优质护理在康复科的应用分析

目的探讨开展优质护理服务在康复科的应用效果。方法对我科开展优质护理服务活动前、后住院患者护理中的相关指标发生率及患者满意度进行比较。结果开展优质护理服务后患者的相关护理指标发生率较未开展优质护理服务活动前显著降低,而且患者满意度明显提高。结论实施优质护理可有效提高护理质量,提高患者的满意度。     

全髋关节置换术治疗老年股骨颈骨折的效果分析

目的 探讨全髋关节置换术治疗老年股骨颈骨折的临床疗效.方法 对2007年8月~2012年5月我院收治的120例股骨颈骨折患者采用全髋关节置换术治疗,术后随访1~3年,按Harris评分进行评定髋关节功能.结果 本组患者Harris评分总优良率达到90.8%,无1例出现感染、脱位、假体松动下沉等严重并发症.结论 全髋关节置换术对老年股骨颈骨折的疗效显著,能有效提高患者的生活质量,远期效果佳.     

New microbiota found in sputum from patients with community-acquired pneumonia

Community-acquired pneumonia （CAP） is a major concern in hospitals and the bacterial community of which has not been systemically discussed yet. Sputum from patients in the acute stages is a kind of accessible sample reflecting its fea- tures. In our study, we analyzed 45 sputum samples from 45 patients with CAP. Eighteen sputum samples from healthy people were chosen as the controls. Pyrosequencing of the 16s rDNA V3 hypervariable regions of aH the bacteria con- tained in the sputum was used as a culture-independent method to disclose the community constitution. Also, our published data for hospital-acquired pneumonia （HAP） in sputum was used for comparison. By pyrosequencing, 〉90,000 DNA reads were detected. After being analyzed by tools in the Ribosomal Database Project, the reads were clas- sified into five main phyla and 〉100 genera. At the phyla level, the reads＇ distribution of CAP is similar to that of healthy people and at genera level, the occurrence of each genus possesses their feature in three categories. Genera such as Streptococcus and Neisseria showed stability in their percentages, indicating that such genera are rarely affected by exogenous bacteria or antibiotics. The role of other genera such as Moraxella and Rothia in CAP should be emphasized. According to our analysis, the bacterial communities of CAP are with slight change when compared with those of healthy people, but have a large gap between HAP. Meanwhile, Rothia might be an important endogenous pneumonia-causing factor.     

Association of human leukocyte antigen E polymorphism with human cytomegalovirus reactivation in Chinese burn patients

The seroprevalence of human cytomegalovirus （HCMV） in adults increased steadily from 55% in developed countries to over 90% in developing countries like China [1]. As all her- pesviruses, HCMV establishes lifelong latency after primary infection. In immunocompetent individuals, host immune responses prevent the development of overt HCMV diseases. However, in immunoeompromised people who suffer from burn injuries, HCMV reactivation has been shown to lead to significant diseases with considerable morbidity and mortal- ity [2-4]. Recently, increasing evidence has suggested that HCMV reactivation might have been considerably underesti- mated in burn patients [5,6]. Review of the available litera- ture identifies 〉50% of HCMV antibody-positive burn patients may reactivate this virus [5,6]. Although the exact mechanisms of HCMV reactivation are still not clearly under- stood, the immune system and host genetics are thought to be the non-behavioral factors determining the acquisition of a reactivation.     

精神科护理与人权意识

"人权"是西方法学的概念,是人基于自然属性与社会属性所固有的基本权利。长期以来,由于受传统观念的影响,人们往往忽视甚至是漠视精神病人作为公民所应享有的"基本权利"。笔者结合汕头大学精神卫生中心的一些具体做法,从临床护理工作作为切入点,谈谈精神科护理工作者应该如何正确地对待精神病人——尊重精神病人的人权问题。     

各国研究者云集横滨为患者带来全新疗法

日本再生医疗学会（JSRM）全会和国际干细胞研究学会（ISSCR）年会在横滨召开。参会者从基础研究到再生医疗、细胞治疗的临床应用及其商品化各个方面展开了热烈的讨论。支持研究的企业在会议期间展示了反映ips细胞研究进展的仪器、试剂等多种新产品。     

一组有或无CT 脑灌注" 点征"的自发性脑内出血患者临床效果观察

目的:观察有或无CT脑灌注"点征"自发性脑内出血(sICH)患者的临床疗效。方法:以本院2013年5月~2015年5月就诊的100例s ICH,均接受基线CT脑灌注检查,依据是否有"点征"将患者分为观察组(有"点征")与对照组(无"点征"),24内行CT平扫复查,比较两组影像学结果及临床结果。并通过Logistic多因素分析影响s ICH患者预后不良(死亡)危险因素。结果:观察组24h内CT平扫复查血肿增长6 mL以上、血肿增长相对值33%及以上比率均明显高于对照组(P0.05);观察组血肿进展发生率、3个月内死亡率分别为63.04%、36.96%,显著高于对照组的14.81%、7.41%(P0.05)。Logistic回归分析发现sICH患者预后不良独立危险因素包括基线血肿体积、"点征"。结论:有或无CT脑灌注"点征"自发性脑内出血患者血肿进展、预后不同,基线血肿体积、"点征"为sICH患者预后不良的独立危险因素。     

