ABSTRACT
Objective To evaluate the application value of non-invasive hemodynamic monitoring by thoracic electrical bioimpedance (TEB) in elderly non-cardiac surgery patients after general anaesthesia.Methods Fifty-six elderly non-cardiac surgery patients after general anaesthesia were divided into control group and TEB group with 28 patients in each group by random digits table. All patients received standardized care including central venous pressure (VAP). Besides these monitoring, hemodynamic monitoring by TEB was used to evaluate the hemodynamic state of patients in TEB group. Diuretics, inotropic agents, vasoactive drugs or intravenous fluid therapy were used according to monitoring guidance. The heart rate (HR), mean arterial pressure (MAP), VAP, urine output (UO) were recorded in different time. The length of mechanical ventilation and ICU stay were also recorded. The difference in HR, MAP, VAP, UO, the length of mechanical ventilation and ICU stay between two groups were analyzed. Results The differences between two groups had no significance in HR, MAP, VAP, UO at the same time (P ＞ 0.05 ). The length of mechanical ventilation of TEB group [ (19.5±15.9)h] was shorter as compared to that of control group [ (25.5 ± 16.5) h ], but the difference was not significant (P =0.173). The ICU stay of TEB group [(2.8 ± 1.0) d ] was shorter as compared to that of control group[(3.6±1.6)d] and the difference was significant (P=0.032). Conclusion Non-invasive hemodynamic monitoring by TEB can monitor the changes of hemodynamics and direct treatment in elderly non-cardiac surgery patients after general anaesthesia.
ABSTRACT
OBJECTIVE To investigate the pathogen distribution and antimicrobial resistance in ventilator-associated pneumonia(VAP) in intensive care unit(ICU) of our hospital and provide reference for clinical treatment.METHODS Among 135 patients with VAP in ICU of our hospital,pathogens distribution and resistance rate from sputum culture were analyzed retrospectively.RESULTS Among 188 strains of isolated pathogens in 135 patients,the Gram-negative bacteria accounted for 74.5%,the Gram-positive bacteria 14.4% and the fungi were 11.2%.The predominant pathogens were Pseudomonas aeruginosa(19.7%),Stenotrophomonas maltophilia(18.6%),Klebsiella pneumoniae(16.0%),and Acinetobacter baumannii(14.4%),Staphylococcus aureus(10.6%),Candida albicans(9.6%).The percentage of meticillin-resistant S.aureus(MRSA) was 95.0% and no vancomycin-resistant S.aureus isolate was detected out.Sensitive antibiotics were cefoperazone/sulbactam,imipenem/cilastatin,fluconazole etc.CONCLUSIONS The multi-drug resistant Gram-negative bacilli are the main pathogens in VAP in ICU of our hospital.Cefoperazone/sulbactam and imipenem/cilastatin can be used as first empirical antibiotics for patients with VAP in ICU of our hospital.