目的 调查非重症监护室护士对住院卧床老年患者肺康复的知信行现状,探讨其影响因素。方法 采用自行设计的卧床老年患者肺康复知信行现状调查问卷,对广州市第一人民医院的555 名非重症监护室护理人员进行调查。结果 共回收有效问卷513份。调查对象肺康复知信行总分为（76.01±12.27）分,知识维度、态度维度、行为维度得分分别为（14.09±3.25）、（21.89±3.38）、（40.03±9.87）分。多元回归分析显示,主要影响护士对住院老年卧床患者实施肺康复知信行的因素为护龄、是否参加过肺康复相关培训及科室是否已开展肺康复（P<0.05）。结论 非重症监护室护士对卧床老年患者肺康复的态度积极,行为良好,但知识有待提升。建议开展卧床老年人相关肺康复培训,激励护士主动学习肺康复新理念的积极性和主动性,强化理论联系临床实践,从而提高临床护理质量。

Objective To investigate the knowledge,attitude and practice of non-intensive care unit（ICU）nurses about pulmonary rehabilitation of hospitalized bedridden elderly patients,and to explore the influencing factors．Methods A self-designed questionnaire on the status of knowledge,attitude and practice about pulmonary rehabilitation of bedridden elderly patients was used to investigate 555 non-ICU nurses in our hospital．Results A total of 513 valid questionnaires were collected．The total score of pulmonary rehabilitation was（76.01±12.27）,and the scores of knowledge,attitude and practice were（14.09±3.25）,（21.89±3.38）and（40.03±9.87）,respectively．Multiple regression analysis showed that the main factors affecting nurses' knowledge,attitude and practice in implementing pulmonary rehabilitation for hospitalized elderly bedridden patients were nursing age,whether they had participated in training related to pulmonary rehabilitation and whether pulmonary rehabilitation had been carried out in the unit（P<0.05）．Conclusions Non-ICU nurses have positive attitudes and good practice toward pulmonary rehabilitation for bedridden elderly patients,but their knowledge needs to be improved．It is recommended that training on pulmonary rehabilitation for the bedridden elderly be carried out to motivate nurses to learn new concepts of pulmonary rehabilitation,strengthen the link between theory and clinical practice,and improve the quality of clinical care．

目的 研究探讨重症监护病房(ICU)病原菌的分布及耐药情况,为临床合理使用抗菌药物提供科学依据。方法 回顾性分析2015年ICU住院患者送检细菌分离培养及药敏试验结果。结果 ICU共送检标本1 326份,分离出病原菌554株,其中革兰阴性病原菌462株(83.4%),革兰阳性病原菌48株(8.7%),真菌44株(7.9%)。革兰阴性杆菌前5位依次为鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷伯菌、粘质沙雷菌和大肠埃希菌,且多耐药菌株比例较高。革兰阳性病原菌以金黄色葡萄球菌为主,32株(66.7%),MRSA检出率78.3%(25/32)。结论 加强重症监护病房的细菌及药敏监测,根据病原菌药敏结果指导临床合理使用抗菌药物,控制耐药菌株的产生,预防及控制院内感染及感染暴发。

Objective To investigate the distribution characteristics and drug resistance of pathogenic bacteria in intensive care unit(ICU) and provide scientific evidence for clinically reasonable use of antibiotics. Methods Specimens from hospitalized intensive care unit patients in 2015 were obtained for routine bacterial isolation and culture. Results A total of 554 bacterial strains were isolated from 1326 specimens, in which Gram-negative bacilli accounted for 462 stains (83.4%),Gram-positive cocci accounted for 48 stains (8.7%),and fungi accounted for 44 stains (7.9%). Gram-negative bacilli of the top five were Acinetobacter baumannii,Pseudomonas aeruginosa,Klebsiella pneumoniae, Serratia marcescens and Escherichia coli,and the rate of multiple resistant bacteria was relatively high.Staphylococcus aureus were the main Gram-positive cocci, including MRSA accounted for 78.3%(25/32). Conclusion The monitoring of ICU clinical pathogens and their resistance should be strengthened. It is a great significance to use antibiotics rationally according to the results of susceptibility testing, in order to control the occurrence of resistant bacteria , prevent and control hospital infection and infection outbreak.

