ObjectiveTo analyze the significance of application of pulse indicated continuous cardiac output (PICCO) as hemodynamic monitoring for low cardiac output patients after coronary artery bypass grafting (CABG) operation. Method We retrospectively analyzed the clinical data of 110 patients conducted non-extracorporeal circulation CABG operation in Beijing Anzhen Hospital between June 2013 and October 2014. The patient were divided into two groups including a PICCO applied group and a non-PICCO applied group. There were 49 patients including 29 males and 20 females at average age of 60.80±9.34 years in the PICCO group. There were 61 patients with 37 males and 24 females at age of 62.22±10.41 years in the non-PICCO group. We compared the treatment effects between the two groups. ResultsComparing to the non-PICCO group, the PICCO group had shorter average days of postoperative intra-aortic balloon pump (IABP) usage (t=2.155, P=0.039), less usage rate of endotracheal reintubation (χ2=5.098, P=0.039), shorter average postoperative mechanical ventilation time (t=2.087, P=0.044), less occurrence rate of cardiac arrhythmia (χ2=4.011, P=0.045), less occurrence rate of multiple organ dysfunction syndrome (MODS) (χ2=5.075, P=0.035), shorter days in ICU (t=2.141, P=0.040) and in-hospital time (t=2.061 P=0.048). During monitoring, the PICCO group had slower average heart rate, higher average arterial pressure, lower blood lactate, greater oxygenation and greater left ventricular ejection fraction (LVEF) than those in the non-PICCO group. ConclusionThe application of PICCO reduces occurrence of postoperative complications for low cardiac output patients with post coronary artery bypass grafting operation, increases cure rate.
Objective To investigate the epidemical status of influenza in Mianyang during 2010-2011, so as to provide evidence for formulating prevention and control strategies. Methods Surveillance data, ILI etiological results, outbreak and epidemic situation of the influenza-like illnesses (ILI) in Mianyang during 2010-2011 were collected for analysis. Results There were 12 100 ILI cases reported in 2010, accounted for 2.72% of the total outpatients. While 8 364 ILI cases accounted for 1.83% of the total outpatients were reported in 2011, reduced by 32.47% compared with 2010. The temporal distribution of doctor-visiting ratio in those two years was in an increased bimodal pattern. Most cases were children aged 0-5 years, accounted for 46.24%. Most ILI cases were treated in the department of fever, accounted for 88.56%. A total of 788 ILI specimens were collected for the detection of Real time RT-PCR, of which 34 specimens showed positive strains (4.31%) including 5 influenza A/H1N1 (0.63%), 8 influenza A (1.02%), 1 seasonal influenza A/H3 (0.13%) and 20 influenza B (2.54%). No outbreak and epidemic situation in Mianyang during 2010-2011. Conclusion The influenza activity is relatively stable without large-scale outbreak in Mianyang during 2010-2011. The reporting quality of surveillance hospitals should be improved and the lab of flu surveillance network should actively prepare to do the isolation and identification of influenza virus. It is necessary to enhance flu surveillance so as to prevent and control influenza prevalence．
Objective To investigate the current situation of self-monitoring of blood glucose (SMBG) in patients with type 2 diabetes mellitus (T2DM) in Sichuan province, and to analyze the influencing factors of SMBG, so as to provide evidence for improving the level of SMBG. Methods By the convenience sampling method, 410 patients with T2DM for more than 1 year were selected from 17 hospitals and community health service centers in 7 cities across Sichuan province, and their SMBG was investigated with a questionnaire. Results Among 410 eligible patients, the average frequency of SMBG was 7.3 times per month. There were 268 patients (65.4%) performed SMBG less than 4 times per month, 94 (22.9%) performed 4-15 times per month, 29 (7.1%) performed 6-29 times per month, and 19 (4.6%) performed over 30 times per month. Just 234 patients (57.1%) monitored the HbA1c in the past 6 months. FPG, 2-hour PPG and HbA1c were negatively correlated with the frequency of SMBG. The influencing factors of SMBG were insulin treatment and education. Conlusion The SMBG status in D2TM patients is relatively poor in Sichuan province, and the compliance of SMBG is expected to be improved by enhancing diabetic education.
