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Clinical Analysis of 156 Old Patients with Severe Acute Cholangitis Treated by PTCD under Ultrasonic Guidance

目的 总结超声引导下经皮经肝穿刺胆管引流术(PTCD)的优、缺点,为临床治疗重症急性胆管炎（SAC）提供参考。方法 回顾性分析我院1994年8月至2008年7月期间对156例老年SAC患者行在超声引导下的PTCD治疗的临床资料。结果 156例行PTCD均获成功,1次穿刺成功140例，其成功率达89.7%（140/156）; 16例首次穿刺失败后再次穿刺均成功。无一例发生腹腔出血、胆汁性腹膜炎等并发症。本组引流效果较好,中毒危象缓解，黄疸减退，肝功能改善。结论 PTCD较外科手术创伤小、操作简单、快速,具有微创的特点,对老年、有严重合并症及复杂疾病不能耐受手术及麻醉的SAC患者，其作为紧急抢救措施切实可行,并为后期施行根治性手术争取了时间。

Analysis of clinical characteristics of 49 patients with coronavirus disease 2019 in Jiangxi

ObjectiveTo analyze the clinical characteristics and epidemiological characteristics of patients with coronavirus disease 2019 treated early in Jiangxi province.MethodsFour-night patients with coronavirus disease 2019 treated in this hospital from January 21st to 27th, 2020 were included in this study. The epidemiological and clinical data of patients after admission were collected, and laboratory tests such as blood routine, urine routine, stool routine, liver and kidney function, electrolytes, myocardial enzymes, erythrocyte sedimentation (ESR), C-reactive protein (CRP), calcitonin, coagulation, T cell subset and Chest CT were reviewed. The clinical results of common and severe/critically ill patients were compared.ResultsOf the 49 patients, 40 were common and 9 were severe/critical. Fourty-six patients had a clear history of contact with Wuhan or other areas of Hubei. The sex ratio was 2.06∶1, and the average age was 42.9 years. The symptoms were mainly fever (78.7%), cough (38.8%), and fatigue (18.4%). 28.6% (14 cases) of patients had hypertension and diabetes. Serum lymphocyte count and calcium concentration of the patients were decreased, but lactate dehydrogenase, ESR, CRP and serum amyloid A were increased in these patients. T lymphocyte subsets (CD3+, CD4+, CD8+) decreased significantly in these patients. Forty-seven patients (95.9%) had single or scattered patchy ground glass density shadows on the chest CT. Compared with common patients, the patients with severe/critical patients were older (P=0.023), hospitalized later (P=0.002), and had higher comorbidities (P=0.017). ESR (P=0.001）, CRP (P=0.010) and the serum amyloid A (P=0.040) increased significantly, while CD3+ (P<0.001), CD4+ (P=0.012), CD8+ (P=0.006) decreased significantly in severe/critical patients.ConclusionsThe patients with coronavirus disease 2019 in Jiangxi province are commonly imported from Wuhan. Severe/critical patients are older, hospitalized later, and have more medical complications and more severe systemic inflammatory reactions than common patients.

影响重症急性胰腺炎中心静脉压监测结果的相关因素及护理干预

【摘要】 目的 分析影响重症急性胰腺炎中心静脉压监测结果的相关因素，并探讨其护理干预方法。 方法 分析2009年1月-2010年1月156例重症急性胰腺炎患者中心静脉压监测结果与病情的吻合情况，了解其相关影响因素。 结果 共监测2 478例次，中心静脉压符合病情者2014例次，占81.27%，不符合病情者464例次，占18.73%，其中护理人员因素133例次（5.37%），测压装置因素130例次（5.25%），患者病情因素201例次（8.11%）。 结论 重症急性胰腺炎中心静脉压监测结果受多种因素影响，通过护理干预可减少对监测结果的影响，从而为分析、判断病情提供准确的参考依据。

Parenteral Nutrition and Enteral Nutrition Combined with The Experience of Treatment of Severe Acute Pancreatitis with 200 cases Report

