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1.
目的分析新型冠状病毒肺炎(Novel coronavirus pneumonia,NCP;亦称为COVID-19)确诊患者的流行病学和临床特征,为疫情防控提供参考依据。方法描述分析2020年1月23日至3月1日鄂东医疗集团黄石市中心医院收治的92例COVID-19确诊患者的病例资料,归纳COVID-19患者的流行病学及临床特征。结果 92例COVID-19患者中,轻症组71例(无症状感染者5例,普通型66例),重症组21例(重型11例,危重型10例)。有明确武汉旅居史者32例,占34.78%;与COVID-19患者有明确接触史者38例,占41.30%;家族聚集性发病47例,占51.09%。92例患者平均年龄(50.05±16.19)岁;男女比例为1∶1.19;合并其他基础疾病患者32例,占34.78%,居前3位的基础疾病依次为高血压病、糖尿病、冠心病;首发症状以发热、咳嗽、头痛为主。入院时34.78%的患者淋巴细胞减少,33.70%的患者白蛋白下降。40.22%的患者C-反应蛋白(C-reactive protein, CRP)升高,全部患者胸部CT均表现单侧或双侧肺部斑片状磨玻璃密度影,21例重症组患者均出现肺呼吸功能障碍。结论新冠肺炎临床以普通型为主,大多数病例具有明确的流行病学特征。合并基础疾病多、年龄偏大的患者容易发展为重型。淋巴细胞计数下降,炎症反应水平增高可作为重症患者的预警指标,从而提早进行干预。  相似文献   

2.
目的:评价超声在诊断妊娠合并急腹症中的临床应用价值。方法:回顾分析686例妊娠合并急腹症患者的临床资料,总结妊娠合并急腹症超声图像特征。结果:超声诊断符合率为:异位妊娠87.2%(184/211),急性阑尾炎84.2%(32/39),卵巢囊肿蒂扭转90.0%(27/30),急性胰腺炎66.7%(6/9),不全流产及难免流产、子宫肌瘤扭转、子宫肌瘤红色变性、胎盘早剥、泌尿系结石、急性胆囊炎和胆结石、急性胃肠炎、急性肠梗阻的诊断率为100%(43/43)。结论:超声可以作为妊娠合并急腹症首选的检查手段,为临床早期诊断及治疗提供可靠依据。  相似文献   

3.
目的提高对非粒细胞缺乏患者侵袭性气道曲霉病的认识及诊疗水平。方法回顾性分析19例非粒细胞缺乏患者侵袭性气道曲霉病的危险因素,临床特征,影像学,支气管镜下表现,治疗及预后资料。结果 19例患者男性13例(68%),女性6例(32%),年龄33~76岁、平均(57.32±11.69)岁。既往患慢性阻塞性肺疾病4例(21%),糖尿病4例(21%),肺癌3例(16%),高血压病3例(16%),陈旧性肺结核病2例(11%),支气管扩张2例(11%),肺血管炎1例(5%),间质性肺病1例(5%);其中2例患者有3种以上基础疾病,7例有2种基础疾病。常见的临床症状为咳嗽,气急(100%),发热(74%);影像学改变早期主要为沿气道分布的结节,渗出,12例患者入院后胸部CT显示病灶明显进展;支气管镜下改变以混合型为主;首选治疗药物为伏立康唑针;总疗程均大于6周,最长22周;死亡率为16%,其中1例因经济原因治疗4周后自行停药,8周后再次因为肺部出现新病灶病情进展再次入院。结论侵袭性气道曲霉病是侵袭性肺曲霉病的一种少见类型,在非粒细胞缺乏的患者身上常常漏诊、误诊,提高对本病的认识,及早进行支气管镜检查,早期诊断及全身治疗可以减少患者的死亡率。  相似文献   

