三种经外周静脉置入中心静脉导管固定方法临床效果的比较

目的 比较3种不同的经外周静脉置人中心静脉导管(PICC)固定方法对导管固定的临床效果.方法 将120例留置PICC导管患者采用便利抽样的方法分为3组,每组各40例,分别采用缝合固定(A组)、免缝胶带交叉固定(B组)和思乐扣免缝导管固定装置固定(C组).观察并比较3组患者置管后留置期间导管固定的牢固性、并发症发生率、固定部位皮肤损伤情况及患者的满意度.结果 B组导管移位的发生率(57.5%)明显高于A组(12.5%,P=0.000)和C组(7.5%,P=0.000),导管脱出的发生率(15.0%)亦明显高于A组(0,P=0.034)和C组(0,P=0.034).导管留置期间静脉炎的发生率在B组(25.0%)明显高于A组(7.5%,P=0.034)和C组(5.0%,P=0.012);在A组中并发穿刺部位蜂窝织炎的发生率明显高于C组(20.0%比2.5%,P=0.034).A组患者出现固定翼下的皮肤压痕的发生率(37.5%)明显高于B组(5.0%,P=0.000)和C组(5.O%,P=0.000),且A组患者皮肤破损的发生率(22.5%)也高于B组(5.0%,P=0.023)和C组(0,P=0.005);各种原因所致的皮肤刺激痛在A组(52.5%)中明显增加,高于B组(0,P=0.000)和C组(2.5%,P=0.000).患者对3组不同导管固定法的满意度在A组(12.0%)显著低于B组(62.5%,P=0.000)和C组(90.0%,P=0.000),且C组满意度最高,明显高于B组(P=0.004).结论 思乐扣免缝导管固定装置固定法可以作为胶带和缝合固定的替代,具有等同于缝合法对导管的固定作用,预防了导管移位、脱出等导管相关并发症,同时也避免了缝合固定造成的皮肤损伤.     

自我管理教育对经外周静脉置入中心静脉导管置管患者的影响

目的 探讨自我管理教育对经外周静脉置人中心静脉导管(PICC)患者的自我管理能力和自我效能的影响.方法 60例PICC置管患者按随机数字表随机分配进入自我管理教育组(n=32)与常规护理组(n=28),分别进行6个月的自我管理教育及常规的置管后护理,比较两组患者在体现自我管理能力的自我管理行为、健康状况、导管功能、卫生服务利用率方面及自我效能水平的差别.结果 与常规护理组相比较,自我管理教育组患者自我管理能力中除与护士交流评分(P=0.618)、健康状况总分(P=0.083)及疼痛评分(P=0.069)外,其余各项指标差异均有统计学意义(P均<0.05),且并发症发生率明显降低(P=0.038),自我效能水平明显提高(P=0.012).结论 自我管理教育可以提高PICC置管患者的自我管理能力和自我效能,从而降低并发症的发生率,是导管有效利用、改善患者健康状况的有效方法.

Abstract：

Objective To investigate the influence of self-management education(SME)on the selfmanagement ability and self-efficacy of patients with peripherally inserted central catheters(PICC).Methods Sixty patients with PICC were randomly divided into SME group(n=32)and control group(n=28).Patients in the SME group took SME and the control group received routine nursing;both lasted six months.The self-management ability(including self-management action,health status,catheter function,utility of health service)and selfefficacy were compared between these two groups.Results Except the scores of communication with the nurse (P=0.618),health status(P=0.083),and pain(P=0.069),the other indicators of self-management ability in the SME group had significantly higher scores than those in control group(all P<0.05).The incidence of complications was significantly lower(P=0.038)and the self-efficacy was significantly higher in SME group(P=0.012).Conclusion SME can improve the self-management ability and self-efficacy and prevent the catheter-related complications in patients with PICC.     

