目的探讨影响老年脓毒症患者预后的因素。方法采用回顾性分析的研究方法。共收集脓毒症患者122例,根据患者出院状态分为死亡组和存活组。记录患者一般情况、并发症及24h内检测的指标,统计分析2组之间各指标的差异,多因素相关分析采用Logistic回归。结果与存活组比较,死亡组患者年龄高、基础疾病多、合并多脏器功能障碍、休克及血小板下降者多(P<0.05或<0.01)。死亡组患者白细胞数和中性粒细胞计量水平高于存活组(P<0.01),白蛋白低于存活组(P<0.01)。Logistic回归分析,年龄、白蛋白及血小板与患者预后相关性大。结论老年脓毒症患者若合并低蛋白血症,血小板下降明显,提示病情危重,预后差。

1病例资料 女,16岁.因恶心、呕吐、腹泻2周伴发热、谵语、四肢抽搐8天,由外院转入我院.患者于2周前无明显诱因出现全身乏力、食欲缺乏,自认为是感冒,自服退热药,症状好转,次日出现腹泻,便色黄,无明显腹痛,无发热、恶心、呕吐,于外院就诊,查血白细胞2.7 × 109/L,予奈替米星静脉滴注,继之出现恶心、呕吐4～5次,初为胃内容物,后为深绿色胆汁样液体,以"急性胃肠炎"收入院.

Objective: Methods: Results: Conclusion:

Objective:To find out the antibiotic resistance of Acinetobacter baumannii in ICU and to provide strategies for prevention and treatment.Methods:Drug resistances of 44 Acinetobacter baumannii during July 2006 and June 2007 were retrospectively analyzed.Results:The rate of drug resistance of Acinetobacter baumannii to Imipenem, Meropenem and Cefoperazone/Sulbactam was the lowest (6.82%,9.09%,11.36%).The rate of multidrug resistance to 3 groups and 4 groups of antibiotics was50%.Conclusion:Acinetobacter baumannii is a major emerging opportunistic pathogen in ICU,which shows an increasing multidrug resistance with important clinical impact.

韦尼克脑病(WE)是1881年由Carl Wernicke首先发现并命名的,它由维生素B1缺乏引起,目前对其认识和重视程度尚不够,易致误诊、漏诊,因此有必要给予重视.

Objective:To observe the effect of Tanreqing injection on treating pneumonia patients with the type of phlegm thermal resistance lung.Methods:This was an open,one-treatment study of investigating 1050 pneumonia patients(child:219,adult:831).Results:The curative effect of Tanreqing injection reached to 80% whether in children or in adults,and the symptoms were improved obviously.using antibiotic or not was the same to treat this disease whether in different ages or in different states.The type of solvent could not affect effect.This medicine did not make the patient's blood routine,urine routine,feces routine,liver function,kidney function,electrocardiogra changed by meanings.The toxicity and side effects of injection the medicine could not be found out.Conclusion:Tanreqing injection could treat pneumonia patients with the type of phlegm thermal resistance lung safely and effectively,it could be popularized.

Objective To search for clinical appearance and fungal resistance of candidemia in ICU.Methods Thirty-four cases of candidemia in ICU during 2003and 2006 were analyzed retrospectively.Results Twelve of 34 cases of candidemia were C.albicans,and 22 of 34 cases were non-C.albicans,which were 64.71% in candida monilia.Fever and chill of candidemia were 100% and 70.59% differently.Conclusion If there is high risk factor of fungous infection in clinic,at the same time fever and chill appear,and antibiotics treat is inefficacy not effective,it is possible to consider candidemia.

