【摘要】 目的 探讨并分析导致肺曲霉病患者误诊的原因，为早期诊断并及时正确治疗提供科学的依据。 方法 回顾性分析2010年1-4月间确诊为肺曲霉病的3例患者在诊治过程中被误诊的原因。 结果 3例患者均缺乏明显的特异性临床表现和影像学表现，最后确诊均依据病理学活检证实。 结论 肺部的曲霉菌感染缺乏特异性的临床和影像学表现，及早行纤维支气管镜检查或肺组织活检可提高早期诊断率。【Abstract】 Objective To analyze the misdiagnostic causes of pulmonary aspergillosis. Methods The clinical data of three patients with pulmonary aspergillosis from January to April 2010 were retrospectively analyzed, and the misdiagnostic causes were analyzed. Result No specific clinical and imaging findings were found in the three patients, and pulmonary aspergillosis was finally diagnosed according to the pathological biopsy. Conclusion Pulmonary aspergillus lacks specific clinical and imaging manifestations; early fiberoptic bronchoscopy or pulmonary biopsy may improve the rate of accurate diagnosis.
在过去二十年间，麻醉技术和手术技术的改进使肺部恶性肿瘤患者的手术死亡率大大降低，但术后并发症仍是主要问题。肺切除术后的常见并发症是肺部并发症[1]，主要表现是低氧血症，尤其在肺功能减退的肺切除患者中发病率更高[2]。目前国内对低氧血症的诊断缺乏统一的诊断标准，一些作者采用Russell等[3]提出的标准，吸空气氧的情况下，患者动脉血氧饱和度（SpO2）≤92%，大于30 s就可诊断为术后低氧血症。也有作者建议[4]将一次或以上血气检查PaO2lt;8 kPa或PaO2/FiO2lt;300 mm Hg（1 mm Hg=0.133 kPa）作为诊断低氧血症的标准。30%~50%的术后患者可发生低氧血症，一般认为这样的低氧血症是一过性的，对大多数患者是无害的[5]。但如果合并心脑或其他器官动脉硬化或其他原因的血管阻塞，这种低氧血症就是很危险的[6]。常见低氧血症的原因是肺萎陷不张和误吸、心源性肺水肿、静脉输入液体过量、通气血流比例失调和急性肺损伤/急性呼吸窘迫综合征（ALI/ARDS）[7]，其中ALI/ARDS是肺切除术后患者死亡的主要原因[8-10]。
目的 了解医院内血源性职业暴露高风险人群，有针对性采取防护措施，降低血源性职业暴露的发生率。 方法 对2008年1月－2011年12月四川省妇幼保健院52例血源性职业暴露医务人员，按照暴露人群、暴露方式、暴露病种、暴露地点的不同进行调查分析。 结果 52例职业暴露人群中护士27例（占51.9%）；产房和手术室为高发职业暴露场所，共32例，分别为17例（占32.7%）和15例（占28.8%）；职业暴露病种主要为乙型肝炎，共27例（占51.9%）；暴露方式主要为针刺伤，共37例（占71.2%）。 结论 提高医务人员职业防护意识，规范操作流程，加强自身防护是减少职业暴露的根本所在。
Hot topics on the diagnosis and antimicrobial therapy of ventilator-associated pneumonia, including clinical diagnostic criteria, evaluation of biomarkers, ventilator associated events, clinical pulmonary infection score, ventilator-associated tracheobronchitis, microbiological diagnosis and duration of therapy were discussed. The viewpoints in the guidelines of America, Europe and Japan were also reviewed.
Objective To explore the application effect of the four-dimensional teaching library model in the training of neuroinfection subspecialty continuing physicians, and compare it with traditional rotational training. Methods Continuing physicians who received training in the Department of Neurology of Xuanwu Hospital, Capital Medical University between March 2021 and February 2023 were selected. The continuing physicians who received traditional rotational training between March 2021 and February 2022 would serve as the control group, and the continuing physicians who received four-dimensional teaching library model training between March 2022 and February 2023 would serve as the experimental group. The Mini-CEX scale was used to evaluate the clinical comprehensive abilities of two groups of continuing physicians. At the same time, self-made questionnaires were used to evaluate the evaluation of two groups of continuing physicians on different teaching modes. Results A total of 55 continuing physicians were included. Among them, there were 27 people in the control group and 28 people in the experimental group. There was no statistically significant difference in the comparison of general information between the two groups (P＞0.05). At the time of graduation, all items on the Mini-CEX scale in the experimental group were higher than those in the control group (P<0.05). The survey questionnaire results showed that the experimental group scored higher than the control group in terms of improving learning interest, improving self-learning ability, improving clinical thinking, improving analysis and problem-solving ability, improving doctor-patient communication ability, and increasing teamwork (P<0.05). Conclusion The application effect of the four-dimensional teaching library model in the training of neuroinfection subspecialty continuing physicians is better than that of traditional rotational training, which can significantly improve the clinical comprehensive ability of continuing physicians and is worth promoting.