Swan-Ganz导管球囊充气与充液定位气胸肺漏气支气管对比研究

目的 探讨Swan-Ganz导管球囊充气与充液定位气胸肺漏气支气管的方法,并比较其效果及安全性.方法 38例气胸患者随机分为2组,均采用Swan-Ganz导管与纤维支气管镜并行气道内置入.A组:导管球囊充气、阻断气流,定位气胸肺漏气支气管.B组:导管球囊充液定位气胸肺漏气支气管.结果 A组定位成功率89.5%(17/19),B组94.7%(18/19),组间比较差异无统计学意义(P＞0.05).A组定位时间(13.3±4.1)min,而B组(9.6±3.2)min,组间比较差异有统计学意义(P＜0.05).A组球囊脱出率47.4%和邻近支气管受压率68.4%,分别高于B组21.1%和26.3%,组间比较差异有统计学意义(P＜0.05).两组患者术中均耐受良好,无明显不良反应.结论 Swan-Ganz导管球囊充液定位肺破裂支气管的方法是一种简单,快捷、价廉和同样安全有效的新方法.

Abstract：

Objective To evaluate efficacy and safety of two methods for gas-filled and liquid-filled balloon of Swan-Ganz catheter to locate the bronchus of pulmonary air leakage. Methods All of 38 cases with pneumothorax were randomly divided into two groups. Group A : the bronchus of pulmonary air leakage were detected by injecting gas into balloon of Swan-Ganz catheter. Group B: the bronchus of pulmonary air leakage were detected by injecting physiological saline into balloon of Swan-Ganz catheter. Results The locating success rate in Group A was 89. 5% (17/19) and Group B was 94. 7% (18/19) ( P＞0. 05). The mean time of locating in Group A was (13. 3 ±4. 1) min and Group B was (9. 6 ±3. 2) min( P ＜0. 05).In Group A, the dislocation rate was 47.4% and adjacent bronchial compression rate was 68.4% , and was respectively higher than Group B 21. 1% and 26. 3% ( P ＜ 0. 05). Patients in both groups were well tolerated without any obvious adverse effects. Conclusion It is a more simple, quicker, the same safe and effective to locate the broken bronchus of pneumothorax by injecting physiological saline into balloon of Swan-Ganz catheter.     

Effects of growth hormone in down-regulating hormone replacement cycle on the outcome of frozen-thawed embryo transfer北大核心CSCD

Objective To analyze whether the application of growth hormone (GH) in the frozen-thawed embryo transfer (FET) cycle can improve the pregnancy outcome of patients. Methods The retrospective cohort study including 1042 FET cycles was carried out between January 2015 to July 2018 in Reproductive Medicine Center, the Fourth Hospital of Hebei Medical University. According to medication before transfer, all patients were divided into GH group (group A ) and no GH group (group B). The pregnancy outcomes were compared between the two groups in aged patients (≥35 years), polycystic ovary syndrome (PCOS) patients and repeated implantation failure (RIF) patients. Results In group A, the maternal age [(31.1±4.5) years old] and the clinical pregnancy rate [67.1% (114/170)] were higher than those in group B [(30.1±4.4) years old, 57.5% (501/872)] (P=0.010, P=0.020). There were no significant differences in the implantation rate, the clinical pregnancy rate, the abortion rate and the live birth rate between group A and group B in aged patients (all P>0.05). In PCOS patients, the live birth rate in group A [65.8% (25/38)] was significantly higher than that in group B [42.3% (96/227)] (P=0.007). In the RIF patients, the implantation rate [37.3% (57/153)], the clinical pregnancy rate [50.5% (46/91)] and the live birth rate [37.4% (34/91)] in group A were significantly higher than those in group B [23.0% (115/501), 29.1% (92/316), 21.8% (69/316)] (P<0.001, P<0.001, P=0.003). Conclusion For the aged patients, adding GH could not improve pregnancy outcomes. The application of GH in PCOS patients could increase the live birth rate. For the RIF patients, the application of GH could increase the implantation rate, the clinical pregnancy rate and the live birth rate. © 2021 Chinese Medical Journals Publishing House Co.Ltdg. All rights reserved.     

哺乳期瘢痕子宫早孕流产方式的临床研究

Objective To estimate abortion ways and announcements of early-staged gestation termination in lactation scarred uterus. Methods A retrospective analysis was made on clinical date of 312 early-staged gestation termination cases in lactation scarred uterus. These cases were divided into three groups based on abortion ways: induced abortion group (group A,92 cases), drugs abortion group (group B,98 cases), misoprostol combined uterine aspiration group (group C,122 cases). The abortive efficiency,operation time, operative bleeding, colporrhagia time, postoperative infection and drug adverse reaction were observed and compared. Results Complete abortion rates in group A (97.8%,90/92) and group C(99.2%,121/122) were significantly higher than that in group B (77.6% ,76/98),colporrhagia times in group A [(5.9 ± 1.1) d] and group C [(5.6 ± 1.2) d] were significantly lower than that in group B [(12.4 ± 1.8) d],postoperative infection and drug adverse reaction rate were lower in group A and group C, with significant difference compared to group B (P ＜ 0.05). The operation time was shorter, bleeding was less,third-grade pain rate was lower in group C, there was significant difference between group A and group C (P ＜ 0.05).Conclusions Misoprostol combined uterine aspiration terminated early-staged gestation in lactation scarred uterus is effective and safe, makes the operation easy and simple, decreases the blood loss. The influence to mother and infant is smaller, it is the best abortion style.     

