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微创胸膜腔置管注入尿激酶治疗结核性胸腔积液

【摘要】 目的 探讨微创胸膜腔置入中心静脉导管(简称导管)注入尿激酶治疗结核性包裹性胸腔积液(简称积液)的临床价值。方法 2008年6月-2009年8月在正规抗结核治疗基础上,选取确诊积液患者72例,按数字随机法分为治疗组和对照组,治疗组36例经超声引导导管置入胸膜腔并注入生理盐水50 mL加尿激酶10万 U,对照组36例多次穿刺抽液,比较两组疗效及积液引流量、胸膜厚度、积液吸收时间等。结果 治疗组28例显效,5例好转,3例无效;对照组10例显效,13例好转,13例无效,两组疗效差异具有统计学意义(Plt;0.05)。治疗组与对照组平均积液引流量分别为1 421 mL和756 mL,胸膜厚度分别为(1.9±0.4) mm和(3.7±1.2) mm,积液吸收时间分别为(13.3±1.2)d和(17.3±1.6)d,两组间比较差异均有统计学意义(Plt;0.05)。结论 超声引导导管置入胸膜腔并注入尿激酶治疗结核性包裹性胸腔积液疗效显著,可增加引流量,减轻胸膜肥厚,改善肺功能,减少穿刺机会。

外周静脉置入中心静脉导管术在高原地区肿瘤患者中的应用观察

目的　探讨外周静脉置入中心静脉导管（PICC）术在高原地区肿瘤患者中的临床应用，为西藏地区更好开展PICC技术提供依据。 方法　回顾性分析2010年8月－2012年4月113例肿瘤患者临床资料。 结果　穿刺成功111例，失败2例，成功率为98.2%。发生相关并发症14例，发生率12.4%，其中导管异位6例（5.3%），导管相关性感染3例（2.7%），栓塞2例（1.8%），机械性静脉炎2例（1.8%），导管部分脱出1例（0.8%）。 结论　PICC置管是一种置管成功率高，保留时间长，并发症较少、可靠有效的静脉治疗新途径，可在高原地区广泛推广应用。

对规范化培训护士外周静脉置入中心静脉导管维护技能的调查分析

【摘要】　目的　了解规范化培训护士对经外周静脉置入中心静脉导管（PICC）相关知识的认知及掌握情况。　方法　采取问卷调查方式，对2009年-2010年已在医院肿瘤科轮转工作过的57名规范化培训护士进行PICC维护知识的不记名调查。　结果　规范化培训护士对揭除穿刺处敷料的方向、穿刺处皮肤消毒面积、PICC导管是否可直接接触无菌胶带、脉冲式冲管及正压式封管的方法等内容，回答正确率均在90.9%以上；而对于PICC术后首次更换敷料的时间、注射器型号的选择、导管相关性血流感染等内容，回答正确率为69.09%。　结论　为降低PICC相关并发症的发生率，保证PICC维护质量安全，对规范化培训护士进行具有针对性、持续性、全面性的PICC维护培训刻不容缓

胃癌患者中心静脉导管的护理改进

【摘要】目的探讨改进胃癌患者中心静脉导管护理的可行性。方法从2009年开始对胃癌患者中心静脉导管的护理流程、导管附件、贴膜及贴膜更换时间等方面进行了改进。结果180例胃癌患者中心静脉导管留置期间出现并发症明显减少,特别在导管相关性感染方面取得很好效果,无大批感染。结论改进胃癌患者中心静脉导管护理可减少护理过程中的并发症。

日间化学疗法留置经外围静脉置入中心静脉导管带管出院患者依从性调查分析

【摘要】　目的　了解化学疗法中不同居住地点留置经外围静脉置入中心静脉导管（peripherally inserted central catheter，PICC）且带管出院患者的依从性问题。　方法　2009年5月-2010年4月采用自行设计的调查问卷，对100例行日间化学疗法的留置PICC患者，就影响带管出院依从性的各因素进行调查分析。　结果　本地化疗患者对PICC导管带管出院的依从性明显优于外地患者（Plt;0.05）。就影响因素而言，本地、异地化疗患者所担忧的问题不尽相同，异地化疗患者对带管出院的担忧主要集中在导管维护困难（81.8%）、并发症发生（67.3%）、导管维护质量（60.0%）等与治疗密切相关的几个因素。　结论　大力开展上臂PICC置管术即超声引导下的PICC置管术，以解决影响患者日常生活、美观、活动自如等问题。加大对区、县级医院护理人员PICC导管维护技能及并发症处理的培训，以提高外地患者PICC导管带管出院依从性。

