化疗药物对肿瘤科护士的职业危害与防护对策

目的:分析常用化疗药物对肿瘤科护士的职业性危害,探讨相应防护对策.方法;对36名护士进行调查,分析抗肿瘤化疗药物对护士的职业危害情况.结果:体检50人次,其中发生白细胞减少10例,血小板减少7例,脱发20例,流产3例,口腔溃疡6例.结论:正确认识化疗药物对护士的职业危害,探讨防护对策,对保护护士健康和环境安全非常重要.     

对护士职业接触化疗药物防护士预的效果评价

目的为了强化护士的防护意识，减少护士职业接触化疗药物对健康的损害，探讨有效的 防护干预对策。方法胗目的抽样法，对32名肿瘤科职业接触化疗药物护士进行了防护干预研究，并与干预前调查组的48名护理人员进行了对照。结果干预后职业接触抗肿瘤药物的护士白细胞减少、脱发、月经异常等临床副反应发生率下降了百分之56.6结论职业接触化疗药物的护士防护，必须建立和使用有效的防护设备及措施，实施教育与行为干预为主的防护原则，严格执行卫生防护制度，才能有效的控制护士职业接触化疗药物对健康造成的损害.     

对护士职业接触化疗药物防护士预的效果评价

目的为了强化护士的防护意识，减少护士职业接触化疗药物对健康的损害，探讨有效的 防护干预对策。方法胗目的抽样法，对32名肿瘤科职业接触化疗药物护士进行了防护干预研究，并与干预前调查组的48名护理人员进行了对照。结果干预后职业接触抗肿瘤药物的护士白细胞减少、脱发、月经异常等临床副反应发生率下降了百分之56.6结论职业接触化疗药物的护士防护，必须建立和使用有效的防护设备及措施，实施教育与行为干预为主的防护原则，严格执行卫生防护制度，才能有效的控制护士职业接触化疗药物对健康造成的损害.     

对护士职业接触化疗药物防护干预的效果评价

目的为了强化护士的防护意识，减少护士职业接触化疗药物对健康的损害，探讨有效的防护干预对策。方法采用目的抽样法，对32名肿瘤科职业接触化疗药物护士进行了防护干预研究，并与干预前调查组的48名护理人员进行了效果对照。结果干预后职业接触抗肿瘤药物的护士白细胞减少、脱发、月经异常等临床副反应发生率下降了56.6％。结论职业接触化疗药物的护士防护，必须建立和使用有效的防护设备及措施，实施教育与行为干预为主的防护原则，严格执行卫生防护制度，才能有效的控制护士职业接触化疗药物对健康造成的损害。     

护士接触抗肿瘤药物职业防护行为及其影响因素的调查

目的了解护士接触抗肿瘤药物防护行为的现状及影响因素,为制订防护制度、提高防护意识、规范防护行为提供依据。方法采用自设问卷对某肿瘤专科医院的163名护士进行调查。结果护士抗肿瘤药物防护知识得分为(36.12±7.71)分,抗肿瘤药物防护行为得分为(56.01±9.45)分;防护行为得分受学历、防护知识兴趣程度、培训频次及防护知识得分的影响;控制一般资料后,防护知识得分对防护行为得分的影响增加5.3%。结论护士对抗肿瘤药物防护行为较差,管理者应通过培训和制度监管手段,建立护士防护理念,规范其防护行为。     

应用简易层流柜对护士防护作用的探讨

目的　探讨自制简易层流柜对护理人员在配制化疗药物时的防护作用。方法　比较长期接触化疗药物的 32名护士在使用自制简易层流柜前和使用 1 2个月后的白细胞数、脱发、月经等情况作对此调查并统计学处理。结果　护士在使用自制简易层流柜后白细胞数、脱发、月经异常情况均较使用前明显改善 (P <0 .0 5 )。结论　简易层流柜对护理人员在配制化疗药物时起到了良好的防护作用     

轮状病毒肠炎并肝损害83例分析

目的：探讨小儿轮状病毒肠炎与肝功能损害的关系.方法：对83例轮状病毒肠炎并肝功能损害患儿的临床资料进行分析.结果：83例患儿中,ALT升高总例数53例,占63.9%;AST升高总例数40例,占48.2%;γ-GT升高总例数13例,占15.7%;治疗前ALT为（78.45±6.72）IU/L,治疗后ALT为（46.70±3.86）IU/L,两者比较,差异有统计学意义（P＜0.01）;治疗前AST为（72.40±5.65）IU/L;治疗后AST为（43.70±4.46）IU/L,两者比较,差异有统计学意义（P＜0.05）.6～12个月组共48例,ALT升高者38例,占79.2%;AST升高者31例,占64.6%.结论：轮状病毒感染可发生肝功能损害,此年龄越小肝功能损害发生率越高.     

