金黄散加蜂蜜外敷治疗皮肤过敏的效果观察及护理

目的探讨金黄散加蜂蜜外敷治疗重组人粒细胞-巨噬细胞集落刺激因子导致局部皮肤过敏的效果。方法对7例重组人粒细胞-巨噬细胞集落刺激因子导致局部皮肤过敏的患者,将金黄散粉末与蜂蜜以1：1剂量均匀搅拌,制成糊状涂擦患处,2次,d。结果7例患者局部皮肤过敏反应均在3～5d内治愈。结论采用金黄散加蜂蜜外敷治疗重组人粒细胞-巨噬细胞集落刺激因子导致的局部皮肤过敏,效果良好,值得临床推广应用。     

重组人粒细胞集落刺激因子对药物性皮肤溃疡愈合的影响

背景:粒细胞集落刺激因子对成纤维细胞、角质细胞、皮肤黏膜细胞均有不同程度的刺激作用。目的:观察粒细胞集落刺激因子对药物性外渗所致皮肤溃疡的愈合作用。设计:随机对照动物实验。单位:解放军第四军医大学西京医院呼吸内科。材料:实验于2004-06/2004-11在解放军第四军医大学西京医院呼吸内科实验室完成。取雄性昆明种小白鼠20只,体质量18～24g。方法:将制备好的皮肤溃疡动物模型随机分为对照组和治疗组,每组10只。对照组给予酚妥拉明1mg,利多卡因20mg,地塞米松1mg,用生理盐水稀释至0.5mL,封闭,1次/d,共7d;治疗组在溃疡周围注射粒细胞集落刺激因子25μg,用生理盐水稀释至0.5mL,隔日给药1次,共7d。观察溃疡处皮肤组织的愈合时间和组织学变化。主要观察指标:观察粒细胞集落刺激因子对药物性外渗所致皮肤溃疡、糜烂的愈合时间和组织学变化。结果:20只小白鼠均进入结果分析。①愈合时间:对照组糜烂、溃疡的愈合时间明显长于治疗组[(20～24,8～12)d,t=2.264,P=0.01];②组织学观察:对照组治疗7d后肉芽组织增生不明显;治疗组治疗7d后肉芽组织增生,新生血管丰富。结论:粒细胞集落刺激因子能促进药物性糜烂、溃疡的创伤愈合。     

重组人粒细胞集落刺激因子对药物性皮肤溃疡愈合的影响

背景：粒细胞集落刺激因子对成纤维细胞、角质细胞、皮肤黏膜细胞均有不同程度的刺激作用。 目的：观察粒细胞集落刺激因子对药物性外渗所致皮肤溃疡的愈合作用。 设计：随机对照动物实验。 单位：解放军第四军医大学西京医院呼吸内科。 材料：实验于2004—06／2004—11在解放军第四军医大学西京医院呼吸内科实验室完成。取雄性昆明种小白鼠20只，体质量18～24g。 方法：将制备好的皮肤溃疡动物模型随机分为对照组和治疗组，每组10只。对照组给予酚妥拉明1mg，利多卡因20mg，地塞米松1mg，用生理盐水稀释至0．5mL，封闭，1次／d，共7d；治疗组在溃疡周围注射粒细胞集落刺激因子25μg，用生理盐水稀释至0．5mL，隔日给药1次，共7d。观察溃疡处皮肤组织的愈合时间和组织学变化。 主要观察指标：观察粒细胞集落刺激因子对药物性外渗所致皮肤溃疡、糜烂的愈合时间和组织学变化。 结果：20只小白鼠均进入结果分析。①愈合时间：对照组糜烂、溃疡的愈合时间明显长于治疗组[（20-24，8～12）d，t=2．264，P=0．01]；②组织学观察：对照组治疗7d后肉芽组织增生不明显；治疗组治疗7d后肉芽组织增生，新生血管丰富。 结论：粒细胞集落刺激因子能促进药物性糜烂、溃疡的创伤愈合。     

