【摘要】 目的 探讨负压引流技术对不同部位、不同类型创面的方法和效果。 方法 回顾性分析2009年5月-2010年12月采用负压引流技术治疗85例创面的临床资料。其中男51例，女34例；年龄4~75岁，平均年龄48岁。 结果 79例创面行1次负压治疗后、6例创面连续行2次负压治疗后情况明显改善，二期行游离皮片移植术或皮瓣转移术修复创面，术后创面均Ⅰ期愈合，皮片或皮瓣存活良好。 结论 负压吸引治疗技术简便有效，可靠安全，能加速清除不同部位、不同类型创面的坏死组织，改善创面条件，缩短创面治疗时间。【Abstract】 Objective To explore the effects of negative pressure treatment on wound of different types at different parts. Methods The clinical data of 85 patients (51 males and 34 females; 4-75 years old) with wound who received negative pressure treatment between May 2009 and December 2010 were retrospectively analyzed. Results After receiving negative pressure treatment for once in 79 patients and twice in 6, the wound improved obviously. All cases received regular methods such as skin grafting or tissue flap transferring to reconstruct the wound. All of the 85 patients healed by first intention and the skin grafts or flaps survived well. Conclusion Negative pressure treatment is a simple, effective, stable and safe method for wound treatment, which can accelerate eliminating necrotic tissue of wound of different types at different parts, improve the wound condition and shorten the period of therapy.
Facial filling injection is one of the technologies to achieve facial rejuvenation in a non-surgical way. With the application of emerging cosmetic filler preparations and the development of new technologies, there are more and more options to achieve facial rejuvenation. Complications may result from the use of new materials whose safety has not been proven in studies. This article describes common facial filler choices, facial risk areas and vascular complications, and discusses how to improve the safety of facial injections. The purpose is to enable operators to fully understand the facial risk area, select the appropriate filling injection, and be able to identify the symptoms of vascular complications as early as possible, thereby improving the safety of facial filling injection.
Objective To analyze the species distribution and resistance of the pathogens isolated fromblood cultures of the patients in intensive care unit ( ICU) , and provide a basis for prevention and control of bloodstream infections in critically ill patients. Methods The data of blood cultures of the patients in ICUduring January 2009 to December 2011 was investigated retrospectively.Results In the last 3 years, positive rate of blood cultures of ICU patients was 15. 4% , 15. 7% , and 17. 6% respectively. Among the isolates, Gram-positive bacteria were predominant ( 52. 3% ) , followed in order by gram-negative bacteria ( 33. 1% ) and fungi ( 14. 7% ) . Aerobe and facultative anaerobe were the predominant bacterial isolates ( 99. 7% ) . Enterococcus faeciumand Staphylococcus spp. were the most common gram-positive bacteria, and 4. 5% of E. faecium isolates were resistant to vancomycin. Rate of methicillin-resistance for S. aureus and S. epidermidis was 73. 5% and 93. 7% respectively. In terms of gram-negative bacteria, Acinetobacter calcoaceticus- A. baumannii complex were the leading species, 96. 9% of the isolates had multi-drug resistance and 14. 1% of the isolates had extra-drug resistance. Klebsiella pneumonia and Escherichia coli isolates were less frequently isolated and those producing extended spectrum beta-lactamases accou ted for 70. 3% and 80. 0% of the isolates respectively. Candida spp. was the most common fungi isolates ( 96. 7% )with an annual change of species distribution and declining susceptibility to azoles.Conclusions Gram-positive bacteria should be the major target for prevention and control of bloodstream infections in critically ill patients. Whereas, more attention should be paid to the infection caused by candida spp. and multidrug resistant gram-negative bacteria.
Objective To investigate the characteristics of the pathogens isolated from the cerebrospinal fluid (CSF) and the prognosis of the adult patients with central venous system (CNS) infection, and to provide the basis for disease treatment. Methods The clinical data and findings of the laboratory examination of the patients, who were admitted to West China Hospital of Sichuan University from January 2014 to September 2016, and suffered from CNS infection with the positive results of CSF culture, were retrospectively analyzed. The species distribution and in-vitro susceptibility of the pathogens and hospital mortality were analyzed. Results A total of 157 cases, involving 87 (55.4%) community-acquired cases and 70 (44.6%) hospital-acquired cases, were included. One hundred and fifty-eight strains of the pathogens were isolated from the CSF specimens of these patients, including 73 isolates (46.2%) of gram negative bacteria, 64 isolates (40.5%) of fungus, and 21 isolates (13.3%) of gram positive bacteria. In terms of species distribution,Cryptococcus neoformans was the predominant (62/87, 71.3%) species isolated from the patient with community-acquired infection, whileAcinetobacter calcoaceticus-A. baumannii complex (31/71, 43.7%) was the predominant specie from the patients with hospital-acquired infection. Analysis of the resistance phenotypes showed that all theC. neoformans isolates were susceptible to the antifungal agents. More than 90% ofA. calcoaceticus- A. Baumannii complex isolates were resistant to the regular antibiotics. The resistant rates ofK. pneumoniae isolates to the regular antibiotics were no more than 25%. The hospital mortality of the groups infected by gram-negative bacteria, fungi, and gram-positive bacteria were 52.3% (38/72), 32.8% (21/64), and 19.0% (4/21), respectively. There was statistical difference for the hospital mortality among these groups (P=0.006). Conclusion In our hospital,C. neoformans are the common species isolated from CSF of the patients with community-acquired CNS infection. Gram negative bacilli are commonly isolated from CSF of the hospital-acquired cases. The mortality of patients with gram negative bacilli is high.
