改良PICC维护法防治肿瘤病人夏季过敏性皮炎的疗效观察

[目的]探讨改良经外周静脉置入中心静脉导管术（PICC）维护法防治夏季过敏性皮炎的效果。[方法]将48例应用PICC的肿瘤病人随机分为对照组和观察组,对照组局部皮肤按常规用乙醇、碘伏各顺、逆时针消毒3遍待干后用无菌透明贴固定导管;观察组局部皮肤用碘伏顺、逆时针彻底消毒3遍待干后再用生理盐水将碘伏清洗干净,自然风干后,用康惠尔水胶体透明贴固定导管。两组均每周维护1次。[结果]治疗20 d后两组疗效差异有统计学意义（P〈0.05）。[结论]采用改良PICC维护法防治夏季过敏性皮炎疗效较好。     

皮肤保护膜联合氯己定预防PICC置管后局部过敏性皮炎的疗效观察

目的探讨皮肤保护膜联合氯己定预防PICC置管后局部过敏性皮炎的效果。方法将200例PICC置管患者随机分为对照组和实验组,每组100例患者。实验组用酒精消毒三遍,然后使用氯己定消毒敷贴覆盖处,擦拭范围为20 cm×20 cm,待干后再用皮肤保护膜喷涂,再次待干后使用透明敷贴固定PICC导管;对照组使用酒精消毒三遍后使用0.5%碘伏消毒,待干后使用透明敷贴固定置管皮肤处导管。随访至置管40天后,比较两组患者过敏性皮炎发生率。结果实验组有6例患者发生轻度过敏反应,皮肤瘙痒,1例患者中度过敏反应,皮肤发生红肿,没有患者发生重度过敏反应,皮肤未出现水泡破溃等情况,共计7例患者发生过敏性皮炎,发生率为7.0%;对照组有12例患者发生轻度过敏反应,皮肤瘙痒,9例患者发生中度过敏反应,皮肤红肿,6例患者发生重度过敏反应,皮肤有水泡破溃,共计27例患者发生过敏性皮炎,发生率为27.0%。两组患者过敏性皮炎发生率比较具有显著性差异(P0.05)。结论皮肤保护膜联合氯己定能够有效预防PICC置管后局部过敏性皮炎的发生,提高患者的治疗效果。     

应用乙醇预防春夏季PICC置管后透明贴膜过敏的效果观察

[目的]探讨乙醇预防春夏季节的PICC置管后透明贴膜过敏的疗效,减少PICC置管后透明贴膜过敏的发生率。[方法]将53例PICC置管病人随机分成两组,对照组28例采用常规消毒换药护理(先用3次乙醇清洁皮肤,再用3次安尔碘Ⅱ型消毒皮肤,待干,再粘贴透明贴膜),观察组25例采取常规消毒后,待干,再用乙醇脱碘,待干,最后粘贴透明敷料。[结果]观察组过敏发生率显著低于对照组(χ2=9.248,P<0.01)。[结论]乙醇能有效预防春夏季节的PICC置管后透明贴膜过敏,减轻病人的痛苦,提高PICC置管的安全性。     

3M TegadermTM透明贴膜上涂药治疗PICC置管后局部过敏性皮炎的疗效观察

[目的]探讨在透明贴膜上涂药治疗经外周静脉穿刺置入中心静脉导管(PICC)后局部过敏性皮炎的疗效。[方法]将PICC置管后出现局部过敏性皮炎的病人45例分为实验组和对照组,两组均给予999皮炎平乳膏涂擦,其中实验组在透明贴膜外面涂药,对照组在皮肤上直接涂药。[结果]两组有效率比较差异无统计学意义,实验组脱管率(8.7%)低于对照组(68.2%)。[结论]在透明贴膜外面涂药,通过渗透作用,对治疗PICC置管后轻中度过敏性皮炎有一定疗效,同时可防止导管脱出。     

