目的 分析社区综合干预对小儿反复呼吸道感染的影响,为社区临床治疗小儿反复呼吸道感染性疾病提供理论依据。方法 采用随机抽签方式,从我社区2012年10月—2014年10月期间收治的小儿反复呼吸道感染患儿中,随机抽取60例纳入本项研究,依据就诊单双顺序,分为研究组30例(社区综合干预方式)和对照组30例(常规性治疗和常规措施进行干预),对两组患儿干预结果进行对比分析。结果 研究组治疗总疗效高于对照组(93.33% vs 76.67%),差异有统计学意义(P<0.05)。对比治疗干预过程中疾病发作次数、就诊次数状况,研究组优于对照组,差异有统计学意义(P<0.05)。干预后研究组小儿呼吸道感染致病因素改善情况(除滥用抗生素外)优于对照组,差异有统计学意义(P<0.05)。结论 针对小儿反复呼吸道感染疾病可采用社区综合干预方式,可显著提升治疗有效率,缓解病情,降低反复感染发生率,效果突出,具有广阔应用前景。

目的 通过对婴幼儿泌尿系感染并发脓毒症的临床特点、病原菌情况及相关因素的分析,探讨其早期诊断和及时治疗的措施。方法 选取83例我科收治的确诊泌尿系感染合并脓毒症的婴幼儿作为研究对象,回顾性分析其临床表现、实验室检查及治疗预后情况。结果 所选婴幼儿均确诊泌尿系感染合并脓毒症,以男性患儿多见,全身中毒症状重,6月以下多以严重脓毒症、脓毒性休克为首诊表现,尿路刺激症状不明显。有明显细菌感染生物标记物的改变。细菌学培养共检出细菌22株,大肠埃希菌占54.55% (12/22),对头孢吡肟较为敏感,对亚胺培南、美罗培南全部敏感;屎肠球菌占22.73%(5/22),对万古霉素、利奈唑胺、替考拉宁敏感。结论 在婴幼儿常见的感染部位中,泌尿系感染容易被忽略。而小于6月的患儿更易并发严重脓毒症、脓毒症休克等危重症。因此,以脓毒症为首诊表现的婴幼儿应特别警惕泌尿系感染,尽可能早期明确感染部位,防止漏诊。首诊1小时内给予广谱抗生素治疗,可降低婴幼儿脓毒症的病死率,改善患儿预后。

Objective By analyzing the clinical features, laboratory tests, pathogenic bacteria culture and the treatments of infants and toddlers with urinary tract infection UTI accompanied with sepsis, we aim to guide the further clinical treatments and prevention. Methods We selected 83 cases from January 1, 2014 to December 31, 2016 in our hospital as the research objects which were accepted the diagnosis and treatments of urinary tract infection complicated with sepsis. Its clinical manifestations, laboratory tests, bacteriology examination and treatment prognosis were retrospectively analyzed. Results Among the selected infants and toddlers diagnosed with urinary tract infection complicated with sepsis, male patients were more common. Symptoms of systemic poisoning were observed in the majority especially in the children aging under 6 months, with severe sepsis and septic shock as the first manifestation, while conventional symptoms were not obvious. Biological markers of bacterial infection were significantly changed. In bacterial culture, 22 strains of bacteria were detected, Escherichia coli accounted for 54.55% (12/22), were almost sensitive to cefepime, and all sensitive to imipenem and meropenem; Enterococcus following accounted for 22.73% (5/22), could be more sensitive to vancomycin, linezolid, teicoplanin. Conclusion Urinary tract infection is common in under 3 years old babies. Patients aging under 6 months are more likely to be complicated with severe sepsis and septic shock. Therefore, we should be especially vigilant of the UTI among the babies whose first manifestations appear to be sepsis only. It is important to find out the site of infection as early as possible, in order to prevent misdiagnosis. It is also critical to use broad-spectrum antimicrobial therapy within 1 hour when severe sepsis is diagnosed in order to reduce the mortality of sepsis in infants and improve the prognosis.

