目的 探讨首荟通便胶囊治疗腹腔镜术后腹胀的临床疗效.方法 选取成都市郫都区人民医院于2016年8月-2018年8月收治的腹腔镜术后腹胀患者98例作为研究对象,按照治疗方案将患者随机分为对照组和观察组,每组49例.对照组患者进行常规护理;观察组在对照组基础上口服首荟通便胶囊,2粒/次,3次/d.两组均连续治疗14 d.观察并比较两组患者的临床疗效、术后肠鸣音恢复时间、术后排气时间,及治疗前后不同腹胀程度人数的变化.结果 治疗后,对照组总有效率71.4％,显著低于观察组的87.8％(P＜0.05).治疗后,观察组肠鸣音恢复时间和术后排气时间显著低于对照组,两组比较差异有统计学意义(P＜0.05).治疗后,两组不同腹胀程度人数均有显著改善(P＜0.05),且观察组显著优于对照组(P＜0.05).结论 首荟通便胶囊对治疗腹腔镜术后腹胀疗效显著优于常规护理,可有效提高治疗总有效率,缩短首次排气时间,增加治疗后无腹胀人数,安全高效,值得临床推广.

目的：了解大肠埃希菌临床感染及其耐药性变化。方法收集2000至2009年所有从临床标本中分离的大肠埃希菌1631株，观察其检出率及耐药性变化。用全自动微生物分析系统及其对应的鉴定卡进行鉴定；体外药物敏感性试验用最低抑菌浓度法；超广谱β-内酰胺酶（ ESBLs ）检测用表型确证方法进行。结果2000至2009年其分离率维持在12％～20％。产ESBL菌株由2000年18％提高到2009年61％。2000至2005年是产ESBL菌株迅速增长期。药物敏感性趋势氨苄西林13％以下，一代头孢菌素从35％降到15％，三代头孢从78％降到40％，其他变化不明显，碳青霉烯类没有耐药。结论大肠埃希菌在感染中的分离率变化不大，产ESBL菌株比率增长明显， ESBLS检测应常规进行，头孢类抗菌药物耐药性提高明显，其他抗菌药物耐药性变化不明显。

Objective To investigate antimicrobial resistance and pathogen in hebei antibacterial resistance investigation net in 2012.Methods Antimicrobial susceptibility test was detected by Kirby-Bauer method or broth dilution test.Results were analyzed according to CLSI 2010 breakpoints.WHONET 5.5 software was used to analyze the data.Results A total of 10 504 clinical isolates were collected in 2012,of which gram negative bacilli and gram positive cocci accounted for 76.2%, 23.8%,respectively.The most common pathogen in gram-negative rod was E.coli,K.pneumoniae,P.aeruginosa, A.baumanii and E.cloacae respectively.The most common pathogen in gram-positive cocci was S.aureus,E.facium,E-.faecalis,S.pneumoniae and S.epidermidis.ESBL rate of E.coli and K.pneumoniae was 66.5 and 46.7%.The resistant rate of E.coli,K.pneumoniae,E.cloacae to imipenem was 0.1%,0.5%,8.9% and to meropenem was 0.1%,0.6%,4.2%, respectively.P.aeruginosa was resistant to imipenem and meropenem were 38.9% and 32.3%.A.baumanii was resistant to imipenem and meropenem were 5 6.5% and 5 9.7%.Methicillin-resistant strains accounted for an average of 5 7.5% in S.aureus and 87.3% in coagulase negative staphylococcus.Staphylococcus was still susceptible to minocycline and chloram-phenicol.No staphylococcal strains were found resistant to vancomycin,linezolid.But a few coagulase negative staphylococcal strains were resistant to teicoplanin.Conclusion Surveillance of antimicrobial agents played an important role in controlling hospital infection.

