高血压是我国重点防治的心血管疾病, 血压的控制率备受关注。在一些血压控制不良的患者中睡眠呼吸暂停是导致顽固性高血压的重要原因。以睡眠过程中反复、频繁出现呼吸暂停和低通气为特点的睡眠呼吸暂停低通气综合征( sleep apneahypopnea syndrome, SAHS) 自20 世纪80 年代以来也受到广泛关注, 临床和基础研究取得了迅速发展。目前, 多项临床、流行病学和基础研究证实SAHS可以导致和/ 或加重高血压, 与高血压的发生发展密切相关。
Objective To study the catheter-related infection (CRI) in cancer patients treated with central venous catheterization. Methods A prospective study with 196 cancer patients was conducted to analyze the types of catheter-related infection and pathogen, as well as the relationship between CRI and the following factors: insert location, gender, age, remained time, or bone marrow suppression. Results Of the total 196 cases, 16 cases were diagnosed as CRI and the CRI rate was 8.2%. The types of CRI were five cases of pathogen colonization, four cases of insert location infection and seven cases of catheter-related bloodstream infection. Of the total 244 specimens, 20 were positive including 7 pathogenic bacteria in either Gram positive or Gram negative types, the dominating pathogens were staphylococcus aureus, staphylococcus epidermidis, acinetobacter baumannii and klebsiella pneumoniae. CRI was related to both insert location and age which were both the independent risk factors. Conclusion The concept of prevention should be set up, and the comprehensive measures should be taken to reduce CRI, such as choosing an appropriate insert location and complying with a strict catheter insert standard.
Objective To investigate the infection rates of toxin-producing Clostridium difficile and Candida albicans in patients with antibiotic-associated diarrhea (AAD) in West China Hospital of Sichuan University, analyze their clinical characteristics and make a survey of the therapy. Methods Fecal specimens of AAD patients were collected in West China Hospital of Sichuan University from September 2014 to January 2015. Toxin-producing Clostridium difficile and Candida albicans were identified by polymerase chain reaction and then clinical data of cases was collected and analyzed. Results Twenty-eight patients with Clostridium difficile infection were detected from the 126 AAD patients, 20 patients (15.9%) in whom were infected with toxin-producing Clostridium difficile. Type A+B+, type A-B+, and type A+B- accounted for 35.7% (10/28), 35.7% (10/28) and 28.6% (8/28), respectively. Fifty-four patients (42.9%) with yeast infection were detected. The predominant isolate was Candida albicans, accounting for 20.6% (26/126), and the others were Candida glabrata (n=11), Candida tropical (n=10), Candida parapsilosis (n=3), Saccharomyces cerevisiae (n=2), Pichia pastoris (n=1), and Kodamaea ohmeri (n=1). Toxin-producing Clostridium difficile strains and Candida albicans strains were both isolated from 3 patients (2.4%). The main antibiotics used in AAD ppatients were penicillins, carbapenems, third generation cephalosporins, and fluoroquinolones. AAD patients were all with underlying diseases at different degrees. The main treatments were probiotics and montmorillonite powder. Conclusion The relatively high infection rates and complicated factors of AAD indicate that much more attention needs to be paid to the diagnosis and therapy of AAD by the clinical doctors.
Objective Secondary osteoporosis is very common in patients with primary osteoporosis. Diabetes is a known cause of secondary osteoporosis. While type I diabetes has been clearly linked with diabetic osteoporosis, the effect of type II diabetes on bone health is controversial.Methods In the present study, we investigated the associations between type II diabetes and osteoporosis as well as fractures at different skeletal sites in Women’s Health Initiative participants.Results Common risk factors such as age, race, BMI, HRT use, and the history of fractures were significantly associated with osteoporosis and fractures in this study population. Diabetic women appeared to have a decreased risk of osteoporosis although it no longer remained significant after adjusting for other risk factors (crude HR=0.78, 95%CI 0.61 to 0.99; adjusted HR=0.93, 95%CI 0.73 to 1.19). The impact of diabetes on fractures varied at different body sites. There was a significant increase of risk of hip fracture (HR=2.54, 95%CI 1.14 to 5.66), but not spine fracture (HR=1.71, 95%CI 0.81 to 3.60) and arm fracture (HR=0.92, 95%CI 0.48 to 1.76) among the women with diabetes. Although the overall risk of fractures in diabetic women did not differ significantly from non-diabetic women (HR=1.37, 95%CI 0.89 to 2.09), the difference had a two-fold increase and was statistically significant after 2,000 days (HR=2.01, 95%CI 1.21 to 3.35), indicating a different hazard at different stages of diabetes.Conclusion Our findings suggest that type II diabetes may not be clearly associated with osteoporosis, it increases a site-specific fracture risk at least in the hip. In addition, the overall fracture risk appears to increase in a time-dependent manner.