目的 了解龙川地区肺炎支原体耐药情况,以便临床合理运用抗生素。方法 收集2014年—2015年间疑似肺炎支原体感染住院小儿患者的咽分泌物标本2 666例,同时作Mp培养及IgM检查,同为阳性者共149例进行耐药性统计分析。结果 在2 666例疑似感染患者中,培养肺炎支原体阳性149例,阳性率为5.59%,学龄前儿童(≤3岁)患者阳性率2.06%,学龄儿童(4～15岁)阳性率9.79% ,学龄儿童感染肺炎支原体与学龄前儿童比较有显著差异(P<0.05)。其中红霉素、阿奇霉素、罗红霉素、克林霉素、依托红霉素、克拉霉素、乙酰螺旋霉、交沙霉素、加替沙星、莫西沙星、环丙沙星、左氧氟沙星、多西环素、米诺环素耐药率分别为2%、12.4%、4%、22% 、2%、1%、80%、44%、2%、15%、10%、1%、61%、44%。冬季感染与在其他季节比较有差异(P<0.05)。结论 阿奇霉素,红霉素为代表大环内脂类抗生素仍可以作为临床一线经验用药,乙酰螺旋霉、交沙霉素耐药率大于40%,不建议作为经验药物使用。喹诺酮类抗生素耐药率一般小于15%,可作为肺炎支原体治疗的第二选择。四环素类抗生素在本地区耐药性高,不建议作为经验药物使用。要加强预防冬季肺炎支原体感染。

目的 总结本地区低龄婴儿侵袭性B族链球菌(GBS)感染的流行病学特点, 为临床预防和诊治提供指导。方法 对2012年1月—2015年12月广州地区两家三甲妇儿专科医院收治的0～89 d低龄婴儿侵袭性GBS感染病例进行回顾性分析。结果 研究期间两院共收治侵袭性GBS感染病例120例,2015年感染病例数为2012年的2.8倍,感染病例的发生无明显季节倾向。早发型感染以败血症合并肺炎(46.3%)为主,围产期多伴有一个或以上的高危因素,死亡率为7.4%;晚发型感染以败血症合并脑膜炎(占42.4%),多以发热为首发症状,其中42%伴有神经系统症状,14.6%遗留神经系统后遗症。结论 广州地区低龄婴儿侵袭性GBS感染病例呈逐年增加趋势,临床应重视新生儿GBS感染的预防,加强感染高风险新生儿的管理,及时诊治,改善预后。

Objective To describe the epidemiological characteristics of invasive group B streptococcal (GBS) infection among infants during the past 4 years in Guangzhou, in order to provide scientific basis for the prevention and control of the disease. Methods Medical records of infants with invasive GBS infection from two tertiary hospitals in Guangzhou from January 2012 to December 2015 were reviewed. Results There were 120 infants with invasive GBS infections during the past 4 years in two tertiary hospitals, the number of patients increased from 2012 to 2015, and the occurrence of infectionshad no obvious seasonal tendencies. Among infants with EOD, the most common syndrome was sepsis complicated pneumonia (46.3%), respiratory sign and at least one of perinatal risk factors were commonly recorded, and the mortality rate was 7.4%. By contrast, a higher proportion of late-onset cases manifested as sepsis associated with meningitis (42.4%), fever was the most common presentation and 42% LOD cases accompanied by neurological symptoms, 14.6% infants had neurological sequelae. Conclusion The number of GBS-infected infants increased during the past 4 years in Guangzhou. Relevant departments should pay attention to the prevention of neonatal GBS infection, strengthen the management of high risk newborns to improve the prognosis.

目的 探讨幽门螺杆菌(HP)感染与不同年龄段健康体检人群中血脂异常发病率的相关性。方法 在健康体检人群中开展¹³C尿素呼气试验及血脂等检测,对比不同年龄段人群中HP感染率,研究HP感染与年龄及血脂异常的相关性。结果 不同年龄段人群之间的HP感染率无差异。HP阳性组的血脂异常患病率在30岁后的每个年龄段内均高于HP阴性人群,在60～69岁阶段两组人群差异最明显,血脂异常的发生率分别为74.29%vs 26.15%。结论 HP的感染与血脂异常相关,HP阳性组人群血脂异常患病率随年龄增高而增高的趋势较HP阴性组更加明显。

目的 探讨幽门螺杆菌(Helicobacter pylori,H.pylori)感染与反流性食管炎(Reflux esophagitis,RE)二者之间的关系。方法 选取 2010年1—12月在我院消化内科门诊就诊,经内镜检查确诊为反流性食管炎的 364 例患者作为研究对象。364 例患者的食管炎程度按洛杉矶标准进行分级,记为相应的 A(156 例)、B(196 例)、C(7 例)、D(5 例) 4 组。内镜下常规取胃窦黏膜组织 2～3 块送病理检查,标本分别行 HE 染色明确胃炎类型、炎症活动度及快速尿素酶实验、改良 Giemsa 染色明确 H.pylori 感染情况等。结果 反流性食管炎患者中以男性多见,平均发病年龄早于女性平均发病年龄[(52.4± 11.6)岁 vs(56.6±12.4)岁,P=0.002];门诊反流性食管炎患者的总体 H.pylori 感染率为 90.9%,以轻度 H.pylori 感染为主,四组的 H.pylori 感染率及感染程度的比较差别无统计学意义(P值分别为 0.419,0.332);反流性食管炎患者以慢性浅表性胃炎、中度活动性炎症为主,四组比较差别无统计学意义(P值分别为 0.146,0.496);H.pylori 阳性、阴性患者的食管炎程度比较差别无统计学意义(P>0.05);不同程度 H.pylori 感 染情况下,患者的食管炎程度比较差别无统计学意义。结论 四组反流性食管炎患者的 H.pylori 感染率及感染程度的比较无差别,H.pylori 阳性患者与阴性患者的食管炎程度比较无差别,不同程度 H.pylori 感染情况下,患者的食管炎程度比较无明显差别。提示 H.pylori 感染与反流性食管炎程度无关。

