Objective:Risk factors affecting the prognosis were analyzed according to the outcome of patients with methicillin resistant saphylococcus epidermidis(MRSE)infection.Methods:This study was a retrospective study, collecting clinical data of 42 patients hospitalized in all clinical departments from January 2020 to Shenhe General Hospital in December 2020(data selected from Laboratory), 33 males and 9 females, age(53±19)years old, age range from 16 to 96 years old.According to the situation after effective antibiotic treatment, patients who were normally discharged after effective antibiotic treatment were in the improved prognosis group, and those who died after active anti-infection treatment were in the non-improved group.All factors to be studied were included in the univariate analysis, and results with significant univariate analysis were included in the multivariate analysis.Results:Better prognosis and non-improvement group in sex, age, antibiotic duration, surgery, mechanical ventilation, immunosuppression, brain disease, or injury, lung disease, renal insufficiency, the differences were no statistically significant( P>0.05), in hospital length, antibiotic application, ICU, catheterization, heart disease, and hyperglycemia, the differences were statistically significant( P<0.05).The results of univariate logistic regression analysis indicated a significant association between length of hospitalization, antibiotic type, cardiac disease, and hyperglycemia and different prognosis conditions, suggesting that it may be a risk factor for poor prognosis of MRSE.Multivariate logistic regression analysis showed a significant association between cardiac disease and MRSE, suggesting that it may be an independent risk factor for poor prognosis of MRSE. Conclusions:A history of cardiac disease as well as hyperglycemia may be risk factors affecting the prognosis of patients with MRSE.

目的:调查我国急危重症医护人员对镇静镇痛指南和规范的认知情况，为进一步采取措施提供依据。方法:2018年6月26日在全国116家综合性医院的EICU和ICU，针对医生和护士开展横断面多中心调查。参照指南制定认知状况调查表，采用电子版在线方式填写，内容涉及ICU镇静镇痛治疗的主要原则和知识。结果:最终共2 615名医护人员参与调查并纳入分析。116家医院包括三甲105家（90.5%），三乙9家（7.8%），二甲2家（1.7%）。2 615名医护人员中，医生与护士比例为38.6% vs 61.4%，男女比例为31.2% vs 68.8%，职称（初/中/高级）和科室（EICU/ICU）构成比为56.9% vs 33.4% vs 9.7%和77.7% vs 22.3%。其中80.6%的调查对象所在科室具有镇静镇痛的标准流程，89.2%的调查对象对结果进行记录，评估记录间隔时间为4（1, 4）h。约80%医护人员对镇静镇痛指南较熟悉，且按照指南进行实践。但对于镇痛的原则、镇静深度的选择、谵妄的处理原则和每日唤醒等的认知尚有不足。 结论:本次调查范围内的大部分急危重症医护人员对镇静镇痛指南较熟悉且能按照指南实践，但尚有一些不足，有待进一步培训学习。

目的:调查我国EICU/ICU危重患者镇静镇痛实施状况，为镇静镇痛规范化实施提供改进依据。方法:2018年6月26日在全国116家综合性医院EICU/ICU内纳入年龄大于18周岁的患者，收集患者一般信息，评估镇静镇痛指征，筛选"需要镇静/镇痛治疗组"，进一步收集该组患者实际镇静镇痛信息，最后比较镇静/镇痛合理性及达标情况。结果:⑴最终共116家医院1 195例患者纳入研究并分析，116家医院包括三甲105家（90.5%），三乙9家（7.8%），二甲2家（1.7%）。1 195例患者中位年龄65（49，78）岁，男性769例（64.4%），女性426例（35.6%），APACHE Ⅱ评分16（10，22）分。⑵机械通气536例，已镇静未达标166例（31.0%），需镇静未实施29例（5.4%），镇静不合理占36.4%（195/536）；非机械通气659例，已镇静未达标36例（5.5%），需镇静未实施35例（5.3%），镇静不合理占10.8%（71/659）。14.0%的机械通气和15.9%的非机械通气患者未使用镇静评估工具。已实施镇静的341例患者，机械通气患者达标率为40.3%（112/278），非机械通气患者达标率42.9%（27/63）。⑶清醒患者760例，已镇痛未达标133例（17.5%），需镇痛未实施24例（3.2%），镇痛不合理占20.7%（157/760）；非清醒患者435例，已镇痛未达标85例（19.6%），需镇痛未实施27例（6.2%），镇痛不合理占25.7%（112/435）。17.9%的清醒患者和13.3%的非清醒患者未使用镇痛评估工具。已实施镇痛的345例患者，清醒患者达标率为25.7%（46/179），非清醒患者达标率为48.8%（81/166）。⑷73例患者（6.1%）发生谵妄，谵妄评估工具使用率为35.3%。结论:本次调查范围内的EICU/ICU镇静镇痛实施状况并不理想，有必要对医护人员进行镇静镇痛规范化培训，进一步规范镇静镇痛实施状况。

Objective To explore the prognostic significance of CRP and PCT level to organ damage in patients with emergency abdominal multiple trauma.Methods The clinical data of 136 patients admitted in our hospital emergency department with abdominal multiple injuries from September 2015 to December 2016 were analyzed and classified into MODS group (n =58) and non-MODS group (n =78) according to whether they had multiple organ dysfunction syndrome (MODS).Another 20 normal subjects were selected as normal control group.The differences of APACHE Ⅱ score,CRP,and PCT between the three groups were compared.The differences of CRP and PCT before and after treatment between the dead patients and survivors in MODS group were analyzed,and the risk factors of MODS were analyzed.The differences of APACHE Ⅱ score,CRP and PCT levels between the three groups were compared.The differences of CRP and PCT between the death and survivors before and after treatment in the MODS group were analyzed,and the risk factors of MODS were analyzed.Results The level of CRP and PCT in MODS group and non-MODS group were significantly higher than those in normal control group (P ＜ 0.05).The level of CRP and PCT of MODS group were significantly higher than those in non-MODS group (P ＜ 0.05).The level of CRP and PCT in death patients were higher than survivors on admission and on the 7th day of treatment (P ＜ 0.05).Elevated PCT and CRP are risk factors for emergency MODS.Conclusion The combination of CRP and PCT can assess the early stage of infection in patients with acute abdominal multiple trauma.Timely control of infection and adjustment of treatment plan are of great significance to protect the organ function and improve the prognosis of patients.

