Objective To understand the pathogenic bacteria distribution and drug resistance in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD). Methods The retrospective analysis was per-formed in the sputum culturs and drug resistance results of 740 patients with AECOPD. Results The positive rate of bacterial infection was 39. 1%. Among them, gram-negative bacteria were 196 strains (62. 4%), gram-positive bacteria 21 strains (6. 7%), and fungi 97 strains(30. 9%). The main kinds of gram-negative bacteria were Pseud-omonas aeruginasa, Acinetobacter baumannii,Klebsiella pneumoniae,Stenotrophomonas maltophilia and Escherichia-coli. Staphylococcus haemolyticus, Streptococcus pneumoniae and Staphylococcus aureus were the most frequent gram-positive bacteria. The major fungi was Candida albicans. Gram-negative bacteria showed high resistance to the third-generation cephalosporins,penicillins, moderate resistance to aminoglycosides,low resistance to imipenem. Gram-positive bacteria were resistant to many kinds of antibiotics, but they were responsive to linezolid and vancomycin. Fungi showed high sensitivity to antifungal agents. Conclusion The pathogens of AECOPD mainly are gram-nega-tive bacteria with a high drug resistance rate. To monitor pathogenic bacteria is conducive to master the pathogens distribution, drug resistance and provide the basis of rational use of antibiotics,which can slow down the emergence and spread of resistant bacteria.

Objectives:To research the relation of high blood glucose,GCS and prognosis after craniocerebal injury.　Methods:63 patients were divided into three groups,“GCS” 3～8,“GCS” 9～12,and GCS 13～15.Blood glucose of these groups were tested at admission of all patients and one week after hosptialization.　Results:The level of blood glucose and the mortality in GCS 3～8 group were significantly high than those in the other two groups.　Conclusions:After cranidcerebral injury,the blood glucose is an index of the injury degree.We should try to control the blood glucose in normal levels to improve the prognosis of patients with craniocerebral injury.

32 Cases of coronary heart diseases (M 20, F 12; age 58+10 y) were treated with polysacchairde sulfate (PSS). PSS 200 mg in 10% glucose solution 500 ml iv, drip, qd, and 14 d, as a course. The results showed; The cardiac function, blood fat and indices of hemorheology were significantly improved ( P

The secondary hyperparathyroidism is one of the complications of chronic renal failure (CRF) and end stage renal failure (ESRD), and becomes more serious with the development of the primary disease. Parathyroid hormone (PTH) is considered as one of the biomarks of the development of renal failure. The purpose of this article will expound the physiological effects of the PTH, the causes and clinical significances of PTH rising in CRF and ESRD patients, the determination of PTH level, and the relationships between the increase of PTH and the polymorphism of CYP2D6, GSTT1,GSTM1.

Objectives:To research the relation of high blood glucose,GCS and prognosis after craniocerebal injury. Methods:63 patients were divided into three groups,“GCS” 3~8,“GCS” 9~12,and GCS 13~15.Blood glucose of these groups were tested at admission of all patients and one week after hosptialization. Results:The level of blood glucose and the mortality in GCS 3~8 group were significantly high than those in the other two groups. Conclusions:After cranidcerebral injury,the blood glucose is an index of the injury degree.We should try to control the blood glucose in normal levels to improve the prognosis of patients with craniocerebral injury.

Objective To study the surgical treatment and defect repair of the former skull base comminuted fracture.MethodsClinical data of 47 patients were retrospectively analyzed and emergency treatment,surgical debridement and defect repair were discussed consulting the literature..Results Restore score was determined according to international standards after surgical treatment for 3 months,in all cases,36 cases restored good,6 cases with light disability,3 cases with severe disability,2 cases died.Subsequent following-up revealed 31 cases completely recovered for normal work and life,14 patients survived in varying degrees of neurological function obstacles without encephalomeningocele.Conclusion The successful surgery is determined by thorough debridement,closing the damaged local subarachnoid,repairing reconstruct former dural skull base and defective bones.

Objective To investigate the effect of adenosine on pulmonary injury after extracorporeal circulation. Methods Twelve mongrel dogs were randomly divided into two groups, the test group and control group. The model of extracorporeal circulation was established. In the test group and control group, adenosine(50μg/kg*min) and normal saline were infused before extracorporeal circulation respectively. Hemodynamics, right cardiac function and arterial blood gas were assessed. Lung water and malondialdehyde content were assessed. Histological evaluation was also made. Results　There were no differences between the two groups with respect to heart rate, mean systemic artery pressure, left atrial pressure, and central venous pressure. In the test group, pulmonary vascular resistance was lower and right cardiac function improved remarkably; arterial oxygen pressure (PaO2) was also higher, less lung water was observed and the malondialdehyde content in the pulmonary tissue was lower (P＜0.05,P＜0.01). Histological evaluation of the test group revealed normal pulmonary architecture without abundant intra-alveolar neutrophils. Conclusion Adenosine can attenuate ischemia-reperfusion lung injury and right cardiac insufficiency caused by extracorporeal circulation. At a proper dose, there was no significant effect on systemic hemodynamics.

Objective Controlled hypotension induced by different drugs may have different effects on splanchnic perfusion. The purpose of this study was to assess the effects of nicardipine- induced hypotension on splanchnic perfusion. Methods Twenty-three ASA Ⅰ-Ⅱ patients (14 male, 9 female) aged 21-60 yr undergoing meningioma resection were studied. The patients were premedicated with ranitidine 150 mg per os and atropine 0.5 mg i.m. Anesthesia was induced with propofol 1.5-2.0 mg?kg-1 , fentany1 2.0?g?kg-1 and vecuronium 0.1 mg? kg-1 and maintained with isoflurane inhalation and intermittent i. v. boluses of fentanyl and vecuronium. The patients were mechanically ventilated after tracheal intubation and PETCO2 was maintained at 33-35 mm Hg. Nicardipine-induced hypotension started from opening of mininges to the resection of tumor. 0.01% nicardipine infusion was started at 30 ml?h-1 and adjusted to reduce systolic blood pressure by 30% of the baseline or MAP to≥60 mm Hg. The adequacy of splanchnic perfusion was defined by gastric intramucosal CO2 tension (PgCO2), the intramucosal pH (pHi) and the difference between intramucosal and arterial PCO2(PCO2 gap) and was assessed before induction of anesthesia, the 1st, 2nd and 3rd hour during controlled hypotension and 1, 2 hour after termination of controlled hypotension. Results The MAP was maintained at about 62 mm Hg during controlled hypotension. The heart rate was stable. Hct was significantly decreased at 1st, 2nd and 3rd hour of hypotension compared with baseline but the mean Hct was greater than 30% . The intramucosal pH decreased slightly with no statistical significance and pHa, PaCO2 , PgCO2 and PCO2 gap were almost unchanged during controlled hypotension compared with the baseline values. Conclusion Nicardipine-induced hypotension is safe when MAP is maintained at≥60 mm Hg and has no adverse effects on splanchnic perfusion.

Objective To analyse the encoding gene of ? lactamase of the clinically isolated Klebsiela pneumoniae 99 799 and to identify its subtype. Methods The gene of ? lactamase derived from a stain of Klebsiela pneumoniae 99 799 named as was amplified by PCR. The purified PCR product was cloned into pUCm T vector and sequenced by Sanger's dideoxy chain termination composition method. Results The encoded gene of the bacterium was identified as TEM by PCR. It had the same sequence as the gene encoding TEM 1 and positioned at the 150 bp and 80 bp plasmids. Conclusion The TEM 1 ? lactamase exists in Chongqing area.