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ObjectiveTo investigate the effect of antiretroviral (ARV) treatment on AIDS patients in Hunan Province and to analyze the drug resistance of human immunodeficiency virus (HIV), so as to improve the treatment effect of highly active antiretroviral therapy (HAART) and provide reference for clinical application of drugs. MethodsBlood  samples of 252 AIDS patients who had taken HAART for more than 6 months were collected for viral load test, viral load of 32 samples were >103 copies/mL,  these samples  were further detected HIV  genotypic resistance profile.ResultsAmong 31 HIV detected sequences , 18 samples were found the drug resistance mutations,13 samples (5.16%,13/252) showed  drug resistance mutation  to protease inhibitors (PIs), nucleoside reverse transcriptase inhibitors (NRTIs) and nonnucleoside reverse transcriptase inhibitors(NNRTIs), 1 (0.40%) sample was resistant to PIs, NRTIs and NNRTIs, 9 (3.57%) were resistant to both NRTIs and NNRTIs, 3 (1.19%) were resistant to NNRTIs. M184V,K103N,Y181CG and G190A were common mutation sites which induced highlevel resistance to NRTIs and NNRTIs.ConclusionThe prevalence of HIV drug resistance to PIs among AIDS patients is very low, and NRTIs and NNRTIs are relatively higher; high level NNTIs multidrug resistance has emerged,  the level of HIV drug resistance in AIDS patients in Hunan is still low.

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To prospectively observe the efficacy, tolerance , immune reconstruction and toxicity of longterm highly active antiretroviral therapy (HAART) in HIVinfected patients in China.MethodsFour hundred and thirtyseven HIVinfected patients initiated HAART and originally received two nucleoside reverse transcriptase inhibitors（NRTI） and one nonnucleoside reverse transcriptase inhibitors（NNRTI）, and were traced  HIV RNA levels, T lymphocyte subsets, blood routine tests, main laboratory parameter changes and treated for active opportunistic infections. Patients with severe side effects or virological failure changed to the second line regimens.Results437 patients from 8 hospitals received a  mean of  4.69 years (3.15~7.34) followup. Total mortality was 6.86 %, and the majority of patients  died within the first 6 months  of the treatment. The proportion of subjects who had HIV1 RNA＜500 copies/mL were 90.80%, 63.46%, 69.41%, 70.00%, and 72.22% at 1,4,5,6 and 7 year (±1 month) respectively. CD4+ T cell count were 115, 246, 301, 334, 363, 356,386 and 373 cells/μL at 0, 1, 2, 3, 4, 5, 6 and 7 year （±1 month） of followup, respectively. 67.73% of HIVinfected patients showed various drugrelated side effects, the majoriy were digestive system symptoms , neurological system symptoms, liver dysfunction, marrow toxicity ,skin rash, and hyperlipemia, et al. 19.22%  of patients changed their primary regimens into other firstline drugs for drugrelated side effects, 11.67%  of patients switch to secondline regimen for viral resistance. ConclusionThis paper firstly reported the 3 to 7year results from the multicenter prospective followup of HIVinfected patients in China taking potent antiretroviral therapy. The study demonstrated antiretroviral therapy with two NRTI and one NNRTI regimen may persistently suppress HIV and increase CD4 cell in a majority of subjects. The majority of subjects take firstline regimen effectively, minor switch to secondline regimen for drugrelated side effects or viral resistance.

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［Abstract］ObjectiveTo study the immune function of dendritic cell (DCs) in HBVinfected patients.MethodsHBV DNA in DCs of 12 chronic hepatitis B (CHB) patients with serum positive HBV DNA and 10 CHB patients with serum negative HBV DNA were detected by fluorescent quantitative polymerase chain reaction, the  function of secreting interleukin12(IL12) by DCs under different titers of HBV was compared, 10 persons with negative HBV markers and normal liver function were as control.ResultsHBV DNA in DCs was detected in 7 of 12 (58.33%) CHB patients with positive HBV DNA. The levels of IL12 in DCs supernatants of serum positive HBV DNA group were obviously  lower than  that of HBV DNA negative and healthy control group（both P<0.01）; The expression levels of IL12 in DCs HBV DNA positive group was obviously lower than that of DCs HBV DNA negative group and healthy control group（ both P<0.01）.ConclusionThe DCs derived from peripheral blood in patients with CHB can  be infected by HBV, the secretion function of IL2 by HBVinfected DCs decreased significantly