目的 探讨乌司他丁对危重症血流感染患者全身炎性反应的作用效果.方法 选取2014年3月至2016年3月于沈阳军区总医院接受治疗的85例危重症血流感染患者作为研究对象,根据随机数字表法将其分为观察组(43例)和对照组(42例).对照组患者接受常规血流感染治疗,观察组患者在接受常规治疗基础上采用乌司他丁进行治疗,比较两组患者的治疗效果.结果 治疗后,观察组患者体温、心率及呼吸频率均明显低于对照组,差异均有统计学意义(均P<0.05);治疗后,观察组患者C反应蛋白(CRP)、白细胞计数以及血乳酸水平均明显低于对照组,差异均有统计学意义(均P<0.05).结论 静脉滴注乌司他丁治疗危重症血流感染患者全身炎性反应的疗效显著.

目的 研究持续性肾脏替代联合血必净对脓毒症患者炎症反应、免疫功能的影响.方法 选取2014年3月至2016年2月,在我院接受诊治的脓毒症患者88例.按照治疗方式的不同分为观察组及对照组各44例.对照组患者给予单纯血必净治疗,观察组患者在对照组的基础上加用持续性肾脏替代治疗,对比两组效果.结果 治疗后两组的各项免疫指标水平与治疗前对比差异均有统计学意义(均P＜0.05);治疗后观察组的CRP、CD3+较对照组含量均明显降低,CD4+明显升高,差异均有统计学意义(均P＜0.05).治疗后两组炎性因子水平与治疗前对比差异均有统计学意义(均P ＜0.05),治疗后观察组的IL-6、TNF-a以及WBC水平均显著低于对照组,差异均有统计学意义(均P ＜0.05).结论 持续性肾脏替代联合血必净能有效改善患者炎症反应,增强免疫功能,有利于促进患者早日康复.

Objective To explore the mechanism and effect of peroxisome proliferators-activated receptor-β( PPAR-β) on acute lung injury ( ALI) in rats with lung tissue apoptosis. Methods The arterial blood oxygen par-tial pressure (PaO2) and BALF were detected, the rate of lung tissue apoptosis and lung wet/dry weight (W/D) were calculated. Their pathological morphology was checked. It used PPAR-β activator to intervene on ALI in rat model. ALI uncontrolled hemorrhagic shock and BALF cell apoptosis of lung tissue were observed. Results The lev-el of PaO2 was obviously higher in the study group than in the control group (P<0. 05), and the decrease of BALF, lung tissue apoptosis rate, W/D value and lung tissue pathology score was more pronounced in the study group than in the control group (P<0. 05). Conclusion PPAR-βagonists has a certain degree of protection for ALI lung tissue, which mechanism of action is by inhibiting the inflammatory reaction and reducing the secretion of inflammatory medi-ators.

Objective To observe the protective effects of peroxisome proliferation activated receptorβ (PPAR-b) on acute lung injury in the wake of hemorrhagic shock in rats in order to illuminate the mechanism.Methods After ALI model of rat was established following hemorrhagic shock,96 SD rats were divided randomly (random number) into 4 groups:group A (sham operation group),group B (ALI group),group C (GSK0660,an antagonist to PPAR-b given prior to exsanguinations for pretreatment) and group D (GW0742,an agonist of PPAR-b given before exsanguinations for pretreatment).Each group was further divided into 1 h,2 h,4 h and 6 h subgroups.Six mice of each subgroup were sacrificed at each interval.Expression of PPAR-β receptor in lung tissues was detected at 1 h,2 h,4 h and 6 hours.Pathological examination and lung wet/dry weight ratio were detected,and lung tissue antioxidant enzyme SOD and 8-iso-PGF2α,the oxidation product of activated GSH-Px were evaluated.Results (①)Antioxidant enzymes SOD and activated GSH-Px were significantly higher in ALI group than those in the sham operation group (P＜0.01).(②Tne antioxidant enzyme SOD and activated GSH-Px in lung tissue in GW0742 group decreased at each interval especially at 2 h and4 h compared with ALI group (P ＜0.01).(③) GW0742 used alone can improvePaO2,W/D ratio of lung tissue of rats,lung pathology integral,and inhibit the activity of SOD and GSH-Px in lung tissue (P ＜ 0.01) and decrease the content of 8-iso-PGF-2α.The antagonist GSK0660 can lessen the above effects (P ＜ 0.01).Conclusions (①)ALI emerged from hemorrhagic shock in rats leading to significantly increased activity of SOD and GSH-Px in lung tissue,suggesting rats subjected to acute oxidative stress.(②)GW0742 can up-regulate the levels of SOD and GSH-Px in lung tissue of rats with ALI.It also decreased the content of 8-iso-PGF2 α,the oxidation products of GSH-Px.(③) It was suggested that GW0742 might inhibit the expression of TNF-α mRNA and level of TNF-a protein,and decreased SOD activity in lung tissue,protecting lung tissue to some degree from ALI and improving PaO2.The mechanism of it may be attributed to preventing NF-κ B activation.