饮食、C反应蛋白与2型糖尿病颈动脉内膜厚度的关系

Objective To compare the characteristics of food and nutrition intake in type 2 diabetes mellitus (T2DM) patients with or without carotid atherosclerosis and analyze the relationship between diets/C-reactive protein (CRP) and carotid intima-media thickness (C-IMT). Methods Sixty patients with T2DM were enrolled and divided into two groups based on C-IMT: group A (C-IMT ＜ 1 mm, n=30) and group B (C-IMT≥1 mm, n=30). All subjects were investigated with questionnaires including 3-day food recall They all took somatometric measurement. Blood and urine samples were collected in all subjects to examine the levels of high sensitive-CRP,C-peptide, blood glucose, glycosylated hemoglobin, blood lipid, renal function, urine microalbumin, and other indicators. Results The intakes of vegetables, fruits, and aquatic products were significantly higher in group A than in group B ( P ＜ 0. 05 ). The intake of vitamin C in group A was significantly higher than that in group B ( P ＜0. 05 ). The levels of CRP in group B was significant higher than that in group A (P = 0. 000). Positive correlation was found between CRP level and C-IMT in T2DM patients ( r = 0. 36, P = 0. 004). Furthermore, CRP was negatively correlated with the intakes of vegetables and fruits ( r = - 0. 334, P = 0. 01 ), aquatic products ( r = -0. 315, P = 0. 016), and vitamin C ( r = - 0. 2786, P = 0. 038 ), respectively. The intake of fruits was negatively correlated with C-IMT (r, = -0. 33, P = 0. 01 ). Conclusions T2DM patients without carotid atherosclerosis intake more vegetables, fruits, aquatic products and vitamin C than those with atherosclerosis. Vegetables, fruits,sea foods and vitamin C may be the protective factors against atherosclerosis in T2DM patients. CRP is associated with the development of atherosclerosis in T2DM patients.     

流程管理预防经外周静脉置入中心静脉导管相关性血流感染的效果

目的 评估制订标准流程管理对预防经外周静脉置入中心静脉导管(PICC)相关性血流感染的效果.方法 制订预防PICC导管相关性血流感染(CRBSI)的标准管理流程,对全院PICC置管实行统一管理,比较流程管理前后CRBSI的发生情况.结果 流程管理前每1000个导管留置日的CRBSI发生率为6.0‰(48/79 783),明显高于流程管理后的2.9‰(29/99643)(P=0.000).结论 遵照标准程序统一管理,早期护理干预能够有效预防和控制PICC相关性感染.

Abstract：

Objective To explore the role of process management in preventing peripheral central venous catheter (PICC)-related bloodstream infections (CRBSI). Methods A standard process management policy was established for the uniform management of PICC in our hospital. The incidences of CRBSI before and after the implementation of this policy were compared. Results The incidences of CRBSI was 6.0‰ (48/79 793 ) every 1000 catheter-days before process management and 2.9‰ (29/99643) after process management (P =0.000).Conclusion Standard process management can effectively prevent and control CRBSI caused by PICC.     