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ObjectiveTo study the characteristics of hepatitis B virus (HBV) precore G1896A mutation and basal core promoter (BCP) A1762T and G1764A mutations among HBeAgnegative and HBeAgpositive chronic hepatitis B (CHB) patients， and to explore the relationship between the above mutations and the serum levels of interferonγ (IFNγ) and interleukin10 (IL10) in these patients.Methods120 patients with HBV DNA positive CHB including 60 HBeAgnegative CHB (group A) and 60 HBeAgpositive CHB (group B)， and 60 healthy persons were enrolled in this study. The serum HBV DNA of group A and B were determined by realtime fluorescence quantitative polymerase chain reaction (PCR). The HBV precore G1896A mutation and BCP A1762T and G1764A mutation in group A and B were detected by PCR  and direct sequencing. The levels of IFNγ and IL10 in serum were measured by enzyme linked immunosorbent assay.ResultsThe total incidence of precore and BCP mutations was 60.00%(72/120) in 120 patients, the incidence of precore and BCP mutation in group A and B was 80.00% (48/60) and 40.00% (24/60) respectively (χ2=20.00，P=0.000). The incidence of precore G1896A mutation (38.33%) and the united mutation (G1896A and A1762T and G1764A mutation,25.00%) in group A were significantly higher than those in group B (16.67%, 0.00%) (χ2=7.06，P=0.008； χ2=17.14，P=0.000).  The serum level of IFNγ in the mutation group were（102.33±27.20）pg/mL, which were significantly higher than （79.18±16.43）pg/mL in the nonmutation group (t=5.72，P=0.000) and （35.77±4.23）pg/mL in the healthy control group (t=19.33，P=0.000) .The serum level of IL10 in the mutation group were（28.13±7.00）pg/mL , which were  also significantly higher than（13.91±5.42）pg/mL in the nonmutation group(t=12.50，P=0.000) and （13.68±2.27）pg/mL in the healthy control group (t=15.65，P=0.000).ConclusionThe G1896A mutation and the united mutation commonly occur in the HBeAg negative CHB patients. The mutations of G1896A and A1762T/G1764A may be related to the serum increased levels of IFN γ and IL10.

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ObjectiveTo investigate the current state of hepatitis B infection in population in Gansu Province ,  evaluate the effect of vaccination of hepatitis B vaccine, and to find out better prevention strategies.MethodsHBsAg was detected among 2 200 persons between 1~ 59 years old selected with multistage stratified cluster sampling method , related data were statistically analysed .ResultsAmong 2 200 persons, 79 were hepatitis B positive, the carrying rate of hepatitis B was  3.59%, which decreased by 52.26% compared with 7.52% of 1992. 1 060 persons received hepatitis B vaccination, 20(1.89%) of whom were hepatitis B positive; 947 persons didn’t receive hepatitis B vaccination, 51 (5.39%) of whom were hepatitis B positive; 193 persons were with unclear hepatitis B vaccination , 8 (4.15%) of whom were hepatitis B positive; There was significant difference in the carrying rate of hepatitis B among population with different vaccination states (P<0.001).Children between 1 ~ 4 years old had the lowest carrying rate (1.13%, 5/442). Among persons with different age, area, gender, and occupation, hepatitis B carrying rate of different immunization state was significantly different (P<0.05%).ConclusionHBsAg carrying rate has declined remarkablely, particularly in children between 1 ~ 4 years old , the effect of immunization among children is obvious, hepatitis B vaccination should cover more wide range of population.

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ObjectiveTo establish domestic entirely automatic nucleic acid testing (NAT) assay for blood screening, and to study the feasibility of domestic NAT.MethodsOn the basis of enzyme linked immunosorbant assay for blood screen, blood samples were  pooled and extracted nucleic acid with entirely automatic nucleic acid apparators, then the extracted nucleic acid was amplified and detected with realtime polymerase chain reaction，sensitivity and efficacy was evaluated, NAT positive donors were traced.ResultsThe 95% detection limits of HBV DNA, HCV RNA and HIV1 RNA tested by automatic system  were 35.9 IU/mL，147.7 IU/mL and 66.1 IU/mL，respectively,95% confidence intervals were ［21.9，124.8］，［93.3，386.4］ and ［38.8，235.3］ respectively. Twelve of 60 112 samples were HBV DNA positive，DNA positive ratio was 1︰5 009, 6 of which  were antiHBc positive;one sample was HCV RNA positive, RNA positive ratio was 1︰60 112; no HIV1 RNA positive was detected among all samples. Seven HBV DNA donors were followed up, 4 of whom had  seroconverted.ConclusionThe domestic entirely automatic system can be applied in blood HBV DNA , HCV RNA and HIV RNA screening. 

