支气管扩张合并支气管哮喘患者的病原菌检测及危险因素分析

目的分析支气管扩张合并支气管哮喘患者的病原菌及危险因素。方法选取湖州市中心医院115例支气管扩张合并支气管哮喘患者作为观察组,另选取同期110例健康体检者作为对照组。分析患者病原菌的组成、耐药性及发病危险因素。结果观察组患者送检痰样本经痰培养,阳性检出者68例,阳性率为59.13%(68/115)。全部样本共分离出104株病原菌,其中革兰阴性菌92株(以铜绿假单胞菌最多,占54.81%),革兰阳性菌8株,真菌4株。药敏试验结果表明革兰阴性菌对复方新诺明、头孢曲松、左旋左氧氟沙星和阿莫西林/克拉维酸等药物的耐药性均较高,对妥布霉素、亚胺培南、头孢哌酮/舒巴坦和哌拉西林的耐药性较低。Logistic回归分析显示,吸烟史、药物过敏史、食物过敏史、过敏性鼻炎、哮喘、过敏性肺炎、慢性支气管炎及慢性阻塞性肺疾病均是支气管扩张伴支气管哮喘发生的危险因素。结论支气管扩张合并支气管哮喘患者其病原菌以革兰阴性菌为主,吸烟史、药物过敏史、食物过敏史、过敏性鼻炎等是支气管扩张伴支气管哮喘发生的危险因素。     

支气管扩张急性加重期病原学分布及耐药性分析

【摘 要】 目的 分析不同病程支气管扩张急性加重期患者的病原及耐药情况,为临床合理用药提供参考。方法 选择2010年1月至2012年12月入住东南大学附属中大医院呼吸内科经HRCT确诊的支气管扩张的138例患者,根据入院时病史记录的病程时间,将患者分成病程＜10年（组Ⅰ）33例,10～20年组（组Ⅱ）52例及＞20年组（组Ⅲ）53例,分析不同组间病原学构成及耐药性。结果 共104例患者送检痰培养,其中有效痰标本256份,阳性标本108份（痰菌阳性率42.2%）。共分离出病原菌121株,其中,革兰阴性菌88株,革兰阳性菌17株,真菌16株。阴性菌中以铜绿假单胞菌最多（55.7%）。三组患者的痰真菌阳性率分别为7.7%、6.1%和23.9%,组间比较差异有统计学意义（P＜0.05）。在痰培养结果为阴性杆菌中,耐药情况比较普遍,其中,铜绿假单胞菌的耐药率随着病程的延长有所增加,在＞20年组患者,对亚胺培南及美罗培南的耐药率分别达到34.4%和37.5%,与其他两组间比较差异有统计学意义（P＜0.05）。结论 不同病程的支气管扩张患者,革兰阴性杆菌特别是铜绿假单孢菌仍是急性加重的主要因素,大于20年病程的患者对亚胺培南及美罗培南的耐药率增高,合并真菌感染的比例增加。     

支气管扩张合并感染患者病原体分布及其与病情的关系

目的 探讨支气管扩张合并感染患者病原体分布及其与病情的关系,为该类患者的治疗提供参考.方法 选取2018年6月至2019年6月我院收治的76例支气管扩张合并感染急性加重期患者为研究对象,对所有患者痰液标本进行病毒PCR检测,同时进行细菌培养以及实验室检查,分析所有患者病原体分布.比较不同病情程度患者病原体分布情况,同时...     

Community care compared with hospital outpatient care for hypertensive patients.

Three hundred and seventy-six patients with treated diastolic blood pressures of less than 105 mm Hg and no history of accelerated hypertension or renal failure were selected from among those attending the Hammersmith Hospital hypertension clinic. Their average lying treated blood pressure was 146 mm Hg systolic and 90 mm Hg diastolic and average age 56 years; 18% were black, 6% Asian, and 76% white. The patients were mostly having multiple treatment, 90% receiving a diuretic, 35% methyldopa, 33% propranolol, 18% atenolol, 9% hydrallazine, and 7% bethanidine. They were randomly allocated to either two years of further hospital outpatient care or referred back to their general practitioners. During the two years 19 (10%) of the 187 patients followed up in hospital defaulted and three had their treatment discontinued. Twelve (6%) of the 189 followed up by their general practitioners defaulted from follow-up and nine had their treatment discontinued. At the end of the trial the average lying blood pressure was 148 mm Hg systolic and 88 mm Hg diastolic in the hospital group and 149 mm Hg systolic and 90 mm Hg diastolic in the general practice group. The change in blood pressure was calculated for each individual and showed an average fall of 1.6 mm Hg in standing diastolic pressure in the hospital group and a rise of 1.4 mm Hg in the general practice group (p less than 0.05). The 90% confidence limits for a difference in standing diastolic pressure between the groups were 1 and 5 mm Hg with the pressure lower in the hospital group. General practice care was not quite as effective in controlling blood pressure as continued specialist supervision over two years in this selected group of treated outpatients with mild or moderate hypertension, but these results show that the discharge back to general practitioners of patients who are well controlled after hospital treatment is a sensible policy.     