熊去氧胆酸治疗妊娠合并肝内胆汁淤积症患者的疗效

目的：观察熊去氧胆酸对妊娠合并肝内胆汁淤积症患者的疗效及对妊娠结局的影响。方法：选取2015年7月~2017年7月我院收治的52例妊娠合并肝内胆汁淤积症患者为研究对象,按照随机数字表法分为观察组与对照组各26例,对照组在常规治疗基础上给予地塞米松治疗,观察组在对照组基础上给予熊去氧胆酸治疗。观察两组患者妊娠结局、治疗前后血清TBA、CBA、sVCAM-1、ALT、AST水平差异。结果：治疗后,观察组ALT水平（102.35±69.36） IU/L,低于对照组（146.42±77.48） IU/L,t=2.308,P＜0.05;观察组AST水平（90.74±58.25） IU/L,低于对照组（130.45±65.36） IU/L,t=2.312,P＜0.05;治疗后,两组患者TBA、CBA、sVCAM-1水平均明显降低,且观察组低于对照组,P＜0.05;两组剖宫产率比较无明显差异,P＞0.05;观察组终止妊娠时间、新生儿Apgar评分均高于对照组,产后出血量、羊水污染率均低于对照组,P＜0.05。结论：熊去氧胆酸用于妊娠合并肝内胆汁淤积症的治疗,可明显降低患者血清TBA、CBA、sVCAM-1、ALT、AST水平,保护肝功能,促进胆汁正常代谢及疾病转归,改善妊娠结局,临床疗效显著。     

肿瘤科护士化疗药物配置应用防护措施效果观察

目的探讨肿瘤科护士化疗药物配置过程中采取防护措施的效果。方法比较20例肿瘤科护士采用正规防护措施前后的白细胞下降、脱发、月经紊乱的发生率。结果采用正规防护措施前后肿瘤科护士的白细胞下降的发生率分别为45％（9/20）与10％（2／20），脱发的发生率分别为75％（15／20）与15％（3/20），月经紊乱的发生率分别为60％（12／20）与10％（2/20），统计学上均有显著性差异（均p〈0．05）。结论采用正规防护措施，可以减少长期接触化疗药物的护士引起的白细胞下降、脱发、月经紊乱等不良反应。     

配药罩治疗车的研制与应用

抗肿瘤药物在配制过程中可出现肉眼看不见的逸出，形成有毒性的微粒气雾，通过皮肤或呼吸道进入人体。据报道。护士职业接触肿瘤药物可导致白细胞、血小板下降、月经紊乱、脱发等毒性反应。为使广大护士在配制化疗药物时能减少对身体的损害，我们设计了集防护、无菌配药于一体的配药罩治疗车。现介绍如下．     

加强病人药物过敏的护理干预

加强病人药物过敏的护理干预是护理安全管理的重要环节之一。必须对护士加强药物过敏的安全教育;不断学习和认识药物过敏的深刻意义,每一种药物和给药途径均可能发生过敏反应,药物过敏试验不是判断药物过敏的唯一标准,应走出药物过敏的误区;严格遵守护理技术操作规程,把好药物过敏试验质量关;密切观察药物过敏反应,掌握药物高度过敏反应发生的时间,早期发现不典型过敏性休克的症状;熟练掌握过敏性休克的抢救规程,病人对药物过敏的相关内容应有醒目标志。     

健康人群丙氨酸氨基转移酶及天门冬氨酸氨基转移酶参考区间初步调查

目的建立含5′-磷酸吡哆醛（PLP）的试剂测定血清丙氨酸氨基转移酶（ALT）和天门冬氨酸氨基转移酶（AST）催化活性浓度的参考区间,并与不含PLP试剂方法的参考区间作比较。方法采用国际临床化学联合会（IFCC）推荐方法测定3 249名健康人血清ALT和AST,试剂采用罗氏公司试剂,分别用罗氏公司cfas定标液中加PLP及不加PLP的标准液进行定标。结果加入PLP的试剂测定健康人血清ALT、AST的结果与不加PLP试剂的测定结果有明显差异（P〈0.000 1）。健康人群血清ALT、AST测定值男、女性之间有明显差异（P〈0.000 1）。如以含PLP试剂检测值的95%分位作为参考值上限时,ALT为男性55 IU/L、女性36 IU/L;AST为男性42 IU/L、女性33 IU/L。如以不含PLP试剂检测值的95%分位作为参考值上限时,ALT为男性50 IU/L、女性32 IU/L;AST为男性35 IU/L、女性28 IU/L。二者均有随年龄升高的趋势。结论含PLP的ALT和AST试剂测定健康人ALT和AST活性升高。PLP能有效地激活ALT和AST活性,用含PLP的试剂测定ALT、AST活性可准确反映患者血液中ALT、AST的实际含量。推荐临床用含PLP的试剂作为测定ALT、AST的常规方法 。     