餐后血糖水平与冠心病发生的相关性

目的 探讨餐后血糖水平与冠心病发生的相关性.方法 选择血糖水平异常并已行冠状动脉造影的患者85例,按血糖水平将患者分为三组:空腹血糖调节受损(IFG)组28例、糖耐量减低(IGT)组29例及糖尿病(DM)组28例,观察各组冠心病发生率及冠状动脉病变程度,分析三组患者C反应蛋白(CRP)、颈动脉内膜中层厚度(CIMT)、血脂、血压、体重指数(BMI)的变化及与冠心病危险因素的相关性.结果 IGT组和DM组冠心病发生率[分别为79.3%(23/29)、85.7%(24/28)]明显高于IFG组[53.6%(15/28)](P＜0.01),DM组冠心病发生率高于IGT组,但差异无统计学意义(P＞0.05).IGT组和DM组2支病变、3支病变发生率均高于IFG组(P＜0.01),DM组2支病变、3支病变发生率高于IGT组,但差异无统计学意义(P＞0.05).IGT组、DM组CRP、CIMT、BMI、三酰甘油(TG)、收缩压(SBP)较IFG组明显升高(P＜0.01或＜0.05),高密度脂蛋白胆固醇(HDL-C)较IFG组明显降低(P＜0.01);DM组CRP、TG、SBP较IGT组升高(P＜0.05),其他指标比较差异无统计学意义(P＞0.05);相关性分析表明,IGT组和DM组餐后2 h血糖与CRP、CIMT、BMI、TG呈显著正相关(P＜0.05或＜0.01),与HDL-C呈显著负相关(P＜0.05或＜0.01).结论 餐后高血糖与冠心病的发生、发展有密切关系,对于IGT患者应尽早予以干预治疗,可有效预防心血管事件的发生.

Abstract：

Objective To investigate the correlation between the level of postprandial blood glucose (PBG)and the incidence of coronary artery disease(CAD). Methods Eighty-five patients performed coronary angiography with abnormal blood glucose levels were divided into 3 groups according the blood glucose levels: impaired fasting glucose(IFG)group(28 cases), impaired glucose tolerance(IGT)group(29cases)and diabetes mellitus(DM)group(28 cases). The detection rate and the extent of CAD were observed. The risk factors of CAD in 3 groups such as C-reactive protein(CRP),carotid artery intima-media thickness(CIMT), blood lipids, blood pressure, body mass index(BMI)and the correlation with CAD were analyzed. Results Sixty-two cases were confirmed CAD by coronary angiography. The incidence rate of CAD in IGT group[79.3%(23/29)]and DM group[85.7%(24/28)]was significantly higher than that in IFG group[53.6%(15/28)](P ＜ 0.01). The incidence rate of CAD in DM group was higher than that in IGT group, but there was no significant difference(P ＞ 0.05). The incidence rate of two-lesion and three-lesion in IGT group and DM group were significantly higher than those in IFG group(P＜ 0.01). The incidence rate of two-lesion and three-lesion in DM group were higher than those in IGT group, but there was no significant difference(P＞0.05). The levels of CRP, CIMT, BMI, triacylglycerol(TG)and systolic blood pressure(SBP)were higher and HDL-C was lower in IGT group and DM group than those in IFG group(P ＜ 0.01 or ＜ 0.05).The levels of CRP,TG and SBP were higher in DM group than those in IGT group(P＜0.05). Correlation analysis showed, in IGT group and DM group,2 h PG had significantly positive correlation with CRP, CIMT,B MI, TG(P＜0.05 or＜0.01), and had significantly negative correlation with HDL-C(P＜0.05 or ＜0.01).Conclusions PBG is closely related with the development of CAD.IGT patients should be intervened as early as possible, which can be effective in preventing cardiovascular events.     

两种新型非生物型人工肝治疗慢性乙型重型肝炎疗效观察

Objective To explore the clinical effects of two new treatment methods of non-biologic artificial liver [slower plasma exchange (PE) combined with continuous veno-venous hemofiltration (CWH), and coupled plasma exchange filtration adsorption (CPEFA)] in treatment of chronic severe hepatitis B patients. Methods 130 patients with chronic severe hepatitis B were divided into three groups. 44 patients were treated with a parallel circuit of being combined slower PE and CWH based on the conservation medical therapy (group A). 43 patients were treated with CPEFA based on the conservation medical therapy (group B). 43 patients received PE with conservative medical therapy (group C). The clinical symptoms, signs, liver function, blood sodium concentration, effective rates and survival rates in three groups were surveyed before and after treatment. Results The symptom and signs of the majority in the above different groups improved. In group A and B, hyponatremia of patients were improved, the effective rates (within 6 months after the treatment) were 70.45% and 72.09% respectiverly. There was no statistical difference between the two groups (χ2=0.10,P>0.05), the survival rates(6 months) were 45.45% and 46.51% respectively and there was no statistical difference (χ2 = 0.08, P > 0.05). In group C, patients' hyponatremia did not change, the effective rate (51.16%)was obviously lower than those in group A and B (χ2 = 7.55,9.31, P < 0.01) and the total survival rate(6 months) was 30.23% also lower than those in group A, B (χ2 = 4.80,6.10, P < 0.05). Conclusions Being combined slower PE and CWH with a parallel circuit and CPEFA are two new, safe and effective methods of non-biologic artificial liver treatment.     