目的:了解集菌涂片方法检菌的效果,提高脓性标本细菌的检出率。为临床快速诊断和治疗细菌感染提供证据。方法:临床送检的脓性穿刺液标本,直接涂片进行相应染色后显微镜下找菌。未找到细菌的标本通过集菌方法处理后再次涂片检菌。结果:65例直接涂片没有找到细菌的脓性标本集菌后47例找到了细菌。其中G+球菌3例;G-杆菌38例;G+球菌和G-杆菌5例;抗酸杆菌1例。48例只有G-杆菌生长的培养结果中集菌涂片检菌找到G-杆菌40例;找到+球菌和G-杆菌5例。结论:集菌检菌方法能明显提高脓性标本中细菌的检出。

Objective: To explore the effects of puncture fluid samples by differential centrifugation or rapid centrifugation smear technique.To provides an effective method for reduceing false-positive specimens bacteria examination.Method: Clinical puncture fluid samples of conventional smear-negative,inspection bacteria by differential centrifugation or rapid centrifugation smear technique.Result: 75 purulent specimens with differential centrifugation,and the detection of bacteria in 49 cases.Rapid centrifugation smear technique inspection in 3 cases.63 hematocrit more than 5% puncture fluid samples of non-sepsis,differential centrifugation detection of bacteria in 15 cases.Rapid centrifugation smear technique inspection in 5 cases.71 hematocrit less than 5% puncture fluid samples,differential centrifugation detection of bacteria in 6 cases.Rapid centrifugation smear technique inspection in 3 cases.Conclusion: Puncture fluid samples by rapid centrifugation smear technique is the most effective method of inspection bacteria.It is worth promoting.

目的了解嗜麦芽寡氧单胞菌(Sm)的临床分布特点及耐药情况,为临床治疗Sm感染提供依据。方法对75份分离自我院住院患者的痰液、尿液、血液、脓液等标本进行鉴定。分析其临床分布特点并进行抗菌药物敏感试验。结果 75株Sm的分布以痰液为主(65.3%);感染患者主要来自呼吸科、ICU、老年病科等。嗜麦芽寡氧单胞菌对亚胺培南、氨基糖苷类及大部分β-内酰胺类抗菌药物呈高度耐药;对头孢哌酮/舒巴坦耐药率最低,其次为复方新诺明、米诺环素、左氧氟沙星。结论 Sm的分布以痰液为主,感染患者主要来自呼吸科,Sm对多数抗菌药物具有较高的耐药性,临床治疗Sm感染应根据药敏试验结果为依据。

目的:探讨提高穿刺液标本细菌培养阳性率的方法,为临床诊断治疗提供指导。方法:无菌部位采集的穿刺液标本除按传统方法进行细菌分离培养,将标本进行集菌处理后再进行细菌分离培养。结果:有108例进行了两种方法培养。集菌后培养比直接培养多分离出26株细菌。64例常规涂片检菌和集菌后涂片检菌都找到了一致的细菌的标本中,41例两种培养方法所分离的细菌一致,生长的细菌和涂片结果不矛盾;10例直接培养只有G-杆菌生长G+球菌未能生长,集菌后有G-杆菌和G+球菌生长,生长的细菌和涂片结果不矛盾;4例常规方法培养阴性,集菌后培养有细菌生长,生长的细菌和涂片结果不矛盾;9例两种培养都阴性。25例常规涂片检菌阴性,集菌后涂片检菌阳性的标本中,15例两种培养都有相同细菌生长,生长的细菌和集菌涂片结果不矛盾;8例直接接种培养阴性,集菌培养有细菌生长,生长的细菌和集菌涂片结果不矛盾;4例两种培养都阴性。19例常规涂片检菌和集菌后涂片检菌都阴性的标本,4例常规方法培养无菌生长,集菌后培养有细菌生长;15例两种方法培养都无细菌生长。结论:无菌部位采集的脓液标本应该增加集菌后分离培养细菌的方法。

目的:为临床正确分析细菌学检查结果提供参考。方法:临床送检585例深部穿刺液标本以涂片镜检和培养两种方法检查。结果:585例穿刺液涂片检菌阳性率60.9%,培养阳性率55.3%。229例涂片阴性标本培养阳性率19.7%。9例涂片找到抗酸杆菌。61例抗生素治疗前采集的标本涂片与细菌培养结果一致。结论:标本采集是影响细菌学检验的主要原因。在注重细菌培养的同时,应重视标本直接涂片镜检。

不动杆菌是引起医院内感染的重要机会致病菌,近年来其感染率和耐药率不断增加,本文总结了我院2006年1月至2007年12月从临床分离的96株不动杆菌的感染及药敏情况,现将结果报告如下.