Objective To evaluate the effectiveness and advantages of the wide local excision for Paget’s disease involing the penis and scrotum by comparing with the radical excision. Methods A retrospective analysis was made on the clinical data of 41 patients with Paget’s disease involving penis and scrotum who met the inclusion criteria between November 2010 and August 2015. Among them, 14 patients received wide local excision (group A), and 27 patients received radical excision (group B). No significant difference was found in age, course of disease, and lesion site between two groups (P>0.05). The recurrence rate, operative time, times of intraoperative frozen section pathology, hospitalization time, grade of wound healing, appearance and functions satisfaction were recorded and compared between two groups. Results The operative time and hospitalization time in group A were significantly shorter than those in group B (P<0.05); the times of intraoperative frozen section pathology in group A were significantly less than that in group B (P<0.05). All patients were followed up 13 to 67 months (mean, 35.5 months) in group A and 11 to 70 months (mean, 38.8 months) in group B. Grades A, B, and C wound healing was obtained in 11 cases, 2 cases, and 1 case of group A and in 12 cases, 7 cases, and 8 cases of group B respectively, showing significant difference between two groups (Z=–2.102, P=0.036). The 5-year recurrence rate was 28.6% (4/14) in group A and 22.2% (6/27) in group B, showing no significant difference (χ2=0.202, P=0.654). The score of satisfaction in appearance and functions in group A was significantly higher than that in group B (t=–2.810, P=0.008). Conclusion Paget’s disease involving penis and scrotum has a slow disease progression and good prognosis. Wide local excision can relieve symptoms effectively and obviously decrease perioperative risk in elderly patients, with no significant increase of the recurrence rate.
ObjectiveTo analyze the distribution and drug resistance of Enterobacteriaceae in West China Hospital of Sichuan University, to provide long-term monitoring data references for clinical practice.MethodsThe clinical information of non-repetitive Enterobacteriaceae isolates from 2006 to 2015 was collected and analyzed. All the isolates were identified by VITEK-2 Compact Automatic Microbial Identification Analyzer (Bio Merieux, France). The statistic informations were analyzed by WHONET 5.6 and iLabDataforMDR 1.03.ResultsA total of 38 487 strains of Enterobacteriaceae were isolated from 2006 to 2015, mainly including 14 862 stains of Escherichia (38.6%), 12 894 stains of Klebsiella (33.5%), 6 277 stains of Enterobacter (16.3%), 1 758 stains of Proteus (4.6%), 1 257 stains of Serratia (3.3%), 933 stains of Citrobacter (2.4%), and 506 stains of Morganella (1.3%). The top three sample types were sputum (46.9%), urine (18.7%), and secretions (11.5%). The drug resistance rate of Enterobacteriaceae showed a downward trend to most antibacterials. The average resistance rate of Enterobacteriaceae to ampicillin, ampicillin/sulbactam, and cefazolin was 85.3%, 52.6%, and 72.9%, respectively. The resistance rates to ceftriaxone, cefepime, gentamicin, and tobramycin were significantly reduced. The resistance rates to other antibiotics showed decreasing or slow increasing trends. The isolation rate of extended-spectrum β-lactamases (ESBL)-producing strains in Escherichia did not change, but the rate in Klebsiella decreased significantly. The isolation rate of multidrug-resistant organisms (MDRO) showed a slow decrease.ConclusionsThe overall antimicrobial resistance and the isolation rates of MDRO and ESBL-producing organisms showed a downward trend in investigating period. However, the carbapenem-resistant Enterobacteriaceae was rising continuously. Long-term monitoring of drug resistance is of notable value to antibiotic management policies.
ObjectiveTo understand the drug resistance of Mycobacterium tuberculosis complex in West China Hospital, Sichuan University, analyze its drug resistance characteristics, and provide reference for the monitoring of drug-resistant tuberculosis.MethodsFrom January 2016 to March 2018, Mycobacterium tuberculosis drug susceptibility testing kit was used to detect the drug susceptibility of Mycobacterium tuberculosis culture-positive strains in Department of Laboratory Medicine, West China Hospital, Sichuan University. The tested drugs included four of the first-line anti-tuberculosis drugs: rifampicin, isoniazid, ethambutol, and streptomycin, and ten of the second-line anti-tuberculosis drugs: capreomycin, ofloxacin, ethionamide, p-aminosalicylic acid, levofloxacin, moxifloxacin, rifabutin, amikacin, kanamycin, and chlorine phenazine.ResultsA total of 130 patients (130 strains) were enrolled, including 82 newly diagnosed patients (82 strains) and 48 re-treated patients (42 strains). The drug resistance rate of the 130 patients was 37.69%. The drug resistance rate of the newly diagnosed patients (28.05%) was significantly lower than that of the re-treated patients (54.17%), and there was a statistical difference (χ2=8.794, P=0.003). The multi-drug resistance rate of the newly diagnosed patients (6.10%) was significantly lower than that of the re-treated patients (25.00%), and the difference was statistically significant (χ2=9.517, P=0.002). The resistance rate of isoniazid, rifampicin, and streptomycin in newly diagnosed patients (23.17%, 8.54%, and 7.32%, respectively) were significantly lower than those in the re-treated patients (45.83%, 41.67%, and 29.17%, respectively), and the differences were statistically significant (P<0.05). The resistance rate of ofloxacin, moxifloxacin, rifabutin and ethionamide in the newly diagnosed patients (9.76%, 8.54%, 7.31%, and 4.88%, respectively) were significantly lower than those in the re-treated patients (39.58%, 27.08%, 25.00%, and 22.92%, respectively), and the differences were statistically significant (P<0.05).ConclusionIt is necessary to strengthen the standardized treatment of patients with newly diagnosed tuberculosis, increase the treatment and management of re-treated tuberculosis patients, and prevent the generation and spread of drug-resistant patients, especially multidrug-resistant patients.