ABO非同型血小板输注的现状及建议

ABO非同型血小板输注在国外已广泛应用。近年来,国内也已有了地方性应用专家共识,但由于相关专业知识的不普及,使得临床普遍担心ABO非同型血小板输注的安全性和有效性,导致国内ABO非同型血小板应用较少,特别是紧急抢救没有同型血小板时也不使用。本文介绍了ABO非同型血小板输注的概念、血小板上的红细胞血型抗原及国内血小板供需现状,阐述了国内外ABO非同型血小板输注在安全性和有效性方面的研究进展,总结提出了ABO非同型血小板输注的指导建议,为ABO非同型血小板国内临床输注提供应用策略。     

肠外营养安全输注专家共识

目的 形成《肠外营养安全输注专家共识》（以下简称《共识》）,规范临床肠外营养安全输注操作流程,以减少肠外营养相关并发症的发生。 方法 以循证实践为指导,系统检索UpToDate、BMJ Best Practjce、英国国家卫生与临床优化研究所、国际指南网、美国指南网、加拿大安大略注册护士协会、苏格兰院际间指南网、欧洲肠外肠内营养学会、美国肠外肠内营养学会、中华医学会肠外肠内营养学分会、中国医脉通指南网、澳大利亚乔安娜布里格斯研究所循证卫生保健数据库、中国生物医学文献数据库、维普中文科技期刊全文数据库、万方数据库、中国知网、PubMed、Web of Science、Scopus、Embase等中有关肠外营养安全输注的高质量证据,检索年限为建库至2021年1月。评价、提取并汇总该领域的相关推荐建议,形成《共识》初稿,通过2轮专家函询和2次专家论证会议,结合专家意见修改完善各条目内容,形成《共识》终稿。 结果 2轮专家函询的专家积极系数均为100%,专家权威系数分别为81.00%和89.50%,专家意见协调系数分别为0.13和0.15。最终《共识》包括多学科团队组建、肠外营养输注评估、操作规范、并发症管理4个方面。 结论 《共识》的制订可为临床肠外营养安全输注的规范开展提供指导依据,保障患者安全,提升服务质量。     

输液连接装置安全管理专家共识

目的 为预防导管相关血流感染,为患者提供安全、有效、规范的静脉治疗,制订《输液连接装置安全管理专家共识》（以下简称《共识》）。方法 运用循证方法,按照证据级别高低,检索、评价和汇总该领域的证据,提取相关推荐意见和研究结论,形成《共识》初稿,通过1轮德尔菲专家函询和2轮专家论证会,征求国内多领域、多学科专家的意见并整合,对内容进行调整并达成共识。结果 专家积极系数为100%,权威系数为0.92,每个指标的重要性赋值均数均>4分,变异系数均<0.22,专家意见的肯德尔和谐系数为0.35（ χ²=144.44,P<0.001）。在输液连接装置的分类、维护等方面达成一致推荐意见。结论 《共识》可为国内输液连接装置的安全管理提供参考,为临床制订预防导管相关血流感染决策提供依据。     

超声对比剂的材料学特点及临床应用

背景：目前临床上应用的超声对比剂均是含有不同包膜材料和气体成分的微泡对比剂,微泡对比剂的出现使超声诊断技术得到了较大的发展。目的：探讨超声对比剂的材料学研究特点,及超声对比剂在临床疾病治疗中的应用。方法：超声对比剂是由气体微泡和外部包裹的膜物质组成,包膜材料主要分为白蛋白、大分子脂质体、多聚体和各种表面活性剂等。超声造影是通过增强背向散射信号来成像。超声对比剂研究的发展大致分为3个阶段,造影相关技术包括二次谐波、组织特异性显像、反相脉冲谐波成像、相干造影成像技术、对比脉冲序列、能量多普勒谐波成像、间歇谐波成像技术、编码谐波成像和超声造影三维成像。结果与结论：超声对比剂形式的不同主要是通过改变微泡包膜和气体的性质和设计来实现的。微气泡能够实现超声对比剂的显影作用,还可在药物传输上发挥功能。新型的微泡超声对比剂不仅可以提供血流灌注学信息,还可以通过靶向作用于病变组织,分析病变的发生机制,使微泡对比剂的诊断更准确。随着微泡对比剂材料学研究以及制备工艺完善,使超声对比剂具有良好的生物相容性。不仅可以用于各种状态下的特异性超声造影,还可以利用空化效应携带药物或治疗基因向目标组织转移释放。微泡造影技术具有治疗、诊断和超声成像的功能,是一种安全、高效、无创的诊断和靶向传输治疗手段。     