ObjectiveTo summary the effect of parenteral nutrition combined with enteral nutrition on patients with severe acute pancreatitis. MethodsThe clinical data of 200 patients with severe acute pancreatitis admitted in our hospital in recent 10 years were retrospectively analyzed. Of which 88 cases were treated by traditional nutritional support therapy (traditional nutrition group), the rest of 112 cases of patients with early parenteral nutrition to later period gradually combined with enteral nutrition comprehensive nutritional support strategy (comprehensive nutrition group). ResultsThe APACHEⅡscores and serum level of C-reactive protein (CRP) of patients in comprehensive nutrition group were significantly lower than patients in traditional nutrition group (P < 0.05), while the serum albumin level was significantly higher than that of traditional nutrition group (P < 0.05). In the incidence of complications and mortality, the average length of stay and total cost of comprehensive nutrition group were significantly lower than patients with traditional nutrition group (P < 0.05), the cure rate was significantly higher than that of traditional nutrition group (P < 0.05). ConclusionThe combination of parenteral nutrition and enteral nutrition of nutrition support model not only can shorten the duration of symptoms but also alleviate the burden of patients and reduce complications and mortality.

中西医结合治疗重症急性胰腺炎（附63例报告）

Clinical Efficacy of Percutaneous Nephroscope in Treatment of Patients with Severe Acute Pancreatitis

ObjectiveTo investigate clinical efficacy of percutaneous nephroscope in treatment of patients with severe acute pancreatitis (SAP). MethodsEighty-six patients with SAP in this hospital from August 2012 to November 2015 were selected, which were divided into percutaneous nephroscope treatment group (43 cases) and laparotomy treat-ment group (43 cases) according to the difference of therapy modality. The conventional drug therapy was performed for all of them. The postoperative recovery, content of serum C reactive protein (CRP) on day 14 after operation, and post-operative complications were observed in these two groups. Results① The abdominal pain relief time, postoperative bowel sounds recovery time, normal body temperature recovery time, and postoperative hospitalization time in the percu-taneous nephroscope treatment group were significantly shorter than those in the laparotomy treatment group (P<0.05). ② The contents of serum CRP in the percutaneous nephroscope treatment group and in the laparotomy treatment group on day 14 after operation were significantly lower than those on day 1 before operation[(8.35±2.13) mg/L versus (31.44±3.45) mg/L, P<0.05; (16.42±2.44) mg/L versus (32.09±2.98) mg/L, P<0.05]. On day 14 after operation, the content of serum CRP in the percutaneous nephroscope treatment group was significantly lower than that in the laparotomy treat-ment group[(8.35±2.13) mg/L versus (16.42±2.44) mg/L, P<0.05]. ③ The incidence rate of postoperative complications in the percutaneous nephroscope treatment group was significantly lower than that in the laparotomy treatment group[14.0% (6/43) versus 32.6% (14/43), P<0.05]. ConclusionPercutaneous nephroscope in treatment of patients with SAP is effect, it has advantages of shorter hospital stay and early recovery, which could reduce incidence of postoperative complications, and it's mechanism might be related to systemic inflammatory response.

霍桑效应对重症监护病房手卫生依从性的影响研究

目的 探索霍桑效应对重症监护病房（Intensive Care Unit，ICU）医护人员手卫生依从性的影响。 方法 2014 年 10 月—12 月科室根据世界卫生组织手卫生调查方法，采用现场直接观察法和隐蔽式观察法，分别对 ICU 122 名护士、12 名医生、4 名保洁、14 名工人的手卫生情况进行明访和暗访，并将明访和暗访监测到的手卫生时机的洗手执行情况进行对比分析；2015 年 1 月研究者对中国知网数据库中所报道的手卫生依从性调查的文章进行了文献回顾，检索关键词为“手卫生”“依从性”，对搜索获取到的文献进行分析。 结果 ICU 医护人员手卫生依从性明访、暗访结果分别为 70.05%（1 275/1 820）和 57.28%（1 023/1 786），差异有统计学意义（P<0.001）。对中国知网数据库中检索到的 62 篇核心期刊的研究方法采用明访的居多，其中明访 36 篇，暗访 24 篇，明暗访相结合的 2 篇；仅有 3 篇提及霍桑效应，其中 2 篇采取了避免霍桑效应的措施；手卫生依从性<50% 的文献占总文献的 25.8%，依从性在 50%～80% 的文献占总文献的 46.8%，依从性在 80%～90% 的文献占总文献的 12.9%，依从性>90% 的文献占总文献的 14.5%。 结论 ICU 医护人员手卫生依从性可能受霍桑效应影响，因此在进行手卫生依从性的调查时要避免霍桑效应，以取得真实的调查结果。