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ObjectiveTo explore the distribution of disinfectantsulfadiazineresistance gene qacEΔ1sul1 in Pseudomonas aeruginosa (P. aeruginosa) and the resistance of positive strains to four kinds of disinfectants (iodophor, glutaraldehyde, chlorhexidine and “84” disinfectant ).MethodsTwenty strains of P.aeruginosa isolated from a hosptial between December, 2007 and January 2008 were detected qacEΔ1sul1 gene by polymerase chain reaction, minimum inhibitory concentrations (MICs) of the above four disinfectants were detected.ResultsIn 20 strains of P. aeruginosa, 10(50.00%) strains were positive for qacEΔ1sul1 gene. MICs of iodophor, glutaraldehyde, chlorhexidine and “84” disinfectant to positive qacEΔ1sul1 strains were 8.0~128.0 μg/mL,16.0~256.0 μg/mL，1.0~16.0 μg/mL， and 4.0~64.0  μg/mL, respectively.ConclusionqacEΔ1sul1 gene is widespread in the clinical isolated P. aeruginosa, there are differences in resistance of positive strains against four kinds of disinfectants, disinfectants should be used rationally so as to control the spread of  P. aeruginosa.

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ObjectiveTo study the risk factors for surgical site infections (SSI) in patients with hepatobiliary operations, and provide the basis for preventing SSI.MethodsTargeted monitoring method was adopted to study the incidence rate of hepatobiliary SSI, the related factors for hepatobiliary SSI were analyzed with univariate and multivariate Logistic regression analysis model, which include preoperative hospital days, diabetes mellitus, plasmaalbumin, the length of operation process, surgical approach, ASA score, direction of incision, incision length, blood loss during operation process, drainage days, postoperative complication， et al.ResultsThe incidence rate of hepatobiliary SSI was 11.74% (35/298), 24 cases (68.57%) acquired infections during hospitalization period, 11 cases (31.43%) acquired infections after discharge. Logistic regression analysis showed that the independent  risk factors of hepatobiliary SSI included postoperative complications such as fatty liquefaction ,incision fissuration,  length of operation and drainage days. ConclusionMultiple factors contribute to hepatobiliary SSI , comprehensive preventive measures should be taken to control the incidence rate of hepatobiliary SSI.
［Chin Infect Control，2010，9（5）：334-336,333］

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ObjectiveTo evaluate the endotoxin and bacterial contamination in reverse osmosis (RO) water and dialysate in hospitals in Chongqing.MethodsSpecimens of RO water and dialysate were obtained from 8 hemodialysis units in Chongqing；Bacterial culture was performed and endotoxin was measured with ATi dynamic test tube meter.ResultsBacterial counts of RO water in 8 hospitals were all ≤200 CFU/mL,bacteria counts of dialysate of 1 blood purification centers were>2 000 CFU/mL, the majority of isolated bacteria were gramnegative bacteria；the contents of endotoxin in the RO water of  8 centers were all ＜2 EU/mL.ConclusionRO water and dialysate in most hospitals in Chongqin are conformed to national standard, but bacterial contamination of RO water and dialysate is existing in some Chongqing blood purification centers.The regular detection of endotoxin and bacteria should be undertaken to ensure the safety of medical treatment.

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ObjectiveTo observe the clinical effects of combination therapy of etimicin sulfate and montmorillonite powder on acute bacillary dysentery.MethodsThree hundred and twentysix patients were randomly divided into two groups: 182 patients in treatment group were  treated with combination of etimicin sulfate 0.2 g (added into 250 mL saline solution) intravenous drip for consecutive 3~5 days and montmorillonite powder orally (3 g/time, 3 times/day, the initial dose was doubled); 144 patients in control group were treated with etimicin sulfate intravenous drip with the same dose. Clinical therapeutic effect in two groups was observed.ResultsThe clinical effective rates were 93.96% (171/182) and 81.25%(171/144) in treatment and control group respectively, clinical effective rate in treatment group was significantly higher than that of control group (χ2=6.32, P<0.05); the average treatment course in treatment and control group were (2.04±0.48) and (3.12±0.71)days respectively, the former was obviously shorter than the latter(t=2.57, P<0.05) .ConclusionCombination therapy of etimicin sulfate and montmorillonite powder is an effective method for acute bacillary dysentery, and can shorten treatment course .