4.
目的分析继发性噬血细胞综合征(HPS)患者的实验室指标及临床特点,以提高对该病的认识。方法对2005年6月~2015年6月在广西肿瘤防治研究所治疗的32例继发性HPS患者的病因、临床表现、实验室特征、治疗及预后等进行分析。结果 32例患者中,血液系统肿瘤17例,单纯感染13例,自身免疫性疾病2例。临床上以发热(100%)、肝脾(87.5%)及淋巴结(43.8%)肿大为主要表现。实验室检查以血细胞减少(100%)、铁蛋白升高(96.9%)、自然杀伤细胞活性降低或缺失(96.9%)为主,纤维蛋白原降低(68.8%),甘油三酯升高(56.3%),81.3%的患者骨髓涂片检查可见噬血细胞现象。结论继发性HPS可由多种病因引起,临床表现多样,对可疑患者及时进行相关实验室检查有助于早期明确诊断;合并多脏器衰竭、DIC的患者预后不良。  相似文献   

5.
目的研究肺部真菌感染的易患因素、临床特征、治疗结果和预后。方法应用回顾性的调查方法对106例肺部真菌感染患者进行分析。结果92.5%(98/106)的病例患有慢性阻塞性肺疾病(COPD)、系统性红斑狼疮(SLE)、白血病和慢性肾病等基础疾病,原发性肺部真菌感染少见。肺部真菌感染的临床表现无明显特异性,早期诊断仍比较困难,X线表现以支气管肺炎多见(占59.4%)。病原菌主要以酵母菌属为主(79.2%)。肺部真菌感染的预后较差,病死率较高,基础病为慢性肾病、COPD和血液系统疾病者死亡风险较大。结论肺部真菌感染是多种疾病继发感染的重要原因,其临床表现特异性少,病死率高,发病呈上升趋势,应引起临床高度重视。  相似文献   

6.
目的分析侵袭性肺曲霉病(IPA)的临床特点,提高对本病的认识。方法对13例确诊的IPA患者的临床资料进行回顾性分析。结果 IPA患者中存在基础疾病或危险因素者占69.2%(9/13);临床表现包括咳嗽、黄痰(13/13)、高热(11/13)、胸闷或呼吸困难(7/13)和咯血(2/13)等;92.3%(12/13)患者有高白细胞血症,WBC大多为(15~30)×109;10例G试验检测的患者中有9例出现阳性;影像学检查:肺内多发空洞及"空气新月征"9例(69.2%),"晕轮征"2例(15.4%),支气管炎表现6例(46.2%),胸腔积液3例(23.1%),颅内播散病灶1例;气管镜检查以粘膜水肿、脓痰、管腔坏死物为主;9例患者痰培养或肺泡灌洗液培养阳性(占69.2%),所有患者病理检查均见曲霉菌丝。所有患者均接受抗真菌药物治疗,4例好转出院,9例恶化放弃治疗或死亡。结论 IPA是临床严峻挑战;掌握该病的临床特点、实验室检查和胸部影像特征,及时的气管镜、组织病理检查有助于IPA确诊。临床医师应高度重视曲霉病。  相似文献   

7.
目的探讨感染性心内膜炎(IE)患者致病菌分布、致病菌耐药性及患者死亡因素。方法回顾性分析我院2014年11月至2018年3月收治的80例感染性心内膜炎患者的临床资料。根据是否发生死亡将患者分成存活组(75例)与病死组(5例)。采集两组患者血液标本进行细菌培养、鉴定及药敏试验,并对患者死亡因素进行统计。结果 80例IE患者共检测出96株病原菌,其中革兰阳性菌63株,占65.63%;革兰阴性菌27株,占28.13%;真菌6株,占6.25%。药敏试验显示链球菌属及金黄色葡萄球菌对青霉素耐药率最高,分别为90.32%和93.33%;其次为红霉素,分别为70.97%和73.33%。单因素分析结果显示,肝脏肿大、血红蛋白(90 g/L)及抗生素的使用与IE患者的死亡有关(均P0.05)。结论 IE患者病原菌以革兰阳性菌为主,其主要菌属对青霉素耐药率最高,要加强对肝脏肿大、血红蛋白及抗生素相关因素的防治,降低IE患者的病死率。  相似文献   

