目的 探讨维持性血液透析患者症状负担的现状,并分析影响因素。方法 采用一般状况调查表、血液透析患者症状评估量表、慢性病自我效能量表对96名维持性血液透析患者进行调查。结果 维持性血液透析患者症状负担总得分为63.76±46.70,平均每位患者经历14.10±7.91个症状;其中自我效能、原发病、是否进行日常运动、碱性磷酸酶、血清钠是独立影响因素(P＜0.05)。结论 根据影响因素采取针对性的干预措施,有望缓解患者的症状负担。

Objective To explore the symptom burden and evaluate the risk factors in maintenance hemodialysis patients.Methods A total of 96 patients were retrospectively investigated by Karnofsky Performance Status, dialysis symptom index and chronic disease self-efficacy scale.Results The total score of symptom burden in patients was 63.76±46.70. The average experienced symptoms were 14.10±7.91 per patient. The result by multiple regression analysis indicated that self-efficacy, the primary disease, daily exercises, the level of alkaline phosphatase and sodium in serum were independent risk factors for symptom burden in patients.Conclusion Tailored treatments based on risk factors for hemodialysis patients may relieve their symptom burden.

目的 分析基底节区脑出血患者接受神经内镜手术治疗的疗效。方法 将2019年6月—2020年8月接诊且行开颅血肿清除术的33例基底节区脑出血患者作为对照组,将同期接诊且行神经内镜手术的33例基底节区脑出血患者作为观察组,对组间美国国立卫生研究院卒中量表(NIHSS)、独立功能量表(FIM)、日常生活能力(ADL)评分、手术情况、血清水通道蛋白4(AQP4)水平、脑水肿体积、并发症情况展开分析。结果 (1)组间NIHSS、FIM、ADL评分在术前无明显差异,P>0.05;术后,观察组NIHSS评分更低,且FIM、ADL评分更高,P<0.05;(2)观察组骨窗大小(2.53±0.66)cm、切口长度(4.22±0.67)cm、术中失血量(47.58±11.25)mL、手术用时(1.58±0.42)h均少于对照组(10.88±1.13)cm、(11.84±2.31)cm、(149.83±33.76)mL、(2.99±0.63)h,且血肿清除率(88.84±9.62)%大于对照组(75.31±7.24)%,P<0.05;(3)观察组术后1周、术后2周、术后1个月时的AQP4水平、脑水肿体积均小于对照组,P<0.05;(4)观察组发生1例并发症(3.03%),对照组发生7例并发症(21.21%),P<0.05。结论 对基底节区脑出血患者进行神经内镜手术治疗,手术创伤小,可以降低AQP4水平,减少脑水肿体积及并发症,提高生活能力,值得推广。

Objective To analyze the curative effect of neuroendoscopic surgery in patients with basal ganglia intracerebral hemorrhage. Methods From June 2019 to August 2020, 33 patients with basal ganglia intracerebral hemorrhage who received craniotomy and hematoma clearance were selected as the control group, and 33 patients with basal ganglia intracerebral hemorrhage who received neuroendoscopic surgery at the same period were selected as the observation group. NIHSS,FIM and ADL scores,details of the surgery, levels of AQP4, brain edema volume and complications were analyzed. Results (1) There were no significant differences in NIHSS, FIM and ADL scores between the two groups before operation, P＞0.05; after operation, NIHSS score of the observation group was lower, and FIM and ADL scores were higher, P＜0.05. (2) Bone window size of the observation group was (2.53±0.66) cm, incision length was (4.22±0.67) cm, intraoperative blood loss was (47.58±11.25) mL, and operation time was (1.58±0.42) h, which were less than those of the control group [(10.88±1.13) cm and (11.84±2.31) cm, (149.83±33.76) mL, (2.99±0.63) h], and the hematoma clearance rate (88.84±9.62)% was higher than that of the control group (75.31±7.24)%, P＜0.05. (3) The AQP4 level and brain edema volume of the observation group 1 week, 2 weeks and 1 month after operation were lower than those of the control group, P＜0.05. (4) There was one complication (3.03%) in the observation group and seven complications (21.21%) in the control group,P<0.05. Conclusion Neuroendoscopic surgery for patients with basal ganglia cerebral hemorrhage can reduce the level of AQP4, the volume of brain edema and complications, and improve the ability of life, which is worthy of promotion.

