目的 探讨提高肺热循环灌注质量的技术要点。 方法 2005 年 10 月至 2015 年 6 月我院 42 例（男 23 例、女 19 例，年龄 32～78 岁）恶性胸腔积液患者在电视胸腔镜下行胸膜活检后行肺热循环灌注治疗。采用体外循环机灌注 12 例，专用热循环灌注机 16 例，自行设计简易循环灌注法 14 例，病理检查明确为胸膜转移癌后以 43℃ 0.9%NaCl 与 50 mg 顺铂溶液循环胸腔热灌注 60 min，随访观察胸腔积液的有效控制率、不良反应、患者的生活质量以及生存期。 结果 电视胸腔镜下胸膜活检诊断阳性率达 100.0%，细胞学检查诊断阳性率为 26.2%。全组胸腔积液控制总有效率为 96.5%，完全缓解率为 86.7%，部分缓解率为 9.8%，无效率为 3.5%。3 例分别于热灌注治疗后 4、6、11 个月胸腔积液复发，其余均无胸腔积液复发。39 例患者热灌注治疗后生活质量明显提高，Karnofsky 行为评分超过 80 分。全组中位生存期为 17.5 个月，1 年生存率为 89.3%，其中 7 例生存 3 年以上。手术顺利，除 1 例切口皮下溢液外无明显并发症和手术死亡。 结论 影响灌注质量的因素有肿瘤大小、肺复张程度、切口选择、灌注持续温度、胸腔灌注平面的控制、灌注管口径长度、流量控制、灌注技巧、引流管留置方法。主要防范并发症有切口皮下溢液，出血、发热，术后残腔等。
ObjectiveTo investigate the species and resistance phenotypes of the pathogens causing catheter-associated urinary tract infection (CAUTI) in critically ill patients in West China Hospital of Sichuan University, and to provide the basis for the prevention and treatment of this kind of infection. MethodsThe clinical data and findings of the laboratory examination of the patients, who were admitted to intensive care units and suffered from CAUTI in our hospital during January 2012 to December 2014, were retrospectively analyzed. The pathogens isolates from the urine specimens of the patients with CAUTI and their resistance phenotypes were analyzed. ResultsThree hundred and seventy patients suffering from CAUTI were included in this study. Five hundred and seventeen strains of pathogens were isolated from the urine specimens of these patients, including 222 isolates (42.9%) of fungus, 181 isolates (35.0%) of gram negative bacteria, and 114 isolates (22.0%) of gram positive bacteria. In terms of species distribution, Candida albicans (105 isolates, 20.3%), C.glabrata (78 isolates, 15.1%) and C.glabrata (30 isolates, 5.8%) were the predominant fungus. Among the gram negative bacteria, Escherichia coli (81 isolates, 15.7%), Klebsiella pneumoniae (37 isolates, 7.2%), and Acinetobacter calcoaceticus-baumannii complex (23 isolates, 4.4%) were the main species. Enterococcus faecium (79 isolates, 15.3%) and E.faecalis (13 isolates, 2.5%) were the frequently isolated gram positive bacteria. Analysis of the resistance phenotype showed that the resistance rates to itraconazole, voriconazole and fluconazole of Candida spp. were above 10%. Thirty percent of the isolates of E.coli and K.pneumoniae, and 60% of the isolates of A.calcoaceticus-Baumannii complex were resistant to many of the regular antibiotics. Imipenem resistance rate of A.calcoaceticus-Baumannii complex was 60.8%. Sixty percent of the isolates of E.faecium and E.faecalis were resistant to many of the regular antibiotics. The vancomycin-resistant isolates accounted for 16.5% of E.faecium and 31.0% of E.faecalis. ConclusionCandida species are the major pathogens for CAUTI in critically ill patients in our hospital and show the resistance to azoles. We should focus on the drug resistance of gram negative bacteria and gram positive bacteria. The rational use of antibiotics and application of effective infection control measures are important to decrease the CAUTI.