目的探讨本院急诊呼吸科就诊的发热伴呼吸道症状病人的临床特点及病种分布情况.方法发热门诊353例发热伴呼吸道症状病人,按有无基础疾病分为两组,分别观察各种疾病的分布情况.结果就诊病人353例,男189例,女164例,年龄16～90岁.急性上呼吸道感染,占89.0%,临床表现以发热为主,伴咽痛、流涕、头痛、乏力等症状.白细胞计数及中性分叶核均不高,胸片检查均正常,诊断以普通感冒型最常见.其次为社区获得性肺炎病人,除发热外,还有咳嗽、咳痰,气急,肺部闻及干湿罗音,白细胞计数及中性分叶核高于正常,胸片有肺炎或支气管炎表现,抗生素治疗有效,占总数的7.7%.白细胞计数不高及低于正常者,应与非典型肺炎发热鉴别.本组353例病人中未发现传染性非典型肺炎、人禽流感及流脑病人.少见疾病为病毒性脑炎、全身疾病发热、结缔组织疾病、肿瘤、结核等,占3.4%.结论急性上呼吸道病毒感染是发热的主要原因,其次为社区获得性肺炎,传染病发热虽占极少数,但不容忽视.

目的探讨医院感染真菌败血症的临床现象及真菌菌株分布.方法对22例真菌败血症病人进行回顾性分析.结果22例真菌败血症病人死亡12例,死亡率为54.6%.22株真菌均为念珠菌,其中非白念珠菌12/22株,占54.6%.结论对于医院感染真菌败血症的防治,首先应减少感染的危险因素,一旦考虑真菌败血症,就应尽早给予抗真菌治疗.

Objective:To evaluate the clinical efficacy of meropenem on patients with severe gram-negative bacterial infection and to analyze drug sensitivity in vitro. Methods:To analyze retrospectively of meropenem on 20 cases with severe gram-negative bacterial infection. Results:The effective rate of meropenem was 80 %. The sensitivity rate of meropenem to gram-negative bacterium in vitro was the highest (82.14 %).The strains of drug resistance to ceftazidime and cefoperazone/ sulbactam were sensitive to meropenem,whose sensitivity rates to meropenem were 77.27 % and 80 %, respectively. Conclusion: Severe gram-negative bacterial infection of drug resistance to the third generation cephalosporin and enzyme inhibitor compound preparation may be treated by meropenem.

Objective: To observe the effects of Feisuqing Apozem on blood gas analysis and blood viscosity of the patients with acute episode of COPD and respiratory failure. Methods: 30 patients with acute exacerbation of COPD were randomly divided into treatment group and control group,15 patients per group. Both took the routine medical treatment,at the same time Feisuqing Apozem was added to treatment group. Results: At 3d,7d,14d,PaO2,SaO2 values of the treatment group both improved compared with those of pretherapy,but at 14d,PaCO2 value had decreased compared with that of pretherapy,and the PaCO2 value of treatment group had obviously decreased compared with that of control group. The whole blood viscosity,blood plasma specific viscosity,fibrinogen of treatment group had decreased compared with pretherapy,and the decreasing of blood plasma specific viscosity more obviously. Conclusion: Feisuqing apozem can improve the high viscosity status and correct respiratory failure of patients with acute exacerbation of COPD and respiratory failure.

Objective To evaluate clinical features,pathogens and antimicrobial resistance in nosocomial-acquired septicemia(NAS).Methods Clinical data of thirty-three cases of NAS were analyzed retrospectively.Results Among 33 cases of NAS,18 cases((54.55%)) infected with fungi,6((18.18%)) with gram-negative bacteria,3((9.09%)) with gram-positive bacteria,6((18.18%)) with at least two kinds of bacteria,12 cases((36.36%)) died.Among 39 isolated bacteria,22 strains((56.41%)) were fungi,10((25.64%)) were gram-negative bacteria, 7((17.95%)) were gram-positive bacteria.Drug resistant rate of gram-negative bacteria to piperacillin,ciprofloxacin and ceftazidime were all more than 50%,drug resistant rate of gram-positive bacteria to vancomycin and teicoplanin was 0.Conclusion Septicemia with fungi has a high proportion in nosocomial-acquired septicemia,comprehensive treatment should be adopted as soon as septicemia is diagnosed.

近几年来机械通气对ARDS治疗的策略有了许多新的进展,有助于提高机械通气的治疗效果.现将本院ICU采用有创机械通气治疗ARDS的病例作回顾性分析.

肺心病是呼吸系统的常见病,为慢性阻塞性肺部疾病罹疾日久致使肺循环阻力增加而形成的严重并发症.笔者认为根据其临床表现可分为以下各型论治.