8.
目的分析老年难愈性创面患者的临床特征、创面细菌学及疗效,为临床治疗提供参考依据。方法回顾性分析我科2012年1月至2017年12月收治的114例老年难愈性创面患者的临床资料。对患者合并内科基础疾病、生理机能状况、创面病因和部位、创面分泌物细菌和多重耐药菌分布、创面治疗效果等进行分析。结果患者常见内科基础疾病有高血压(63例)、糖尿病(42例)、脑血管疾病(38例)和心脏病(31例),常见生理指标异常为白蛋白降低(89例)和贫血(70例)。本组共有186处创面(37例患者有1个以上创面),常见病因为烧伤(44.62%)、压迫(35.48%),常见病变部位为下肢(67.74%)。创面分离出病原菌113株,革兰阴性菌占71.68%。常见菌为铜绿假单胞菌(35.40%)、金黄色葡萄球菌(25.66%)、大肠埃希菌(12.39%)。多重耐药菌检出率为71.68%(81/113)。本组创面的治疗效果为:治愈94处、好转64处、未愈28处。38.17%创面进行了手术治疗。手术治疗的疗效为治愈58处、好转10处、未愈3处,明显优于非手术治疗(Z=-6.478,P=0.000)。结论老年难愈性创面患者合并内科基础病多、生理机能状况差,创面细菌以革兰阴性球菌为主、多重耐药菌比例高,创面治疗效果偏差,手术比例低,但手术治疗取得了较好疗效。  相似文献   

9.
目的:总结细菌性肝脓肿(pyogenic liver abscesses,PLA)的临床特点、诊断及治疗经验,提高诊疗水平。方法:回顾性分析哈尔滨医科大学第二临床医学院2013年1月-2014年12月收治的75例PLA患者的临床资料。结果:75例患者的平均年龄57岁,最大78岁,最小34岁。其中,男45例,女30例,男:女为1.5:1。75例患者中表现为发热者69例(92.0%)、寒战28例(37.3%)、右上腹痛66例(88.0%),伴恶心呕吐者28例(37.3%),黄疸15例(20.0%),肝肿大8例(10.7%)。有糖尿病病史患者28例(37.3%)。胆系疾病(78.7%)是本组资料主要的易患因素,其中53例患有胆囊炎(70.7%)。外周血白细胞增高67例(89.3%),血红蛋白降低41例(54.7%),白蛋白降低46例(61.3%);75例患者转氨酶升高58例(77.3%)。肝右叶单发脓肿多见(75例患者中36例,占48%)。51例B超确诊,24例行B超+CT或CT检查。48例行穿刺液细菌培养及25例血培养,其中肺炎克雷伯氏菌为主要病原菌。平均住院天数为19天,多数患者经皮下肝脓肿穿刺或置管引流而好转,1例漏诊为肺炎,2例患者反复入院,1例因菌血症死亡。结论:PLA的临床表现多样,以发热最为常见;多为肝右叶单发,部分患者血红蛋白及血清白蛋白降低。糖尿病为PLA最常见基础疾病,胆系疾病是主要的易患因素。肺炎克雷伯杆菌是本组PLA患者的主要致病菌。  相似文献   

10.
目的:明确各孕周胎儿超声心动图四腔观、腹部横断面观等切面显示率,探讨孕早期超声心动图对超声软指标阳性胎儿复杂先天性心脏病(CHD)的诊断价值。方法:用GE Voluson E8彩色超声诊断仪(探头频率4~8 MHz)对120例超声软指标阳性胎儿进行孕早期(11~13+6周)超声心动图检查,探查胎儿方位、腹部大血管位置、心脏位置、心尖指向及超声心动图各切面,判断胎儿心脏结构是否正常,将检查结果与引产病理尸检、孕中期(孕18~24周)复查或分娩后新生儿期超声心动图检查结果作对照,并以ROC曲线分析孕早期超声心动图的灵敏度和特异度。结果:孕早期胎儿超声心动图对胎儿心脏四腔观、腹部横断面观、动脉导管弓观、左心室流出道观、主动脉弓观、三血管气管观、上下腔静脉长轴观的显示率均随孕周的增加而提高,分别为72.7%、89.2%、80.0%、65.8%、70.0%、72.5%、74.2%。胎儿孕早期超声心动图对复杂性CHD的灵敏度为86.4%(19/22),特异度为96.7%(87/90),准确度为72.7%(16/22),ROC曲线下面积(AUC)为0.81。结论:孕早期胎儿超声心动图对各切面的显示率随孕周的增加而提高,且超声图像特征基本同于孕中期超声检查。孕早期超声心动图筛查复杂性CHD胎儿特异性好,灵敏度及准确度均较高,对于部分复杂性CHD胎儿可作出提示性诊断,对减少先天性畸形胎儿出生率有重要意义。  相似文献   