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ObjectiveTo evaluate the clinical value of  bronchoscopy for children with postcardiothoracic operation atelectasis.MethodsTwentyfour children who were diagnosed as postcardiothoracic operation atelectasis received suction, lavage and local injection through bronchoscope.ResultsAfter treatment through bronchoscope, 14 cases (58.33%) recovered, 9 (37.50%) improved, and 1(4.17%) didn’t recover, the percentage of atelectasis improvement was up to 95.83% .ConclusionTreatment through bronchoscope is safe and effective for postcardiothoracic operation atelectasis in children.

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ObjectiveTo investigate the management level of nosocomial infection (NI) in western China.MethodsSix hospitals in 2 Chinese western provinces were surveyed, the management problems of NI were investigated, and strategies on solving these problems were put forword.ResultsSix hospitals were all established NI management departments, but only 2 provinciallevel hospitals and 1 citylevel hospital carried out catheterrelated targed surveillance; the main problems of management of key departments were lack of facilities, irrational procedure, inadequate medical instrument, incorrect disinfection and hand hygiene methods, and inadequate consciousness of occupational protection; Most hospitals participated in antimicrobial management, and use antimicrobial agents rationally.ConclusionManagement of NI in western hospitals should be intensified, the key factors of improving NI management level is hospita1 leaders’ high attention and occupation of professionals to NI.

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ObjectiveTo investigate the distribution and change in drug resistance of clinical isolates in a hospital from 2006 to 2008.MethodsBacteria were isolated and identified by routine methods， antimicrobial susceptibility test was carried out by KirbyBauer method.ResultsA total of 3 499 clinical isolates were collected, grampositive and negative bacteria accounted for 24.12% (844 strains) and 75.88% (2 655 strains) respectively. 60.29% (208/345) of Staphylococcus aureus isolates were identified as methicillinresistant Staphylococcus aureus. Isolates of Enterobaceriaceae were still highly sensitive to carbapenem antibiotics. ESBLsproducing strains accounted for 45.23%(403/891) in Escherichia coli and 38.92% (130/334) in Klebsiella spp. respectively; Pseudomonas aeruginosa isolates showed relatively higher resistant rates to imipenem and meropenem,  which was 41.06% and 34.52% respectively, Acinetobacter spp. isolates showed relatively lower resistant rates to imipenem and meropenem, which was 15.52% and 31.90% respectively.ConclusionThe prevalence of MRSA and ESBLsproducing strains is high; surveillance of antimicrobial resistance can help clinicians use antimicrobial agents rationally and control the transmission of drugresistant strains.

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ObjectiveTo analyse the clinical distribution and drugresistance of Streptococcus pneumoniae （S.pneumoniae） isolated from patients in a hospital, so as to guide the rational use of antimicrobial agents in clinic.MethodsSeven hundren and eleven strains of  S. pneumoniae were isolated from inpatients and outpatients between April, 2007 and February, 2010, and identified with VITEK Compact system, antimicrobial susceptibility of  S. pneumoniae to penicillin and the other 12 kinds of antimicrobial agents were performed by automatic antimicrobial susceptibility system.ResultsMost strains were isolated from sputum samples (83.26%), the next were from nasopharyngeal swabs (8.86%) and blood (4.36%), most patients were in departments of respiratory/ digestive internal medicine (39.94%) and cardiovascular internal medicine (22.50%), sensitive rate to penicillin was 15.61%, resistant rate to penicillin was 84.39% (600 strains). The resistant rate to erythromycin, trimethoprim/sulfamethoxazole and amoxicillin was 91.98％,86.32％ and 31.23％，respectively , the resistant rate to vancomycin and linezoid was  0.00%.ConclusionAntimicrobial resistance of S.pneumoniae from children has become a severe problem, surveillance of drugresistance and antimicrobial use must be intensified.

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 ObjectiveTo investigate clinical distribution and antimicrobial resistance of Staphylococcus aureus（S. aureus）isolated from neonates,and provide guidance for rational use of antimicrobial agents.MethodsOne hundred and twelve strains of S. aureus isolated from neonates in Hunan Children's Hospital between January, 2008 and December, 2009 were analysed retrospectively.ResultsMost strains of S. aureus  were isolated from sputum and throat swabs in neonates with respiratory tract infection (65.18%,73/112）, the next were from blood, wound secretion and pus, which accounting for 12.50%, 12.50% and 7.14% respectively, resistant rate of S. aureus to clindamycin, erythromycin, amoxicillin and penicillin were high (41.08%~96.43%)； Methicillinresistant S. aureus (MRSA) were 20 strains (17.86%), drugresistance of methicillinsensitive S. aureus was significantly lower than that of MRSA (P=0.00 or P<0.05); All strains were sensitive to vacomycin and linezolid.ConclusionS.aureus is mainly isolated from respiratory tract specimens, and has strong resistance to antimicrobial agents, monitoring of pediatrics should be strengthened, and antimicrobial agents should be used rationally to prevent the emergence of drugresistant strains.