Risk factors of central line-associated bloodstream infection

Objective To investigate the risk factors of central line-associated bloodstream infection (CLABSI) and provide clinical guidance for reducing the incidence of CLABSI. Methods The clinical data of patients with central venous catheter catheterization in Sichuan Provincial People’s Hospital between January 2018 and December 2021 were retrospectively collected. According to whether CLABSI occurred, the patients were divided into CLABSI group and non-CLABSI group. The data of patients were analyzed and the risk factors of CLABIS were discussed. Results A total of 43 987 patients were included. Among them, there were 63 cases in the CLABSI group and 43924 cases in the non-CLABSI group. The incidence of CLABSI was 0.18/1 000 catheter days. Multivariate logistic regression analysis showed that admission to intensive care unit (ICU) [odds ratio (OR)=74.054, 95% confidence interval (CI) (22.661, 242.005), P<0.001], hemodialysis [OR=4.531, 95%CI (1.899, 10.809), P=0.001] and indwelling catheter days [OR=1.017, 95%CI (1.005, 1.029), P=0.005] were independent risk factors for CLABSI. A total of 63 strains of pathogenic bacteria were isolated from the 63 patients with CLABSI. Among them, 28 strains of Gram-positive bacteria, 25 strains of Gram-negative bacteria and 10 strains of Candida. Conclusions Admission to ICU, hemodialysis and long-term indwelling catheter are independent risk factors for CLABSI. The prevention and control measures of CLABSI should be strictly implemented for such patients to reduce the risk of infection.

X线透视引导下经外周静脉置入中心静脉导管误入胸壁静脉处置一例

超声引导下颈内静脉阻断法预防经外周静脉置入中心静脉导管异位颈内静脉的效果观察

目的　观察超声引导下颈内静脉阻断对预防外周静脉置入中心静脉导管（PICC）时发生颈内静脉异位的效果。 方法　2011年6月－12月将326例PICC置管的患者随机分为观察组和对照组各163例，观察组在送管时运用B型超声引导下阻断颈内静脉；对照组在送管时采用传统的偏头压肩法阻断颈内静脉。置管后通过胸部X线片比较两组患者导管异位率。 结果　观察组发生导管异位2例，对照组发生12例，两组导管异位率差异有统计学意义（χ2=7.537，P=0.006）。 结论　超声引导下颈内静脉阻断法对预防PICC置管时发生导管异位于颈内静脉具有较高的临床意义。

Clinical Efficacy of Comfeel Transparent Paste in Treating Peripheral Inserted Central Cathether-associated Allergic Dermatitis

ObjectiveTo investigate the efficacy and nursing strategy of Comfeel transparent paste in treating peripheral inserted central catheter (PICC)-associated allergic dermatitis. MethodsSixty patients with PICC puncture-associated local allergic dermatitis treated between June 2011 and March 2013 were randomly divided into experimental group and control group with 30 patients in each group. The experimental group was treated with dexamethasone sodium phosphate and Comfeel transparent paste, while the control group was treated with dexamethasone sodium phosphate and 3M transparent dressing. The curative effect was compared between the two methods. ResultsTwelve patients were cured with a curing rate of 40.0% in the control group and 22 patients were cured, and the curing rate was 73.3% in the experimental group. The difference between them was significant (P<0.05). ConclusionTreatment with dexamethasone sodium phosphate and Comfeel transparent paste for PICC-associated allergic dermatitis is quite effective, and the patients felt comfortable with low pains. In addition, it reduces the extubation rate of PICC and improves the care quality.

Investigation on Knowledge of Peripheral Inserted Central Venous Catheter in Oncology Medical Staff Members of Class-Ⅲ Hospitals in Chengdu City

目的　了解成都市肿瘤科医护人员经外周静脉留置中心静脉导管术（PICC）认知现状，为今后开展PICC相关知识培训提供科学依据。 方法　2009年12月－2010年1月采用自行设计的问卷对成都市5家三甲医院的肿瘤科医护人员309名（医生134名，护士175名）进行PICC认知态度现状调查。 结果　成都市三甲医院肿瘤科医护人员PICC认知呈中等偏低的水平，护士PICC知识的掌握高于医生（P＜0.05），护士PICC态度得分优于医生（P＜0.05）。94.84%的医护人员知道PICC技术；只有8.38%的肿瘤科医护人员接受过PICC专业培训。不同文化程度、年龄、工龄、职业与PICC认知之间的差异存在统计学意义（P＜0.05）。 结论　三甲医院肿瘤科医护人员对PICC技术有一定的了解，但总体认知仍有待提高，需加强PICC相关知识培训，进一步提高医护人员PICC认知水平，以利于肿瘤专科开展PICC技术，促进肿瘤护理的专业化发展。