目的:探讨我院产超广谱β-内酰胺酶(extend Spectrum beta-Lactamases,ESBLs)大肠埃希氏菌和肺炎克雷伯菌院内感染的危险因素.方法:收集我院2002年1月-2003年10月院内感染产ESBLs大肠埃希菌和肺炎克雷伯菌住院患者病历42例,对照病历46例;采用卡方检验单因素及非条件多因素Logistic回归分析产ESBLs大肠埃希菌和肺炎克雷伯菌感染的危险因素.结果:产ESBLs大肠埃希菌和肺炎克雷伯菌院内感染的独立危险因素是:消化道插管,前期应用三代头孢菌素,前期应用奎诺酮类药物.结论:对存在以上危险因素的患者,应监测大肠埃希菌和肺炎克雷伯菌ESBLs的产生情况,积极采取相应的消毒隔离措施,合理应用抗菌素.

Objective:To investigate the reasons why the results of bacterial culture of medistream urine is indefinite,and provide bases for exactly analyzing the value of bacterial clulture of medistream urine in clinic. Methods:155 cases medistream urine were collected and for bacterial culturing.The samples that the culturing results were indefinite in the first culturing were recollected by puncturing the urinary bladder and cultured for the second time.Results:Among the 155 medistream urine samples cultured for the first time:68 samples single bacterium grew and the number of colony was more than 10~5CFU/ml;28 samples had no bacterium growth cultured for 48h;39 samples single bacterium grew but the number of colony was less than 10~5CFU/ml(A);22 samples more than 2 kinds of bacteria grew(B).In A,28 samples the culturing results of urine obtained by puncturing urinary bladder were same as the culturing results of medistream urine twice;In B,2 samples were the same.Conclusions:Single bacterium growth and colony exceeding 10~5CFU/ml have identified diagnostic value for urinary tract infection;the samples that had more than 2 kinds of bacteria growth were disqualification in general.Strictly execute the method collecting medistream can effectively elevate the accuracy of bacterial culturing results.

Objective:To understand the drug-resistance of ext ended spectrum beta lactamase (ESBLs)-producing Escherichia coli and Klebsiella pneumonia at our hospital for the purpose of providing a basis for rational use of antibiotics in clinical practice.Methods:41 strains of ESBL s-producing Escherichia coli and Klebsiella pneumonia were isolated from hospi talized patients with various infection from January to October,2002.The drug re sistance against 9 antibiotics in these 41 strains was analyzed.Results :The drug-resistance rate of ESBLs-producing Escherichia coli and Kle bsiella pneumonia against ampicilin,cefazolin,cefoperazone,ceftriaxone,compound sulfamethoxazole was over 90% while the rate against ceftazidime,ciprofloxacin ,gentamicin was higher than 60%.3 strains of Escherichia coli were against imipe nem.Conclusions:ESBLs-producing Escherichia coli and Klebsiela pneumonia isolated at our hospital were seriously multiple drug resistant and c ross drug resistant.So more attention should be paid to monitoring the drug-res istance in ESBLs-producing Escherichia coli and Klebsiela pneumonia at our hosp ital and the antibiotics should be rationally administrated according to drug se nsitivity.

由于肠球菌对现今常用的多种抗菌药物存在特定的耐药性，所以肠球菌以成为医院内感染的重要细菌。特别是近年来，耐万古霉素肠球菌（ＶＲＥ）的比例增长明显［１］，临床治疗选药困难而受到广泛关注。

近年来由于广谱抗生素、肾上腺皮质激素及免疫抑制剂等大量应用及侵入性诊疗手段广泛开展等原因,使深部真菌的感染率明显上升,为了解我院真菌感染的发生情况,我们对我院一年来深部真菌感染作回顾性调查,旨在提高临床医生对抗真菌感染的重视.

随着高效广谱抗菌药物的广泛使用,临床细菌室分离感染菌的种类发生了重大变迁.近几年,我院自下呼吸道标本中分离到的病原菌种类变化非常明显.

目的: 了解临床常见致病菌型,为临床医师诊断、合理选用抗生素、控制广谱抗生素的滥用提供依据.方法:采取整群抽样方法,对承德市几家代表医院长时期1998年5月至2000年5月的临床细菌培养结果进行统计分析.结果:培养阳性的1393株菌株中 ,G-阴性菌株占67.98%,顺位依次为:埃希氏菌属、肠杆菌属、假单胞菌属.G + 阳性菌株占22.90%,顺位依次为:葡萄球菌属、肠球菌属、肺炎链球菌属.结论:抗生素类药物不宜作为非处方药,而应依据药敏实验,在临床医师指导下合理选用抗生素.