重组人粒细胞集落刺激因子治疗化疗患者口腔黏膜溃疡的效果评价

目的 探讨重组人粒细胞集落刺激因子治疗化疗患者口腔黏膜溃疡的临床效果及应用价值.方法 回顾性分析40例经化疗后出现口腔黏膜溃疡患者的一般资料,按照随机、对照的原则分为观察组和对照组各20例.对照组患者采用普通常规的口腔护理,观察组采用重组人粒细胞集落刺激因子进行护理治疗.观察和比较2组患者的护理治疗效果及口腔黏膜炎愈合的平均时间.结果 观察组临床总有效率为100.0％,对照组临床总有效率为60.0％,2组比较,观察组治疗效果明显优于对照组；观察组患者口腔黏膜溃疡愈合的平均时间为(2.4±1.5)d,对照组患者口腔黏膜溃疡愈合的平均时间为(4.3±1.9)d,2组比较,观察组患者溃疡愈合的平均时间明显短于对照组.结论 临床采用重组人粒细胞集落刺激因子对化疗后出现口腔黏膜溃疡的患者护理治疗效果较好,能够加速患者口腔黏膜炎的愈合,改善患者的病情及预后,提高患者的生存质量,值得临床进一步大胆推广应用.     

肿瘤患者压疮用重组人粒细胞集落刺激因子换药效果观察

目的 探讨采用重组人粒细胞集落刺激因子局部换药治疗肿瘤患者压疮的效果.方法 将2004年9月-2006年8月人院的25例(32处)压疮患者作为对照组,2006年9月-2008年8月入院的25例(36处)压疮患者作为观察组.在常规清创清毒的基础上,观察组采用重组人粒细胞集落刺激因子稀释液涂抹局部,对照组将龙血竭胶囊打开取其粉0.3～0.6 g,用75%乙醇2～3ml调匀,用无菌棉签涂于疮面.治疗2周后观察对比两组疗效.结果 两组患者治疗效果比较经秩和检验,u=5.24,P<0.05.差异有统计学意义,观察组疗效明显优于对照组.结论 重组人粒细胞集落刺激因子治疗肿瘤患者压疮效果显著.     

粒细胞-巨噬细胞集落刺激因子治疗肺泡蛋白沉积症1例

收集1例肺泡蛋白沉积症(pulmonary alveolar proteinosis,PAP)患者临床资料并相关文献复习。患者因气短4个月,加重1个月入院,行纤维支气管镜活检。经过碘酸雪夫(Periodic acid-Schiff,PAS)染色阳性明确诊断为PAP,在经2次全肺灌洗治疗,病情反复后给予皮下注射粒细胞–巨噬细胞集落刺激因子,病情得到改善,提示对特发性PAP患者皮下注射粒细胞–巨噬细胞集落刺激因子是一种可行的治疗方法。     

下肢静脉溃疡患者自我管理的最佳证据总结

目的 检索、评价和总结下肢静脉溃疡患者自我管理的相关证据,为护理人员健康宣教及患者自我管理提供循证依据。方法 系统检索指南网站、数据库、专业协会网站中所有关于下肢静脉溃疡患者自我管理内容的相关文献,包括指南、最佳实践、专家共识、证据总结、系统评价、原始研究,检索时限为建库至2021年8月1日。由2名研究者独立对纳入文献进行质量评价,并结合专业人士的判断,进行证据的提取与整合。结果 共纳入14篇文献,其中,指南9篇,最佳实践2篇,系统评价2篇,专家共识1篇。最终总结出21条最佳证据,包括患者自我评估、压力治疗管理、饮食营养管理、运动管理、伤口周围皮肤管理5个方面。结论 该研究总结的下肢静脉溃疡患者自我管理的最佳证据具有科学性和实用性,可为临床医护人员提供参考和借鉴,使其更有针对性、科学性地指导下肢静脉溃疡患者的自我管理行为。     

1例糖尿病性类脂质渐进性坏死患者的护理

糖尿病性类脂质渐进性坏死是一种罕见的皮肤病变,在糖尿病患者中其发生率为0.3%～0.7%[1],临床上以胫前出现大片黄色硬皮样斑块,并常伴发糖尿病为特征.     

