异基因造血干细胞移植是一种治疗血液系统疾病的有效方法,然而移植物抗宿主病大大影响了治疗效果.移植物抗宿主病可累及各个器官.近年来,肺部移植物抗宿主病得到了越来越多的关注,其中闭塞性细支气管炎综合征(bronchiolitis obliterans syndrome,BOS)最常见.BOS主要影响终末细支气管,与高死亡率有关.本综述就BOS的临床特点、发病机制、预测指标及治疗进行讨论.

Objective To analyze the clinical manifestations and risk factors of patients with bloodstream infections (BSI) caused by multi-drug resistant Acinetobacter baumannii (MDR-AB).Methods Clinical data of patients with BSI caused by MDR-AB hospitalized in Chinese PLA General Hospital from January 2012 to December 2015 were analyzed retrospectively.According to the 14-day survival after diagnosis,the patients were divided into survival group and death group.The risk factors of death were investigated by single-factor analysis and multifactor Logistic regression analysis.Results Among the 157 patients,55.4％ were collected from ICU,and the 14-day mortality was 54.8％.Single-factor analysis showed that the survival group was significantly lower than the death group in malignancy,immunosuppressive therapy,neutropenia,ventilator use and Pitt Bacteremia Score (PBS),with statistically significant difference (P ＜ 0.05).And the survival group was significantly higher than the death group in appropriate therapy and treatment with Sulbactam,with statistically significant difference (P ＜ 0.05).Muhifactor Logistic regression analysis showed malignancy (OR=4.78,95％CI:1.30-15.32,P ＜ 0.05),neutropenia (OR=16.01,95％CI:1.64-172.21,P ＜ 0.05) and increased PBS (OR=0.47,95％CI:0.32-0.63,P ＜ 0.05) were independent risk factors of 14-day mortality.Patients with hematological malignancies were often accompanied with neutropenia,and the survival analysis revealed that mortality in patients with hematological malignancies was higher than that in patients with solid tumors (P ＜ 0.05).The percentage of patients treated with antibiotics containing Sulbactam in the survival group was significantly higher than that in the death group (P ＜ 0.05),but it was not revealed as a death protection factor in multivariate analysis.Conclusion The patients with BSI caused by MDR-AB usually have serious sunder lying diseases from ICU,and the mortality is quite high.Malignancy,neutropenia and increased PBS are independent risk factors of early mortality.Antimicrobial regimens containing Sulbactam may be a candidate for the treatment of BSI caused by MDR-AB,but its clinical efficacy deserves further exploration.

目的 总结快速康复护理在腹腔镜卵巢囊肿剥除术患者围术期护理管理中的应用效果.方法 选取该院妇产科2016年1-12月期间收治的腹腔镜卵巢囊肿剥除术患者120例,采用回顾性分析,将观察对象分为二组,研究组采用快速康复护理路径,实施集成化护理方法;对照组采用常规护理方法.记录并比较二组病例基线数据、围术期相关指标以及护理满意度情况.结果 二组患者平均年龄、体重指数、腹部手术史、手术时间、手术出血量和囊肿病理类型比较差异无统计学意义(P＞0.05).研究组平均住院日[(2.31±0.85)d vs.(4.46±1.51) d]、相关诊疗费用[(9365.37±873.12)元vs.(12076.92±1364.46)元]、术后排气时间[(19.33±5.13)h vs.(28.40±10.69)h]均少于对照组(P＜0.001);二组并发症发生情况比较[4例(6.7％)vs.3例(5％)]差异无统计学意义(P＞0.05);研究组护理满意度(91.67％)高于对照组(78.33％),差异有统计学意义(P＜0.05).结论 将快速康复护理引入腹腔镜卵巢囊肿剥除手术患者的围术期管理中,能够加快患者术后康复速度、改善护理满意度,减少住院花费,具有重要意义.

目的 对机器人手术治疗子宫内膜癌分期术患者围手术期感染及并发症进行观察和护理干预,提高机器人手术治疗效果.方法 选取医院2013年9月-2015年9月行机器人手术子宫内膜癌分期术的74例患者为研究对象,对其围手术期感染和并发症进行观察,并积极进行个体化护理.结果 74例患者行机器人手术子宫内膜癌分期术后,发生并发症12例,发生率为16.2％;其中4例感染,感染率为5.4％;经过采取个体化护理措施患者均痊愈出院.结论 机器人手术治疗子宫内膜癌围手术期护理,应根据每一例患者制定个体化护理对策,使患者充分做好术前准备,保证手术顺利进行,减少术后感染和并发症发生率,提升患者就医满意度,尽快康复出院.