Comparison of the early follicular long-term protocol and antagonist protocol in unexplained infertility patients北大核心CSCD

Objective To investigate the clinical effects and pregnancy outcomes of the early follicular long-term protocol and antagonist protocol in the treatment of unexplained infertility patients. Methods From January 2018 to January 2019, 642 cases of unexplained infertility patients with early follicular long-term protocol and antagonist protocol in in vitro fertilization/ intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET) were collected using the clinical assisted reproductive technologies management system software database of the Department of Reproductive Medicine of the First Affiliated Hospital of Nanjing Medical University. Patients were divided into early follicular long-term protocol (n=283) and antagonist protocol (n=359) groups. The clinical outcomes of the two groups were analyzed retrospectively, including the implantation rate, the clinical pregnancy rate, and the live birth rate. Furthermore, the pregnancy outcomes of different age and body mass index (BMI) patients were further analyzed. Results 1) The BMI in the antagonist protocol group was higher than that in early follicular long-term protocol group [(22.17±2.96) kg/m2vs. (21.68±2.29) kg/m2, P=0.018]. The other based data did not exhibit remarkable difference between the two groups (P>0.05). 2) The starting dosage of gonadotropin (Gn) in early follicular long-term protocol group was less than that of antagonist group [(149.74± 36.24) IU vs. (177.97±38.85) IU, P<0.001]. While the total duration and dosage of Gn used in early follicular long-term protocol group were significantly higher than those in antagonist group [(11.93± 2.26) d vs. (8.86±1.45) d, P<0.001; (1 908.35±632.36) IU vs. (1 638.57±497.23) IU, P<0.001). The cleavage embryo implantation rate, the clinical pregnancy rate and the live pregnancy rate in fresh cycle in early follicular long-term protocol group were significantly higher than those in the antagonist group [57.14% (152/266) vs. 39.53% (68/172), P<0.001; 66.48% (121/182) vs. 51.72% (60/116), P=0.011; 59.89% (109/182) vs. 40.52% (47/116), P=0.001]. The incidence of moderate and severe ovarian hyperstimulation syndrome between the two groups were not statistically different (P>0.05). Multivariate logistic regression analysis showed that different protocols and age were both risk factors for clinical pregnancy and live birth of cleavage embryo transfer [2.261 (95% CI=1.333-3.836), P=0.002; 0.928(95% CI=0.869-0.991), P=0.026; 2.598(95% CI=1.535-4.397), P<0.001; 0.906(95% CI=0.849-0.967), P=0.003]. 3) In patients under 35 years old, the clinical pregnancy rate and the live birth rate in early follicular long-term protocol group were higher than those of the antagonist group, but there was no statistical difference (all P>0.05). The fresh embryo cycle implantation rate, the clinical pregnancy rate and the live birth rate of 35-39 years old patients in the early follicular long-term protocol group were higher than those in the antagonist group, but there was no statistical difference (all P>0.05). 4) In normal BMI group, the implantation rate, the clinical pregnancy rate and the live birth rate in early follicular long-term protocol group were significantly higher than those in the antagonist group [55.71% (122/219) vs. 37.82% (45/119), P=0.002; 63.58% (96/151) vs. 46.99% (39/83), P=0.014; 58.94% (89/151) vs. 39.76% (33/83), P=0.005]. In the overweight population, the implantation rate and the clinical pregnancy rate in early follicular long-term protocol group were significantly higher than those in the antagonist group [68.09% (32/47) vs. 43.40% (23/53), P=0.013; 81.25% (26/32) vs. 57.14% (20/35), P=0.034], but there was no statistically significant difference in the live birth rate (P>0.05). Conclusion Compared with the antagonist protocol, early follicular long-term protocol for unexplained infertility patients may achieve higher clinical pregnancy outcomes in IVF fresh cycle, but it could increased the duration of descending, the duration and dosage of Gn used. © 2021 Chinese Medical Journals Publishing House Co.Ltdg. All rights reserved.     