目的 探讨颅脑超声在高危新生儿颅内疾病的诊断应用。方法 2010年7月—2014年6月间在我院新生儿重症监护室(NICU)813例新生儿应用百胜Mylab Five型彩色多普勒超声诊断仪,探头频率5～7.5 MHz,进行常规颅脑超声检查。患儿取仰卧位,经前囱作矢状切面及冠状切面按顺序扫查,重点扫查几个标志性切面。头皮留置针遮盖前囟者先予拔除,以保证检查顺利进行。结果 超声异常者85.73%(697/813)。其中颅内出血45.62%(318/697)。早期脑室周围—脑室内出血(PIVH)88.05%(280/318),以I级和II级为多;大脑出血4.40%(14/318);丘脑出血2.22%(7/318);小脑出血1.89%(6/318);蛛网膜下腔出血1.89%(6/318);硬膜下出血1.57%(5/318)。缺氧缺血性脑损伤(HIHB) 36.01%(251/697)。足月儿缺氧缺血性脑病(HIE)67.33%(169/251),轻度HIE52.59%(132/251),中重度HIE14.74%(37/251)。早产儿缺氧缺血性脑病(PVL)33.67%(82/251),化脓性脑膜炎3.30%(23/697)。脑积水15.06%(105/697),以外围性脑积水多见。出院前复查: I度及II度PIVH大部分吸收,III级及IV级PIVH可见侧脑室扩大、脑实质液化性囊腔。大脑出血、丘脑出血、小脑出血均有不同程度吸收,严重者遗留液化性囊腔,蛛网膜下腔出血及硬膜下出血亦有不同程度地吸收。轻度HIE大部分恢复正常,中重度HIE 均有脑室扩大、脑萎缩、液化性囊腔。PVL后期见囊泡性改变。化脓性脑膜炎后期可见硬膜下积液及梗阻性脑积水。结论 颅脑超声便携,可床边,价廉,可重复,具有较实用临床应用价值。适用于新生儿颅内疾病的筛查及诊断。对脑中线部位脑室周围—脑室内出血,对脑积水的程度、预后具有特异性诊断价值。它可提示颅内病变类型、程度、部位及动态监测病情进展情况。对某些颅内病变如蛛网膜下腔出血,硬膜下腔出血,小脑出血则需要结合CT、MRI等其它影像技术,为临床诊断提供依据。

目的 调查重症监护病房(ICU)医院感染的常见细菌分布及耐药性变化,为合理使用抗生素和医院感染的预防控制提供相关科学依据。方法 回顾性分析医院2007—2011年ICU收治的381医院感染患者感染菌株分布特点及耐药性情况。结果 ICU医院感染常见菌株主要来源于痰液标本,占78.2%,其次是血液。381 株临床分离菌中共检出革兰阴性杆菌262 株、革兰氏阳性球菌70例和真菌49例,分别占68. 8%、24.9%和占17.4%。革兰阴性杆菌中鲍氏不动杆菌(24.7%)、肺炎克雷伯氏杆菌(10.8%)、铜绿假单胞菌(9.2%)排前三位。其中除碳青霉烯类药物及抑酶制剂,鲍氏不动杆菌对其余抗菌药物耐药率均＞40%。革兰氏阳性球菌以金黄色葡萄球菌为主。对青霉素、庆大霉素、红霉素的耐药率均＞50%。结论 呼吸道仍是ICU最常见的感染部位。病原菌以革兰阴性杆菌为主,且对常用抗菌药物的耐药率逐渐升高,临床应加强抗菌药物规范使用,避免耐药菌株的产生。

Objective To investigate the distribution and drug resistance of pathogens in intensive care unit(ICU)causing nosocomial infections so as to provide scientific basis for antibiotic adoption and the prevention and control of nosocomial infections. Methods The specimen sources and the clinical distribution of the 381 pathogens isolated from 2007 to 2011 were retrospectively analyzed. The drug resistance was observed in ICU that causing nosocomial infections. Results The sputum was the major specimens source in ICU, accounting for 78.2%. Of the 381 pathogens causing nosocomial infections in ICU, the 262 gram-negative bacilli (68.8%), 70 gram-positive cocci (24.9%),and 49 fungi (17.4) were isolated, Among gram-negative bacilli the top three were acinetobacter baumannii (24.7%), klebsiella pneumonia(10.8%),and pseudomonas aeruginosa (9.2%). The drug resisitance rate of baumannii to antibiotics were more than 40%,beside carbapenem and B-Lactamaseinhibitors. The main gram-positive cocci of causing nosocomial infections was saphylococcus aureus in ICU. The drug resisitance rate of S. aureus to penicillin, erythromycin and gentamicin were higher than 50.0%. Conclusion The main distribution area of nosocomial infections was the respiratory tract and the gram-negative bacilli were the common pathogens in ICU. It was benefit to avoid presenting of drug resistant strain, and antibiotics should be reasonably used in clinic.