567例老年患者全身麻醉气管插管后下呼吸道感染病原菌特点分析及危险因素

目的探讨高龄患者全身麻醉气管插管后下呼吸道感染的病原菌特点,并对引起感染的高危因素进行分析。方法调查分析2010年1月至2014年12月在阿坝州人民医院567例进行手术的高龄患者在全身麻醉气管插管后是否出现呼吸道感染状况,并记录感染后的病原菌分布情况,检测病原菌的方法按照全国统一的方法进行,对容易引起感染的因素进行分析。结果进行全身麻醉气管插管手术的高龄患者中感染例数为66例,感染率为11.64%,根据病原菌检测标准检测出感染患者中有18例为痰培养阳性,并且以铜绿假单胞菌、鲍氏不动杆菌和金黄色葡萄球菌居多,占总细菌数的82.35%;耐药菌株中,鲍氏不动杆菌所占比例最大,为37.50%;在因素分析中,发现患者的年龄、有无吸烟史、是否进行过肺部手术、麻醉时间、插管途径、喉镜消毒方式为患者引发感染的危险因素。结论对于高龄患者在术中进行全身麻醉气管插管的感染因素是多方面的,在临床上应对感染的危险因素进行分析、预防,从而将高龄患者术后感染率降到最低。     

分离自老年病房的鲍曼不动杆菌耐药机制初步研究*

目的:检测老年住院患者分离的鲍曼不动杆菌的主要耐药基因,并研究不同耐药基因型与耐药表型之间的对应关系。方法:用PCR方法检测分离自老年住院患者的不同标本来源的170例非重复鲍曼不动杆菌的耐药基因。检测的耐药基因包括D类碳青霉烯酶:bla_(OXA-51),bla_(OXA-23),bla_(OXA-24),bla_(OXA-58),B类金属碳青霉烯酶:bla_(VIM),bla_(IMP),bla_(SIM),bla_(GIM),bla_(DIM),bla_(NDM-1),以及A类超广谱β-内酰胺酶:blaKPC,共计11种。根据检测结果对菌株进行基因分型,并研究不同基因型与CRAB和CSAB这两种耐药表型之间的对应关系。结果:170株鲍曼不动杆菌的固有基因bla_(OXA-51)均为阳性,此外,主要检出基因为bla_(OXA-23),共124株。另外检测出blaKPC12株,bla OXA-58 6株,bla_(NDM-1)3株,bla_(SIM)2株,bla_(OXA-24)、bla_(VIM)和bla_(DIM)各1株,IMP和GIM未检出。根据检出耐药基因的不同组合,分为bla OXA-51+bla_(OXA-23)阳性为基础的A型(124株)及bla_(OXA-23)阴性为基础的B型(bla_(OXA-51),39株)、C型(bla_(OXA-51)+bla_(OXA-58),6株)、D型(bla_(OXA-51)+bla_(OXA-24),1株)共计四类基因型。从耐药表型来看,128株碳青霉烯耐药菌中有122株bla_(OXA-23)为阳性,在CRAB中占95.3%(122/128),42株碳青霉烯敏感株中,有40株bla_(OXA-23)为阴性,在CSAB中占95.2%(40/42)。结论:老年病房流行的耐碳青霉烯鲍曼不动杆菌的耐药基因型以bla_(OXA-23)阳性为主。其与鲍曼不动杆菌CRAB耐药表型、bla_(OXA-23)阴性与CSAB耐药表型之间有良好的对应关系。     

靶控输注依托咪脂在老年患者颌面外科手术中的应用效果

目的:研究靶控输注依托咪脂在老年患者颌面外科手术中的应用效果。方法:选择60例美国麻醉医师协会(ASA)分级I～II级行颌面外科手术的患者,并将其随机分为靶控输注丙泊酚组(P组,n=30)和靶控输注依托咪酯组(E组,n=30),记录麻醉诱导前、气管插管前、气管插管后5 min、手术开始时、停药时的有创收缩压、有创舒张压、心率,并记录手术时间、拔管时间、麻醉维持时依托咪酯和丙泊酚的靶控输注浓度。结果:P组气管插管前、气管插管后5 min、手术开始时、停药时血压均低于麻醉诱导前,且低于E组各对应时间点,差异均具有统计学意义(P0.05),P组气管插管前心率显著低于麻醉诱导前和E组(P0.05);E组气管插管前、气管插管后5 min和手术开始时血压均低于麻醉诱导前(P0.05),但各时间点心率无显著变化(P0.05)。P组靶控浓度为(1.95±0.54)μg/m L～(4.48±0.61)μg/mL,E组靶控浓度为(0.20±0.05)μg/mL～(0.51±0.05)μg/mL。两组药物拔管时间、术后恶心呕吐和躁动发生率差异无统计学意义(P0.05),但P组低血压发生率显著高于E组(P0.05)。结论:在颌面外科手术中,靶控输注依托咪脂,能有效减少麻醉诱导和维持中低血压发生,维持血流动力学稳定,对于老年患者而言,是一种比丙泊酚更为安全可靠的静脉麻醉药。