血液透析安全注射临床实践专家共识

目的 制订血液透析安全注射临床实践专家共识（以下简称《共识》）,落实血液透析安全注射的规范化临床实践,确保血液透析患者治疗安全。方法 查阅国内外相关文献,结合临床护理专家工作经验,以循证护理为依据,寻找最佳证据,通过3轮德尔菲专家咨询和专家论证,对各个条目进行调整、修改和完善并达成共识。结果 《共识》总结了9个方面的最新证据,包含血液透析治疗中环境管理规范、人员资质要求、注射器具要求、药品安全注射管理、消毒剂使用、血管通路护理操作、血标本安全采集、医疗废弃物处理以及职业安全防护。3轮咨询专家积极系数均为100%,专家权威系数均为0.928,3轮咨询重要性赋值均数为4.38、4.45、4.68,专家意见趋于一致。3轮咨询专家协调系数经检验后均具有显著性差异（P<0.05）。结论 《共识》具有一定的科学性,可为血液透析从业人员行血液透析治疗安全注射提供依据。     

科学规范化管理在防控碘质血管造影对比剂临床风险中的应用

探讨防控碘质血管造影对比剂临床风险的科学规范化管理措施。回顾我院自2012年制定并实施的一系列专门针对碘质血管造影对比剂应用过程中所出现的不良反应防控措施,以及所取得的成就和灵感。我院制订并实施的碘质血管造影对比剂不良反应综合处理治疗方案可提高医护人员对突发事件应对能力,更好应对不良事件,未发生因碘质血管造影对比剂出现不良反应导致的医疗不良事件。科学规范化管理措施可有效防控碘质血管造影对比剂临床风险,值得临床推广应用。     

子宫内膜癌超声造影中国专家共识

为进一步普及、规范和推广超声造影(CEUS)在子宫内膜癌(EC)中的临床应用，中国医师协会超声医师分会组织相关专家进行多次会商，参考国内外文献，结合自身实践经验，围绕CEUS在EC中的应用价值及其方法共同确立本共识。     

规范肠外营养液配制

国内不同地区、不同医院肠外营养混合液处方组成和配制方法差别较大。为改善国内肠外营养液配制认知、减少不当配制、降低患者相关风险, 中华医学会肠外肠内营养学分会药学协作组组织专家, 按目前中国当前实际情况及国际上发表的研究结果及循证医学证据, 结合配制方面有关专家的经验, 形成《规范肠外营养液配制》专家共识, 为国内肠外营养液配制的规范化和标准化提供推荐意见。     

不孕症“一站式”子宫输卵管超声造影技术专家共识不孕症“一站式”超声检查体系多中心研究专家团队

正称“一站式”超声造影)是指将二维超声、三维超声、宫腔水造影、输卵管超声造影有机整合,必要时辅以盆腔水造影等技术,对包括子宫、输卵管、卵巢在内的女性生殖系统或盆腔相关的常见不孕原因进行系统性筛查,从而为临床提供相对全面的诊断信息,为制定合理的治疗方案提供重要依据。不孕症“一站式”超声检查体系多中心研究专家团队针对工作中的常见问题和流程进行深入讨论,初步达成不孕症“一站式”子宫输卵管超声造影技术专家共识,以供临床借鉴和参考。一、“一站式”超声造影的适应证与禁忌证     