糖尿病周围神经病变患者皮肤保护的最佳证据总结

摘要：目的 检索、评价并汇总糖尿病周围神经病变患者皮肤保护的最佳证据，为科学管理糖尿病足溃疡前期皮肤症状、有效预防糖尿病足的发生与发展提供循证依据。方法 检索 UpToDate、BMJ Best Practice、Cochrane Library、乔安娜布里斯格研究所循证卫生保健中心数据库、美国糖尿病学会网站、加拿大安大略注册护士协会网站、苏格兰校际指南网、英国国家卫生保健优化研究所网站、国际糖尿病足工作组网站、PubMed、Embase、中国知网、万方数据、维普、中国生物医学文献数据库等数据库中有关糖尿病周围神经病变患者皮肤保护的临床实践指南、证据总结、系统评价及专家共识，检索时限为建库至2021年7月。由2名研究者进行文献质量评价和资料提取。结果 共纳入17篇文献，包括指南11篇、证据总结2篇、系统评价1篇及专家共识3篇。经整合，最终从下肢皮肤检查、皮肤问题处理及足部保护教育3个方面形成27条最佳证据。结论 糖尿病周围神经病变患者皮肤保护的最佳证据可为临床开展规范的糖尿病周围神经病变患者皮肤保护干预实践提供循证依据，对临床医护人员有效预防糖尿病足的发生与发展具有较好的指导意义。     

应用联合化疗加人粒细胞集落刺激因子治疗急性白血病

目的:探讨联合化疗加人粒细胞集落刺激因子治疗急性白血病的临床效果.方法:治疗组42例急性白血病患者在常规联合化疗基础上加用重组人粒细胞集落刺激因子(升白灵)1～2μg@kg-1@d-1,皮下注射或静滴,从上一化疗疗程结束用至下一疗程开始前停药.对照组28例单用联合化疗.结果:治疗组完全缓解率80.9%,对照组71.4%(P＜0.05);治疗组缓解期4～52个月,中数缓解期20.5个月,生存期7～53个月,中数生存期24个月;对照组缓解期4～31个月,中数缓解期14个月,生存期5.5～35个月,中数生存期14.2个月.结论:应用联合化疗加人粒细胞集落刺激因子治疗急性白血病比单用联合化疗临床效果更好,能更进一步改善其预后.     

1例胰岛素自身抗体所致频发严重低血糖的糖尿病患者的循证治疗

目的针对近期收治的1例少见胰岛素自身抗体（insulin autoantibody,IAA）所致频发严重低血糖的糖尿病患者,检索当前最佳证据,为临床合理治疗提供依据。方法计算机检索Cochrane图书馆（2008年第3期）、PubMed（1966～2009.7）、EMbase（1974～2009.7）、CBM（1978～2009.7）、CNKI（1976～2009.7）,按证据级别高低查找相关证据,并对所获证据进行评价。结果共检索到291篇文献,无临床指南和系统评价,也无临床对照研究。有关临床治疗的文献共有30篇,共包括6种治疗措施,其中胰岛素联合类固醇类药物效果相对较好,副作用发生较低。根据患者意愿和我院实际情况,在应用胰岛素控制血糖的基础上,对该患者短期给予糖皮质激素（强的松）治疗,17天后IAA滴度从13.3%降至5.41%,24天后降至0.62%,血糖水平趋于稳定,未见低血糖发生。随访5个月,病情稳定,血糖控制尚可,未见低血糖发作。结论短期给予糖皮质激素治疗是治疗IAA所致频发严重低血糖的有效方法。     

