目的 统计洛阳市涧西区各作业场的职业病危害因素,分析职业病发生的主要原因,并探讨具体防控策略。方法 收集洛阳市涧西区内2021年1月—2022年12月期间针对各作业场的职业病危害因素监测信息,录入Excel 2010进行数据统计;随机抽取辖区内200名重点职业从业人员,开展回顾性分析,结合职业健康检查结果,将确认存在职业病的115名从业人员列为病例组,其余未发生职业病的85名从业人员列为对照组,比较2组一般资料、临床资料,经统计学单因素、Logistic多因素回归分析归纳可导致职业病发生的影响因素,结合分析结果,探讨具体防控措施。结果 针对辖区内15家厂矿企业,2021年共设立584个监测点,共测得68处锰及其化合物危害、48处矽尘危害、4处苯及其苯系物危害、12处噪声危害,超标率为22.60%（132/584）;2022年共设立1 575个监测点,共测得158处粉尘危害、154处锰及其化合物危害、10处矽尘危害、13处噪声危害,超标率为21.27%（335/1 575）;单因素分析结果显示,2组从业人员的年龄、工作年限、职业类型、体检频率、体检结果等比较差异均存在统计学意义;Logistic多因素回归分析显示,年龄≥50岁,工作年限≥10年,从事制造业、采矿业,未规律体检,血常规异常,免疫力差,X线胸片异常,双耳高频听力阈值≥40 dB均是发生职业病的重要原因（均P<0.05）。结论 洛阳市涧西区的职业危害因素以粉尘、锰及其化合物为主,高龄、工作年限长的制造业、采矿业人员发生职业病的风险相对较高,优化职业病防治措施并规范上述重点人群的职业健康体检能实现对职业病的有效防控。

Objective To analyze the occupational disease hazards in various workplaces in Jianxi District,Luoyang City,and to analyze the main causes of occupational disease occurrence,explore specific prevention and control strategies．Methods Monitoring information on occupational disease hazards in various workplaces within the jurisdiction from January 2021 to December 2022 was collected,Excel 2010 was used for data statistics．Two hundred key occupational employees within the jurisdiction were selected randomly for retrospective analysis．Based on the results of occupational health examinations,115 employees confirmed to have occupational diseases were included in the case group,while 85 employees who did not have occupational diseases were included in the control group．General and clinical data of the two groups were compared,and the influencing factors that could lead to the occurrence of occupational diseases were summarized through statistical single factor and multivariate logistic regression analysis． Combined with the analysis results,specific prevention and control measures were discussed．Results For 15 factories and mining enterprises within the jurisdiction,a total of 584 monitoring sites were established in 2021,and a total of 68 manganese and its compound hazards,48 silica dust hazards,4 benzene and its benzene series hazards,and 12 noise hazards were measured,which the exceeding rate was 22.60%（132/584）．In 2022,a total of 1 575 monitoring sites were established,with a total of 158 dust hazards,154 manganese and its compounds hazards,10 silica dust hazards,and 13 noise hazards detected,which the exceeding rate was 21.27%（335/1 575）．The results of statistical univariate analysis showed that there were certain differences in the age,years of work,occupational type,frequency of physical examinations,and results of physical examinations between the two groups of employees．Multivariate logistic regression analysis showed that age≥50 years old,working experience≥10 years,engaged in manufacturing and mining industries,irregular physical examinations,abnormal blood routine,immune differences,chest X-ray abnormalities,and binaural high-frequency hearing threshold≥40 dB were all important reasons for the occurrence of occupational diseases．Conclusions The occupational hazards in this jurisdiction are mainly dust,manganese,and their compounds．The risk of occupational diseases among elderly manufacturing and mining workers with long working years is relatively high．Optimizing occupational disease prevention and control measures and standardizing occupational health examinations for the above-mentioned key populations can achieve effective prevention and control of occupational diseases．

目的 分析高龄呼吸道感染患者病原菌检测结果及耐药性情况,总结高龄呼吸道感染患者抗菌药物的合理用药经验。方法 对我院2018年1月—2020年12月收治的784例高龄呼吸道感染患者痰液标本进行病原菌培养及药敏试验,统计分析检测结果。结果 701株病原菌中,革兰阴性(G-)菌、革兰阳性(G+)菌和真菌分别检出497株、136株和68株,分别占70.90%、19.40%和9.70%。G-菌以肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌和奇异变形杆菌为主,分别占21.97%(154株)、18.97%(133株)、14.98%(105株)和7.13%(50株),G+菌以金黄色葡萄球菌为主,占11.27%(79株)。G-菌耐药性前五位依次为氨苄西林、哌拉西林、复方磺胺甲噁唑、头孢唑啉和头孢他啶,耐药率依次为95.96%、85.11%、79.88%、77.06%和52.92%。G+菌耐药性前五位依次为青霉素、氨苄西林、红霉素、环丙沙星和复方磺胺甲噁唑,耐药率依次为95.59%、89.71%、84.56%、80.15%和75.00%。结论 高龄呼吸道感染患者病原菌构成以肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌、奇异变形杆菌和金黄色葡萄球菌为主,G-菌对氨苄西林、哌拉西林、复方磺胺甲噁唑、头孢唑啉和头孢他啶耐药最强,G+菌对青霉素、氨苄西林、红霉素、环丙沙星和复方磺胺甲噁唑最强,且呈多重耐药特征,加强临床耐药性监测有助于指导合理用药。

Objective To analyze the test results and drug resistance of pathogenic bacteria in elderly patients with respiratory tract infections, and summarize the rational use of antibiotics in elderly patients with respiratory tract infections. Methods The sputum samples of 784 elderly patients with respiratory tract infections admitted to our hospital from January 2018 to December 2020 were collected for pathogen culture and drug sensitivity test, and the test results were statistically analyzed. Results Among 701 strains of pathogenic bacteria, 497 strains were Gram-negative (G-) bacteria (70.90%), 136 strains were Gram-positive (G+) bacteria (19.40%) and 68 strains were fungi (9.70%). G-bacteria were mainly Klebsiellapneumoniae, Pseudomonas aeruginosa, Escherichia coli and Proteus mirabilis, accounting for 21.97% (154 strains), 18.97% (133 strains), 14.98% (105 strains) and 7.13% (50 strains). G+bacteria were mainly Staphylococcus aureus, accounting for 11.27% (79 strains). The top five antibiotics which G-bacteria resisted were ampicillin, piperacillin, compound sulfamethoxazole, cefazolin and ceftazidime.The resistance rates were 95.96%, 85.11%, 79.88%, 77.06% and 52.92%,respectively. The top five antibiotics which G+bacteria resisted were penicillin, ampicillin, erythromycin, ciprofloxacin and compound sulfamethoxazole, and the drug resistance rates were 95.59%, 89.71%, 84.56%, 80.15% and 75.00%, respectively. Conclusions The pathogenic bacteria in elderly patients with respiratory tract infections were mainly Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli, Proteus mirabilis and Staphylococcus aureus. G-bacteria resisted ampicillin, piperacillin,compound sulfamethoxazole, cefazolin and ceftazidime the most. G+bacteria were most resistant to penicillin, ampicillin, erythromycin, ciprofloxacin and compound sulfamethoxazole, and were characterized by multi-drug resistance.Enhancing bacterial resistance monitoring helps guiding the rational use of drugs.