目的 探讨分析莫西沙星对2型糖尿病合并肺部感染患者内皮素及降钙素基因相关肽的影响。方法 回顾性分析2015年1月—2016年1月来我院就诊并确诊为2型糖尿病合并肺部感染的84例患者的临床资料,根据治疗方案将其分为对照组和观察组,每组各42例。对照组患者给予常规治疗,观察组患者在对照组的治疗基础上予以莫西沙星治疗。观察两组患者治疗后内皮素以及降钙素基因相关肽的变化。结果 ①观察组总有效率(92.86%)优于对照组(78.57%),两组患者间总有效率的比较有统计学意义(P<0.05);②两组患者治疗前ET、CGRP水平无差异(P>0.05)。治疗后,观察组ET水平低于对照组,CGRP水平高于对照组(P<0.05)。结论 临床应用莫西沙星治疗2型糖尿病合并肺部感染具有明显的临床疗效,值得临床推广应用。

目的 研究和分析外科Ⅲ类手术切口术后感染的危险因素,达到进一步预防外科Ⅲ类手术切口术后感染的目的。方法 研究对象为我科2014年1月—2016年12月普外科的1 816例Ⅲ类手术切口患者,以术后是否发生切口感染为因变量,以性别、年龄、是否切口贴用医用薄膜、切口是否碘伏冲洗等相关因素为自变量,进行Logistic回归分析,统计分析外科Ⅲ类手术切口术后发生感染的危险因素。结果 1 816例外科Ⅲ类手术切口中,术后发生切口感染有218例,切口感染率为12%。单因素分析显示,8项影响因素与Ⅲ类手术切口术后感染具有相关性(P﹤0.01),对具有统计学意义的8影响因素进行多因素Logistic回归分析,结果显示手术切皮前应用薄膜保护切口、术后切口碘伏冲洗及合理应用抗生素为切口感染保护因素(P﹤0.01),而患者年龄、全麻、急诊手术、输血及住院时间为切口感染独立危险因素(P﹤0.01)。结论 手术皮肤切开前应用医用薄膜、关腹后碘伏冲洗伤口对降低Ⅲ类手术切口术后感染发生率有一定效果,值得临床推广。

Objective: To research and analyze the risk factor which lead to type Ⅲ operation incision infection,and prevent the incision infection.Methods: The clinical data of 1816 typeⅢoperation incision patients from the general surgery department during 2001-2016,With incision infection serving as a dependent variable, gender, age, using medical films, rinsing the incision with iodophor after the abdomen closing and other factors as independent variables, single factor analysis and logistic regression analysis were used to identify risk factor for typeⅢoperation incisions.Results: From 1816 typeⅢoperation incision patients,218 patients suffered from incision infection with a infection rate of 12%,Single factor analysis showed that 8 factors had significant effects on infection of type Ⅲ operation incision(P<0.01). Logistic regression analysis showed that there were 8 related factors out of 9 factors,and age,anesthesia,blood transfusion,the days of hospitalization and emergency surgery were possible independent risk factors of incision infection(P<0.01), and the critical pathway,using medical films,rinsing the incision with iodophor after the abdomen closing,reasonable use of antibiotics were protective factors against incision infection(P<0.01),while age,anesthesia,blood transfusion,the days of hospitalization and emergency surgery were possible independent risk factors of incision infection(P<0.01).Conclusion: Using medical films before the skin incising, rinsing the incision with iodophor after the abdomen closing can reduce the rate of incision infection postoperation, it is worthy of clinical promotion.

目的 探讨揭阳地区急性下呼吸道感染住院患儿病毒病原学特点。方法 对2 125例急性下呼吸道感染患儿应用直接免疫荧光法(DIF)进行A型流感病毒(甲型流感病毒IFA)、B型流感病毒(乙型流感病毒IFB)、呼吸道合胞病毒(RSV)、腺病毒(AdV)、副流感病毒1(PIVⅠ)、2(PIVⅡ)和3型(PIVⅢ)进行病毒学检测。结果 2 125例患儿鼻咽部分泌物标本中有538例检测出至少1种病毒,总阳性率25.3％,其中RSV 阳性率(19.7%)明显高于其他病毒,具有统计学意义。春、夏、冬季的RSV阳性率大致相当,明显高于秋季。婴儿期组RSV阳性率(27.2%)最高,幼儿期组(18.7%)次之,均显著高于学龄前期、学龄期,后2组阳性率无统计学差异,青春期组未检出RSV。结论 病毒是急性下呼吸道感染的重要病原体,而其中又以RSV为著,RSV感染具有显著的季节性和年龄特征性。