Amplatzer封堵器和外科手术治疗继发孔型房间隔缺损的系统评价

目的评价Amplatzer封堵器介入治疗和外科手术治疗继发孔型房间隔缺损的有效性和安全性。方法计算机检索MEDLINE(1966～2006．7)、EMbase (1966～2006．7)、Cochrane图书馆(2006年第2期)和中国生物医学文献数据库(1979～2006．7),收集所有相关随机和非随机对照试验,质量评价后用RevMan4．2版软件进行Meta分析。结果未获得随机对照试验,纳入16个非随机对照试验,共2 043例。结果显示:①住院期间病死率:14个试验的住院期间病死率都为0,只有2个试验报道外科手术治疗组各有1例死亡;②12个试验(n=1 722)的Meta分析结果显示,Amplatzer封堵器组的治疗成功率略低于外科手术组,其差异有统计学意义[RR=0．95,95%CI(0．92,0．98)];③6个试验(n=1 106)的Meta分析结果显示,Amplatzer封堵器组术后24 h封堵成功率也略低于外科手术组,其差异有统计学意义[RR=0．96,95%CI(0．92．1．00)] ;④1 6个试验(n=1 977)的Meta分析结果显示,Amplatzer封堵器组术后并发症发生率低于外科手术治疗组[RR=0．27．95%CI(0．21,0．35)];⑤14个试验(n=1 807)的Meta分析结果显示,Amplatzer封堵器组术后输血明显少于外科手术组[RR=0．03,95%CI(0．02,0．06)]。结论Amplatzer封堵器介入治疗继发孔型房间隔缺损的成功率略低于手术治疗组,但术后并发症和术后输血少,在适应症范围内可代替外科手术。     

Role of the bispectral index in sedation monitoring in the ICU

OBJECTIVE: To review and critique evidence for the use of the bispectral index (BIS) in intensive care unit (ICU) patients. DATA SOURCES: A computer search of English-language articles in MEDLINE (1966-July 2005), International Pharmaceutical Abstracts (1971-July 2005), and Scientific Citation Index Expanded (1980-July 2005) was conducted. A manual search of abstracts was also performed using the key search terms BIS, sedation, and critical care. STUDY SELECTION AND DATA EXTRACTION: Case series, letters, editorials, and clinical studies that evaluated BIS in ICU patients were considered for inclusion. DATA SYNTHESIS: Nineteen studies comparing the BIS with sedation scales were evaluated, revealing that the BIS trends lower with increasing sedation. The BIS appeared to correlate better when sedation scores were grouped rather than individual values. However, correlations between BIS and subjective scales were low in most studies (r(2) 0.21-0.93). Additionally, there was poor correlation between drug dosage and the BIS. Randomized, controlled trials demonstrating improved outcomes with BIS monitoring have not been reported. CONCLUSIONS: Interpreting literature on the usefulness of the BIS in the ICU is difficult for reasons that include heterogeneous populations, different methods of collecting BIS data, and use of different versions of BIS software and hardware. Outcomes data are lacking. The 2002 Society of Critical Care Medicine Sedation Guidelines recommendation that more data are needed before the BIS should be used routinely in the ICU remains unchanged. We recommend that further studies be conducted to determine the optimal method of obtaining BIS data and evaluate the impact of the BIS on relevant patient outcomes.     