Planned angle osteotomy

An improved method for performing angle osteotomies is described. An angle-osteotomy nomogram has been constructed allowing calculation of the width of a wedge osteotomy from the known thickness of the bone and the desired final degree of angulation. Use of the nomogram will speed operating time, improve technical precision, and minimize the chance of inadvertent injury to a vascularized bone graft that might occur in the event of repeated saw cuts.     

Primary care physicians' refusal to care for patients infected with the human immunodeficiency virus.

We conducted a telephone survey of a random sample of office-based primary care physicians in Los Angeles County to determine their practice experiences with patients infected with the human immunodeficiency virus (HIV). Telephone interviews included questions related to the physicians'' experiences evaluating patients for HIV infection during the past 6 months and the presence of HIV-infected patients in their practices. Those without HIV-infected patients were asked if this was because they had not encountered such patients, because those patients had died, or because the physicians had chosen to refer these patients elsewhere or the patients had gone elsewhere for care. Of physicians who participated in the survey, 78% had evaluated a patient for HIV infection in the past 6 months; 34% were currently providing primary care for infected patients; and 36% had elected to refer HIV-infected patients elsewhere, or their patients had elected to find other physicians. In all, 48% of physicians in the sample had elected not to care for, or said they would not provide care for, patients with HIV infection. Among Los Angeles County primary care physicians, 36% have refused to provide continuing care for HIV-infected patients and another 12% indicated their unwillingness to do so should such patients present themselves for care. As of 1991, the reservoir of primary care physicians in Los Angeles not yet involved with but willing to care for HIV-infected patients is relatively small (15%).     

Process and outcome of care for patients with ovarian cancer.

The process and outcome of care for a group of patients with ovarian cancer treated over two years in two groups of Italian general hospitals were investigated. The quality of diagnostic and therapeutic measures did not substantially differ in specialised and non-specialised centres when selected indicators of quality of care were examined. Similarly, no differences in survival emerged for the two groups of hospitals. Overall results of the Italian series compared well with statistics of survival published by international centres for cancer, suggesting that when the yield of available treatments is limited both the process and outcome of care should be evaluated to obtain a reliable picture of quality of care. In the light of these results there are useful implications for planning future clinical trials and ways of caring.     

Indicators of quality of care for patients with acute myocardial infarction

Background

There is a wide practice gap between optimal and actual care for patients with acute myocardial infarction in hospitals around the world. We undertook this initiative to develop an updated set of evidence-based indicators to measure and improve the quality of care for this patient population.

Methods

A 12-member expert panel was convened in 2007 to develop an updated set of quality indicators for acute myocardial infarction. The panel identified a list of potential indicators after reviewing the scientific literature, clinical practice guidelines and other published quality indicators. To develop the new list of indicators, the panel rated each potential indicator on 4 dimensions (reliability, validity, feasibility and usefulness in improving patient outcomes) and discussed the top-ranked quality indicators at a consensus meeting.

Results

Consensus was reached on 38 quality indicators: 17 that would be measurable using chart-abstracted data and 21 that would be measurable using administrative data. Of the 17 chart-review indicators, 13 address pharmacologic and nonpharmacologic care delivered to patients in hospital. In-hospital mortality was recommended as a key outcome indicator. Three system indicators were recommended to measure the collaborative responsiveness of the health care system from the call for help to intervention. It was recommended that hospitals strive for a minimum target benchmark of 90% or greater on process-of-care indicators.

Interpretation

Implementation of strategies by clinicians and hospitals to meet target benchmarks on these quality indicators could save the lives of many individuals with acute myocardial infarction.There is a large practice gap between optimal and actual patterns of care for patients with acute myocardial infarction in hospitals around the world.¹ Acute myocardial infarction is a highly treatable condition for which many advances in treatment have occurred over the past several decades. However, the uptake of many of these advances and their incorporation into routine clinical practice has often lagged behind their development and publication in clinical journals by many years.^2–4 To reduce this gap and improve quality of care, many jurisdictions are using indicators of the quality of care for patients with acute myocardial infarction. These quality indicators are intended to measure adherence to selected key clinical practice guidelines in routine clinical care and serve as a foundation for efforts to improve quality.⁵ They define the minimum standard of care that might be expected for all “ideal” patients who meet certain criteria and have no contraindications for a given health care intervention.National organizations in Canada, the United States, the United Kingdom and other OECD (the Organisation for Economic Co-operation and Development) countries have all developed indicators to measure and improve the quality of care for patients with acute myocardial infarction both within and across countries, regions and hospitals.^6–9 In 2003, the Canadian Cardiovascular Outcomes Research Team (a Canadian Institutes of Health Research Interdisciplinary Health Research Team) worked in association with the Canadian Cardiovascular Society to develop and publish the first set of quality indicators for myocardial infarction in Canada.⁶ The Canadian Cardiovascular Outcomes Research Team comprises more than 30 leading outcome researchers who work together on projects to measure and improve cardiac care. From the outset, we recognized that the indicators would need to be modified over time to reflect changes in practice guidelines and clinical evidence. In 2007, a Canadian expert panel was convened by the Canadian Cardiovascular Outcomes Research Team to develop and recommend a set of quality indicators that took into account the best indicators developed elsewhere and that also included some unique indicators that were felt to be of particular relevance and use to Canadian clinicians and hospitals.     