11.

Background

Infective endocarditis (IE) is commonly complicated by cerebral embolization and hemorrhage secondary to intracranial mycotic aneurysms (ICMAs). These complications are associated with poor outcome and may require diagnostic and therapeutic plans to be modified. However, routine screening by brain CT and CT angiography (CTA) is not standard practice. We aimed to study the impact of routine cerebral CTA on treatment decisions for patients with IE.

Methods

From July 2007 to December 2012, we prospectively recruited 81 consecutive patients with definite left-sided IE according to modified Duke’s criteria. All patients had routine brain CTA conducted within one week of admission. All patients with ICMA underwent four-vessel conventional angiography. Invasive treatment was performed for ruptured aneurysms, aneurysms ≥5 mm, and persistent aneurysms despite appropriate therapy. Surgical clipping was performed for leaking aneurysms if not amenable to intervention. Results: The mean age was 30.43±8.8 years and 60.5% were males. Staph aureus was the most common organism (32.3%). Among the patients, 37% had underlying rheumatic heart disease, 26% had prosthetic valves, 23.5% developed IE on top of a structurally normal heart and 8.6% had underlying congenital heart disease. Brain CT/CTA revealed that 51 patients had evidence of cerebral embolization, of them 17 were clinically silent. Twenty-six patients (32%) had ICMA, of whom 15 were clinically silent. Among the patients with ICMAs, 11 underwent endovascular treatment and 2 underwent neurovascular surgery. The brain CTA findings prompted different treatment choices in 21 patients (25.6%). The choices were aneurysm treatment before cardiac surgery rather than at follow-up, valve replacement by biological valve instead of mechanical valve, and withholding anticoagulation in patients with prosthetic valve endocarditis for fear of aneurysm rupture.

Conclusions

Routine brain CT/CTA resulted in changes in the treatment plan in a significant proportion of patients with IE, even those without clinically evident neurological disease. Routine brain CT/CTA may be indicated in all hospitalized patients with IE.  相似文献   

12.
目的:确定先天性心脏病活动期感染性心内膜炎(active infective endocarditis,AIE)的手术指征。方法:于2003-2011年从71个机构数据库中调查并采集247例患有感染性心内膜炎的儿童及成人先天性心脏病(congenital heart disease,CHD)患者数据,其中74例(30%)进行了AIE手术治疗。回顾性分析患者的年龄、性别、感染心内膜炎前对CHD的诊断、致病微生物和感染部位等数据。结果:与AIE手术治疗必要性显著相关的指标是感染性心内膜炎(infective endocarditis,IE)病发前对心脏异常的诊断缺乏、主动脉瓣IE、瓣周脓肿、心力衰竭以及抗生素发生变化。逐步逻辑回归方程分析结果表明瓣周脓肿、心力衰竭以及抗生素改变是先天性心脏病患者进行AIE手术治疗必要性的独立决定因素。结论:对IE合并CHD的患者而言,当心力衰竭、瓣周脓肿或抗生素变化发生时,手术可作为治疗AIE的一种手段。  相似文献   