Analysis of condensate contamination in pipelines of severe pneumonia patients undergoing mechanical ventilation

ObjectiveTo investigate the condensate pollution in the pipeline of severe pneumonia patients undergoing mechanical ventilation.MethodsFrom January 2017 to January 2019, 120 patients with severe pneumonia treated by mechanical ventilation in our hospital were collected continuously. The lower respiratory tract secretions were collected for bacteriological examination. At the same time, the condensed water in the ventilator exhaust pipe was collected for bacteriological examination at 4, 8, 12, 16, 20 and 24 hours after tracheal intubation and mechanical ventilation. The bacterial contamination in the condensed water at different time points was analyzed and separated from the lower respiratory tract. The consistency of bacteria in secretion and drug resistance analysis of bacterial contamination in condensate water were carried out.ResultsOf the 120 patients with severe pneumonia after mechanical ventilation, isolates were cultured in the lower respiratory tract secretions of 102 patients. One strain was cultured in 88 cases, two strains were cultured in 10 cases, and three strains were cultured in 4 cases. The isolates were mainly Gram-negative bacteria (57.5%) and Gram-positive bacteria (42.5%). The most common isolates were Pseudomonas aeruginosa, Staphylococcus aureus and Acinetobacter baumannii. The contamination rate of condensate water was 5.0% at 4 hours, 37.5% at 8 hours, 60.0% at 12 hours, 76.7% at 16 hours, 95.0% at 20 hours, and 100.0% at 24 hours, respectively. The bacterial contamination rate in condensate water at different time points was statistically significant (P=0.000). The pollution rate at 4 hours was significantly lower than that at 8 hours (P=0.000). Gram-negative bacteria accounted for 57.5% and Gram-positive bacteria accounted for 42.5%. The most common isolates were Staphylococcus aureus, Pseudomonas aeruginosa and Acinetobacter baumannii. The consistency of bacteria in lower respiratory tract and condensate water was 83.3% in severe pneumonia patients undergoing mechanical ventilation. The overall resistance of Pseudomonas aeruginosa, Acinetobacter baumannii and Staphylococcus aureus was higher, but the resistance to imipenem/cilastatin was lower.ConclusionsThe bacterial contamination in the condensate of patients with severe pneumonia during mechanical ventilation is serious. The pollution rate is low within 4 hours. It is consistent with the bacterial contamination in lower respiratory tract and the bacterial resistance is high.

Role of Related Cytokines in Severe Acute Pancreatitis Associated Lung Injury

ObjectiveTo summarize the changes and interaction of the cytokine in severe acute pancreatitis associated lung injury. MethodsThe published literatures at domestic and aboard in recent years about severe acute pancreatitis associated lung injury were collected and reviewed. ResultsThe cytokines had a chain effect, and influenced each other when severe acute pancreatitis with lung injury attacked. ConclusionsRelated cytokines play important roles in severe acute pancreatitis associated lung injury. Researching the related cytokines will contribute to the diagnosis and treatment for severe acute pancreatitis with lung injury.

重症监护室侵入性操作的感染分析与护理干预

【摘要】　目的　总结重症监护室（ICU）内各种侵入性操作与相关感染的关系及护理干预。　方法　对2008年7月-2009年6月ICU收治的患者进行回顾性调查，了解ICU内侵入性操作与相关感染发生情况。　结果　479例患者在ICU住院期间发生医院感染83例次，医院感染率17.33％，其中与侵入性相关感染74例次，占89.16%。各侵入性操作的医院感染发生率:气管插管/切开（未使用呼吸机）为14.81%；使用呼吸机为33.65%；留置导尿管为7.69%，留置胃管为7.14%；动静脉置管为0.94%。侵入性操作越多，感染率相应增高。　结论　对危重患者实施侵入性操作时，加强对呼吸系统、泌尿系统、血管内导管等相关感染的预防与控制，切断感染链是控制因侵入性操作而发生医院感染的有效方法。