左氧氟沙星联合哌拉西林钠/他唑巴坦钠对支气管扩张症铜绿假单胞菌急性感染者的疗效评估

目的 探讨左氧氟沙星联合哌拉西林钠/他唑巴坦钠对支气管扩张症铜绿假单胞菌急性感染者的疗效及其经济影响。方法 选取60例支气管扩张症铜绿假单胞菌（非耐药）急性感染患者,随机分为3组,每组20例。其中A组予以左氧氟沙星治疗,B组予以哌拉西林钠/他唑巴钠治疗,C组予以左氧氟沙星联合哌拉西林钠/他唑巴钠治疗,疗程均为14 d。比较3组患者临床疗效、生理指标及抗菌药物治疗费用等。结果 治疗后,A、B和C组患者的临床总有效率分别为85.0%、90.0%、95.0%,差异均无统计学意义（χ2=0.5556、0.1802,P>0.05）。3组患者主要生理指标均有所改善,与治疗前比较差异均有统计学意义（P0.05）。C组患者抗菌药物治疗费用最高,与A、B组比较,差异均有统计学意义（t=36.8448、13.8504,P<0.05）;A组患者抗菌药物治疗费最低,与B组比较差异有统计学意义（t=28.1640,P<0.05）。结论 左氧氟沙星、哌拉西林钠/他唑巴坦钠均可用于治疗支气管扩张症铜绿假单胞菌急性感染,药物联用治疗无明显优势,且治疗费用显著增高。     

The detection of 5-lipoxygenase and cyclo-oxygenase products in sputum of patients with chronic bronchitis and bronchiectasis

Leukotrienes (LTs) and prostanoids (Ps) were detected in sputum of patients with chronic bronchitis and/or bronchiectasis (CB/B) using selective superfusion bioassay and radioimmunoassay (RIA) techniques. Analysis of sputum extracts showed a 4-fold increase in the level of LTB4 compared to the cysteinyl-containing LTs (LTC4/LTD4). The measurement of cyclo-oxygenase products (COPs) indicated relatively greater amounts of the vasodilator prostaglandin E2 (PGE2) and prostacyclin (PGI2) compared to the vasoconstrictor prostaglandin F2 alpha (PGF2 alpha) and thromboxane A2 (TxA2) agents (70:30% of total COPs respectively). The presence of eicosanoids (LTs and Ps) in sputum of patients with CB/B suggest that these biologically active substances may act as mediators of bronchoconstriction and inflammation in these diseases.     

Neutrophil elastase in bronchiectasis

The role of neutrophil elastase (NE) is poorly understood in bronchiectasis because of the lack of preclinical data and so most of the assumptions made about NE inhibitor potential benefit is based on data from CF. In this context, NE seems to be a predictor of long-term clinical outcomes and a possible target of treatment. In order to better evaluate the role of NE in bronchiectasis, a systematic search of scientific evidence was performed.Two investigators independently performed the search on PubMed and included studies published up to May 15, 2017 according to predefined criteria. A final pool of 31 studies was included in the systematic review, with a total of 2679 patients. For each paper data of interest were extracted and reported in table.In this review sputum NE has proved useful as an inflammatory marker both in stable state bronchiectasis and during exacerbations and local or systemic antibiotic treatment. NE has also been associated with risk of exacerbation, time to next exacerbation and all-cause mortality. This study reviews also the role of NE as a specific target of treatment in bronchiectasis. Inhibition of NE is at a very early stage and future interventional studies should evaluate safety and efficacy for new molecules and formulations.     

The detection of 5-lipoxygenase and cyclo-oxygenase products in sputum of patients with chronic bronchitis and bronchiectasis

Leukotrienes (LTs) and prostanoids (Ps) were detected in sputum of patients with chronic bronchitis and/or bronchiectasis (CB/B) using selective superfusion bioassay and radioimmunoassay (RIA) techniques.Analysis of sputum extracts showed a 4-fold increase in the level of LTB₄ compared to the cysteinyl-containing LTs (LTC₄/LTD₄).The measurement of cyclo-oxygenase products (COPs) indicated relatively greater amounts of the vasodilator prostaglandin E₂ (PGE₂) and prostacyclin (PGI₂) compared to the vasoconstrictor prostaglandin F_2∝ (PGF_2∝) and thromboxane A₂ (TxA₂) agents (70:30% of total COPs respectively).The presence of eicosanoids (LTs and Ps) in sputum of patients with CB/B suggest that these biologically active substances may act as mediators of bronchoconstriction and inflammation in these diseases.