Once-daily cefazolin and probenecid for skin and soft tissue infections

OBJECTIVE: To review the pharmacokinetic and clinical evidence for the use of once-daily cefazolin and probenecid in the treatment of skin and soft tissue infections (SSTI). DATA SOURCES: MEDLINE (1966-July 2003), EMBASE (1980-July 2003), and PubMed (1966-July 2003) databases for English language, human reports were searched. Search terms included cefazolin, probenecid, cellulitis, and soft tissue infections. STUDY SELECTION AND DATA EXTRACTION: Studies that described pharmacokinetic and clinical outcomes that evaluated the use of cefazolin in conjunction with probenecid for SSTI were included. All studies were evaluated independently by both authors. For pharmacokinetic studies, the effect of probenecid on the pharmacokinetics of cefazolin was evaluated. For clinical trials, efficacy and safety endpoints were evaluated. For efficacy endpoints, definition of cure was used as defined by each trial. DATA SYNTHESIS: In all 3 pharmacokinetic studies identified, the addition of probenecid to cefazolin therapy prolonged the half-life and increased serum concentrations of cefazolin. This process allowed serum concentrations to be above the minimal inhibitory concentrations (MIC) for the most likely skin pathogens (Staphylococcus aureus, beta-hemolytic streptococci) at the end of the dosing interval. In the first of 2 clinical trials, 7 (7%) of 96 patients receiving intravenous ceftriaxone 2 g and oral probenecid 1 g daily were reported to fail therapy compared with 8 (8%) of 98 patients receiving intravenous cefazolin 2 g and oral probenecid 1 g daily. In the second clinical trial, clinical success was reported in 51 (86%) of 59 patients receiving the same doses of cefazolin and probenecid as above compared with 55 (96%) of 57 patients receiving intravenous ceftriaxone 1 g and oral placebo daily. CONCLUSIONS: Limited pharmacokinetic and clinical data suggest that intravenous cefazolin 2 g and oral probenecid 1 g daily is an effective regimen in the treatment of SSTI.     

急诊急性有机磷农药中毒的循证治疗

目的应用循证医学的基本原理和方法为急性有机磷农药中毒患者制定合理的治疗方案。方法针对急性有机磷农药中毒具体病例提出临床问题,以有机磷农药、中毒、胆碱酯酶复能剂肟类、中间综合征等MeSH主题词及自由词为关键词,电子检索ACP Journal Club(1991-2006．4)、Cochrane图书馆(2006年第1期)、MEDLINE(1966-2006．5)和中国生物医学文献数据库(1980-2006．5),查找与肟类复能剂治疗急性有机磷农药中毒有关的系统评价、临床随机对照试验等,并对所获证据进行质量评价。结果检索到2005年的Cochrane系统评价和2006年Meta分析各1篇,其结果均提示,肟类复能剂对急性有机磷农药中毒的治疗效果不肯定。据此临床证据,结合医生经验及患者家属意见,对该患者未使用肟类复能剂,而是小剂量阿托品递减剂量及对症支持治疗。一周后,患者生命体征平稳,临床症状缓解出院。结论采用循证医学的方法为急性有机磷中毒患者选择了合理的治疗方案。肟类复能剂对急性有机磷农药中毒的疗效不肯定,尚待大样本高质量的随机对照试验证实。     

Patient and Provider Attributes Associated With Chronic Obstructive Pulmonary Disease Exacerbations

The purpose of this quality improvement project was to identify key patient and provider attributes associated with chronic obstructive pulmonary disease (COPD) exacerbations in primary care. Multiple regression analysis was performed on data retrieved from a retrospective chart review. Four variables produced an R of .424, R2 = .18, (F (4,45) = 2.464, P = .059) for the prediction of COPD exacerbations. The strongest predictor was number of counseling occurrences (β =.402), followed by stage (β = .135), CPG (β = ?.109), and tobacco status (β = .003). Practice-based evidence generated through this study is a means for improving patient care and patient outcomes.     

Fatal aspiration pneumonia during transition from donepezil to rivastigmine

OBJECTIVE: To report a case of fatal aspiration pneumonia in a patient shortly after initiation of rivastigmine and discontinuation of donepezil, with no washout period between therapies. CASE SUMMARY: An 83-year-old white man presented to the emergency department in respiratory distress (O2 saturation 70%; RR 44 breaths/min) secondary to aspiration. He had started rivastigmine 1.5 mg twice daily that same day. The patient had been previously treated with donepezil 10 mg/d, and there was no washout period. He was intubated due to worsening respiratory status and was transferred to the cardiac care unit. He then became hypotensive and required dopamine and fluid support. Brief bronchoscopy revealed food particles in the lower airways and bile-stained secretions. Intubation was notable for the large amount of secretions. The patient died approximately 27 hours after presentation to the emergency department. Blood and sputum cultures were subsequently positive for Haemophilus influenzae. DISCUSSION: Cholinesterase (ChE) inhibitors approved for treatment of Alzheimer disease are associated with nausea and vomiting in a sizable percentage of patients, ranging from 5% to 31% in clinical trials. Most of these adverse events occur during the initiation/titration phase of therapy. An additive risk of adverse events may be expected with coadministration of ChE inhibitors or cholinergic agents or, potentially, with an inadequate washout period between such agents. Review of MEDLINE (1966-July 2002) and International Pharmaceutical Abstracts (1970-July 2002) failed to identify any previous reports of aspiration with rivastigmine or donepezil. CONCLUSIONS: A washout period should be considered when switching between ChE inhibitors to minimize the risk of vomiting and aspiration.     