Objective To investigate the viral etiology feature in hospitalized children with acute lower respiratory infection in Jieyang area. Methods A total of 2 125 children with acute lower respiratory tract infection were screened by direct immune fluorescence assay (DIF) for influenza virus A (IFA), influenza virus B (IFB), respiratory syncytial virus (RSV), adenovirus (AdV), parainfluenza virus I (PIV Ⅰ), PIV Ⅱ and PIV Ⅲ. Results In 2 125 cases of nasopharyngeal secretory specimens, 538 cases were detected at least one kinds of viruses. The total positive rate was 25.3%, of which the positive rate of RSV (19.7%) was higher than that of other viruses. The positive rate of RSV was similar in spring, summer and winter, much higher than that in autumn.The positive rate of RSV in infancy group (27.2%) was the highest,then the second was the toddler's age(18.7%), both of which were higher than that in preschool age group and school age group. There was no significant difference in the positive rate between preschool age group and school age group. In addition, RSV was not detected in the adolescence group. Conclusion Virus is an important pathogen of acute lower respiratory tract infection. The most common virus is RSV, infection of which has seasonal and age characteristics.

目的 研究血清胃蛋白酶原(PG)、胃泌素17(G-17)水平和HP感染与慢性萎缩性胃炎(CAG)和肠上皮化生的相关性。方法 连续选择2016年6月—2017年6月于我院诊断慢性非萎缩性胃炎60例,CAG 40例和肠上皮化生40例,比较患者血清PGI、II和PGI/II,G-17水平以及HP阳性感染率。结果 CAG和肠上皮化生患者PGI和PGI/II低于非萎缩性胃炎患者,而PGII水平升高,G-17水平和HP阳性感染率也增加,差异均有统计学意义(P＜0.05)。结论 血清PG、G-17水平和HP感染是CAG和肠上皮化生的重要机制。

Objective To study correlation in serum pepsinogen(PG),gastrin 17(G-17) levels and helicobacter pylori(HP) infection and chronic atrophic gastritis(CAG), intestinal metaplasia. Methods A total of 60 cases as non-CAG,40 of CAG and other 40 of intestinal metaplasia from June 2016 to June 2017 were consecutives enrolled, then to compare differences of serum PGI,II,PGI/II,G-17 levels, HP infection positive rate. Results The PGI and PGI/II values in patients with CAG and intestinal metaplasia were both lower than non-CAG patients, while PGII level got more,G-17 level and HP infection positive rate were higher too(P＜0.05). Conclusion The expressions of serum PG,G-17 and HP infection may be the important mechanism to CAG and intestinal metaplasia.

目的 探讨幽门螺杆菌(Helicobacter pylori,Hp)感染与儿童过敏性紫癜(Henoch-Schnlein purpura,HSP)的相关性及预后关系,为临床疾病诊治提供一定依据。方法 随机选取2016年12月—2018年2月于我院就诊并经确诊的HSP儿童患者90例为观察组,另选取同期于我院就诊行体检的健康儿童90例为对照组,比较两组患者Hp感染情况。根据Hp感染情况及治疗方式将观察组分为A、B、C三组,其中A组(29例)为Hp(-)组,行常规治疗;B组(31例)为Hp(+)组,行常规治疗;C组(30例)为Hp(+)组,行常规治疗联合抗Hp治疗,比较三组患者治疗疗效。结果 观察组患者Hp感染阳性率高于对照组,差异有统计学意义(P<0.05);合并腹部症状的HSP患者Hp感染阳性率高于不合并腹部症状的HSP患者,差异有统计学意义(P<0.05);B组患者治疗有效率低于A组,C组患者治疗有效率高于B组,差异有统计学意义(P<0.05)。结论 Hp感染可能是HSP发病的原因之一,其腹部症状与Hp密切相关,根除Hp治疗可改善HSP患者预后。