目的 探讨糖尿病肾病患者肾功能恶化的危险因素。 方法 采用回顾性队列研究分析山东省立第三医院2017年1月—2020年5月108例患者的临床数据。将病人分为糖尿病肾病肌酐翻倍组和不翻倍组,比较两组间临床数据的变化。结果 糖尿病肾病肌酐翻倍组的BUN、胱抑素C和ACR水平均高于肌酐不翻倍组;eGFR、CO₂、ALB、HGB均低于肌酐不翻倍组,差异有统计学意义(P<0.05)。而UA、GLU、血脂、糖化血红蛋白,糖尿病和高血压病史差异无统计学意义(P>0.05)。相关分析表明血肌酐与BUN、eGFR、胱抑素C、ACR呈正相关;与ALB,HGB和CO₂呈负相关。多元线性回归分析结果显示,eGFR,胱抑素C,ACR, ALB和HGB是糖尿病肾病肾功能恶化的影响因素(P<0.05)。结论 糖尿病肾病除检测肾功能的常规指标外,还可观察ACR、ALB和HGB水平的变化,对判断患者肾功能是否恶化有一定价值。

Objective To investigate the risk factors of renal function deterioration in patients with diabetic nephropathy. Methods Retrospective cohort study was used to analyze the clinical data of 108 patients from January 2017 to May 2020 in the Third Hospital of Shandong Province. Patients were divided into diabetic nephropathy creatinine doubling group and non-doubling group. The changes of clinical data in two groups were compared and the risk factors of renal function deterioration were analyzed. Results The levels of BUN、cystatin C and ACR in the creatinine doubling group were higher than those in the creatinine non-doubling group, and the levels of eGFR、CO₂、ALB、 HGB were lower than those in the creatinine non-doubling group, the differences were statistically significant (P<0.05). However, there were no significant differences in the levels of UA, blood glucose, blood lipid, glycosylated hemoglobin, the history of diabetes and hypertension (P>0.05). The correlation analysis showed that serum creatinine was positively correlated with BUN、 eGFR、cystatin C and ACR and negatively correlated with CO₂、ALB and HGB. The results of multiple regression analysis showed that eGFR、cystatin C、ACR、ALB and HGB were independent influencing factors of renal function deterioration(all P<0.05). Conclusion Diabetic nephropathy can not only notice the routine indexes of renal function, but also observe the changes of ACR、ALB and HGB levels, which has certain value for awareing the renal function deterioration in patients.

目的 探讨高通量透析模式对改善维持性血液透析(MHD)患者β2微球蛋白清除率及高血压的影响。方法 选择2018年9月1日—2018年10月31日期间在广州市增城区新塘医院血液净化中心接受MHD患者40例为实验对象(除外因自身耐受因素长期使用低通量透析患者)。采用随机数表法分两组,每组20例。对照组接受低通量血液透析,观察组接受高通量血液透析。比较两组治疗效果,并记录0个月、3个月、6个月、12个月、18个月治疗前后β2微球蛋白(β2-MG)、全段甲状旁腺激素(iPTH)、心率、血压变化,并对两组心血管疾病情况进行统计。结果 观察组总有效率为95.00%,高于对照组的20.00%(P<0.05);治疗后,观察组β2-MG、iPTH均降低,而3个月后对照组略有升高,观察组[(12.48±2.10)mg/L、(210.13±18.12)ng/L]低于对照组[(30.21±2.37)mg/L、(289.41±17.02)ng/L],观察组治疗3个月、6个月、12个月、18个月的β2-MG清除率高于对照组(P<0.05);与治疗前比较,两组的平均动脉压、收缩压均降低,且观察组低于对照组(P<0.05);对照组各时间点24小时舒张压及收缩压差异无统计学意义(P>0.05);与治疗前比较,观察组24小时舒张压、收缩压治疗后1个月、3个月、6个月、12个月、18个月均降低,且低于对照组(P<0.05);两组患者心血管疾病发生率比较:观察组有1例因急性心肌梗死住院行PCI术;对照组有2例因心力衰竭住院治疗,1例因急性冠脉综合症住院治疗。两组并发症发生率比较P>0.05。结论 高通流量透析模式可有效提高MHD患者的治疗效果,有效清除血液毒素,降低患者的高血压,减少并发症,可在临床推广使用。