13.
Many cardiac diseases demonstrate seasonal variations in the incidence and mortality. This study was designed to investigate whether the mortality of infective endocarditis (IE) was higher in cool seasons and to evaluate the effects of cool climate for IE. We enrolled 100 IE patients with vegetations in our hospital. The temperatures of the IE episodes were defined as the monthly average temperatures of the admission days. The average temperatures in the cool (fall/winter) and warm seasons (spring/summer) were 19.2°C and 27.6°C, respectively. In addition, patients admitted with the diagnosis of IE were identified from the National Health Insurance Research Database (NHIRD) and the in-hospital mortality rates in cool and warm seasons were compared to validate the findings derived from the data of our hospital. The mortality rate for IE was significantly higher in fall/winter than in spring/summer which presents consistently in the patient population of our hospital (32.7% versus 12.5%, p = 0.017) and from NHIRD (10.4% versus 4.6%, p = 0.019). IE episodes which occurred during cool seasons presented with a higher rate of heart failure (44.2% versus 22.9%, p = 0.025) and D-dimer level (5.5 ± 3.8 versus 2.4 ± 1.8 μg/ml, p = 0.017) at admission than that of warm seasons. These results may reflect the impact of temperatures during the pre-hospitalized period on the disease process. In the multivariate analysis, Staphylococcal infection, left ventricular hypertrophy, left ventricular systolic dysfunction and temperature were the independent predictors of mortalities in IE patients.  相似文献   

14.
感染性心内膜炎一直是威胁人类健康的重要疾病之一。近年来人类正面临着此病发病率持续上升的局面,其诊断、治疗和预防依然是目前需要解决的重要临床和公共卫生问题。本文介绍了感染性心内膜炎疾病的最新研究进展,分析了国内外报道的538份巴尔通体感染性心内膜炎的病例,重点阐述了巴尔通体和相关心内膜炎的流行病学、实验室诊断、治疗以及发病的危险因素和预防控制措施。预测这些研究将对人类理解和控制巴尔通体感染性心内膜炎具有重要的指导意义。  相似文献   

15.
16.

Aims

Multicellular organisms maintain vital functions through intercellular communication. Release of extracellular vesicles that carry signals to even distant target organs is one way of accomplishing this communication. MicroRNAs can also be secreted from the cells in exosomes and act as paracrine signalling molecules. In addition, microRNAs have been implicated in the pathogenesis of a large number of diseases, including cardiovascular diseases, and are considered as promising candidate biomarkers due to their relative stability and easy quantification from clinical samples. Pericardial fluid contains hormones secreted by the heart and is known to reflect the cardiac function. In this study, we sought to investigate whether pericardial fluid contains microRNAs and if so, whether they could be used to distinguish between different cardiovascular pathologies and disease stages.

Methods and Results

Pericardial fluid was collected from heart failure patients during open-heart surgery. MicroRNA profiles of altogether 51 patients were measured by quantitative real-time PCR (qPCR) using Exiqon human panels I and II. On the average, 256 microRNAs were detected per sample, and 70 microRNAs out of 742 profiled microRNAs were detected in every sample. The five most abundant microRNAs in pericardial fluid were miR-21-5p, miR-451a, miR-125b-5p, let-7b-5p and miR-16-5p. No specific signatures for cardiovascular pathologies or clinically assessed heart failure stages could be detected from the profiles and, overall, microRNA profiles of the samples were found to be very similar despite the heterogeneity in the study population.

Conclusion

Measured microRNA profiles did not separate the samples according to the clinical features of the patients. However, several previously identified heart failure marker microRNAs were detected. The pericardial fluid microRNA profile appeared to be a result of an active and selective secretory process indicating that microRNAs may act as paracrine signalling factors by mediating the local crosstalk between cardiac cells.  相似文献   