助产士门诊临床实践专家共识的构建

目的 制定助产士门诊临床实践的专家共识。方法 查阅国内外文献,并以广东省助产士咨询门诊服务规范为基础,采用德尔菲咨询的方法,综合相关循证学依据和专家意见,校对和修改后确定此共识内容。结果 专家共识包括助产士门诊临床实践的评估、孕产妇照护2个部分,共28个条目。结论 本研究构建的助产士门诊临床实践专家共识可靠性和实用性较强,可为助产士门诊的开展提供指导,促进其规范化推进。     

MR引导聚焦超声治疗子宫肌瘤中国专家共识

子宫肌瘤是育龄期女性最常见的妇科良性肿瘤，MR引导下聚焦超声(MR-guided focused ultrasound，MRgFUS)是一种无创治疗子宫肌瘤的新手段，其以MRI为引导，精准地将超声波聚焦于肌瘤瘤体组织，产生65~85 ℃的高温，使肿瘤细胞蛋白质失活、细胞凋亡并凝固坏死，在精准消融肌瘤组织的同时避免损伤治疗区域以外的正常组织。为了进一步提高我国子宫肌瘤的MRgFUS治疗水平，减少和避免并发症的发生，为患者提供更加安全、有效、规范的治疗，由中国医学装备协会磁共振应用专业委员会微创治疗学组组织相关专家在总结国内外临床应用经验的基础上，制定了《MR引导聚焦超声治疗子宫肌瘤的中国专家共识》。     

Safety of Image-Guided Treatment of the Liver with Ultrasound and Microbubbles in an in Vivo Porcine Model

Ultrasound and microbubbles are useful for both diagnostic imaging and targeted drug delivery, making them ideal conduits for theranostic interventions. Recent reports have indicated the preclinical success of microbubble cavitation for enhancement of chemotherapy in abdominal tumors; however, there have been limited studies and variable efficacy in clinical implementation of this technique. This is likely because in contrast to the high pressures and long cycle lengths seen in successful preclinical work, current clinical implementation of microbubble cavitation for drug delivery generally involves low acoustic pressures and short cycle lengths to fit within clinical guidelines. To translate the preclinical parameter space to clinical adoption, a relevant safety study in a healthy large animal is required. Therefore, the purpose of this work was to evaluate the safety of ultrasound cavitation treatment (USCTx) in a healthy porcine model using a modified Philips EPIQ with S5-1 as the focused source. We performed USCTx on eight healthy pigs and monitored health over the course of 1 wk. We then performed an acute study of USCTx to evaluate immediate tissue damage. Contrast-enhanced ultrasound exams were performed before and after each treatment to investigate perfusion changes within the treated areas, and blood and urine were evaluated for liver damage biomarkers. We illustrate, through quantitative analysis of contrast-enhanced ultrasound data, blood and urine analyses and histology, that this technique and the parameter space considered are safe within the time frame evaluated. With its safety confirmed using a clinical-grade ultrasound scanner and contrast agent, USCTx could be easily translated into clinical trials for improvement of chemotherapy delivery. This represents the first safety study assessing the bio-effects of microbubble cavitation from relevant ultrasound parameters in a large animal model.     

The Current Situation of Musculoskeletal Ultrasound Education: A Systematic Literature Review

As a radiation-free and dynamic imaging tool, musculoskeletal ultrasound improves diagnostic and therapeutic safety. With its growing application, the demand for training opportunities rises rapidly. Therefore, this work was aimed at mapping the current state of musculoskeletal ultrasonography education. A systematic literature search was conducted in January 2022 in the medical databases Embase, PubMed and Google Scholar. By use of specifically selected keywords, matching publications were filtered; then abstracts were screened independently by two authors and the inclusion of each publication was checked against pre-defined criteria according to the PICO (Population, Intervention, Comparator, Outcomes) scheme. Full-text versions of included publications were reviewed, and relevant information was extracted. Finally, 67 publications were included. Our results revealed a wide variety of course concepts and programs that have been implemented in different disciplines. Musculoskeletal ultrasonography training especially addresses residents in rheumatology, radiology and physical medicine and rehabilitation. International institutions, such as the European League Against Rheumatism and the Pan-American League of Associations for Rheumatology, have suggested guidelines and curricula to promote standardized ultrasound training. The development of alternative teaching methods incorporating e-learning, peer teaching and distance learning on mobile ultrasound devices and the determination of international guidelines could facilitate overcoming the remaining obstacles still to be passed. In conclusion, it can be stated that there is a broad consensus that standardized musculoskeletal ultrasound curricula would improve training and facilitate the implementation of new training programs.     