Objective To assess the value of procalcitonin ( PCT) in serum and percentage of infected cells ( PIC) in bronchoalveolar lavage fluid ( BALF) for the diagnosis of early ventilator-associatedpneumonia ( VAP) .Methods A prospective observational study was conducted in a teaching hospital. The patients consecutively admitted to the intensive care unit from January 2011 to June 2012, who received mechanical ventilation for more than 48h and clinically suspected for VAP, were recruited in the study.Patients with infection outside the lungs and previous diagnosed infection were excluded. PCT was detected and bronchoalveolar lavage was performed in the day when VAP was diagnosed. BALF cells were stained by May-Grunwald Giemsa ( MGG) for counting 100 phagocytic cells and calculating infected cells ( ICs )percentage.Results 76 of all 421 patients were enrolled in this study, 64 of which were diagnosed, 12 were under-diagnosed. The PCT [ ( 3. 48 ±1. 46) ng/mL vs. ( 1. 53 ±0. 60) ng/mL] and PIC [ ( 3. 11 ±1. 47) % vs. ( 1. 08 ±0. 29) % ] were significant higher in the patients with VAP. The threshold of 2 ng/mL of PCT and 2% of PIC corresponded to sensitivity of 78. 12% and 78. 12% , and specificity of 75. 00% and 91. 67% , respectively. The area under the receiver operating characteristic ( ROC) curve was 0. 87 ( 95% CI 78. 9%-95. 9% ) and 0. 874 ( 95% CI 79. 2% -94. 9% ) , respectively. The area under ROC curve was 0. 979, and the sensitivity was 97. 36% , specificity was 97. 36% when the two cutoff values were both achieved. Conclusion PCT and PIC are useful markers to diagnose early VAP quickly and conveniently and allow early antibiotic treatment of patients with suspected VAP.
Objective To evaluate the correlation between benign prostatic hyperplasia (BPH) and metabolic syndrome (MS). Methods Total 666 elderly male patients admitted to West China Hospital for routine physical examination in May, 2010 were included in this study. The related laboratory tests of BPH and MS were taken. The correlation among BPH, lower urinary tract Symptoms (LUTS), prostate volume (PV), MS and its component diseases were analyzed. Results Hypertension was an important risk factor for BPH (OR=1.309, 95%CI 1.033 to 1.661), low HDL-C hyperlipidemia was a risk factor for IPSS scored over 7 points (OR=1.573, 95%CI 0.330 to 0.997), and the score of PV was positively correlated to obesity, hypertension, low HDL-C hyperlipidemia and MS (all Plt;0.05). Conclusion For the patient with BPH, MS and its component diseases mainly exert their effects on PV changes rather than LUTS.
目的 了解呼吸机相关性肺炎（VAP）患者病原菌情况，探讨其细菌耐药性及治疗策略。 方法 通过查阅2008年1月－2009年12月呼吸与危重症医学科收治的128例VAP患者的病历资料，分析其肺部感染病原菌分布特点及耐药率。 结果 VAP平均发病时间为机械通气后5.8 d，总病死率为35.1%（45/128）。共分离出病原菌262株，其中G?杆菌210株（占80.2%），G+球菌38株（占14.5%），真菌14株（占5.3%）。G?杆菌中占前3位的分别是鲍曼不动杆菌、铜绿假单胞菌、肺炎克雷白杆菌，对青霉素类、头孢菌素类抗菌药物高度耐药，而对亚胺培南等耐药率相对较低；G+球菌主要是金黄色葡萄球菌，其中耐甲氧西林的金黄色葡萄球菌对多种常见抗菌药物高度耐药，而对万古霉素敏感。 结论 VAP的主要病原菌为G?杆菌，常为多重耐药的致病菌，应根据药敏结果选用合理的抗菌药物。
目的 了解综合重症监护病房（ICU）呼吸机相关性肺炎（VAP）感染率、危险因素、病原菌分布及其耐药情况，探讨有针对性的预防控制措施。 方法 2009年1月－12月综合ICU共收治患者447例，采用主动监测方法，由ICU医务人员和专职人员每日对综合ICU病房住院时间≥48 h且撤停机械通气后48 h内的患者进行VAP监测。 结果 447例患者中住院时间≥48 h的患者168例，96例患者使用呼吸机，使用呼吸机时间182 d，ICU住院总日数1 339 d，发生VAP 17例，呼吸机使用率13.59%，VAP感染率93.4例/1 000机械通气日，根据平均病情严重程度（ASIS法）调整后的VAP感染率为2.38%。呼吸机使用方式与VAP发生有关联。检出病原菌18株，全部为Gˉ杆菌，其中鲍曼不动杆菌4株，对包括硫霉素、氨曲南在内的多种抗菌药物耐药。 结论 综合ICU病房VAP感染率为2.38%，呼吸机使用不当是VAP的危险因素，VAP致病菌为Gˉ杆菌，其中鲍曼不动杆菌耐药率达100%，并呈多重耐药性；抗生素使用时间过长，预防性使用不当是致病菌产生多重耐药的重要原因。