水胶体敷料在早产儿PICC置管中的应用研究

目的 探讨水胶体敷料结合3M透明敷贴“三明治”式固定早产儿PICC导管的临床应用效果。方法选择150例PICC置管的早产儿为研究对象,按入院顺序随机分为观察组和对照组各75例。观察组采用水胶体敷料结合3M透明敷贴“三明治”式固定PICC导管,对照组采用3M透明敷贴常规固定PICC导管。比较两组PICC留置的时间及穿刺周围局部皮肤情况（包括皮肤机械性损伤、过敏性皮炎、静脉炎及局部皮肤压疮等）。结果 观察组PICC留置的时间明显长于对照组（P〈0.05）;两组皮肤机械性损伤、过敏性皮炎、静脉炎及局部皮肤压疮等情况的比较,观察组均低于对照组,各指标组间比较差异均有统计学意义（P〈0.05）。结论 水胶体敷料结合3M透明敷贴“三明治”式固定早产儿PICC导管,不仅能妥善固定PICC导管,而且还能保护局部皮肤,避免局部机械性损伤、过敏性皮炎及皮肤压疮等情况的发生,还可以预防或减轻PICC置管后静脉炎的发生,延长置管时间。     

藻酸盐敷料在PICC导管过敏性皮炎中的应用研究

[目的]探讨经外周静脉置入中心静脉导管(PICC)过敏性皮炎的有效处理方法,减轻病人痛苦,延长PICC带管时间,提高病人满意度。[方法]将我院2013年6月—2015年12月应用PICC导管发生导管过敏性皮炎的病人24例,随机分为观察组(藻酸盐组)和对照组各12例。观察组用藻酸盐敷料外敷于PICC过敏性皮炎部位,再用IV3000透明贴膜敷贴,根据渗出的程度选择换药的频率,更换至痊愈;对照组地塞米松软膏外涂(穿刺点处除外),2块纱布覆盖,再用3M抗过敏胶布敷贴,每日换药1次,如渗液较多时每日换药2次,更换至痊愈。观察两组导管过敏性皮炎的瘙痒程度、渗出情况、皮疹范围等。[结果]观察组PICC过敏性皮炎渗出情况、皮疹范围都好于对照组。[结论]PICC导管过敏性皮炎可应用藻酸盐敷料,促进恢复,减轻病人的痛苦。     

13例中-重度PICC相关接触性皮炎的护理

[目的]总结13例中-重度经外周静脉置入中心静脉导管(PICC)置管后相关过敏性皮炎的护理经验。[方法]安尔碘湿敷20～30 min待干后涂擦欢肤草本乳膏,最后以水胶体敷料(多爱肤TM超薄)固定,视水胶体敷料与皮肤粘合性和有无渗液而决定换药间隔时间。[结果]13例皮炎病人经处理后全部治愈,中度皮炎治愈时间为6～13 d,重度皮炎2～3周,脱管发生率为0。[结论]肿瘤病人化疗所致的皮肤副作用常见,PICC带管期间维护不当,极易导致接触性皮炎的发生。规范维护人员的操作行为是预防皮炎的基础;针对个人体质选择合适的敷料,在PICC护理过程中应密切观察和跟踪病人皮肤状况,可更好地控制接触性皮炎。     

导管固定贴固定中心静脉导管效果研究

[目的]探讨导管固定贴固定中心静脉导管在临床上的应用效果。[方法]将150例行中心静脉置管的肿瘤病人,采用方便抽样的方法分成对照组和实验组两组,每组75例,对照组采用常规缝线方法固定,实验组采用导管固定贴固定,比较两组固定方法的效果。[结果]实验组病人穿刺点红肿、不适感、导管脱出发生率均明显少于对照组。两者比较有统计学意义(P<0.05)。[结论]导管固定贴固定中心静脉导管在临床应用中具有明显的优点,便于局部皮肤消毒,减少局部皮肤的感染,同时减少因缝线牵拉皮肤引起病人的疼痛和不适感。     

派瑞松治疗外周静脉置入中心静脉导管致过敏性皮炎的效果观察

目的探讨派瑞松治疗外周静脉置入中心静脉导管(peripherally inserted central catheter,PICC)致局部皮肤过敏性皮炎的效果。方法对30例局部实施PICC致局部皮肤过敏性皮炎患者在常规护理基础上,应用派瑞松乳膏外涂患处,1-3次/w,观察治疗效果。结果 30例患者在治疗后过敏性皮炎均得到有效缓解,治疗时间为1-4w,治愈率为100.0%。结论派瑞松是治疗PICC致局部皮肤过敏性皮炎的一种安全、有效的药物。     