Objective To explore the relationship between helicobacter pylori infection and reflux esophagitis. Methods 364 patients with reflux esophagitis were enrolled in our hospital from Jan to Dec in 2010.The severity grade of reflux esophagitis was according to Los Angles standard. All the patients received biopsies from gastric antrum,then received pathologic examinations. Results Reflux esophagitis in men was more common, with an average age of onset earlier than the female(52.4±11.6 years vs 56.6±12.4 years,P=0.002);Reflux esophagitis in patients with H.pylori infection rate was 90.9% overall,mainly with mild infection,four groups of H.pylori infection rate and extent of infection was no significant difference (P values were 0.419,0.702);reflux esophagitis in patients with chronic superficial gastritis(CSG),moderate active inflammation based was more common,there was no statistically significant difference in four group(P values were 0.146,0.496). There was no significant difference between H.pylori positive patients and H.pylori negative patients in esophageal mucosal damage(P> 0.05). There was no significant difference in reflux esophagitis with varying degrees of H.pylori infection on the degree of esophagitis. Conclusion Four groups of H.pylori infection rate and extent of infection was no significant difference; there was also no significant difference between H.pylori positive patients and H.pylori negative patients in esophageal mucosal damage. There was no significant difference in RE with varying degrees of H.pylori infection on the degree of esophagitis. Our research showed H.pylori infection had no relationship with degree of RE.

目的 了解中山市7家医院金黄色葡萄球菌感染的临床分布,并对耐药基因进行检测,为临床经验治疗金黄色葡萄球菌感染提供用药及分子生物学依据。方法 收集2015年1月—2015年6月中山市7家医院分离到的金黄色葡萄球菌,使用ATB半自动细菌鉴定及药敏分析仪(法国梅里埃)对分离到的菌株进行鉴定及药敏试验,使用PCR技术对耐甲氧西林金黄色葡萄球菌(MRSA)的耐药基因进行检测。结果 7家医院共分离到89株金黄色葡萄球菌,其中MRSA检出33株,检出率为37.1%。金黄色葡萄球菌主要来源于呼吸内科(32株,36.0%)、骨科(20株,22.5%),主要分离自痰(41株,46.1%),伤口分泌物(16株,18%),对万古霉素、替考拉宁、奎奴普丁/达福普丁、复方新诺明、左氧氟沙星、诺氟沙星具有较高敏感性,MRSA对常用抗菌药物耐药率高于甲氧西林敏感金黄色葡萄球菌。共有32株MRSA检出bla_mecA基因,检出率为97%。结论 MRSA耐药情况较为严峻,临床科室应根据微生物培养报告合理使用抗菌药物。bla_mecA基因在MRSA检出较高,是MRSA主要的耐药机制。

Objective To analyze clinical distribution of Staphylococcus aureus infections from 7 hospitals in Zhongshan city, as well as to provide basis of empirical treatment and molecular biology for Staphylococcus aureus infections. Methods Staphylococcus aureus were collected from January 2015 to June 2015 in Zhongshan city, and then the strains were identified and tested antibiotic susceptibility by using ATB semiautomatic analyzer(Merieux). Resistance gene of methicillin-resistant Staphylococcus aureus(MRSA) was detected by polymerase chain reaction. Results 89 strains of Staphylococcus aureus were isolated from 7 hospitals and with prevalence of 33 strains of MRSA. Of all strains, 32(36.0%) were isolated from respiratory medicine and 20(22.5%) from orthopedics. 41(46.1%) strains of Staphylococcus aureus were isolated from sputum and 16(18.0%) from wound secretion. 89 strains of Staphylococcus aureus had highly susceptibility to vancomycin, teicoplanin, quinupristin/dalfopristin, cotrimoxazole, levofloxacin, norfloxacin. Resistance rates to commonly used antimicrobial drugs of MRSA were significantly higher than methicillin-sensitive. A total of 32 MRSA were detected carrying bla_mecA gene with the detection rate of 97%. Conclusion Clinical departments should be based on microbial culture report for rational use of antibiotics because of MRSA with more serious drug resistance. The gene of bla_mecA is the main mechanism of resistance for MRSA.