Objective: To search for gram-negative bacterial distribution and analysis of drug resistance in 1CU. Methods: Gram-negative bacterial distribution and drug resistance in ICU from July 2000 to June 2004 were analyzed retrospectively. Results: Anterior of 372 strains of gram-negative bacteria were Pseadomonas aeruginosa, Klebsiella pneumoniae, Escherichia coli, Enterobacter aerogenes, Stenotrophomonas maltophilia and acinetobacter baumannii.Drug resistant rate of gram-negative bacteria to Emipenem/cilastatin was the lowest. Conclusion: To understand the distribution of gram-negative bacteria and drug resistance is helpful to use antibiotics reasonably.

目的了解革兰阴性菌在ICU的分布和对常用抗生素的敏感性.方法对2003年7月至2004年6月本院ICU所分离的革兰阴性菌菌株的构成及体外敏感率进行回顾性分析.结果 172株革兰阴性菌中,铜绿假单胞菌占38.37%(66/172),肺炎克雷伯菌和大肠埃希菌分别占22.67%(39/172)和11.05%(19/172),产气肠杆菌和嗜麦芽窄食单胞菌分别占4.65%(8/176)和4.65%(8/176).革兰阴性菌对亚胺培南-西司他丁的敏感率最高.结论明确ICU的革兰阴性菌分布和抗生素的敏感性,有利于合理选择抗生素.

Objective: To study clinic and sensitivity of antibiotics in ventilator-associated pneumonia(VAP). Methods: 40 cases patients in VAP from July 2000 to December 2003 were analyzed retrospectively. Results: 57.50% patients in VAP were dead.The majority of patients were MODS,shock, respiratory failure and electrolyte acid-base imbalance.88 strains were Gram-negative bacteria (63.77%), 25 strains were Gram-positive bacteria (18.12%) and 25 strains were fungi (18.12%) in all 138 pathogenic bacteria. Mixing strains were 37.68%. Pseudomonas aeruginosa and Klebsiella pneumoniae was the major one (26.14%, 22.72%) in Gram-negative bacteria. In Gram-positive bacteria Staphylococcus aureus was most prominent (76.00%) and Candida albicans was the main type of fungi (60.00%). The sensitivityof Pseudomonas aeruginosa to CAZ and AMK were 60.87% and 52.17%. The sensitivity of Gram-negative bacteria to Emipenem were 70.00-80.00%. Conclusions: Gram-negative bacteria were prominent in VAP, it is important to select rationally sensitive antibiotics..

目的提高对嗜麦芽窄食单胞菌肺部感染的临床认识和合理选用抗生素.方法分析嗜麦芽窄食单胞菌肺部感染的临床表现和病原菌耐药情况.结果嗜麦芽窄食单胞菌院内肺部感染均有基础疾病;高龄患者(≥75a)占67.9%;发热54.5%,咳嗽、咳痰78.6%.17例伴嗜麦芽窄食单胞菌双重感染和多重感染,与白假丝酵母菌混合感染13例(46.4%)、肺炎克雷伯菌12例(42.9%).嗜麦芽窄食单胞菌对复方磺胺甲恶唑耐药率最低(39.4%).结论 ICU患者有气管切开、动静脉置管等危险因素存在时,应密切注意嗜麦芽窄食单胞菌感染的发生,及早进行病原学检查,尽早根据药敏选择用药,以防耐药产生.

患者,女性,46岁.以发热伴头痛,呕吐4天,意识障碍1天为主诉,于2002年10月14日收入我院ICU中心.

目的观察痰热清注射液治疗急性肺炎（痰热壅肺证）的临床疗效。方法将急性肺炎（痰热壅肺证）患者120例随机分为治疗组与对照组,两组分别静脉给痰热清注射液20ml和双黄连注射液20ml,每日1次,疗程均为10d。结果治疗组总疗效优于对照组;治疗组在改善咳嗽症状方面优于对照组。结论痰热清注射液治疗急性肺炎（痰热壅肺证）疗效确切。