Objective To investigate the effect of high flux dialysis mode on the improvement of β2-microglobulin clearance and hypertension in maintenance hemodialysis (MHD) patients. Methods Patients who received MHD at the Blood Purification Center of Xintang Hospital, Zengcheng District, Guangzhou from September 1, 2018 to October 31, 2018 (except for long-term low-flux dialysis patients due to self-tolerance factors)were selected. Random number table method was used to divide the patients into two groups,20 patients in each group. The control group received low flux hemodialysis, and the observation group received high flux hemodialysis. The treatment effects of the two groups were compared, levels of β2-microglobulin (β2-MG), intact parathyroid hormone (iPTH), changes in heart rate and blood pressure, and statistics on cardiovascular disease in the two groups before and after treatment at 3, 6, 12, and 18 months were recorded. Results The total effective rate in the observation group was 95.00%, which was higher than the 20.00% in the control group (P<0.05). After treatment, the levels of β2-MG and iPTH of the two groups decreased, and the observation group [(13.02±2.10) mg/L, (210.13±18.12) ng/L] was lower than the control group [(19.78±2.37) mg/L, (289.41±17.02)ng/L]; the β2-MG clearance rate of the observation group was higher than that of the control group at 3 months, 6 months, 12 months, and 18 months (P<0.05).Compared with that before treatment, the average arterial pressure and systolic blood pressure of the two groups were reduced, and the observation group was lower than that of the control group (P<0.05); the differences between diastolic blood pressure and systolic blood pressure at each time point in the control group were not significant (P>0.05); the 24-hour diastolic blood pressure and systolic blood pressure of the observation group decreased after 1, 3, 6, 12 and 18 months, compared with those before treatment (P<0.05), and were lower than those in the control group (P＜0.05).Comparison of the incidence of cardiovascular disease between the two groups: 1 case in the observation group was hospitalized for acute myocardial infarction; 2 cases in the control group were hospitalized for heart failure and 1 case was hospitalized for acute coronary syndrome; complications incidence in the two groups were compared (P>0.05). Conclusion The high flux dialysis mode can effectively improve the treatment outcomes of MHD patients, effectively remove blood toxins, lower blood pressure, and reduce the incidence of complications. It can be used in clinical practise.

目的 总结一种新的技术在心脏术后纵隔感染的应用经验。方法 回顾性分析2017年2月—2019年6月15日心脏术后发生纵膈感染成人患者,共有5例(1.2%),其中男性4例,女性1例,平均年龄(49±19)岁,平均体质量(70±15)kg,2例为急性A型主动脉夹层,2例为冠心病,1例为感染性心内膜炎合并白塞氏病,患者确诊后出现创面感染重、分泌物多,行VSD(负压封闭引流)进行过渡治疗,待创面清洁、肉芽新鲜后入手术室行清创术,术中4例采用SternaLock胸骨固定系统进行固定,1例因未累及至胸骨后,仅在胸骨前方行清创缝合。结果 4例完全治愈并顺利出院,1例因出现多器官功能衰竭死亡,但伤口愈合良好。结论 通过VSD引流增加了胸骨血流,加速肉芽组织形成,防止感染进一步加重,稳定胸骨,为进一步清创创造了良好的基础,同时运用SternaLock^®胸骨固定系统(8孔型钛板及2.4 mm自钻锁螺钉)进行固定,明显增加了胸骨的稳定性,进一步改善患者预后。

Objective To summarize the application experience of a new technique in mediastinal infection after cardiac operation. Methods A retrospective analysis of adult patients with mediastinal infection after cardiac surgery from February 2017 to June 15, 2019 were taken including a total of 5 cases (1.2%), of which 4 were male and 1 was female, with an average age (49±19) years old, average weight (70±15) kg;2 cases had acute type A aortic dissection, 2 cases had coronary heart disease, 1 case had infective endocarditis with Behcet's disease. After diagnosed, the patients developed severe wound infection and excessive secretion. VSD (vacuum sealing drainage) was performed for transitional treatment. After the wounds were cleaned and the granulation were still fresh, the wounds were for debridement in the operating room. During the operation, 4 cases were fixed with the SternaLock^® plating system, and 1 case was only treated with debridement and suture in front of the sternum because it did not involve the sternum. Results Four cases were cured and discharged smoothly, and 1 case died due to multiple organ failure, but the wound healed well. Conclusion The VSD increased sternum blood flow, which accelerated the granulation tissue formation, further to prevent infection and stable sternum, create a good foundation for further debridement, meanwhile the SternaLock ^® plating system(consists of eight pass since the titanium plate and 2.4 mm drill lock screw) was used for fixation, which significantly increased the stability of the sternum, further improved the prognosis of patients.

