作者投稿
专家审稿
编辑办公
邮件订阅
RSS
-
-
2010年4月17日, 北京协和医院消化科和美国克利夫兰医学中心消化研究院共同举办的“ 2010年协和-克利夫兰炎症性肠病(IBD)研讨会”在北京协和医院召开。
来自克利夫兰医学中心的Victor Fazio教授和沈博教授分别介绍了炎症性肠病的手术和内科治疗方法。沈博教授还就IBD与难辨梭状芽孢杆菌的关系做了生动的评述。国内专家也从IBD整体治疗策略、手术时机和方法, 以及IBD营养支持等方面做了精彩的报告。在会议尾声, 由协和消化科提供的两个IBD病例引起了与会代表的浓厚兴趣, 在讨论过程中, 各位专家不仅各抒己见, 互相之间还有辩驳诘难, 把现场的学术气氛推向了高潮。来自全国各地的近300名消化科和普外科医生参加了此次学术活动。
IBD包括溃疡性结肠炎和克罗恩病, 是以肠黏膜免疫调节失衡为基础, 以反复肠道溃疡、出血和梗阻为主要表现的疾病。IBD并发症多, 致残率高, 迄今尚无根治手段, 病程大多迁延难愈, 给患者和社会均造成沉重负担。该病原本在欧美国家较为常见, 随着我国人民饮食结构和生活方式日益西化, 这一痼疾在我国的发病率已呈上升趋势。
协和消化科多年来在IBD基础和临床两方面进行了大量的研究, 积累了丰富的经验, 在国内居于领先地位。目前国内IBD的诊治水平参差不齐, 由于广大基层医院对该病尚不熟悉, 不仅误诊、漏诊时有发生, 用药不合理的现象也很普遍。有鉴于此, 协和消化科将与国内外同仁共同努力探索IBD的发病机制和诊疗手段, 并将不断加强继续教育, 为提高我国的IBD诊疗水平做出应有的贡献。
(北京协和医院消化科 吴东 舒慧君 朱峰)
-
[1] Vincent JL, Bihari DJ, Suter PM, et al. The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee [J]. JAMA, 1995, 274: 639-644. DOI: 10.1001/jama.1995.03530080055041
[2] Heyland DK, Cook DJ, Crifth L, et al. The atributable morbidity and mortality of ventilator-associated pneumonia in the critically ill patient. The Canadian Critical Trials Group [J]. Am J Respir Crit Care Med, 1999, 159:1249-1256. DOI: 10.1164/ajrccm.159.4.9807050
[3] Girou E, Stephan F, Novara A, et al. Risk factors and outcome of nosocomial infections: results of a matched casecontrol study of ICU patients [J]. Am J Respir Crit Care Med, 1998, 157:1151-1158. DOI: 10.1164/ajrccm.157.4.9701129
[4] Fabregas N, Ewig S, Torres A, et al. Clinical diagnosis of ventilator associated pneumonia revisited: comparative validation using immediate postmortem lung biopsies[J]. Thorax, 1999, 54: 867-873. DOI: 10.1136/thx.54.10.867
[5] Heyland D, Ewig S, Torres A. Pro/con clinical debate: the use of a protected specimen brush in the diagnosis of ventilator associated pneumonia[J]. Crit Care, 2002, 6:117120.
