌(CRPA)临床分布和耐药情况.方法 通过回顾性分析方法,对某医院ICU临床分离CRPA资料进行分析与评估.结果 该医院ICU患者感染CRPA中,医院获得感染和社区获得感染分别占44.24％和52.11％.连续5年社区感染CRPA检出率有升高趋势.医院ICU患者CRPA感染部位均以下呼吸道为主.医院和社区感染CRPA对亚胺培南和美罗培南耐药率较高,对多黏菌素B耐药率为0％.结论 医院ICU患者CRPA感染率较高,医院获得感染的CRPA对多种抗菌药物的耐药率均高于社区感染,应采取有针对性的防控措施,科学合理选用抗菌药物.

输液港,也称完全植入式静脉给药装置(totally implantable venous access devices,TIVAD),可用于药物、静脉输液、肠外营养液、血液制品的输注,以及血液样本的提取.在临床常规中使用输液港是由外科医生在20世纪80年代早期开始的[1].当与耐高压注射针头一起使用时,成为耐高压输液港(power port),可注射造影剂辅助患者CT增强检查.臂式输液港是以上臂的贵要静脉、肱静脉或头静脉为穿刺入路,将注射座埋植于上臂内侧皮下的一种新的输液港置入方式[2].江苏省肿瘤医院回顾2018～2019年在超声联合DSA引导下,经过头臂静脉成功植入输液港106例,其成功率明显高于颈内和锁骨下静脉,提升了患者舒适度[3].

目的 了解神经外科术后造成感染的影响因素.方法 通过对某三甲医院2017年10月至2020年10月神经外科3066例患者进行术后感染监测以及微生物培养,分析术后感染病原菌分布、易感因素分布、感染部位分布,分析神经外科术后造成感染的影响因素.结果 3066例患者中,发生术后感染364例.从术后感染患者的标本中共分离培养出病原菌695株.多因素分析结果显示,年龄≥64岁、住院天数≥29d、手术次数≥2次、术后使用呼吸机、导尿管插管天数≥21d、导尿管插管次数≥3次,术后使用抗菌药物天数≥9d是导致神经外科术后感染的独立危险因素(OR>1,P<0.05).结论 神经外科术后感染发生率较大,并受多种危险因素影响,需制定精准有效的干预措施.

目的 了解不同专业重症监护病房(ICU)连续5年多重耐药菌(MDRO)感染情况,为不同专业的ICU合理使用抗菌药物提供参考依据.方法 回顾性研究2016年1月-2020年12月某三级甲等医院9个不同专业的ICU住院患者检出的MDRO资料,分析不同专业ICU MDRO检出率、发现率、感染部位以及细菌耐药率.结果 2016-2020年不同专业ICU共监测住院患者30030例,检出MDRO 2744株,其中医院感染1235株.5年间不同种类的MDRO检出率比较,差异有统计学意义(P＜0.05);耐碳青霉烯类铜绿假单胞菌(CRPA)和耐碳青霉烯类肺炎克雷伯菌(CRKP)不同年度检出率比较,差异均有统计学意义(均P＜0.05),并有年度升高趋势.5年间MDRO感染发现率为3.86％,发现例次率为4.11％;不同专业间ICU不同年度和持续5年的MDRO感染发现例次率比较,差异均有统计学意义(均P＜0.05);所有ICU不同年度MDRO感染发现例次率比较,差异无统计学意义(P＞0.05).MDRO感染部位居前3位分别为下呼吸道(578例次)、血液(240例次)、泌尿道(170例次).综合ICU、心外ICU、神外ICU、急诊ICU检出的CRAB对庆大霉素、环丙沙星的耐药率比较,差异均有统计学意义(均P＜0.05);CRPA对庆大霉素的耐药率比较,差异有统计学意义(均P＜0.05).不同年度CRAB对头孢哌酮/舒巴坦的耐药率比较,以及CRPA对哌拉西林、哌拉西林/他唑巴坦、头孢哌酮/舒巴坦的耐药率比较,差异均有统计学意义(均P＜0.05).结论 临床诊疗过程中,应根据不同专业ICU的MDRO感染特征指导感染防控措施,并合理使用抗菌药物.

[目的]探讨保留假体清创治疗急性假体周围感染(PJI)的临床效果与炎性指标的早期变化.[方法]2010年1月～2017年8月,对28例髋/膝关节置换术后急性PJI患者采用保留假体清创联合抗生素治疗,设为感染组.随机选取同期初次髋/膝关节置换患者40例为非感染组.比较两组患者围手术期、随访与实验室检验结果.[结果]两组患者均顺利手术,无严重并发症.膝关节PJI患者中3例出现切口远端裂开,经VSD覆盖患肢制动后瘢痕愈合.两组患者均获得2年以上随访,感染组28例中,23例治愈(82.14％),其中,髋关节PJI治愈率75.00％(9/12),膝关节PJI治愈率87.50％(14/16).非感染组40例患者随访过程中均未发生感染.实验室检查方面,两组ESR和CRP术后3d上升至峰值,而IL-6于术后1d即上升至峰值,而后各指标持续下降,14 d接近正常水平上限.不同时间点,感染组ESR、IL-6水平均显著高于非感染组(P＜0.05).感染组的CRP术前、术后1、3d两组差异有统计学意义(P＜0.05),但术后7、14d两组间差异无统计学意义(P＞0.05).[结论]保留假体清创联合抗生素应用可有效治疗PJI,显著降低IL-6、ESR及CRP水平,其中IL-6变化较为敏感.