康惠尔透明贴对肘上PICC置管所致皮肤问题的预防

[目的]探讨康惠尔透明贴在肘上经外周静脉穿刺置管的中心静脉导管(PICC)置管所致皮肤问题的预防效果。[方法]将2011年1月—2011年6月91例肘上PICC置管者设为对照组,用3M公司生产的无菌透明贴换药,将2012年1月—2012年6月92例肘上PICC置管者设为观察组,用康惠尔透明贴换药。观察两组病人皮肤问题的发生率。[结果]观察组穿刺点局部及敷料所及范围的皮肤问题发生率明显低于对照组,差异有统计学意义(P<0.05或P<0.01)。[结论]康惠尔透明贴对肘上PICC置管所致的皮肤瘙痒、局部发红、皮疹、水疱有明显的预防效果。     

Acquired predisposition to mycobacterial disease due to autoantibodies to IFN-gamma

Genetic defects in the IFN-gamma response pathway cause unique susceptibility to intracellular pathogens, particularly mycobacteria, but are rare and do not explain mycobacterial disease in the majority of affected patients. We postulated that acquired defects in macrophage activation by IFN-gamma may cause a similar immunological phenotype and thus explain the occurrence of disseminated intracellular infections in some patients without identifiable immune deficiency. Macrophage activation in response to IFN-gamma and IFN-gamma production were studied in whole blood and PBMCs of 3 patients with severe, unexplained nontuberculous mycobacterial infection. In all 3 patients, IFN-gamma was undetectable following mitogen stimulation of whole blood, but significant quantities were detectable in the supernatants of PBMCs when stimulated in the absence of the patients' own plasma. The patients' plasma inhibited the ability of IFN-gamma to increase production of TNF-alpha by both autologous and normal donor PBMCs, and recovery of exogenous IFN-gamma from the patients' plasma was greatly reduced. Using affinity chromatography, surface-enhanced laser desorption/ionization mass spectrometry, and sequencing, we isolated an IFN-gamma-neutralizing factor from the patients' plasma and showed it to be an autoantibody against IFN-gamma. The purified anti-IFN-gamma antibody was shown to be functional first in blocking the upregulation of TNF-alpha production in response to endotoxin; second in blocking induction of IFN-gamma-inducible genes (according to results of high-density cDNA microarrays); and third in inhibiting upregulation of HLA class II expression on PBMCs. Acquired defects in the IFN-gamma pathway may explain unusual susceptibility to intracellular pathogens in other patients without underlying, genetically determined immunological defects.     

Immunoglobulin administration to fetuses with anemia due to alloimmunization to D

BACKGROUND: The purpose of this study was to examine fetal tolerance of high-dose intravenous immunoglobulin (IVIG), given directly at the time of intravascular transfusion, and its effects on fetal hemolysis and pregnancy outcome in the setting of alloimmunization to D. STUDY DESIGN AND METHODS: Thirteen consecutive D+ fetuses requiring transfusion for maternal alloimmunization received high-dose IVIG (1.0 g/kg) and red cell transfusions. Twenty-four previous, consecutive fetuses with maternal anti-D served as controls. The schedules for subsequent transfusions were the same in the two groups. RESULTS: High-dose IVIG was well tolerated by all fetuses. In the IVIG group, daily decreases in hematocrit were smaller than those in controls after the second administration of IVIG (mean hematocrit decrease, 0.72 percent/day vs. 1.45 percent/day; p = 0.007). No significant difference was found in the total number of fetal transfusions, the gestational age at delivery, the duration of neonatal intensive care, the number of neonates requiring postnatal transfusion therapy, and perinatal mortality. CONCLUSION: In this small pilot study, direct administration to fetuses of IVIG with red cell transfusions was well tolerated and appeared to have a beneficial effect on fetal hemolysis.