Sutured securement of peripherally inserted central catheters yields fewer complications in pediatric patients

BACKGROUND: Pediatric peripherally inserted central catheters (PICCs) can be secured with tape, sutures, or sutureless securement devices. Despite widespread catheter use, no standardized method of securement has been proven superior. METHODS: A prospective randomized trial of catheter securement with either tape or suture was undertaken in pediatric patients hospitalized at a tertiary children's hospital. Patient demographics, catheter dwell time, and all catheter complications were collected. All patients were followed for the entire dwell time of the catheter, including those discharged with lines still in place. RESULTS: Sixty-six patients completed the study, with 34 children in the suture group and 32 children in the tape group. Patients' ages ranged from 9 months to 19 years. Overall complication rate in our sutured group was 5.8%, and 32.4% in the tape group. CONCLUSIONS: In this study of children of varying ages, sutured PICCs were associated with significantly fewer complications than those catheters secured with tape (p=.005). The 3 most common complications included migration, occlusion, and leaking catheters.     

皮下潜行法颈内静脉穿刺置管的可行性研究

目的：皮下潜行法颈内静脉穿刺置管与中路颈内静脉穿刺置管进行比较,评价其可行性。方法选择脊柱手术病人80例,随机分为2组,每组40例,A组皮下潜行法颈内静脉穿刺置管,B组中路颈内静脉穿刺置管。观察记录总穿刺成功率、一次试穿成功率、置管成功率及并发症,并均于术后摄胸部平片观察中心静脉导管的位置,记录导管留置时间及导管相关性感染发生率。结果 A组穿刺总成功率97.50%,一次试穿成功率90.00%,无误穿动脉、气胸、血胸及导管异位等并发症发生,与B组比较无显著差异（P〉0.05）。 A组导管平均留置时间（15.2±2.3）d,无导管相关性感染,B组导管平均留置时间（9.5±1.5）d,导管相关性感染4例（10.00%）。 A组导管相关感染率明显低于（P=0.04）,而导管留置时间明显高于B组（P=0.00）存在明显区别。结论皮下潜行法颈内静脉穿刺置管具有操作容易、安全性大、导管留置时间长、导管相关性感染率低等特点,具有实用价值。     

大子宫全切除术3种术式的临床比较

目的探讨腹腔镜下改良大子宫切除术的临床可行性、安全性及临床效果。方法回顾性分析2011年12月至2015年8月在江阴市人民医院妇科进行大子宫切除术的临床资料174例,将其随机分为3组,其中86例行开腹手术为A组,50例行腹腔镜下常规大子宫切除术为B组,38例行腹腔镜下改良大子宫切除术为C组。比较3组的手术时间、术中出血量、术后肛门排气时间、住院时间、术后病率、中转开腹率、手术并发症的发生率。结果 B组手术时间、术中出血量均高于A组及C组,差异均有统计学意义(K=103.740,P=0.000;K=108.375,P=0.000);A组肛门排气时间、住院时间均长于B组、C组,差异均有统计学意义(K=114.054,P=0.000;K=124.152,P=0.000),而B组与C组之间差异无统计学意义(Z=-1.620,P=0.105;Z=-1.089,P=0.276);A组术后病率高于B组及C组,但3组术后病率比较差异无统计学意义(x^2=4.344,P=0.114);A组、C组手术全部成功,无中转开腹,无输尿管损伤等并发症发生,而B组中转开腹率为12.00%(6/50),并发症发生率为6.00%(3/50)。结论腹腔镜下改良大子宫切除术手术时间短,术中出血量少,中转开腹率少,术后肛门排气时间及住院时间短,术后病率、手术并发症低,值得临床推广应用。     

Cohort study of the pathogenesis and molecular epidemiology of catheter-related bloodstream infection in neonates with peripherally inserted central venous catheters.