目的 儿童流感相关坏死性脑病(influenza-associated necrotizing encephalopathy,IANE)是一种严重的流感并发症,目前缺乏早期诊断预警指标,本文探讨血生化和脑脊液检测在儿童IANE早期预警中的作用,为IANE早期诊断提供预测参考。 方法 回顾分析2016年1月—2020年12月在我院接受诊治的确诊流感并发神经系统并发症的患儿。40例流感相关性脑病(influenza-associated encephalopathy,IAE)和32例IANE患儿纳入研究。采用受试者工作特征曲线(ROC)分析来确定所选变量的预警价值。 结果 与IAE组相比,IANE组丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、肌酐激酶(CK)、乳酸脱氢酶(LDH)、脑脊液乳酸脱氢酶(CSF LDH)、脑脊液蛋白(CSF PRO)均升高,两组差别有统计学意义(P<0.05)。用于区分IAE和IANE的LDH、CSF LDH和CSF PRO的曲线下面积(AUC)分别为0.876、0.853和0.831。LDH>535 U/L预测IANE的敏感度为89.7%,特异度为86.5%。CSF LDH>67 U/L预测IANE的敏感度为82.8%,特异度为73.3%。CSF PRO>0.49 g/L预测IANE的敏感度为73.7%,特异度为76.6%。IANE患儿死亡10例(43.3%),IAE患儿死亡0例(P<0.05)。 结论 IANE组LDH、CSF LDH和CSF PRO明显升高,可作为IANE的早期预警指标。对此类患儿要密切评估,早期预测及干预,减少后遗症及病死率,改善预后。

Objective Influenza-associated necrotizing encephalopathy (IANE) in children is a serious complication of influenza. At present, there is a lack of indicators for early diagnosis and early warning. In this paper, the role of blood biochemical and cerebrospinal fluid detection in early warning of IANE in children is discussed, so as to provide a predictive reference for early diagnosis of IANE. Methods A retrospective analysis was conducted on children diagnosed with influenza and with neurological complications who were treated in our hospital from January 2016 to December 2020. Forty children with influenza-associated encephalopathy (IAE) and 32 children with IANE were included. Receiver operating characteristic curve (ROC) analysis was used to determine the predictive value of the selected variables. Results Compared with IAE group, the levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatinine kinase (CK), lactate dehydrogenase (LDH), cerebrospinal fluid lactate dehydrogenase (CSF LDH) and cerebrospinal fluid protein (CSF PRO) were all increased in IANE group, and the differences between the two groups were statistically significant (P<0.05). The area under curve (AUC) of LDH, CSF LDH and CSF PRO used to distinguish IAE from IANE were 0.876, 0.853 and 0.831, respectively. The sensitivity and specificity of LDH>535 U/L for predicting IANE were 89.7% and 86.5% respectively. The sensitivity and specificity of CSF LDH>67 U/L for predicting IANE were 82.8% and 73.3% respectively. The sensitivity and specificity of CSF PRO＞0.49 g/L in predicting IANE were 73.7% and 76.6%. There were 10 deaths of IANE (43.3%) and 0 death of IAE (P<0.05). Conclusion The levels of LDH, CSF LDH and CSF PRO were significantly increased in IANE group, which could be used as early warning indicators for IANE. For such children, close evaluation, early prediction and intervention should be made to reduce sequelae and fatality rate and to improve prognosis.