Objective To explore the correlation between helicobacter pylori infection and children allergic purpura disease and its prognosis, and provide some basis for clinical diagnosis and treatment. Methods A total of 90 children with allergic purpura who were treated in our hospital from December 2016 to Feb 2018 were randomly selected as observation group. 90 healthy children who were admitted to our hospital for physical examination during the same period were selected as the control group, and the Hp infection in the two groups was compared. According to Hp infection and treatment, the observation group was divided into three groups: A, B and C, among which group A (29 cases) was Hp (-) group, and routine treatment was performed.Group B (31 cases) were Hp (+) group, and routine treatment was performed. group C (30 cases) were Hp (+) group, and conventional treatment combined with anti-hp treatment were performed. We compared three groups of .curative effects. Results The positive rate of Hp infection in the observation group was higher than that in the control group, and the difference was statistically significant (P<0.05).The positive rate of Hp infection in HSP patients with abdominal symptoms was higher than that in HSP patients without abdominal symptoms, and the difference was statistically significant (P<0.05). The effective rate of treatment in group B was significantly lower than that in group A, and the effective rate of treatment in group C was higher than that in group B, and the difference was statistically significant (P<0.05). Conclusion Hp infection may be one of the causes of HSP, and its abdominal symptoms are closely related to Hp, and the eradication of Hp treatment would improve the prognosis of HSP patients.

目的 对比纤维支气管镜肺灌洗治疗和常规治疗重症肺部感染患者的临床疗效。方法 将2015年5月—2017年4月间在我院接受治疗的92例重症肺部感染患者作为研究对象,按照随机数字表分为实验组(n=46)和对照组(n=46),其中对照组采用常规对症治疗,实验组加以实施纤维支气管镜肺灌洗治,治疗后,纤支镜气道灌洗检测两组患者的血气分析指标变化,采用ELISA测定血清炎症因子含量,及放射免疫法测定血清应激激素含量。结果 经比较,实验组患者治疗后的PaO₂、SaO₂、PaCO₂高于对照组患者(P<0.05);实验组患者的血清炎症因子hs-CRP、IL-6、IL-8水平低于对照组患者(P<0.05);此外,实验组患者的Ang-II、NE、Cor含量低于对照组患者(P<0.05)。结论 纤支镜气道灌洗可有助于改善重症肺部感染患者的肺通气功能,降低全身炎症应激程度,促进疾病康复。

Objective To compare the clinical efficacy of bronchoalveolar lavage and conventional treatment in patients with severe pulmonary infection. Methods 92 patients with severe pulmonary infection treated in our hospital from May 2015 to April 2017 were selected as research objects. They were randomly divided into experimental group (n=46) and control group (n=46). The control group was treated with conventional symptomatic treatment, The experimental group implemented bronchoscopy lung lavage treatment. After treatment, blood gas bronchoscopic airway lavage in two groups were detected with analysis indexes. Serum inflammatory factors were determined by ELISA, and the serum levels of stress hormones were determined by radioimmunoassay. Results After the treatment, the PaO₂, SaO₂ and PaCO₂ in the experimental group were higher than those in the controlgroup(P<0.05). The levels of serum inflammatory factors hs-CRP, IL-6、IL-8 in the experimental group were lower than those in the control group (P<0.05); in addition, the levels of Ang-II, NE and Cor in the experimental group were lower than those in the control group(P<0.05). Conclusion Bronchoscopy airway lavage may help to improve the pulmonary ventilation function of patients with severe pulmonary infection, reduce the degree of systemic inflammatory stress, and promote disease recovery.

目的 分析于剖宫产产妇围手术期实施针对性护理对其切口感染率及不良情绪的影响。方法 选取2015年6月—2016年4月于我院择期行剖宫产术的102例产妇,通过随机数表法分为观察组与对照组,各51例。给予对照组常规护理,在此基础上观察组给予针对性护理干预。对比两组术后恢复情况、护理前后疼痛评分(VAS)、抑郁评分(SDS)及焦虑评分(SAS)变化情况,并统计两组并发症发生率、护理满意度。结果 观察组肛门排气时间、切口愈合时间、24 h睡眠时间、住院时间、下床活动时间均少于对照组,差异有统计学意义(P＜0.05);护理前两组SAS评分、SDS评分、VAS评分间无明显差异(P＞0.05),经护理干预,观察组SAS评分、SDS评分、VAS评分低于对照组,差异有统计学意义(P＜0.05);两组切口感染率、并发症发生率(1.96%、7.84%)低于对照组(15.69%、31.37%),差异有统计学意义(P＜0.05);两组护理满意度对比,观察组(98.04%)高于对照组(82.35%),差异有统计学意义(P＜0.05)。结论 给予剖宫产围术期产妇针对性护理疗效确切,可缓解不良情绪,减轻疼痛感,促使机体功能及早康复,减少切口感染与并发症发生。

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。