阿托伐他汀钙预防大鼠肝缺血再灌注损伤的实验研究

目的探讨阿托伐他汀钙对肝缺血再灌注损伤的保护作用及其作用机制。方法采用在体大鼠肝原位缺血再灌注模型。21只健康雄性SD大鼠随机分成假手术组(N)、缺血再灌注组(I/R)、阿托伐他汀钙处理组(AT+I/R),每组7只。各组于再灌注90 min后经肝上下腔静脉取血,用于检测血清谷丙转氨酶(ALT)和谷草转氨酶(AST);取肝匀浆低温离心后采用试剂盒测定肝组织中总超氧化物歧化酶(TSOD)、丙二醛(MDA)、髓过氧化物酶(MPO)、一氧化氮(NO)、一氧化氮合酶(NOS)含量变化;同时取肝脏组织作病理切片观察。结果 AT+I/R组较I/R组:ALT分别为(928.43±96.17)、(1234.89±327.17)IU/L;AST分别为(1 222.91±249.85)、(1635.74±481.86)IU/L;MDA分别为(2.35±0.57)、(3.29±1.23)nmol/mg;MPO分别为(2.33±0.71)、(3.18±0.82)IU/mg;NO分别为(89.27±8.27)、(102.32±11.81)μmol/mg;iINOS分别为(0.25±0.14)、(0.45±0.21)U/mg,AT+I/R组明显降低(P<0.05),而SOD(20.86±2.49)、(14.58±2.04)IU/mg;cNOS(0.69±0.17)、(0.56±0.13)U/mg明显升高(P<0.05)。结论阿托伐他汀钙有保护肝缺血再灌注损伤的作用。其可能机制为激活了抗氧自由基、提高机体清除氧自由基、抗炎作用和减轻钙超载有关。     

ALT和HBV DNA联合诊断e抗原阴性的慢性活动性乙型肝炎诊断界值的建立及评价

目的建立和评估丙氨酸氨基转移酶(ALT)、乙型肝炎病毒(HBV)DNA和天门冬氨酸氨基转移酶(AST)对乙型肝炎e抗原(HBeAg)阴性活动性乙型肝炎的诊断界值(Cut-off值)。方法将290例HBeAg阴性的慢性乙型肝炎患者以肝组织活检结果为标准分为活动性(213例)和非活动性(77例)慢性乙型肝炎,用受试者工作特征(ROC)曲线评价ALT、AST和HBV DNA载量在诊断HBeAg阴性的活动性慢性乙型肝炎中的价值。结果血清中ALT、AST、HBV DNA载量的ROC曲线下面积(AUC)分别为0.849、0.807、0.867;诊断界值为男性ALT 30 IU/L、女性ALT 19 IU/L,HBV DNA载量1×105拷贝/mL时的敏感性为90.6%、特异性为98.7%、阳性预测值为99.5%、阴性预测值为79.2%;AST以40 IU/L作为Cut-off值时的敏感性为77.0%、特异性为63.3%、阳性预测值为85.4%、阴性预测值为50.0%。结论可以以男性ALT 30 IU/L、女性ALT 19 IU/L且HBV DNA载量1×105拷贝/mL作为中国四川自贡地区HBeAg阴性的慢性活动性乙型肝炎的诊断Cut-off值。     

A descriptive analysis of aspartate and alanine aminotransferase rise and fall following acetaminophen overdose