目的 探讨四君寿胎汤对地中海贫血孕妇贫血状况的改善效果,以期指导地中海贫血孕妇的中药治疗。方法 选择2019年5月—2020年10月期间我院诊治的200例地中海贫血孕妇,根据随机数字表法将其分为两组,观察组与对照组,各100例,观察组患者给予四君寿胎汤,1剂/d,连续治疗3个月,对照组患者给与安慰剂,1剂/d,连续治疗3个月;治疗前、治疗3个月后,比较两组血液检测指标[血红蛋白(HGB)、红细胞(RBC)、红细胞比容(HCT)、平均红细胞体积(MCV)、平均血红蛋白含量(MCH)]、中医症候积分、肝肾指标[谷丙转氨酶(ALT)、谷草转氨酶(AST)、肌酐(Cre)、尿素(ure)、总胆汁酸(TBA)],记录两组孕妇妊娠结局、新生儿情况并比较。结果 治疗前,两组HGB、RBC、HCT、MCV、MCH比较,差异无统计学意义(P＞0.05);治疗3个月后,两组均升高,且观察组高于对照组(P＜0.05);治疗前,两组食少纳呆、体倦乏力、食后或午后腹胀、大便异常症候积分比较,差异无统计学意义(P＞0.05);治疗结束后,两组症候积分均较治疗前降低,且观察组低于对照组,差异有统计学意义(P＜0.05);治疗前后,两组ALT、AST、TBA、Cre、Ure差异无统计学意义(P＞0.05)。两组胎儿宫内窘迫、宫内生长受限发生率、产妇产后出血率比较,观察组较对照组发生率低,但差异无统计学意义(P＞0.05)。观察组早产发生率较对照组明显下降,差异有统计学意义(P＜0.05);观察组孕妇分娩孕周大于对照组,剖宫产率低于对照组,差异有统计学意义(P＜0.05);两组新生儿窒息率、转PICU率比较,差异无统计学意义(P＞0.05);观察组新生儿出生体重、HGB高于对照组(P＜0.05)。结论 四君寿胎可以改善地中海贫血孕妇的整体贫血状况,对肝肾功能无不良影响,中医证候得到改善,且有利于减少早产发生风险,降低剖宫产率,改善新生儿情况。

Objective To investigate effect of Sijun Shoutai decoction in improving anemia status of pregnant women with thalassemia, and to guide the Chinese medicine treatment of thalassemia in pregnant women in the future. Methods Two hundred pregnant women with thalassemia who were diagnosed in the hospital from May 2019 to October 2020 were divided into observation group and control group randomly, with 100 cases in each group. The observation group was treated with Sijun Shoutai decoction,1 dose/d, with continuous treatment for 3 months. The control group was given placebo,1 dose/d, with continuous treatment for 3 months. The indicators of blood test [hemoglobin (HGB), red blood cell (RBC), hematocrit value (HCT), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH)], TCM symptom scores, hepatic and renal indicators [alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatinine (Cre), urea (Ure), total bile acid (TBA)] were compared between the two groups before and after treatment for 3 months. The maternal pregnancy outcome and neonatal condition in the two groups were recorded and compared. Results There were no statistical difference in the HGB, RBC, HCT, MCV and MCH between the two groups before treatment (P>0.05); after 3 months the indicators above of two groups increased, and those in observation group were higher than those in control group (P<0.05). There were no statistical differences in the symptom scores of poor appetite, fatigue, abdominal distension after eating or after noon and fecal abnormalities between the two groups before treatment (P<0.05). The levels of ALT, AST and TBA in the two groups decreased after treatment for 3 months, while the Cre and Ure increased, but the differences were not statistically significant (P>0.05). There were no statistical differences in the rates of intrauterine fetal distress, intrauterine growth restriction, and postpartum hemorrhage between the two groups (P>0.05), though the results of observation group were lower than control group.The rate of premature birth was lower than that of control group(P<0.05) ; the gestational week of observation group was more than control group, and the cesarean section rate of observation group was lower than that of control group (P<0.05). There were no statistical differences in the rates of neonatal asphyxia and transfering to PICU between the two groups (P>0.05); the neonatal birth weight and HGB in observation group were higher than those in control group (P<0.05). Conclusion Sijun Shoutai decoction in the treatment of pregnant women with thalassemia can improve anemia status, with no adverse effect on liver or kidney function, improve TCM syndrome, reduce the risk of premature birth,reduce the rate of cesarean,and improve the neonatal condition.

目的 探讨血培养分离菌的分布特点及耐药性,为临床科室诊治血流感染疾病和控制感染提供重要的参考依据。方法 收集某院2016—2020年血培养阳性样本,采用细菌鉴定和药敏分析系统检测,用WHONET 5.6软件进行病原菌分布特点及药敏结果的整理分析。结果 从血培养阳性标本分离出非重复菌3 424株,主要来自老年病科、危重症监护室、急诊留观室等。其中革兰阴性菌1 873株,常见有大肠埃希菌、肺炎克雷伯菌、铜绿假单胞菌等。近五年超广谱β-内酰胺酶革兰阴性耐药菌呈缓慢上升趋势,其余耐药菌变化趋势不大。革兰阴性菌对头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、头孢他啶、头孢吡肟、庆大霉素、妥布霉素、阿米卡星等总体耐药率均＜30%。革兰阳性菌1 328株,主要是葡萄球菌属,对达托霉素、替加环素均无耐药,对利奈唑胺、万古霉素、替考拉宁耐药率处于较低水平,对复方新诺明和克林霉素等的耐药率近五年呈缓慢下降趋势。结论 血流感染主要常见分离菌为肠杆菌属和葡萄球菌属,临床应重视早期规范血培养和药敏结果,科学合理规范使用抗菌药。

