目的 探究耐碳青霉烯類銅綠假單胞菌血流感染（carbapenem-resistant Pseudomonas aeruginosa bloodstream infection, CRPA-BSI）患者的預(yù)后情況及其影響因素。方法 該研究為單中心回顧性隊(duì)列研究，選取 2017 年－2021 年于四川大學(xué)華西醫(yī)院發(fā)生銅綠假單胞菌血流感染患者的臨床資料，比較 CRPA-BSI 患者與碳青霉烯敏感銅綠假單胞菌血流感染（carbapenem-sensitive Pseudomonas aeruginosa bloodstream infection, CSPA-BSI）患者的預(yù)后情況，采用 Cox 回歸分析 CRPA-BSI 患者預(yù)后不良的影響因素。結(jié)果 共納入 53 例 CRPA-BSI 患者和 175 例 CSPA-BSI 患者，根據(jù)年齡校正的 Charlson 合并癥指數(shù)（age-adjusted Charlson Comorbidity Index, aCCI）將患者進(jìn)行 1∶1 匹配以控制混雜因素。在 aCCI 相近時(shí)，CRPA-BSI 患者的預(yù)后不良發(fā)生率高于 CSPA-BSI 患者［41.5% vs. 18.9%；相對(duì)危險(xiǎn)度=2.20，95% 置信區(qū)間（confidence interval, CI）（1.16，4.19），P=0.011］，CRPA-BSI 組住院時(shí)間中位數(shù)比 CSPA-BSI 組延長(zhǎng) 3 d 但差異無(wú)統(tǒng)計(jì)學(xué)意義（29 vs. 26 d，P=0.388）。單因素 Cox 回歸分析結(jié)果顯示最高體溫≤39℃（P=0.014）、患有肝膽胰疾?。≒=0.011）、中心靜脈置管時(shí)間（P=0.025）、留置導(dǎo)尿管時(shí)間（P=0.037）、根據(jù)藥敏結(jié)果調(diào)整用藥時(shí)間（P=0.015）和 Pitt 菌血癥評(píng)分（P=0.007）與 CRPA-BSI 患者預(yù)后不良有關(guān)；多因素 Cox 回歸分析結(jié)果顯示肝膽胰疾?。畚ｋU(xiǎn)比（hazard ratio, HR）=3.434，95%CI（1.271，9.276），P=0.015］和 Pitt 菌血癥評(píng)分［HR=1.264，95%CI（1.057，1.510），P=0.010］與 CRPA-BSI 患者的不良預(yù)后獨(dú)立相關(guān)。結(jié)論 與 CSPA-BSI 患者相比，CRPA-BSI 患者的預(yù)后較差，肝膽胰疾病會(huì)顯著增加 CRPA-BSI 患者不良預(yù)后的發(fā)生風(fēng)險(xiǎn)，Pitt 菌血癥評(píng)分是 CRPA-BSI 患者預(yù)后的預(yù)測(cè)因素。
【摘要】 目的 總結(jié)復(fù)雜脛骨平臺(tái)骨折手術(shù)治療的臨床經(jīng)驗(yàn)?！》椒ā?007年1月-2009年12月，采用切開(kāi)復(fù)位內(nèi)固定治療復(fù)雜脛骨平臺(tái)骨折56例。男37例，女19例；年齡19～76歲，平均45.6歲。骨折按Schatzker分型:Ⅳ型12例，Ⅴ型26例，Ⅵ型18例。合并半月板損傷20例，膝內(nèi)側(cè)副韌帶損傷9例，外側(cè)副韌帶損傷8例，交叉韌帶損傷4例。受傷至手術(shù)時(shí)間7～14 d，平均9 d?！〗Y(jié)果 術(shù)后53例切口Ⅰ期愈合；2例術(shù)后3 d切口出現(xiàn)淺表感染，1例術(shù)后7 d外側(cè)切口出現(xiàn)皮膚壞死、鋼板外露，均對(duì)癥處理后愈合。56例均獲隨訪，隨訪時(shí)間14～49個(gè)月，平均19個(gè)月。骨折均于術(shù)后4～8周愈合，平均6周。并發(fā)膝關(guān)節(jié)僵硬1例、創(chuàng)傷性關(guān)節(jié)炎2例、異位骨化1例，相應(yīng)處理后治愈。術(shù)后12個(gè)月按美國(guó)特種外科醫(yī)院評(píng)分標(biāo)準(zhǔn)評(píng)價(jià)療效，獲優(yōu)43例，良5例，可4例，差4例，優(yōu)良率85.7%。 結(jié)論 手術(shù)治療復(fù)雜脛骨平臺(tái)骨折需重視軟組織條件，掌握好手術(shù)時(shí)機(jī)、選擇合適內(nèi)固定、提高手術(shù)技巧、術(shù)后有效的功能鍛煉是保證療效的關(guān)鍵?！続bstract】 Objective To summarize the clinical experiences of surgical treatment for complex tibial plateau fractures. Methods From January 2007 to December 2009, 56 patients with complex tibial plateau fractures underwent open reduction and internal fixation. The patients included 37 males and 19 females with the age of 19-76 years old (average 45.6 years old). The Schatzker type of the fractures were type Ⅳ in 12 patients, type Ⅴ in 26, and type Ⅵ in 18. The injuries included meniscus injury in 20 patients, injury of lateral collateral ligament of knee in 9, injury of lateral collateral ligament in 8, and cruciate ligaments injury in 4. The time duration between the injury and the surgery was 7-14 days (average 9 days). Results After the surgery, the incision healed at I stage in 53 patients. The incision was superficially infected 3 days after surgery in 2 patients, and the Necrosis of skin around the incision and revealed steel plate were found 7 days after surgery in 1 patient; the injuries was healed after corresponding treatment. All of the patients were followed up with the average follow-up period of 14-49 months (average 19 months). The fractures healed 4-8 weeks (average 6 weeks) after the surgery. Knee joint ankylosis was found in one, traumatic arthritis was found in two, and heterotopic ossification was found in one; the injuries was healed after corresponding treatment. Twelve months after the surgery, the therapeutic effect according to HSS criteria indicated that the score was excellent in 43, good in 5, generally in 4 and poor in 4; with a fine rate of 85.7%. Conclusion Appropriate conditions of the soft tissue, good surgical opportunity, a appropriate fixation, improved surgical technique and effective postoperative functional training are the key points of surgical treatment for complex tibial plateau fractures.