静脉输液安全流程的应用研究

目的探讨静脉输液的安全流程,促进专业化发展,最终为患者提供安全、有效、经济的输液护理。方法成立静脉输液安全管理委员会,致力于建立医院静脉输液安全管理标准,制订安全操作流程,加强理论知识和操作流程培训,培养静脉输液专业护士,进行静脉输液的专业化管理。结果护士的认同率和依从性达95%以上,可操作性强,有效提高了患者对静脉输液的满意度。结论程序化、规范化的静脉输液安全流程,易于护士掌握与应用、便于管理者进行督导检查,有效防范发生医疗差错事故,保障患者安全。     

Contrast enhanced ultrasound (CEUS) in the diagnosis of post-partum bilateral renal cortical necrosis: a case report and review of the literature

Renal cortical necrosis is a rare condition with complex pathogenesis. There is no consensus over the best investigative modality for an initial diagnosis that is often in the context of acute renal failure. The applications of ultrasound contrast are ever growing, particularly with regard to the assessment of abdominal organs. Here, we present a case of post-partum bilateral renal cortical necrosis affecting bilateral native kidneys and the subsequent use of contrast enhanced ultrasound in confirming this diagnosis. The sonographic appearance was found to correlate with the patients’ clinical presentation and other imaging findings. Secondarily, this allowed for appropriate and timely medical management and establishes the utility of ultrasound contrast in this clinical scenario. Contrast enhanced sonographic assessment should be considered early in patients with suspected renal vascular compromise. It is a safe, easy and efficacious investigative modality to stratify those patients with renal cortical necrosis from those with potentially reversible medical causes.     

The Gandras catheter for uterine artery embolization: The procedure-driven development of a novel medical device

Microbubble contrast media are used to enhance ultrasound images. Because ultrasound is a real‐time investigation, contrast‐enhanced ultrasound offers possibilities for perfusion imaging. This review is conducted to evaluate the safety of contrast‐enhanced ultrasound and its possible role in medical imaging. The safety of diagnostic ultrasound is still an important field of research. The wanted and unwanted effects of ultrasound and microbubble contrast media as well as the effects of ultrasound on these microbubbles are described. Furthermore, some of the possible applications and indications of contrast‐enhanced ultrasound will be discussed. The shared advantages of MRI and ultrasound are the use of non‐ionizing radiation and non‐nephrotoxic contrast media. From this review it can be concluded that, for certain indications, contrast enhanced ultrasound could be a safe alternative to MRI and a valuable addition to medical imaging.     

Ultrasound imaging and contrast agents: a safe alternative to MRI?

Microbubble contrast media are used to enhance ultrasound images. Because ultrasound is a real-time investigation, contrast-enhanced ultrasound offers possibilities for perfusion imaging. This review is conducted to evaluate the safety of contrast-enhanced ultrasound and its possible role in medical imaging. The safety of diagnostic ultrasound is still an important field of research. The wanted and unwanted effects of ultrasound and microbubble contrast media as well as the effects of ultrasound on these microbubbles are described. Furthermore, some of the possible applications and indications of contrast-enhanced ultrasound will be discussed. The shared advantages of MRI and ultrasound are the use of non-ionizing radiation and non-nephrotoxic contrast media. From this review it can be concluded that, for certain indications, contrast enhanced ultrasound could be a safe alternative to MRI and a valuable addition to medical imaging.