[6] Canadian Critical Care Trials Group. Arandomizedrial of diagnostic techniques for ventilator-associated pneumonia[J]. N Engl J Med, 2006, 355: 2619-2630. DOI: 10.1056/NEJMoa052904
[7] Jackson SR, Emnst NE, Mueller EW, et al. Utility of bilateral bronchoalveolar lavage for the diagnosis of ventilator-associated pneumonia in critically ill surgical patients[J]. Am J Surg, 2008, 195: 159-163. DOI: 10.1016/j.amjsurg.2007.09.030
[8] Mentec H, May-Michelangeli L, Rabbat A, et al. Blind and bronchoscopic sampling methods in suspected ventilator-associated pneumonia. A multicentre prospective study[J]. Intensive Care Med, 2004, 30:1319-1326. DOI: 10.1007/s00134-004-2284-7
[9] Leo A, Galindo-Galindo J, Folch E, et al. Comparison of bronchoscopic bronchoalveolar lavage vs blind lavage with a modified nasogastric tube in the etiologic diagnosis of ventilator-associated pneumonia[J]. Med Intensiva, 2008, 32: 115-120. DOI: 10.1016/S0210-5691(08)70921-5
[10] Flanagan PG, Findlay GP, Magee JT, et al. The diagnosis of ventilator-associated pneumonia using nonbronchoscopic, nondirected lung lavages[J]. Intensive Care Med, 2000, 26: 20-30. DOI: 10.1007/s001340050007
[11] Lorente L, Lecuona M, Jimeńez A, et al. Ventilator associated pneumonia using a heated humidifier or a heat and moisture exchanger: a randomized controlled trial[J]. Crit Care, 2006, 10:R116. DOI: 10.1186/cc5009
[12] Siempos Ⅱ, Vardakas KZ, Kopterides P, et al. Impact of passive humidification on clinical outcomes of mechanically ventilated patients: a metaanalysis of randomized controlled trials[J]. Crit Care Med, 2007, 35: 2843-2851.
[13] Siempos Ⅱ, Vardakas KZ, Falagas ME. Closed tracheal suction systems for prevention of ventilator-associated pneumonia [J]. Br J Anaesth, 2008, 100: 299306.
[14] Subirana M, Sola I, Benito S. Closed tracheal suction systems versus open tracheal suction systems for mechanically ventilated adult patients[J]. Cochrane Database Syst Rev, 2007: CD004581.
[15] Lindgren S. Regional lung derecruitment after endotracheal suction during volumeor pressure-controlled ventilation: a study using electric impedance tomography[J]. Intensive Care Med, 2007, 33:172-180. DOI: 10.1007/s00134-006-0425-x
[16] Valle's J, Artigas A, Rello J, et al. Continuous aspiration of subglottic secretions in preventing ventilator-associated pneumonia [J]. Ann Intern Med, 1995, 122:179-186. DOI: 10.7326/0003-4819-122-3-199502010-00004
[17] Dezfulian C, Shojania K, Collard HR, et al. Sublottie secretion drainage for preventing ventilator-associated pneumonia: a meta-analysis[J]. AmJ Med, 2005, 118:11-18. DOI: 10.1016/j.amjmed.2004.07.051
[18] Dullenkopf A, Gerber A, Weiss M. Fluid leakage past tracheal tube cuffis: evaluation of the new Microcuff endotracheal tube[J]. Intens Care Med, 2003, 29: 1849-1853. DOI: 10.1007/s00134-003-1933-6
[19] Poelaert J, Depuydt P, De Wolf A, et al. Polyurethane cuffed endotracheal tubes to prevent early postoperative pneumonia after cardiac surgery: a pilot study[J]. J Thorac Cardiovasc Surg, 2008, 135: 771-776. DOI: 10.1016/j.jtcvs.2007.08.052
[20] Lorente L, Lecuona M, Jime'nez A, et al. Influence of an endotracheal tube with polyurethane cuff and sublottic secretion drainage on pneumonia[J]. Am J Respir Crit Care Med, 2007, 176:1079-1083. DOI: 10.1164/rccm.200705-761OC
[21] Smulders K, van der Hoeven H, Weers-PothoffI, et al. A randomized clinical trial of intermittent sublottic secretion drainage in patients receiving mechanical ventilation[J]. Chest, 2002, 121: 858-862. DOI: 10.1378/chest.121.3.858
[22] Dragoumanis CK, Vretzakis GI, Papaioannou VE, et al. Investigating the failure to aspirate sublottic secretions with the Evac endotracheal tube[J]. Anesth Analg, 2007, 105: 1083-1085. DOI: 10.1213/01.ane.0000278155.19911.67
[23] Inglis TJ, Lim TM, Ng ML, et al. Structural features of tracheal tube biofilm formed during prolonged mechanical ventilation[J]. Chest, 1995, 108: 1049-1052. DOI: 10.1378/chest.108.4.1049
[24] Kollef MH, Afessa B, Anzueto A, NASCENT Investigation Group. Silvercoated endotracheal tubes and incidence of ventilator-associated pneumonia: the NASCENT randomized trial[J]. JAMA, 2008, 300: 805-813.