OBJECTIVE: To better define the pathogenesis of catheter-related bloodstream infection (BSI) in neonates with peripherally inserted central venous catheters (PICCs) to guide the development of more effective strategies for prevention. DESIGN: Prospective nested cohort study. SETTING: Level III neonatal intensive care unit in a community hospital. METHODS: During a randomized trial to assess the safety and efficacy of a prophylactic vancomycin-heparin catheter-lock solution for the prevention of catheter-related BSI in neonates with PICCs, we performed cultures of peripheral and catheter-drawn blood samples, and quantitative cultures of catheter hub samples if BSI was suspected clinically. We performed semiquantitative cultures of the catheter tip and the catheter hub and the skin at the insertion site when the catheter was removed. Molecular subtyping by pulsed-field electrophoresis was used to determine the probable pathogenesis of all BSIs due to coagulase-negative staphylococci (CoNS); for BSIs caused by other microorganisms, epidemiologic concordance was based on speciation and antibiograms. Catheter-related BSI was considered extraluminally acquired if concordance was demonstrable solely between isolates recovered from the catheter tip and the blood, independent of concordance with isolates recovered from the insertion site. Catheter-related BSI was considered intraluminally acquired if concordance was demonstrated only between isolates recovered from the catheter hub and the blood. The source of the infection was considered indeterminate if both concordance patterns were present. RESULTS: Nosocomial BSI was identified in 23 of the 82 neonates in the cohort. Fifteen of these infections, 14 of which were caused by CoNS, were considered definite or probable catheter-related BSIs. Catheter-related BSI was intraluminally acquired in 10 (67%) of 15 patients, extraluminally acquired in 3 (20%), and indeterminate in 2 (13%). CONCLUSIONS: Most catheter-related BSIs in neonates with PICCs are caused by CoNS and derive from intraluminal contamination. Strategies for prevention of catheter-related BSI directed at this predominant mechanism of infection are most likely to be effective.     

A randomized, controlled trial of a new vascular catheter flush solution (minocycline-EDTA) in temporary hemodialysis access.

BACKGROUND AND OBJECTIVE: We previously demonstrated that minocycline-EDTA was efficacious at preventing catheter-related bloodstream infections (BSIs) in three patients with recurrent infections. This study compared heparin with minocycline-EDTA as flush solutions used among dialysis patients with central venous catheters, a high-risk group for catheter-related BSI. METHODS: Patients were enrolled within 72 hours of catheter insertion and randomized to receive heparin or minocycline-EDTA as a flush after each dialysis session. Each syringe containing flush solution was wrapped in orange plastic to conceal the type of solution it contained. Patients were observed for evidence of infection and catheter thrombosis. After catheters were removed, cultures were performed to determine whether microbial colonization had occurred. RESULTS: During a 14-month period, 60 patients were enrolled (30 in each group). The two groups had similar demographics and underlying diseases. Catheter survival at 90 days was 83% for the minocycline-EDTA group versus 66% for the heparin group (P = .07). Significant catheter colonization, a surrogate measure of catheter-related infection, was significantly more frequent in the heparin group (9 of 14 vs 1 of 11; P = .005). There was only one catheter-related bacteremia and it occurred in the heparin group. CONCLUSIONS: When compared with heparin, minocycline-EDTA had a better 90-day catheter survival (P = .07) and a decreased rate of catheter colonization. This pilot study warrants a larger prospective, randomized trial.     

Efficacy of antiseptic-impregnated catheters on catheter colonization and catheter-related bloodstream infections in patients in an intensive care unit

This study was conducted to evaluate the impact of central venous catheters impregnated with chlorhexidine and silver sulphadiazine on the incidence of colonization and catheter-related bloodstream infection in critically ill patients. One hundred and thirty-three patients requiring central venous catheterization were chosen at random to receive either an antiseptic-impregnated triple-lumen catheter (N=64) or a standard triple-lumen catheter (N=69). The mean (SD) durations of catheterization for the antiseptic and standard catheters were 11.7 (5.8) days (median 10; range 3-29) and 8.9 (4.6) days (median 8.0; range 3-20), respectively (P=0.006). Fourteen (21.9%) of the antiseptic catheters and 14 (20.3%) of the standard catheters had been colonized at the time of removal (P=0.834). Four cases (6.3%) of catheter-related bloodstream infection were associated with antiseptic catheters and one case (1.4%) was associated with a standard catheter (P=0.195). The catheter colonization rates were 18.7/1000 catheter-days for the antiseptic catheter group and 22.6/1000 catheter-days for the standard catheter group (P=0.640). The catheter-related bloodstream infection rates were 5.3/1000 catheter-days for the antiseptic catheter group and 1.6/1000 catheter-days for the standard catheter group (P=0.452). In conclusion, our results indicate that the use of antiseptic-impregnated central venous catheters has no effect on the incidence of either catheter colonization or catheter-related bloodstream infection in critically ill patients.     