Objective To investigate the distribution characteristics and drug resistance of isolates from blood culture, and to provide important reference for the diagnosis and treatment of bloodstream infection and infection control in clinical practice. Methods Positive blood culture samples of a hospital from 2016 to 2020 were collected and detected by bacteria identification and drug sensitivity analysis system. The distribution characteristics of pathogenic bacteria and drug sensitivity results were analyzed by WHONET 5.6 software. Results A total of 3 424 non-repeating strains were isolated from positive blood culture specimens, which were mainly from geriatrics department, critical care unit, emergency observation room, etc.Among them, 1 873 strains of Gram-negative bacteria were found, including Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa. In recent five years, the extended-spectrum beta-lactamases Gram-negative drug resistant bacteria was slowly increasing, while other drug resistant bacteria showed little change. The overall drug resistance rates of Gram-negative bacteria to cefoperazone/sulbactam, piperacillin/tazobactam, ceftazidime, cefepime, gentamicin, tobramycin and amicacin were all less than 30%. There were 1 328 Gram-positive strains, mainly Staphylococcus, showed no resistance to datoromycin and tegacycline, and the resistance rates to linezolid, vancomycin and teicolanin were at a low level, while the resistance rates to cotrimoxazole and clindamycin showed a slow declining trend in recent five years. Conclusion Enterobacteria and Staphylococcus were the most common isolates of bloodstream infection. In clinical practice, attention should be paid to the early blood culture and drug sensitivity results, and the antimicrobial drugs should be used scientifically and rationally.

目的 探究序贯器官衰竭评分(sequential organ failure assessment,SOFA)联合可溶性程序性死亡因子-1(soluble programmed death-1,sPD-1)水平对脓毒症患者的预后影响。方法 选我院2019年3月—2021年3月期间86例脓毒症患者为研究对象,依据其预后情况(28 d转归)分为生存组(59例)、死亡组(27例),记录两组患者sPD-1、炎症细胞因子水平、SOFA评分及急性生理学与慢性健康状况评价系统Ⅱ(APACHEⅡ)评分情况,分析28 d死亡危险因素,并以ROC曲线分析SOFA+sPD-1对脓毒症患者预后评估价值。结果 死亡组年龄、C反应蛋白、降钙素原、sPD-1水平及SOFA、APACHEⅡ评分均较生存组高(P＜0.05);经Logistic回归分析,sPD-1、SOFA、APACHEⅡ为28 d死亡脓毒症患者独立预测因素(P＜0.05);联合预测后,SOFA+sPD-1的ROC曲线下面积最大,为0.862,敏感度、特异度分别为88.89%、88.14%。结论 在对脓毒症患者预后评估中,sPD-1、SOFA评分均为28 d病死独立预测因素,且SOFA+sPD-1对脓毒症患者转归预测能力更为理想。

Objective To explore the effect of sequential organ failure assessment (SOFA) combined with soluble programmed death factor-1 (sPD-1) level on the prognosis of patients with sepsis. Methods A total of 86 patients with sepsis in our hospital from March 2019 to March 2021 were selected and divided into survival group (59 cases) and death group (27 cases) according to their prognosis (28-day outcome). The levels of sPD-1, inflammatory cytokines, SOFA and APACHEⅡ scores of two groups were recorded. The risk factors of 28-day mortality were analyzed. The prognostic values of SOFA+sPD-1 in patients with sepsis were analyzed by ROC curve. Results Age, C-reactive protein (CRP), procalcitonin (PCT) and sPD-1 levels and SOFA, APACHEⅡ scores of death group were higher than those of survival group (P＜0.05). By Logistic regression analysis, sPD-1 level, SOFA and APACHEⅡ scores were identified as independent predictors of 28-day death in patients with sepsis (P＜0.05). After combining prediction, the area under the ROC curve of SOFA+sPD-1 was the largest (0.862), and the sensitivity and specificity were 88.89% and 88.14% respectively. Conclusion In the prognosis evaluation of patients with sepsis, both sPD-1 level and SOFA score were independent predictors of 28-day mortality, and SOFA+sPD-1 was more effective in predicting the prognosis of patients with sepsis.

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.