17.
Over a 51-month period, 143 patients underwent right ventricular endomyocardial biopsy as part of their evaluation for cardiac disease. Of these, 82 patients presented with a clinical dilated cardiomyopathy, 28 patients with unexplained arrhythmia, 22 with other cardiomyopathies, 7 with anthracycline exposure, and 4 with miscellaneous indications. Overall, 47 of the 143 patients (33%) had findings on endomyocardial biopsy that changed the clinical diagnosis. Of these, 18 (38%) had a change in diagnosis based on nonspecific criteria. Although 32 of the 143 patients (22%) had specific therapeutic alterations based on the endomyocardial biopsy findings, the vast majority of these received immunosuppression for myocarditis, a therapy that is currently of unproven benefit. Therefore, endomyocardial biopsy is of limited therapeutic use for most patients with primary myocardial disease. Its current primary indications are for clinical diagnosis and investigation.  相似文献   

18.
19.
ObjectivesTo update the epidemiology of S. aureus bloodstream infection (SAB) in a high-income country and its link with infective endocarditis (IE).MethodsAll consecutive adult patients with incident SAB (n = 2008) were prospectively enrolled between 2009 and 2011 in 8 university hospitals in France.ResultsSAB was nosocomial in 54%, non-nosocomial healthcare related in 18% and community-acquired in 26%. Methicillin resistance was present in 19% of isolates. SAB Incidence of nosocomial SAB was 0.159/1000 patients-days of hospitalization (95% confidence interval [CI] 0.111-0.219). A deep focus of infection was detected in 37%, the two most frequent were IE (11%) and pneumonia (8%). The higher rates of IE were observed in injecting drug users (IE: 38%) and patients with prosthetic (IE: 33%) or native valve disease (IE: 20%) but 40% of IE occurred in patients without heart disease nor injecting drug use. IE was more frequent in case of community-acquired (IE: 21%, adjusted odds-ratio (aOR) = 2.9, CI = 2.0-4.3) or non-nosocomial healthcare-related SAB (IE: 12%, aOR = 2.3, CI = 1.4-3.5). S. aureus meningitis (IE: 59%), persistent bacteremia at 48 hours (IE: 25%) and C-reactive protein > 190 mg/L (IE: 15%) were also independently associated with IE. Criteria for severe sepsis or septic shock were met in 30% of SAB without IE (overall in hospital mortality rate 24%) and in 51% of IE (overall in hospital mortality rate 35%).ConclusionSAB is still a severe disease, mostly related to healthcare in a high-income country. IE is the most frequent complication and occurs frequently in patients without known predisposing conditions.  相似文献   

20.
《Médecine Nucléaire》2022,46(3):156-163
BackgroundNative valve endocarditis (NVE) is a rare but serious disease. The prognosis depends on the rapidity of diagnosis, and is currently based on modified Duke criteria, where echocardiography has a key role but may lack sensitivity if valves are calcified. For prosthetic valves, the European Society of Cardiology 2015 recommendations added 18F-FDG PET/CT as a major imaging criterion as well as for extension assessment. This study evaluated the diagnostic accuracy of 18F-FDG PET/CT in NVE and in extension assessment.MethodsThis retrospective study involved 59 patients suspected of NVE at Bordeaux university hospital between 2011 and 2019 and received 18F-FDG PET/CT. The final diagnosis was established according to Duke criteria after 3 months of management. Infective endocarditis (IE) was assessed in the initial phase according to the Duke criteria. All PET/CTs were blindly reviewed jointly by a junior and senior nuclear-medicine physician.ResultsIn total, 59 patients were included. At 3 months, 26 patients had definite IE, 22 had rejected IE, and 11 possible IE. Twelve patients had positive PET/CT results. The sensitivity of the modified Duke criteria in the initial phase was 77% and the specificity was 81%. When combined with 18F-FDG PET/CT, the sensitivity of the Duke criteria increased to 96% and the specificity was 81%. The sensitivity of 18F-FDG PET/CT alone was 46%. All three patients with perivalvular abscess had positive PET/CT results. Of the 22 patients with NVE definite at 3 months, fourteen (54%) had at least one septic embolism diagnosed on PET/CT.ConclusionsThe implementation of 18F-FDG PET/CT with modified Duke criteria increased the sensitivity for NVE diagnosis in the initial phase and contributed to IE extension assessment. It may contribute to making the diagnosis of a local cardiac complication.  相似文献   

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