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OBJECTIVE To investigate the major pathogenic bacteria and drug resistance in the infantile septicemia and to provide laboratory evidence for clinical diagnosis and treatment. METHODS The venous blood plate was used. RESULTS Totally 328 isolated strains were assayed with French Bio-Merieux API System.Of them,203 strains of coagulase negative Staphylococcus(CNS),being 61.9%.115 strains(56.6%) were(S.epidermidis).45 strains(22.1%) were S.haemolyticus,and 43 strains(21.1%) were S.lugdunensis.The isolated rate of meticillin resistant coagulase negative Staphylococcus(MRCNS) was 35.5%.The drug test for MRCNS showed multiple drug-resistance. CONCLUSIONS MRCNS is the major pathogen in infantile septicemia.The detectable rate of MRCNS is high.Glycopeptide antibiotics are the first-choice drugs for MRCNS infection.
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Objective: To explore the reasonable compatibility of anesthetics in painless small intestinal endoscopy by comparing the influence of different target plasma propofol concentrations combined with remifentanil on anesthesia effects and respiratory and circulatory functions.Methods: Two hundred patients requiring small intestinal endoscopy were randomly divided into 4 groups,Group Ⅰ given 1% propofol only,with the target plasma propofol concentration set at 4.5 ?g/ml,and Group Ⅱ,Ⅲ and Ⅳ receiving 30-second injection of remifentanil(0.3 ?g/kg) 1 min before target-controlled infusion(TCI) of propofol,with the target plasma propofol concentration set at 3.0,3.5 and 4.0 ?g/ml,respectively.The mean arterial pressure(MAP),heart rate(HR),pulse oxygenation(SpO2),induction time,awakening time,orientation recovery time and the incidence of patients' body motion were observed before anesthesia,at the vanishment of the eyelash reflex,while the small intestine endoscope passing through the Treitz ligament or ileoceal valve and after endoscopy.Results: Compared with baseline values,MAP and HR were significantly decreased in all groups when the eyelash reflex vanished,markedly increased in Group Ⅰ,although not so obvious in Groups Ⅱ and Ⅲ,when the small intestinal endoscope passed through the Treitz ligament or ileoceal valve,and greatly reduced at all time points in Group Ⅳ,with difficult entrance of the small intestine endoscope due to low tension of the intestinal cavity.Comparatively,the induction time was shorter and the awakening time and orientation recovery time were longer in Group Ⅰ,the total dose of propofol and the incidence of body motion notably decreased in Groups Ⅱand Ⅲ,and the incidence of respiratory depression obviously increased in Group Ⅳ.Conclusion: Propofol TCI combined with remifentanil can be used safely and effectively in painless small intestinal endoscopy.Target plasma propofol concentration(3.5 ?g/ml) in combination with remifentanil(0.3 ?g/kg) gives more efficient anesthesia,lower incidence of body motion and respiratory suppression and better recovery.Therefore,it is the suitable anesthetic compatibility in painless small intestinal endoscopy.
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Objective: To evaluate the feasibility, technical characters and benefits of laparoscopic cholecystectomy (LC) in patients with cirrhotic portal hypertension(CPH). Methods:40 CPH patients, including 21 Child A class,26 Child B class and 3 Child C class were included. Data of the patients were collected and analyzed. Results: LC was successfully performed in 37 cases, and 3 patients were converted to open cholecystectomy (OC)for uncontrollled bleeding under laparoscopy and dense adhesion of Calot’s triangle. The convertion rate was 7.5%. The time of operation was (52.6? 15.2)min. The intraoperative blood loss was (75.5? 15.5)ml. The time to resume diet was (18.3?6.5)h. Seven postoperative complications occurred in 5 patients (13.2%). All patients discharged from hospital in (4.6?2.4) d after LC. Compared with LC in non cirrhotic patients, LC in patients with CPH has longer surgical time and hospital stay after operation, higher convertion rate and postoperative complication rate, more intraoperative blood loss. Conclusion: LC in patients with CPH has the advantages of minimal invasive surgery. It is feasible and relatively safe. But it has a higher convertion rate. Intraoperative blood loss is a prominent problem. The key step for a successful operation is to pay more attention to the perioperation managements and acquaint with the technical characters of this operation.
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<p><b>OBJECTIVE</b>To determine the level of neurohormonal operative stress response-reactive protein (CRP) and rest energy expenditure (REE) after laparoscopic cholecystectomy (LC) and open cholecystectomy (OC).</p><p><b>METHODS</b>Twenty-six consecutive patients with noncomplicated gallstones were randomized for LC (n = 14) and OC (n = 12). Plasma concentrations of somatotropin, insulin, cortisol and CRP were measured. The levels of REE were also measured.</p><p><b>RESULTS</b>On the third postoperative day, the insulin levels were lower than those before operation (P < 0.05). On the first postoperative day, the levels of somatotropin and cortisol were higher in OC than in LC. After operation, the parameters of somatotropin, CRP and cortisol increased compared to the preoperative period in all patients (P < 0.05). On the all-postoperative day, the CRP levels were higher in OC than in LC (P < 0.05). After operation, the REE level increased in OC and LC (P < 0.05). On the all-postoperative day, the REE levels were higher in OC than in LC (P < 0.05).</p><p><b>CONCLUSIONS</b>LC results in less prominent stress response and smaller metabolic interference compared to open surgery. These benefit the restoration of stress hormones, nitrogen balance, and energy metabolism. However, LC can also induce acidemia and pulmonary hypoperfusion because of pneumoperitoneum during surgery.</p>