慢性阻塞性肺疾病患者治疗依从性研究文献计量分析

目的了解国内COPD患者治疗依从性研究现状,明确目前该领域研究存在的问题,为提高COPD患者治疗依从性提供参考。方法自维普、CNKI、万方提取334篇发表于1999-2013年的相关文献,并采用计量方法进行分析。结果共纳入COPD患者治疗依从性论文334篇,纳入文献的类型主要以临床试验研究为主,共158篇,占所检出文章47.3%;高频主题词共有26个。结论年度发文量呈逐年递增趋势,文献类型分布广泛,同时,研究热点将集中在COPD治疗方案及预后、康复治疗和治疗效果等方面。通过文献计量学分析,表明国内COPD患者治疗依从性的研究尚有较大的提升空间。     

慢性阻塞性肺疾病患者住院时间延长危险因素的Meta分析

目的 明确慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者住院时间延长的危险因素,为临床患者的早期干预提供依据.方法 系统检索中国知网、万方、维普、Pubmed、Web of Science及Cochrane library数据库,收集COPD患者住院时间延长...     

Inhaled dry powder insulin for the treatment of diabetes mellitus

BACKGROUND: Inhaled dry powder insulin (IDPI) is the first inhaled insulin approved for the treatment of type 1 and type 2 diabetes mellitus (DM). OBJECTIVE: This article reviews available information on IDPI, focusing on its clinical pharmacokinetics, comparative efficacy, tolerability, adverse events, dosage and administration, and cost. METHODS: MEDLINE (1966-July 2006) and Web of Science (1995-July 2006) were searched for original research and review articles published in English. The search terms used were inhaled insulin, inhaled human insulin, rDNA origin inhalation powder, inbaled dry powder insulin, and IDPI. All published comparative efficacy studies were included in the review, as well as selected information from the package insert for IDPI. RESULTS: IDPI is an inhaled dry powder form of regular human insulin (RHI) that is used as a premeal insulin to improve glycemic control by reducing postprandial glucose excursions. The literature search identified 5 efficacy trials comparing reductions in glycosylated hemoglobin (HbA(1c)) in a total of 582 patients with type 1 DM who received either premeal IDPI plus neutral protamine Hagedorn (NPH) or Ultralente insulin or injectable RHI plus NPH or Ultralente insulin. The search identified 5 comparative efficacy studies of IDPI monotherapy or the addition of IDPI to the current regimen in a total of 1413 patients with type 2 DM that was uncontrolled with diet and exercise, metformin, a sulfonylurea, metformin and a sulfonylurea, or a secretagogue plus an insulin sensitizer. The use of IDPI as a mealtime insulin in these studies was associated with absolute changes in HbA(1c) ranging from -0.6% to +0.1% in patients with type 1 DM and from -1.4% to -2.9% in patients with type 2 DM. HbA(1c) values <7% were achieved in 16.9% to 28.2% of patients with type 1 DM and 16.7% to 44.0% of patients with type 2 DM. The most common nonrespiratory adverse event noted during clinical trials of IDPI was hypoglycemia (type 1 DM: 8.6-9.3 episodes/subject-month; type 2 DM: 0.3-1.4 episodes/subject-month), and the most common adverse event involving the pulmonary system was cough (21.9%-29.5%). CONCLUSIONS: IDPI is the first available inhaled insulin. It provides an additional option for the achievement of HbA(1c) goals with a premeal insulin.