目的 探讨集束化管理策略预防骨科植入术患者手术部位感染的方法和效果评价.方法 前瞻性研究2017年8月—2019年7月青岛市市立医院骨科植入术患者,按照性别、年龄等因素分为研究组1 424例,对照组1 298例.研究组行集束化策略(包含规范毛发去除、规范预防性使用抗生素、维持围手术期正常体温、血糖控制、标准换药),对照组执行常规感控方案.比较对照组和研究组在手术部位感染率、相关血清炎性指标的变化,以及住院天数、术中失血量等围术期相关指标的变化,并取感染患者分泌物进行细菌培养,分析病原菌构成和耐药性.结果 研究组发生手术部位感染23例,感染率1.62％;对照组感染34例,感染率2.62％,P＜0.05.研究组术后第2天(T2)和第5天(T5)C-反应蛋白(CRP)、白介素-1 β(IL-1 β)、白介素-6(IL-6)、白介素-10(IL-10)和肿瘤坏死因子-α(TNF-α)水平低于对照组(P＜0.05),术后第5天(T5)白细胞计数(WBC)、降钙素原(PCT)两组比较差异有统计学意义(P＜0.05);研究组患者住院天数、术中失血量显著少于对照组(P＜0.05);术后白红蛋白水平高于对照组(P＜0.05).57例感染患者分泌物中,共分离岀病原菌60株,其中革兰氏阴性菌33株,占55％;革兰氏阳性菌25株,占42％;真菌2株,占3％.革兰氏阴性菌对氨苄西林耐药率较高,革兰氏阳性菌对万古霉素敏感率较高.结论 落实集束化管理策略,对骨科植入术患者手术部位感染防控干预效果有效,值得推广.骨科植入物手术部位感染以革兰氏阴性菌为主,应根据药敏试验科学选择抗菌药物.

目的 探讨通心络对冠心病患者内皮细胞功能的改善情况.方法 将45例患者随机分成两组.一组给予常规的冠心病药物治疗,共22例.一组在常规药物治疗的基础上加服通心络胶囊,共23例.检测患者服药前及服药后一段时间NO、SOD、MDA的指标.结果 治疗前,各组患者血清SOD、MDA、NO水平差异无统计学意义(P>0.05).10天左右,加服通心络的冠心病患者血清中MDA水平降低,SOD、NO水平升高.结论 通心络胶囊具有改善内皮细胞功能障碍、清除自由基、抑制脂质过氧化的作用,能够有效防治心肌无再流,缩小心肌梗死面积.

目的 研究骨科植入物患者手术切口感染的病原学特点和危险因素,为制定防控措施提供依据.方法 通过回顾性分析方法,收集某医院骨科行植入物手术患者病原学标本检测结果和感染患者临床资料,分析感染病原菌特点和危险因素.结果 共调查该医院骨科行植入手术患者1921例,发生手术切口感染46例,感染率为2.39％.多因素分析结果显示,高龄患者、BMI指数偏高、糖尿病、术中出血量大和手术时间长为植入物手术后切口感染的独立危险因素.46例感染患者标本共检出病原菌65株,革兰性阴性菌优势菌为铜绿假单胞菌,对氨苄西林、复方新诺明和头孢唑林耐药率均为100％;革兰阳性菌优势菌为金黄色葡萄球菌,对氨苄西林和青霉素耐药率均为91.3％.结论 该医院骨科植入物手术患者切口感染的危险因素较多,检出的病原菌耐药率高,需依据药敏试验结果选择抗菌药物.

