目的 總結中老年人半月板損傷的特點及關節(jié)鏡下治療的效果。方法 2001年10 月～2004年5月，對52例57膝半月板損傷患者行關節(jié)鏡下診斷與治療。其中男20例，女32例，年齡52～78歲，平均65歲。膝關節(jié)病史1～21年。關節(jié)鏡下見半月板水平破裂19膝，退行性破裂13膝，復合型破裂9膝，縱形破裂5膝，斜形破裂4膝，橫形破裂4膝，瓣形破裂3膝。鏡下縫合3膝，行半月板全切或部分切除54膝。結果 術后患者均獲隨訪6～15個月，平均9個月。按董天祥等膝關節(jié)鏡下療效評價標準：優(yōu)39膝，良12膝，中6膝，優(yōu)良率89.5％。結論 中老年人半月板損傷癥狀體征不典型，關節(jié)鏡下半月板治療療效滿意且創(chuàng)傷小。
摘要:目的:探討老年耐亞胺培南銅綠假單胞菌(IRPA)感染的危險因素以指導臨床救治。 方法:采用病例對照研究,選取四川省人民醫(yī)院干部科2006年1月~2008年12月IRPA院內感染老年患者32例,并隨機選擇同時期敏感銅綠假單胞菌院內感染48例作為對照,采用單因素(t檢驗,χ2檢驗)及多因素Logistic回歸進行分析。結果:IRPA分離率為34.8%,IRPA對抗生素的耐藥性遠遠高于敏感銅綠假單胞菌組,但對阿米卡星敏感率達81.3%。單因素分析發(fā)現(xiàn),下列因素與IRPA感染有關:高齡、住院時間≥4周、高急性生理和慢性健康狀況(APACHEⅡ)評分、慢性肺部疾病(慢性阻塞性肺疾病COPD/支氣管擴張)、分離出IRPA前2周用過亞胺培南/美羅培南、早期聯(lián)用抗生素、院內獲得性肺炎(HAP)。多因素Logistic回歸分析表明:長程住院［比值比(OR)= 14.887］,APACHEⅡ評分≥16分(OR=38.908)以及分離出IRPA前2周用過亞胺培南/美羅培南(OR =12.945)是IRPA感染的獨立危險因素。結論:長程住院、APACHEⅡ評分≥16分以及亞胺培南/美羅培南的使用是IRPA感染的危險因素。IRPA對阿米卡星敏感率相對較高,但治療難度大。Abstract: Objective: To study the infection status and risk factors of nosocomial infection caused by imipenemresistant Pseudomonas aeruginosa (IRPA) in elderly patients. Methods: By a casecontrol study, the data of 32 cases of IRPA nosocomial infections were analyzed from Jan. 2006. to Dec. 2008 in cadres Ward of Sichuan Provincial People’s Hospital; 48 cases of Imipenemsensitive pseudomonas aeruginosa infection were randomized as control. Univariate analysis (T test and chisquare test )and multivariate logistic regression analysis were used for statistics. Results: The resistance to antibiotics of IRPA is much higher than the sensitive group.81.3％ of IRPA were sensitive to amikacin. According to univariate analysis,the factors associated with the infection caused by IRPA were age, length of stay in hospital more than 4 weeks, high score of APACHEⅡ, chronic pulmonary disease (COPD/bronchiectasis),imipenem/meropenem used 2 weeks before isolation of IRPA, early combination therapy of antibiotics and hospital acquired pneumonia (HAP). Multivariate logistic regression analysis identified three independent factors: Length of stay in hospital more than 4 weeks, APACHEⅡ score≥16 and imipenem/meropenem used 2 weeks before isolation of IRPA. Conclusion: Long length of stay in hospital, APACHEⅡ score ≥16 and previous imipenem/meropenem use were independent risk factors for IRPA infection. Although the sensitivity of IRPA to amikacin was relatively high, it was difficult to treat in clinical practice.