Context: Risk prediction following acetaminophen (paracetamol, APAP) overdose is based on serum APAP, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) levels. One recently proposed risk stratification tool, the APAPxAT multiplication product, uses either AST or ALT, whichever is higher, yet their interrelation is not well known following APAP-induced hepatic injury. Objective: To describe the kinetics of AST and ALT release into and disappearance from the circulation following APAP overdose. Materials and Methods: An observational case series of adult patients with peak AST or ALT > 100 IU/L attributable to APAP toxicity. Cases were identified by electronic search of hospital laboratory database and by discharge diagnosis corroborated by structured explicit medical record review. Results: Of 68 cases identified (mean age (SD): 39 (18) years, 63% female, and 21% ethanol co-ingested), 28 (41%) developed hepatotoxicity (peak AST or ALT > 1000 IU/L), 28 (41%) coagulopathy (international normalized ratio or INR > 2), and 21 (31%) both. Three patients (4%) were transferred for liver transplantation and ultimately six (8.8%) died. Serum AST and ALT activity rose in a closely aligned 1:1 AST:ALT ratio, but fell at distinctly different rates: AST activity fell with a half-life (interquartile range [IQR]) of 15.1 (12.2, 19.4) hours, and ALT 39.6 (32.9, 47.6) hours. Using an aminotransferase falling to below 50% of peak as the basis for discontinuing acetylcysteine would have resulted in antidotal treatment being stopped 24 (IQR: 9.6, 40) hours earlier (and in no cases later) using AST rather than ALT. Only six patients had an AST:ALT ratio greater than 2:1 at the time of acetylcysteine administration; of these six, four died and one survivor developed coagulopathy. Discussion: AST and ALT release into the circulation appears tightly linked and numerically similar, except in the sickest patients. Once the aminotransferases peak, AST returns to baseline more quickly. Conclusion: Either AST or ALT can be used for early risk stratification tools when only one is known. Any criterion for N-AC discontinuation should be based on the decline of AST rather than ALT, with a potential benefit measured in days.     

Fomepizole as an Adjunctive Treatment in Severe Acetaminophen Toxicity

A 33-year-old male presented to the emergency department with a chief complaint of abdominal pain after taking #50 500 mg acetaminophen tablets over the preceding two days. He was tachycardic and tachypneic, and the initial labs were notable for acetaminophen level, 337 mg/L; AST, 137 IU/L; ALT, 194 IU/L; ABG pH, 7.24; and lactate, 4.1 mmol/L. The patient was started on IV N-Acetylcysteine (NAC) as well as given a single dose of 15 mg/kg fomepizole. The patient did remarkably well, with a peak AST of 198 IU/L, peak ALT of 301 IU/L, and peak INR of 3.1. Biochemical and animal data support fomepizole having hepatoprotective effects in acetaminophen poisoning. To our knowledge, this is the first human case of an intentional dual NAC/fomepizole regimen for severe acetaminophen toxicity.     

Crizotinib-induced acute fatal liver failure in an Asian ALK-positive lung adenocarcinoma patient with liver metastasis: A case report

BACKGROUND Crizotinib-induce hepatotoxicity is rare and non-specific, and severe hepatotoxicity can develop into fatal liver failure. Herein, we report a case of fatal crizotinib-induced liver failure in a 37-year-old Asian patient.CASE SUMMARY The patient complained of dyspnea and upper abdominal pain for a week in August 2017. He was diagnosed with anaplastic lymphoma kinase-rearranged lung adenocarcinoma combined with multiple distant metastases. Crizotinib was initiated as a first-line treatment at a dosage of 250 mg twice daily. No adverse effects were seen until day 46. On day 55, he was admitted to the hospital with elevated liver enzymes aspartate aminotransferase(AST)(402 IU/L), alanine aminotransferase(ALT)(215 IU/L) and total bilirubin(145 μmol/L) and was diagnosed with crizotinib-induced fulminant liver failure. Despite crizotinib discontinuation and intensive supportive therapy, the level of AST(1075 IU/L),ALT(240 IU/L) and total bilirubin(233 μmol/L) continued to rapidly increase,and he died on day 60.CONCLUSION Physicians should be aware of the potential fatal adverse effects of crizotinib.     

Severe hepatotoxicity after therapeutic doses of acetaminophen

BACKGROUND: Acetaminophen overdose is a frequent cause of acute liver failure. Controversy exists over the rare association of severe hepatotoxicity or acute liver failure with therapeutic doses of acetaminophen. CASE SUMMARY: A 45-year-old white man weighing 85 kg with asymptomatic HIV, hepatitis B virus, and hepatitis C virus (HCV) infection presented with signs of severe hepatotoxicity: aspartate aminotransferase (AST), 8,581 IU/L; alanine aminotransferase (ALT), 5,433 IU/L; L-lactate dehydrogenase, 13,641 IU/L; and prothrombin international normalized ratio, 2.15. He reported taking acetaminophen 1,000 mg QID for the previous 4 days and 1,000 mg that morning because of a febrile illness. Immediate administration of continuous IV N-acetylcysteine 150 mg/kg for the first 90 minutes and then 50 mg/kg q4h for the next 3 days was followed by clinical improvement and a rapid decrease in AST and ALT. AST levels decreased from 8,581 to 42 IU/L within 11 days. Several potential risk factors for acetaminophen hepatotoxicity (ie, chronic alcohol, tobacco, and opiate consumption, malnutrition, illness-induced starvation, HIV infection, and HCV infection) were present in this patient. CONCLUSIONS: This patient with multiple risk factors and severe hepatotoxicity after therapeutic dosage of acetaminophen was successfully treated with N-acetylcysteine.     