经左、右侧上肢外周静脉置入中心静脉导管对置管结局的影响:458例前瞻性随机对照研究

目的比较经左、右侧上肢床旁行经外周静脉置入中心静脉导管（PICC）对置管结局的影响。方法2007年5月至2008年5月在武汉大学中南医院行PICC的患者458例，按随机表分为经左侧置入组（n=230）和右侧置入组（n=228）两组，于置管后即刻行胸部X线检查确认导管头端位置，并随访至导管停止使用时为止。结果右侧置入组出现送管困难的比率明显低于左侧置入组（14．9％比24．8％，P=0．003），导管头端大于40°成角的比率也明显低于左侧置入组（2．2％比23．4％，P=0．000）。两组患者导管头端位于中心静脉部位的到位率差异尤统计学意义（54．4％比53．0％，P=0．538），右侧置入组头端位于上腔静脉近心段的比率明显高于左侧置入组（21．0％比6．6％，P=0．001）；右侧置入组导管头端异位于头臂静脉的比牢明显低于左侧置入组（48．1％比66．7％，P=0．008），异伉于颈内静脉（P=0．859）和锁骨下静脉（P=0．696）的比率与左侧置入组差异无统计学意义。两组患者在导管留置时间（P=0．617）、穿刺血管局部静脉炎发生率（P=0．561）、导管堵塞率（P=0．774）及导管相关感染率（P=0．854）方面差异尤统计学意义，右侧置入组的上肢肿胀发生率明显低于左侧置入组（4．4％比8．3％，P=0．043）。结论经右侧上肢置入PICC的效果优于经左侧上肢，建议临床中置入PICC时优先选择经右侧上肢置管。     

不明原因发热患者保留观察和立即拔除中心静脉导管的临床研究

目的 研究不明原因发热患者保留观察中心静脉导管的安全性以及是否能够减少不必要的导管拔除.方法 回顾性分析82例不明原因发热怀疑导管相关性感染同时临床状况相对稳定患者,分为保留观察中心静脉导管组(观察组)31例和立即拔除中心静脉导管组(拔除组)51例.比较两组患者的ICU病死率、序贯器官功能衰竭评估(SOFA)评分、最高体温、导管相关性感染发生率和中心静脉导管拔除率.结果两组患者的ICU病死率、SOFA评分、最高体温和导管相关性感染发生率的差异均无统计学意义(P>0.05);观察组有11例(35.5%)中心静脉导管最终给予拔除,同拔除组100.0%的中心静脉导管拔除率相比,差异有统计学意义(P<0.05).结论 不明原因发热患者临床怀疑导管相关性感染,如果患者临床状况相对稳定,保留观察中心静脉导管方案可以减少相当多的不必要导管拔除,同时也不会恶化患者预后.     

Prevention and treatment of implanted central venous catheter (CVC) - related sepsis: a report after six years of home parenteral nutrition (HPN)

Catheter-related sepsis is a serious and common complication in patients receiving home parenteral nutrition (HPN). Prevention measures, prevalence of infections, types of agents and implanted central venous catheters (CVC), effectiveness of antibiotic therapy have been evaluated in 221 patients consecutively followed in our unit from January 1995 to December 2000. The clinical diagnosis of catheter-related infection was made using well-defined criteria. Patients were divided into two groups: A and B, receiving instructions with different modalities: standard (A) and detailed (B), respectively. Sixty CVC-related sepsis occurred in 32 (14%) patients. A multivariate analysis showed that the duration of HPN (P<0.001; OR=0.9), type of catheter (P=0.009; OR=0.12) and type of disease (P=0.033; OR=4.92) significantly influence catheter infection. The type of implanted CVC (159 port-a-cath in 153 patients and 71 tunnelled in 68) seems to affect the infection rate, this being lower in tunnelled (P=0.03). Infection rate was lower in B vs A group (P<0.001) with all types of catheters, suggesting the preventive role of very careful training. In particular, the incidence of CVC-related sepsis was 6/1000 days of HPN (i.e. 6/1000 days of catheterization) in Group A and 3/1000 in Group B. Systemic and antibiotic lock therapy was performed with an 83% successful rate. Gram-positive bacteria were the most frequent CVC infection agents, which are usually eradicated by antibiotic therapy lasting 7 days.