Objective To explore the effect of “net bottom” management in the control of device-associated infections (DAIs) in elderly patients by setting infection monitoring doctors and nurses in the emergency intensive care unit (EICU). Methods Elderly patients who aged≥60 years old admitted to the EICU of the First People’s Hospital of Lianyungang between April 2018 and March 2021 were selected as the research subjects. A “net bottom” management mode was established and implemented for the purpose of infection prevention and control, taking medical and other departments as the coordination and management subjects, and infection monitoring doctors and nurses as the core. The effectiveness of the management intervention was evaluated by comparing the incidences of DAIs in elderly patients, the compliance rates of medical staff in hand hygiene, and the consumption of hand sanitizer per bed day in EICU among the primary stage (from April 2018 to March 2019), intermediate stage (from April 2019 to March 2020), and later stage (from April 2020 to March 2021). Results During the primary stage, intermediate stage, and later stage, there were 540, 497, and 507 elderly inpatients in EICU monitored, respectively, and the incidences of nosocomial infections were 7.22% (39/540), 5.84% (29/497), and 4.14% (21/507), respectively, showing a decreasing trend (χ2trend=4.557, P=0.033). The incidences of ventilator-associated pneumonia, central line-associated bloodstream infections, and catheter-associated urinary tract infections decreased from 4.82‰, 2.53‰, and 0.95‰, respectively in the primary stage, to 0.51‰, 1.01‰, and 0.53‰, respectively in the later stage, among which the difference in the incidence of ventilator-associated pneumonia was statistically significant (P<0.05). The hand hygiene compliance rate of EICU medical staff increased from 70.39% to 86.67% (P<0.05), and the consumption of hand sanitizer per bed day increased from 33.70 mL to 67.27 mL. The quarterly hand hygiene compliance rate was positively correlated with the quarterly consumption of hand sanitizer per bed day (rs=0.846, P=0.001), and negatively correlated with the quarterly incidence of nosocomial infections (rs=–0.769, P=0.003). Conclusion The “net bottom” management by setting up infection monitoring doctors and nurses in the EICU and multi-department collaboration can reduce the incidence of DAIs in elderly patients in EICU, which plays a positive role in promoting the hospital infection management and improving the quality of hospital infection management.
Objective To investigate the genetic polymorphism of methicillin resistant Staphylococcus aureus ( MRSA) isolated from hospital acquired pneumonia. Methods Seventy-four hospitalized patients were diagnosed as noscomial MRSA pneumonia from January 2007 to January 2008 in Xinhua Hospital, Shanghai Jiaotong Univesity. The genes of MRSA were amplified by random amplified polymorphic DNA typing ( RAPD) assay in 82 clinical isolates from these patients. Results Two to 15 amplified DNA fragments were observed in agarose gel and they were classified into 11 genotypes. Genotypes Ⅲ, Ⅵ and Ⅶ ( 32. 56% , 30. 23% and 13. 95% , respectively) were mainly isolated from the ICU. Both independent genotypes and overlapping genotpyes with those from ICU were identified in isolates from the departments of geriatrics, emergency and respiratory medicine. Outbreak or cluster cases ( 48. 65% ) were found in 36 of the 74 patients while all outbreak cases occurred in the ICU. Conclusions Noscomial MRSA pneumonia is easy to disseminate and small-scale outbreak may occur especially in ICU. RAPD is valuable for identification and prevention of the spread of MRSA in hospital.
Objective To investigate the clinical characteristics of primary malignant tumors of the left atrium and the late results of surgical treatment. Methods The clinical experience with surgical treatment of 13 primary malignant tumors of left atrium was analyzed retrospectively. Complete resection of malignant tumor was achieved in 7 cases(53.8％ )，and subtotal resection was achieved in 3 cases(23.0％), only biopsy was performed in 2 patients(15.4％ )because of extensive metastasis of tumor. Heart transplantation was performed in 1 case(7.7％). Results There was no hospital death. The pathological diagnosis was undifferentiated sarcoma in 5 cases, leiomyosarcoma in 2 cases, malignant transformation of myxoma in 2 cases, angiosarcoma in 1 case, fibrosarcoma in 1 case, malignant fibrous histocytoma in 1 case and malignant hemangiopericytoma in 1 case. There were 11 patients followedup for 3 months to 65 months and showed 9 late death due to recurrence or metastasis. There was 2 patients lost of follow-up. Conclusion Primary malignant tumors of the left atrium should be resected to relieve symptoms caused by local tumor growth. Surgery provides control of primary tumor and allows the potential for cure or longterm survival with effective adjuvant therapy. The prognosis of these patients is still poor.
ObjectiveTo briefly describe the specific contents and analyze the implementation effects of the information-based training system on neurology residents.MethodsSince February 2020, an information-based training system was carried out in the standardized training center for residents in the Department of Neurology, Xuanwu Hospital of Capital Medical University. The effect of the information-based training system was measured by comparing the numbers of training lessions and examinations, participation rates of training lessions and examinations, and mock examination results after 4 months of training of the resident trainees in Grade 2017 under the information-based training mode (n=35) with those of the resident trainees in Grade 2016 under regular face-to-face training mode (n=35). Chi-square test was used for comparison between training groups.ResultsCompared with those in Grade 2016, the number of lessons in Grade 2017 increased by 87.0% (43 vs. 23), the participation rate of lessons in Grade 2017 was higher (100.0% vs. 87.0%, P<0.001), the number of examinations in Grade 2017 increased by 87.5% (15 vs. 8), the participation rates of examinations were both 100.0%, and the pass rate of the mock examination in Grade 2017 was higher (94.3% vs. 77.1%, P=0.040).ConclusionThe training method and effect of the standardized training model of the information-based training system for resident doctors are worthy of recognition, providing a reference for medical teaching, especially for the standardized training of resident physicians.
目的:比较充填式和平片式无张力疝修补术的临床效果。方法:回顾分析用平片式及充填式无张力疝修补术治疗246例腹股沟疝的临床及随访资料。结果:246例患者尿潴留, 阴囊水肿和切口感染等并发症无明显差异(Pgt;0.05),随访6个月至2年,无1例复发。结论:同填充式无张力疝修补术比较,平片式无张力疝修补术具有简单,手术时间短、费用低廉的特点,更适合基层推广。