血清GP73检测在肝脏疾病诊断中的临床意义

目的 探讨GP73检测在肝脏疾病临床诊断中的应用价值.方法 收集155例各类肝脏疾病患者(57例肝炎、69例肝硬化和29例肝癌)及216份对照组(80名健康人血清和136例非肝病患者)血清,利用酶联免疫分析方法 对血清GP73、AFP进行定量检测,利用生化分析仪检测ALP、ALT、AST、GGT、CHE、TP、ALB、TBIL、DBIL的含量,利用荧光定量PCR方法 检测HBV DNA拷贝,分析不同肝病患者血清GP73含量与其他指标的关系.结果 肝脏疾病组的血清GP73、ALP、ALT、TBIL含量中位数(171.3μg/L、100 U/L、51.5 U/L、39.6μmol/L)高于对照组中位数(49.6μg/L、52.5 U/L、33.5 U/L、20.0μmol/L),差异有统计学意义(χ~2值分别为91.429、33.441、36.490、28.183,P均<0.01),肝脏疾病组的血清TP、ALB、DBIL含量(64.5 U/L、30.7 U/L、15.2 μmol/L)与对照组(41.8 U/L、20.5 U/L、13.2 μmol/L)比较差异无统计学意义(χ~2值分别为1.093、2.350、0.335,P均>0.05);血清GP73与AST、CHE、ALB、TBIL和DBIL相关(r分别为0.308、-0.359、-0.278、0.338、0.333,P均<0.01),HBV感染与无HBV感染标本之间的GP73含量比较,差异无统计学意义(χ~2=2.731,P>0.05);将GP73与其他指标结合起来可以将肝病诊断的敏感度和特异度提高到85.2%和89.8%.结论 将GP73列入联合检测可提高各种肝病诊断的准确率.     

妊娠期肝内胆汁淤积症患者血清肝胆酸、总胆汁酸水平及血浆凝血功能检测的临床诊断意义

目的 探讨妊娠期肝内胆汁淤积症(intrahepatic cholestasis of pregnancy,ICP)患者血清肝胆酸(courage acid,CG)、总胆汁酸(total bile acid,TBA)水平及血浆凝血功能检测的临床诊断意义。方法 随机选择31例妊娠期肝内胆汁淤积症患者(ICP组)及31例正常妊娠孕妇(对照组)作为研究对象,分别检测两组血清CG,TBA,丙氨酸氨基转移酶(alanine aminotransferase,ALT)、门冬氨酸氨基转移酶(aspartate aminotransferase,AST)以及血浆凝血酶原时间(prothrombin time,PT)、活化部分的凝血活酶时间(activated partial thromboplastin time,APTT)、凝血酶时间(thrombin time,TT)、纤维蛋白原(fibrinogen,FIB)和D-二聚体(D-Dimer,D-D),并对结果进行统计学分析。结果 ①ICP组CG水平(27.14±18.63 mg/L)和TBA水平(50.93±29.69 μmol/L)均高于对照组(1.14±0.30 mg/L,2.96±1.61 μmol/L),差异具有统计学意义(t=7.73,9.04,均P<0.01),与正常对照组相比,ICP组血清CG和TBA表达水平明显增高。②ICP组血清ALT,AST水平分别为109.01±84.47U/L和96.15±80.51 U/L,对照组血清ALT,AST水平分别为13.27±5.07 U/L和18.24±4.69 U/L,差异均具有统计学意义(t=6.29,5.39,均P<0.01)。③ICP组FIB,D-D水平分别为4.61±1.12 g/L和2.41±1.69 mg/L,对照组FIB,D-D水平分别为3.41±0.32 g/L和1.45±0.87 mg/L,差异均具有统计学意义(t=6.10,2.91,均P<0.01),但两组之间PT,APTT和TT水平比较差异无统计学意义(t=0.49,0.93,1.20,均P>0.05)。结论 ICP患者血清CG,TBA水平升高及凝血功能的改变,对ICP的早期诊断及监测具有重要的临床意义。