OBJECTIVE To investigate the distribution and drug resistance of pathogens causing ascites infections in patients with severe liver disease ,analyze the clinical characteristics of severe liver disease complicated with ascites infections ,and explore the risk factors for the ascites infections in the patients with severe liver disease after ad‐mission to hospital so as to provide reliable basis for developing effective prevention and control measures . METHODS The submitted ascites specimens were obtained from the severe liver disease patients complicated with ascites infections who were treated in hospitals from 2015 to 2016 ,then the distribution of isolated pathogens and data of drug susceptibility testing were retrospectively investigated and analyzed ,the species of pathogens were identified ,and the statistical analysis was performed .RESULTS Of 147 patients with severe liver disease ,44 had the ascites infection ,with the infection rate 29 .9% .A total of 44 strains of pathogens were isolated from the pa‐tients with infections ,of which 56 .8% were gram‐positive bacteria ,40 .9% were gram‐negative bacteria ,and 2 .3% were fungi .The top 5 species of isolated pathogens were as follows :Staphylococcus epidermidis ,Staphy‐lococcus haemolyticus ,Enterococcus f aecalis , K lebsiella pneumoniae ,and Escherichia coli .The drug resistance rates of the Staphylococcus spp to ciprofloxacin ,cefoperazone ,ceftriaxone ,and cefuroxime were more than 50 .0% ;the drug resistance rates of the Enterococcus sp p to cephalothin ,cefepime ,cefazolin ,ceftazidime ,and ceftriaxone were more than 50 .0% ;the drug resistance rates of the K .pneumoniae to ampicillin ,cephalothin , cefepime ,cefoperazone ,and penicillin were more than 50 .0% ;the drug resistance rates of the E .coli to cepha‐lothin and ciprofloxacin were more than 50 .0% .The risk factors for the ascites infection included underlying disea‐ses ,liver function state ,length of hospital stay ,invasive operation ,and use of antibiotics .CONCLUSION The pa‐tients with severe liver disease are at high risk of ascites infections .The Staphylococcus spp is dominant among the pathogens causing the infections and is highly drug‐resistant .It is an effective way to strengthen the management of nosocomial infections ,shorten the operation duration ,and reasonably use antibiotics so as to reduce the inci‐dence of ascites infections .

Objective To know the status of sharp instrument injuries among medical staff and analysis cause,provide the reference for taking effective measures to reduce incidence of the sharp instrument injuries.Methods Retrospective investigation was used to survey and analyze the occupation category,operation link,blood borne diseases,annual trend of medical staff with sharp injuries from July 2007 to June 2016.Results A total of 378 Medical staff were wounded by needle,the nurses and interns accounted for 72.22％ of all personnel.Low seniority medical staff accounted for 39.15％.Non-standard operation accounted for 61.09％ of all operations.Finger injuries accounted for 90.21％.Positive exposure accounted for all 71.43％ sharp injuries.Sharp instrument injuries from 2008 to 2016 in general was increase,and decrease from 2013 to 2016.Four kinds of blood-borne pathogens linear trend of annual total number of detected was slowly rising.Conclusion Risk of sharp instrument injuries mostly happen in nurses and low seniority medical staff.Positive exposure has a correlation with sharp injury.We should improve the occupational protection awareness and protection skills,standard operation process and emergency handling procedure of sharp instrument injuries.

Objective To evaluate the prevalence rate and nosocomial infection rates in a hospital from 2013 to 2015,and to study the representiveness of prevalence rate surveillance of nosocomial infection for the status of nosocomial infection in the whole year,so as to analyze the factors affecting nosocomial infection rates and the rational use of antibiotics.Methods The patients who were hospitalized on Oct 31,2013,June 6,2014,and June 13,2015 were investigated to fill out the uniform tables of prevalence.A retrospective study was carried on in the patients with discharge from hospital in three years.Results 95 430 patients discharged from our hospital during 2013-2015,of whom 2 317 patients experienced nosocomial infections,with the nosocomial infection rate of 2.43％.More than 40％ patients suffered lower respiratory tract infection;and among the 60 154 inpatients participating in the investigation,22 435 patients were treated with antibiotics,with the antimicrobial use rate of 37.30％.Treatment using antibacterial drugs was performed on 11 202 people,accounting for 49.93％.Pathogenic monitoring was performed in 7 526 patients.The pathogenic detection rate was 67.18％.Conclusion Nosocomial infection prevalence rate can reflect the whole hospital infection status,but antimicrobial drug use and pathogenic submission is the more objective annual monitoring index.

冠状动脉粥样硬化性心脏病现成为心血管疾病中最主要同时也是危害性最大的疾病.随着临床研究的不断进展,冠心病的治疗已经进入了介入治疗和药物治疗相结合的阶段.经皮冠状动脉介入治疗和药物治疗的最终目的是尽快开通梗死相关的冠脉,尽快恢复心肌组织再灌注.但冠状动脉大血管的再通,并不等于心肌组织有效的再灌注.冠状动脉结构和功能完整是实现心肌再灌注的前提.许多临床研究发现,经皮冠状动脉介入治疗和药物治疗后仍有部分心肌组织不能得到充分有效灌注,这种现象与冠心病内皮细胞功能的损伤有着十分密切的关系.本文通过深入研究内皮细胞功能损伤与冠心病之间的危险关系,完善内皮细胞功能损伤与冠心病的作用机理,探索如何通过干预内皮细胞功能的损伤,治疗及预防冠心病的发生、发展和预后,为临床冠心病的防治开辟新的方向.