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ObjectiveTo investigate the distribution and antimicrobial resistance of clinical isolates from patients with lower respiratory tract (LRT) infection in neurological intensive care unit (NICU), so as to provide the basis for clinical treatment.MethodsSputum samples of patients with LRT infection in NICU from October, 2005 to December, 2008 were collected according to the standard criteria for routine bacterial culture ， identification and antimicrobial susceptibility test.ResultsA total of 567 pathogenic strains were isolated from 168 patients, 359 (63.32%) of which were gramnegative bacilli, 99(17.46%) were grampositive cocci, and 109 (19.22%) were fungi. Multidrug resistant (MDR) bacteria were common, 73.68% (28/38) of Escherichia coli and 62.30% (38/61) of Klebsiella pneumonia were extendedspectrum βlactamaseproducing strains respectively; carbapenemresistant rate of Acinetobacter baumannii was 43% in 2008, 87.10% (81/93) of Staphylococcus aureus were methicillinresistant strain, all were sensitive to teicoplanin and vancomycin.ConclusionGramnegative bacteria are the most common pathogens in patients with LRT infection in this NICU, drug resistance is severe, surveillance on antimicrobial resistance should be enhanced and rational use of antimicrobial agents should be advocated to reduced drugresistance.

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目的探讨鞘内注射万古霉素治疗开颅术后颅内感染的临床效果。方法2001年3月—2009年9月，对62例开颅手术后颅内感染患者分组治疗，其中30例采用静脉广谱、高效抗菌药物+鞘内注射万古霉素治疗，设为A组；另32例单纯静脉给予广谱、高效抗菌药物治疗，设为B组。观察并比较2组疗效。结果A组治疗1周，颅内感染治愈14例（46.67%），2周治愈28例（93.33%）；B组治疗1周，颅内感染治愈4例（12.50%），2周治愈12例（37.50%）。A、B两组治疗1、2周的治愈率比较，差异均有显著性 (均P＜0.05)。结论 静脉给予广谱、高效抗菌药物+万古霉素鞘内注射治疗开颅术后颅内感染，安全有效并可缩短疗程。

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目的开展培养基的质量控制工作，提高培养基的质量。方法对微生物检验中培养基的配制、灭菌、无菌试验和性能测试及贮存等方面进行探讨。结果配制培养基所用的容器宜为玻璃、搪瓷或不锈钢制品，使用蒸馏水或离子交换水；灭菌前后应测定pH值；自行配制培养基应严格按规定进行，每次详细记录；高压灭菌条件为121℃，15 min；培养基在使用前应进行性能测试，其保质期2~3年，已开封的为6个月；配制培养基使用的电子天平和酸度计应每年进行检定。结论保证培养基的质量控制,才能确保微生物检验的准确性和可靠性。

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目的分析脉动真空灭菌中不同包装材料湿包形成的原因，提出预防对策。方法以《消毒技术规范》和美国消毒锅公司建立的湿包评判标准，对3 020锅次，4种包装材料（双层棉布、双层医用皱纹纸、纸塑包装袋、不锈钢硬制容器）的98 425个灭菌包进行观察分析。结果98 425个灭菌包中产生湿包163个，湿包发生率0.17%；4种包装材料双层棉布、双层医用皱纹纸、纸塑包装袋、不锈钢硬制容器的湿包发生率分别为0.23%、0.00%、0.05%、0.13%，经统计学分析，差异有高度显著性（χ2=37.34，P<0.01）。常见的湿包原因为包裹未冷却出锅（29.45%）、包装方法不规范（22.70%）和物品装载不合理（20.86%）。结论优质包装材料能减少和杜绝湿包的发生；提高灭菌员业务素质和工作责任心是控制湿包的关键。