目的 探讨女性宫内节育器使用年限及类型与生殖道感染的关系,以降低生殖道感染率。方法 2013年1月—2015年1月于我院门诊检查使用宫内节育器360名女性的临床资料进行回顾性分析,研究节育器使用年限、类型、患者年龄、孕次、是否绝经与生殖道感染的关系。结果 带尾丝组患者的生殖道感染率比不带尾丝组高(P<0.05),无尾丝组生殖道感染率与置器年限无关,差异无统计学意义(P>0.05),带尾丝组生殖道感染率与置器年限有关,差异有统计学意义(P<0.05)。生殖道感染率与与女性年龄及妊娠次数无关,与是否绝经有关,未绝经女性的生殖道感染率较高(P<0.05)。结论 带尾丝的宫内节育器的使用可使生殖道感染率增加,使用年限越长,生殖道感染的发生率越高。

Objective To investigate the associations between different time and types of intrauterine device with female reproductive tract infection in order to provide evidence for reducing infection rate. Methods 360 females using intrauterine device were continually recruited during Jan 2013-Jan 2015 in our hospital, and their clinical data was also collected in the same period. The associations between reproductive track infection and clinical characteristics including service time, types, age, gravidity and menopause status were further analyzed. Results We found that the female using intrauterine device with tail wire, as well as with non-menopause had higher infection risk than those did not have(P<0.05). In addition, service time of intrauterine device was significantly associated with infection risk in those patients using intrauterine device with tail wire. However, there was no any remarkable relevance for age and gravidity with risk of reproductive track infection. Conclusion The use of intrauterine device with tail wire, as well as longer service time, could cause the increased risk of reproductive track infection for females.

目的 探讨系统性红斑狼疮(SLE)患者并发感染的影响因素并提出相应对策。方法 统计2012年1月—2015年12月在风湿免疫科住院的SLE患者,依据是否存在感染分为两组:感染组和非感染组。查电子病历记录感染组患者感染部位、所感染病原体的种类、免疫抑制治疗方案、病程、住院次数、血液生化指标、红细胞沉降率、肝肾功能以及补体C3、C4 水平,分析SLE患者发生感染的危险因素。结果 近三年风湿免疫内科共收治SLE患者302例,合并感染44例,发生感染63例次,感染发生率7.32%,高于全院感染发生率2.82%,差异有统计学意义(P<0.05)。呼吸系统感染有43例次,占68.25%,是患者最常见的感染部位。单因素分析显示,激素的冲击治疗、血红蛋白降低、白蛋白降低和血清肌酐水平异常(P<0.01)及ESR异常(P<0.05)是医院感染的危险因素。结论 SLE患者感染发生率高,免疫抑制剂冲击治疗、有合并症患者更易发生感染。应合理使用免疫抑制剂,密切留意患者感染症状,并定期检测血红蛋白、白蛋白及ESR等各项实验室指标,及时发现感染并进行病原学培养,做到尽早、合理治疗。

目的 观察多西环素联合阿莫西林、泮托拉唑、枸橼酸铋钾治疗幽门螺杆菌(Hp)感染消化性溃疡的临床疗效和不良反应。方法 选取于2013年7月—2015年7月收治的98例Hp感染消化性溃疡患者,根据不同的治疗方式,随机将其分为治疗组和对照组,每组各49例,治疗组患者给予多西环素联合阿莫西林、泮托拉唑、枸橼酸铋钾治疗;对照组给予克拉霉素联合阿莫西林、泮托拉唑、枸橼酸铋钾治疗, 两组患者连续服用10天后,均口服泮托拉唑40 mg,每天1次,总疗程为4周。疗程结束4周后,予胃镜复查和Hp检查,观察两组患者的临床疗效、溃疡愈合率、Hp根除率及不良反应。结果 治疗组与对照组患者的临床效果总有效率分别是95.91％、81.63％;治疗组与对照组患者的溃疡愈合率分别是83.67％、61.22％ ;治疗组与对照组患者的Hp根除率分别是89.79％、65.30％;治疗组患者的临床疗效总有效率、溃疡愈合率和Hp根除率均明显优于对照组,差异均有统计学意义(P<0.05),两组患者不良反应发生率比较,差异无统计学意义(P>0.05)。结论 多西环素联合阿莫西林、泮托拉唑、枸橼酸铋钾治疗Hp感染消化性溃疡疗效显著、溃疡愈合率高、Hp根除率高、且安全无明显不良反应,值得临床广泛推广使用。