目的 了解2011年四川大学华西第二医院临床分离菌对常见抗菌药物的耐药性。 方法 采用法国生物梅里埃公司VITEK 2 COMPACT全自动细菌鉴定药敏仪，以及ATB 手工药敏条检测临床分离菌对各种常用抗菌药物的耐药性，参照CLSI 2011年版标准判定药敏试验结果，并用WHONET5.4软件统计分析。 结果 临床分离的1 692株细菌中，G+菌占28.0%（473/1 692），G?菌占72.0%（1 219/1 692）。分离的前5位病原菌分别为大肠埃希菌、流感嗜血杆菌、肺炎克雷伯菌、肺炎链球菌、金黄色葡萄球菌。耐甲氧西林金黄色葡萄球菌和耐甲氧西林的凝固酶阴性葡萄球菌分别占金黄色葡萄球菌和凝固酶阴性葡萄球菌的15.1%（22/146）和76.7%（46/60），未检出万古霉素、利奈唑胺耐药株。屎肠球菌对所测抗菌药物的耐药性显著高于粪肠球菌，对氨苄西林的耐药率分别为95.7%和13.3%，高水平氨基糖苷类抗生素耐药屎肠球菌和粪肠球菌的耐药率分别为82.6%和30.0%，检出1株对万古霉素耐药的屎肠球菌，未发现对利奈唑胺耐药菌株。青霉素耐药的肺炎链球菌占4.0%（6/151），肺炎链球菌对红霉素、克林霉素、四环素、复方磺胺的耐药率均高于90%。流感嗜血杆菌、副流感嗜血杆菌以及卡他布兰汉菌产β内酰胺酶的比例分别为58.1%（175/301）、70.0%（21/30）、75.9%（22/29）。肠杆菌细菌中产超广谱β内酰胺酶的大肠埃希菌和肺炎克雷伯菌检出率分别为59.9%和74.1%，耐药率最低的分别是3种碳青酶烯类抗生素和阿米卡星。不发酵糖G?杆菌在分离病原菌中所占比例较低，为12.1%（148/1 692），主要为鲍曼不动杆菌和铜绿假单胞，药敏结果显示，除铜绿假单胞对复方磺胺耐药率为93.5%和鲍曼不动杆菌对氨曲南耐药率为38.9%外，该两种细菌对所测抗生素敏感性高，均在80%以上，未检出泛耐药细菌。 结论 定期进行细菌耐药性监测有助于了解医院细菌耐药性变迁，对指导医院合理应用抗菌药物有重要意义。
【摘要】 目的 分析床旁陪护行为对视频脑电图的影响，总结护理指导的意义。 方法 2008年7-9月对214例患者行24 h视频脑电图监测（video EEG，VEEG）监测，每例患者留一床旁陪护。重点观察坐床沿或同睡、用手机、拍打及按摩行为，并比较初次及再次护理指导后上述行为发生情况。 结果 坐床沿或同睡、用手机、拍打、按摩均可影响VEEG，初次指导后以上行为出现率分别为62.6%、55.1%、30.4%、20.1%；再次指导后以上行为分别减少78.4%、75.4%、78.5%、79.1%，VEEG监测质量均有提高。 结论 应将规范床旁陪护行为的指导贯穿于VEEG监测的全过程。【Abstract】 Objective To assess the impacts of bedside accompany behavior on the quality of video-electroencephalography (VEEG). Methods A total of 214 patients underwent 24-hour VEEG monitoring from July to September 2008. Each patient had a bedside-accompany family member. The behaviors of accompany included sitting at the bed, using mobile phone, clapping, and kneading the patients, which were evaluated after the first and second nursing education. Results Sitting at the bed, using mobile phone, clapping, and kneading the patients influenced the quality of VEEG. After the first education, the occurrences of the above unfavorable behaviors were 62.3%, 55.1%, 30.4%, and 20.1%. After the second education, the unfavorable behaviors reduced 78.4%, 75.4%, 78.5%, and 79.1% respectively; the VEEG quality improved. Conclusion Proper bedside accompany behavior may improve the quality of VEEG monitoring.
目的:探讨神经电生理监测对脑干手术的指导意义，总结实施体会和改进方向。方法:回顾分析了既往2年内，在电生理监测下完成手术的48例脑干肿瘤病例资料。在总结手术疗效的同时，就影像资料对临床判断的指导作用，手术指征的把握，电生理指标的选择和意义等进行了讨论。结果:运用听觉脑干诱发电位、体感诱发电位、运动诱发电位等手段，为手术提供了强有力的支持。48例患者中，27例全切，15例大部切除，6例部分切除；术后无1例昏迷，一例因脑室炎死亡；神经机能较术前相仿或改善者31例，症候加重或出现新的废损17例（治疗随访，12例明显恢复，达到术前神经机能水平）。结论:在手术入路日趋成熟的今天，多参数神经电生理监测对于提高手术疗效、减少功能废损，具有重要意义。它为术中选择切入的安全区或探知神经通路的完整性提供了有力支撑，但对于特定神经机能评判仍存在不确定性，需要进一步研究
Objective To investigate the clinical significance of intra-abdominal pressure measure in patients with liver transplantation by summarizing the data of 143 cases. Methods Intra-abdominal pressure was indirectly measured by urinary bladder pressure. Intra-abdominal pressure over 10 cm H2O (1 cm H2O=0.098 kPa) was regarded as intra-abdominal hypertension (IAH), and 10＜pressure≤15 cm H2O as gradeⅠ, 15＜pressure≤25 cm H2O as grade Ⅱ, 25＜pressure≤35 cm H2O as grade Ⅲ, over 35 cm H2O as grade Ⅳ. The parameters of circulatory system, respiratory system, renal function and the postoperative intra-abdominal pressure for 7 days were recorded to every patient, and the parameters of each grade IAH group were contrasted with non-IAH group. ResultsAmong 143 cases, 45 cases were IAH (31.5%), in which 18 cases belonged to grade Ⅰ, 13 cases belonged to grade Ⅱ, 11 cases belonged to grade Ⅲ, while 3 cases belonged to grade Ⅳ. Compared with those in non-IAH group, SCr and BUN significantly increased (P＜0.05, P＜0.01), PaO2 significantly decreased (P＜0.05, P＜0.01) in each grade IAH group; Respiratory frequency (RF), heart rate (HR) and PaCO2 significantly increased (P＜0.05, P＜0.01) in some grade IAH group (HR in grade Ⅱ, Ⅲ and Ⅳ, RF and PaCO2 in grade Ⅲ and Ⅳ). Conclusions Intra-abdominal hypertension would affect liver function by impaired circulatory, respiratory and renal function. So, it is necessary to measure intra-abdominal pressure for patients after liver transplantation, which can help to choose appropriate treatment.