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目的了解2型糖尿病患者医院感染情况及其危险因素。方法对某院2006年1月—2008年12月收治的546例2型糖尿病患者的医院感染情况进行调查分析。结果546例2型糖尿病患者发生医院感染106例次，感染例次率19.41%；感染部位主要为呼吸道，占57.55%（61例次），其次为胃肠道16.98%（18例次），皮肤软组织11.32%（12例次），泌尿道6.60%（7例次）等。统计学分析显示，年龄≥60岁、糖尿病病程长（≥5年）、入院时伴发基础疾病多（≥3个）、住院时间长（≥30 d）、血糖水平控制不理想（空腹血糖≥10 mmol/L）、治疗过程中有侵袭性操作、使用免疫抑制剂及肾上腺糖皮质激素等是2型糖尿病患者发生医院感染的危险因素。结论2型糖尿病患者的医院感染率高，应加强对其医院感染危险因素的预防，以有效降低医院感染发生率。

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目的了解某院患者痰培养病原菌种类及其耐药性，以指导临床合理应用抗菌药物。方法回顾性分析该院2008年1月—2009年8月呼吸道感染患者痰培养分离出的病原菌及其耐药情况。结果1 452份痰标本共分离病原菌559株，阳性率38.50%。病原菌构成：革兰阴性（G-）杆菌398株，占71.20%，主要有肺炎克雷伯菌、铜绿假单胞菌、鲍曼不动杆菌、大肠埃希菌、嗜麦芽窄食单胞菌；革兰阳性(G+)球菌99株，占17.71%，主要有金黄色葡萄球菌、凝固酶阴性葡萄球菌和A群链球菌；同时还检出真菌62株，占11.09%，主要为白假丝酵母菌。G-杆菌对亚胺培南、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦较为敏感；G+球菌对万古霉素无耐药菌株，但葡萄球菌对多种抗菌药物耐药严重；A群链球菌对青霉素类均敏感；真菌对两性霉素B 和氟胞嘧啶敏感性最高。结论该院痰培养病原菌菌谱以G-杆菌为主，真菌占一定比例；多重耐药现象严重。加强耐药性监测，合理应用抗菌药物十分重要。

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目的了解某院医院感染现状，评价日常监测资料的准确性，减少漏报率。方法采用横断面调查的方法，于2008年10月5日对所有住院患者进行医院感染现患率调查。结果共调查住院患者1 118例，发现医院感染36例，39例次，医院感染率为3.22%，感染例次率为3.49%。医院感染部位主要为下呼吸道（22例，56.41%）、上呼吸道（5例，12.83%）、泌尿道（4例，10.26%）、皮肤软组织（4例，10.26%）。医院感染高发科室主要为综合重症监护室（38.46%）、神经外科（10.00%）、急诊科（8.69%）。抗菌药物使用率为44.63%，内科抗菌药物使用率（38.53%）显著低于外科（52.83%）（χ2=22.62，P=0.00）；内科以治疗性用药为主（54.26%），外科以预防性用药（76.19%）为主。结论现患率调查可真实反映医院感染情况，为进一步加强重点科室医院感染管理和抗菌药物管理提供依据。

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目的了解某病区静脉药物配制护士手卫生状况，加强输液环节的医院感染管理。方法对医院Ⅲ类环境中44名静脉药物配制护士的手进行随机采样检测。结果44份样本中， 27份检出细菌，其中9份样本细菌数超标。检出细菌居前4位的是凝固酶阴性葡萄球菌、微球菌属、真菌、不动杆菌属，分别占46.15%、28.21%、7.69%、7.69%。结论该病区静脉药物配制护士手卫生状况较差，有必要加强病区配药护士的手卫生监管。

Abstract:

糖尿病足患者常常合并创面感染，是糖尿病患者致残的主要原因。如何诊断、治疗和预防糖尿病足感染是临床医学面临的难题，目前国内外对此课题进行了大量临床和实验室研究。本文从临床角度针对糖尿病足及其感染进行综述。

Abstract:

随着呼吸机功能研究的不断完善及呼吸机的推广应用，机械通气（MV）已成为临床抢救急危重症患者呼吸功能障碍的重要手段。但气管切开插管破坏了患者上呼吸道的正常生理功能，是导致呼吸机相关性肺炎（VAP）的高危因素之一，同时呼吸机治疗造成的气道干燥、吸痰困难等原因常导致人工气道阻塞［1］。人工鼻的加温、湿化及过滤功能在一定程度上弥补了人工气道的缺陷，并可减少呼吸机内外环路的污染，能控制VAP的发生［2］。目前人工鼻以其高效的加温湿化作用在欧美国家得到广泛应用［3-4］，国内处于待普及状态。本文就近几年来有关人工鼻的定义，预防VAP作用机制、效果与护理的研究进展及发展方向综述如下。