慢性阻塞性肺疾病( COPD) 在全球的患病率和死亡率均高居不下, 并有不断增长的趋势, 由此带来了沉重的经济和社会负担。2011 年《COPD 诊断、管理和预防的全球策略》( 以下简称“GOLD 策略”) 更新内容中, 将COPD 定义为一种可防可治的常见疾病, 以持续性气流受限为特征[ 1] 。气流受限呈进行性发展, 伴有气道和肺对有害颗粒或气体所致慢性炎症反应的增加。急性加重和合并症影响患者整体疾病的严重程度。此外, 2011 版GOLD 策略还更新了疾病评价标准, 不再简单地根据气流受限分级治疗, 而是提出整合了患者临床症状、气流受限程度以及急性加重风险等三方面综合评估的概念[ 1 ] 。同时指出, 对于高风险患者, 无论临床症状多少, 吸入糖皮质激素 ( ICS) 与长效β2 受体激动剂( LABA) 联合治疗是 GOLD 策略推荐的首选治疗方案之一。支持这一建议的一个重要或里程碑式的循证医学证据就是“迈向COPD 患者健康的变革 ( TORCH) ”的研究[ 2 ] 。该研究从研究设计、研究主要结果、研究结果的亚组分析及影响因素等多方面进行了详细的分析, 并相继在众多国际著名医学杂志发表了16 篇文章[ 2-1 7] , 成绩斐然, 对COPD 防治策略的制订产生了非常积极的影响。认真分析和借鉴TORCH 研究及其后续分析带给我们的启示, 对提升今后疾病的临床研究质量、发掘研究成果、促进 COPD 的防治等方面将有积极的意义。
ObjectiveTo understand the current status of nosocomial infections in a municipal medical unit, to find problems in daily monitoring, and to provide the evidence for the prevention and control of nosocomial infection in high-risk groups and procedures. MethodsAccording to the 2013 survey requirements made by the nosocomial infection control center of Chengdu, we made a cross-sectional survey about nosocomial infection among all the inpatients on July 25th, 2013 and statistically analyzed the results. ResultsTotally, 1 301 cases were actually investigated within 1 307 inpatients of the time (the actual investigation rate was 99.54%). The prevalence rate of nosocomial infection was 3.38% (44 cases). The top five departments of infection rate were Respiratory Intensive Care Unit (RICU), Center of Intensive Care Unit (CICU), Department of Neurosurgery, Department of Thoracic Surgery and Department of General Surgery. The main site of infection was respiratory tract, which took possession of 62.25%. In univariate analyses, age≥60, length of hospital stay >2 weeks, invasive operation, history of diabetes, operation, radiotherapy/chemotherapy, utilization of antibiotics were found to be risk factors for infections. Multivariate analysis showed that length of hospital stay (OR=3.115, P=0.001), invasive operation (OR=14.930, P<0.001), diabetes mellitus (OR=2.157, P=0.046), radiotherapy/chemotherapy (OR=7.497, P<0.001) were independent risk factors for nosocomial infections. The utilization rate of antibiotics was 45.73%. Among them, there was 85.21% using single antibiotics, and 82.18% of them were used therapeutically. ConclusionUnderstanding the current status of nosocomial infection in municipal hospitals helps us grasp the key and difficulty of infection control, make out prevention-control measures for high-risk groups and high-risk departments, and guide and supervise its implementation in clinical departments, which points out the direction to further reduce the incidence of nosocomial infection.