[25] Raad I, Darouiche R, Hachem R, et al. The broad-spectrum activity and efficacy of catheters coated with minocycline and rifampin[J]. J Infect Dis, 1996, 173: 418-424. DOI: 10.1093/infdis/173.2.418
[26] Iregui M, Ward S, Sherman G, et al. Clinical importance of delays in the initiation of appropriate antibiotic treatment for ventilatorassociated pneumonia[J]. Chest, 2002, 122: 262-268. DOI: 10.1378/chest.122.1.262
[27] Alvarez-Lerma F. Modification of empiric antibiotic treatment in patients with pneumonia acquired in the intensive care unit ICU-Acquired Pneumonia Study Group[J]. Intens Care Med, 1996, 22: 387-394. DOI: 10.1007/BF01712153
[28] Kuti EL, Patel AA, Coleman CI. Impact of inappropriate antibiotic therapy on mortality in patients with ventilator-associated pneumonia and blood stream infection: a meta-analysis[J]. Crit Care, 2008, 23: 91-100. DOI: 10.1016/j.jcrc.2007.08.007
[29] Parker CM, Kutsogiannis J, Muscedere J, et al. Ventilatorassociated pneumonia caused by multidrug-resistant organisms or Pseudomonas aeruginosa: prevalence, incidence, risk factors, and outcomes[J]. J Crit Care, 2008, 23:1826.
[30] Sanders KM, Adhikari NK, Friedrich JO, et al. Previous. cultures are not clinically useful for guiding empiric antibiotics in suspected ventilator-associated pneumonia: secondary analysis from a randomized trial[J]. J Crit Care, 2008, 23: 58-63. DOI: 10.1016/j.jcrc.2008.01.009
[31] Depuydt P, Benoit D, Vogelaers D, et al. Systematic surveillance cultures as a tool to predict involvement of multidrug antibiotic resistant bacteria in ventilator-associated pneumonia[J]. Intens Care Med, 2008, 34: 675-682. DOI: 10.1007/s00134-007-0953-z
[32] Joffe AR, Muscedere J, Marshall JC, et al. The safety of targeted antibiotic therapy for ventilator-associated pneumonia: a multicenter observational study[J]. J Crit Care, 2008, 23: 82-90. DOI: 10.1016/j.jcrc.2007.12.006
[33] Chastre J, Wolf M, Fagon JY, et al. Comparison of8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial[J]. JAMA, 2003, 290: 2588-2598. DOI: 10.1001/jama.290.19.2588
[34] Giantsou E, Liratzopoulos N, Efraimidou E, et al. De-escalation therapy rates are significantly higher by bronchoalveolar lavage than by tracheal aspirate[J]. Intens Care Med, 2007, 33: 1533-1540. DOI: 10.1007/s00134-007-0619-x
[35] Garnacho-Montero J, Sa-Borges M, Sole-Violan J, et al. Optimal management therapy for Pseudomonas aeruginosa ventilator-associated pneumonia: an observational, multicenter study comparing monotherapy with combination antibiotic therapy[J]. Crit Care Med, 2007, 35: 1888-1895. DOI: 10.1097/01.CCM.0000275389.31974.22
[36] Heyland DK, Dodek P, Muscedere J, et al Randomized trial of combination versus monotherapy for the empiric treatment of suspected ventilator-associated pneumonia[J]. Crit Care Med, 2008, 36: 737-744. DOI: 10.1097/01.CCM.0B013E31816203D6
计量
- 文章访问数: 252
- HTML全文浏览量: 109
- PDF下载量: 14
下载:
