化疗药物外渗处理的临床经验

目的 长期化疗的患者发生化疗药物外渗的原因很多,加强巡视及时发现化疗药物外渗,早期有效的处理就显得尤为重要,能减轻的痛苦和对化疗的恐惧,更能有效地减少护患纠纷.方法 1%利多卡因5 ml+地塞米松5 mg行局部封闭,欧莱凝胶涂抹患处.结果 通过对30例化疗患者,在化疗期间发生化疗药物外渗事件,早期使用利多卡因加地塞米松局部封闭和欧莱凝胶涂抹相结合的治疗方法,取得了非常好的效果,没有一例出现皮下组织缺血、坏死现象.结论 上述处理"方案"能有效降低毒性反应、避免溃疡发生,临床应用效果满意.     

抗肿瘤药物静脉外渗预防和护理新进展

化疗药物外渗是指化疗药物输注过程中由于多种原因导致化疗药物渗出或渗浸到皮下组织中.外周静脉化疗药物外渗的发生率国内报道0.1%～6.0%,国外报道5%[1].静脉滴注或推注化疗药物时,如果使用不当,可使药物外渗到皮下组织,轻者引起红肿、疼痛和炎症,严重时可致组织坏死和溃疡,较长时间不愈和,给患者带来痛苦[2].因此,护理人员掌握化疗药物外渗的原因、预防和处理方法至关重要.现将抗肿瘤药物外渗护理进展综述如下.     

化疗药物外渗的护理

化疗药物外渗是指化疗药物输注过程中由于多种原因导致化疗药物渗出或渗浸到皮下组织中[1]。外周静脉化疗药物外渗的发生率国内报道为0.1%~6.5%,国外报道为5%.具有强刺激性的化疗药物,如蒽环类药物,在静脉注射时不慎漏出血管外,可导致皮下组织红肿、剧痛,甚至溃疡或坏死。     

化疗药物外渗原因分析及护理干预体会

目的探讨化疗药液外渗的原因,提出护理干预,减少外渗的发生。方法采用回顾性方法,对2009年1月~2012年1月的857例化疗出院患者的资料进行统计分析。结果 857例中化疗药液外渗的有72例次,外渗率为8.4%。手背穿刺外渗率20.83%,手腕穿刺外渗率44.44%,肘窝处穿刺外渗率31.94%,其他穿刺外渗率2.79%;首次化疗占9.87%,重复穿刺占9.55%;输液瓶次>5占8.39%及用铂类药物占11.37%;发疱药物占10.69%,非发疱药物占4.43%。穿刺部位、解剖因素、生理因素、输液时间、药物刺激强度等都是引起化疗药液外渗的原因。结论选择合适的穿刺部位、提高静脉穿刺技术、做好知识宣教、缩短输液时间及合理安排输液顺序等都可减少化疗药物外渗的发生。     

化疗药物外渗局部治疗新进展

静脉输液中发生药液外渗并不少见,国外报道达5%[1],化疗药物外渗包括原发损害、继发损害,一般而言原发损害轻,而继发损害重,风险是可防可控的。化疗药物外渗意外发生后及时上报、正确评估、恰当处理至关重要,应建立相应的应急预案、会诊制度,从而避免、减轻继发组织损害、功能障碍的发生率,减少医疗纠纷。由于目前医患关系日趋紧张,化疗药物外     

化疗药物外渗的预防和护理

化疗药物的使用挽救和延长了无数病人的生命,但也带来了令人担忧的化疗药物外渗的问题.一般外周静脉化疗药物外渗的发生率为0.1%～6.5%.因此,如何预防化疗药物外渗是肿瘤专科护士面临的一个重要课题.现将我们对化疗药物外渗的预防和护理体会介绍如下.     

外敷硼酸在化疗药物外渗后的护理观察

目的:观察在化疗药物发生外渗后,使用硼酸对外渗部位进行外敷护理的治疗效果。方法:发现化疗患者药物外渗后,要保持镇静。若外渗情况不严重,那么停止输液,让患者平卧并安慰患者,减轻患者的不安情绪;若外渗情况严重,要停止输液并用原针头最大程度地抽取化疗药物。用硼酸对患者化疗外渗部位进行外敷,并抬高患肢,防止外渗药物在体内扩散。结果:实验组的疗效明显优于对照组,使用硼酸外敷化疗药物外渗部位的总有效率为100%。且在换药次数和治疗时间上也优于对照组。化疗发生药物外渗的患者在使用硼酸外敷后痊愈。结论:使用外敷硼酸对化疗药物外渗进行护理,其临床使用方便、操作简单、容易上手、疗效显著、痊愈率高,有效地避免了患者因化疗药物外渗而造成的组织损伤或坏死,值得临床推广。     

简述化疗药物外渗的防护进展

近年来,肿瘤患者逐年增加。化疗是治疗恶性肿瘤的主要手段之一,而化疗药物外渗是化疗过程中的常见并发症。本文首先总结了化疗药物外渗的几种常见原因,外渗后损伤组织的机理及表现,然后重点概括了国内现阶段针对不同化疗药物外渗后所采取的相应的治疗及护理方法。最后简单总结了预防化疗药物外渗的方法。     

地塞米松配合冰敷在化疗药物外渗中的应用效果观察

目的 观察地塞米松配合冰敷在化疗药物外渗中的效果. 方法 将38例化疗药物外渗的患者随机分为实验18例和对照组20例,实验组应用地塞米松配合冰敷24～48h,观察两组外渗后症状缓解情况比较. 结果 实验组总有效率为100%,对照组总有效率为80%,差异有显著性(P＜0.05).结论 地塞米松配合冰敷治疗化疗药物外渗效果明显.     

牛黄解毒丸外敷治疗化疗药物外渗的效果观察

目的:探讨牛黄解毒丸外敷治疗化疗药物外渗导致静脉炎的治疗效果。方法:笔者所在科化疗后发生药物外渗患者16例,将牛黄解毒丸碾碎与70%的酒精混合,外敷在化疗药物外渗部位。结果:15例患者效果良好,1例效果差,出现局部皮肤表皮干痂样改变,色素沉着,皮下组织无明显改变。结论:牛黄解毒丸用于外敷治疗化疗药物外渗,价格低廉,取材容易,操作方便,临床效果好,值得推广应用。     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Electro-Acupuncture Combined with the Trigger Point Needle-Embedding for Treatment of Primary Trigeminal Neuralgia in 31 Cases

In recent years, the author of this essay has applied electro-acupuncture combined with the trigger point needle-embedding for treatment of primary trigeminal neuralgia in 31 cases, yielding satis- factory results as reported in the following.     

Investigation of Matrix Metalloproteinase -1, 2 and tissue inhibitor of matrix metalloproteinases-1 in Endometriosis

Objective： To explore the role of matrix metalloproteinase-1,2 （MMP-1, MMP-2） and tissue inhibitor of matrix metalloproteinases-1 （TIMP-1） in endometriosis. Methods： The eutopic and ectopic endometria from 40 subjects suffering from endometriosis and regular.endometria from 40 subjects （excluding endometriosis） were collected and examined by in situ hybridization technology and western blot assay. Results： Both expressions of MMP-1 and -2 were stronger in ectopic endometrium and eutopic endometrium than in normal endometrium. On the contrary, the expression of TIMP-1 in ectopic endometrium and eutopic endometrium was lower. The differences were significant （P 〈 0.01 ）. Moreover, there was no relationship among the expressions of MMP-1, 2 and TIMP-1 in ectopic endometrium. Conclusion： The expressions of MMP-1, 2 and TIMP-1 lose balance and lack of periodic changes in ectopic endometrium , which explains the biological invasive behavior of endometriosis. It was suggested-that regulating the balance between the MMPs and TIMP-1 should be an ideal therapeutic target to endometriosis.     

Shi Da-zhuo (史大卓) —An outstanding cardiologist of integrative medicine

Prof. SHI Da-zhuo, Ph.D., male, was born on March 20, 1960. Prof. SHI entered the Ph.D. program in 1990 at the China Academy of Chinese Medical Sciences under the supervision of Prof. CHEN Ke-ji, majoring in the treatment of cardiovascular diseases. After receiving his Ph.D. degree in 1993, Prof. SHI started working at the Cardiovascular Center in Xiyuan Hospital affiliated to China Academy of Chinese Medical sciences.     

Persist in and Carry Forward the Integrative Medical Research——Speech at the 6th National General Congress of Chinese Association of Integrative Medicine by Academician CHEN Zhu,Minister of Ministry of Health

The 6th National General Congress of Chinese Association of Integrative Medicine （CALM） was convened at 19-20, April 2008 in Beijing. Academician CHEN Zhu, the minister of Ministry of Health indicated at the congress that the integration of Chinese and Western medicine is very well in keeping with the situation of our country and the general rule of development in medical science; and as a good integration of Chinese medicine and Western medicine, it is mutually beneficial and advantageous to both of them. Seeing the creativity shown in integrative medical investigation in theoretic and methodological sides, we should and must persist in and develop it.