Nursing care of patients receiving immunotherapy for recurrent spontaneous abortion

目的 探讨复发性流产患者免疫治疗的护理方法.方法 对183例复发性流产患者予以免疫治疗,同时做好免疫治疗前供血者准备、患者准备及患者心理护理,正确注射淋巴细胞悬浊液并监测皮丘,加强注射局部皮肤的护理及健康教育等.结果 免疫治疗1个疗程后,137例封闭抗体为阳性或弱阳性,其余46例再予加强治疗2～4次,38例转为阳性,总转阳率为95.62％,其中124例妊娠成功.结论 复发性流产患者免疫治疗成功率高,进行系统、规范的医疗护理,结合心理护理是复发性流产患者免疫治疗成功的保证.     

淋巴细胞免疫疗法治疗复发性流产的疗效分析

目的：探讨不明原因复发性流产临床治疗中淋巴细胞主动免疫治疗的临床价值。方法选取2010～2012年我院诊治的复发性流产患者50例,随机分为两组,分别行无特殊处理和淋巴细胞主动免疫治疗,同时对主动免疫治疗患者封闭抗体阴性与阳性的妊娠结局进行统计。结果观察组患者流产率显著低于对照组（P＜0.05）。主动免疫治疗后封闭抗体阳性患者妊娠成功率为88.5%,阴性患者妊娠成功率为57.1%,阳性组显著高于阴性组（P＜0.05）。结论淋巴细胞主动免疫治疗能过有效治疗复发性流产,具有良好的临床效果,而封闭抗体检测能够对妊娠结局有积极的预测作用。     

主动免疫联合地屈孕酮治疗复发性流产的临床疗效研究

观察比较单纯主动免疫治疗与主动免疫联合地屈孕酮治疗对封闭抗体阴性的复发性流产患者的治疗结局,为临床复发性流产的治疗寻求最佳方案。110例封闭抗体阴性的复发性流产患者随机分为A组(52例,接受单纯主动免疫治疗)和B组(58例,接受主动免疫联合地屈孕酮治疗)。治疗后A组妊娠成功率(78.85%)显著低于B组(93.10%)(P0.05);所有患者在进行妊娠前免疫治疗3次后2周复查封闭抗体,复查封闭抗体阳性组和阴性组妊娠成功率相似(86.21%vs.86.96%)(P0.05)。结果表明,主动免疫联合地屈孕酮治疗复发性流产疗效显著,值得在临床治疗复发性流产中推广应用。     

淋巴细胞主动免疫联合地屈孕酮治疗封闭抗体阴性所致复发性流产的临床观察

目的观察淋巴细胞主动免疫联合地屈孕酮在封闭抗体阴性所致复发性流产治疗中的疗效。方法 55例封闭抗体阴性所致的复发性流产,随机分为2组。治疗组30例,采用淋巴细胞主动免疫联合地屈孕酮常规保胎治疗;对照组25例,未行淋巴细胞主动免疫治疗,仅采用地屈孕酮常规保胎治疗。观察妊娠结局及不良反应。结果治疗组妊娠成功率为83.3%(25/30),显著高于对照组的妊娠成功率44.0%(11/25)(P0.05)。免疫治疗后,封闭抗体阳性组妊娠成功率91.7%(22/24)显著高于封闭抗体阴性组[50.0%(3/6)](P0.05)。结论淋巴细胞主动免疫联合地屈孕酮治疗封闭抗体阴性所致复发性流产患者妊娠成功率较高;主动免疫治疗后封闭抗体阳性组较阴性组妊娠率高。     

380例淋巴细胞主动免疫疗法治疗不明原因的复发性流产疗效观察

目的探讨淋巴细胞主动免疫治疗不明原因的复发性流产临床疗效。方法选取2009年10月至2013年6月我院诊治的复发性流产患者749例,分为淋巴细胞主动免疫治疗组(380例)和黄体酮常规保胎对照组(369例)。根据淋巴细胞注射时机和淋巴细胞来源不同,淋巴细胞免疫治疗组又分为3组。A方案:常规方案;B方案:应急方案;C方案:备选方案。对各组的妊娠结局、再发流产率与妊娠成功率进行比较分析。结果治疗组患者流产率(10.3%)显著低于对照组(67.8%)(P0.05)。主动免疫治疗组患者妊娠成功率为89.7%,对照组治疗成功率为32.2%,差异有统计意义(P0.01)。治疗A、B、C三方案的再发流产率与妊娠成功率进行比较,差异均无统计学意义(P0.05)。结论淋巴细胞主动免疫治疗能有效治疗复发性流产,具有良好的临床效果。封闭抗体检测能够对妊娠结局有积极的预测作用。     

淋巴细胞免疫治疗对不明原因复发性自然流产患者外周血调节性T细胞及妊娠结局的影响

目的 探讨淋巴细胞免疫治疗不明原因复发性自然流产的机制.方法 自2005年9月至2006年4月就诊于中山大学附属第二医院妇产科的107例不明原因复发性自然流产患者采用淋巴细胞免疫治疗,追踪妊娠结局,并采用流式细胞仪检测的方法观察治疗前后患者外周血调节性T细胞的比例及 FOXP3（forkhead box p3）的表达变化.结果 107例患者淋巴细胞免疫治疗后98例成功妊娠,9例妊娠后在孕早期再次流产,妊娠成功率为91.6%.妊娠成功患者治疗后外周血CD4＋CD25high T细胞及FOXP3的表达显著高于妊娠失败患者（P〈0.05）.结论 淋巴细胞免疫治疗不明原因复发性自然流产患者有较高妊娠成功率,治疗后外周血免疫调节性T细胞尤其CD4＋CD25high T细胞的比例及FOXP3表达升高是患者妊娠成功的关键.     

胸腔内注射自体血治疗复发性气胸的护理

目的探讨胸腔内注射自体血治疗复发性气胸的效果与护理。方法对19例复发性气胸患者,经胸腔引流管注射自体血治疗,同时实施饮食和心理护理、卧位指导、观察并发症等护理措施。结果自体血治疗后3～10d肺复张拔除引流管,随访3～18个月未见复发。结论自体血胸腔内注射治疗复发性气胸效果满意,操作中严密的观察与配合、及时变换体位是治疗成功的关键。     

胸腔内注射自体血治疗复发性气胸的护理

目的 探讨胸腔内注射自体血治疗复发性气胸的效果与护理.方法 对19例复发性气胸患者,经胸腔引流管注射自体血治疗,同时实施饮食和心理护理、卧位指导、观察并发症等护理措施.结果 自体血治疗后3～10 d肺复张拔除引流管,随访3～18个月未见复发.结论 自体血胸腔内注射治疗复发性气胸效果满意,操作中严密的观察与配合、及时变换体位是治疗成功的关键.     

内镜下黏膜剥离术治疗早期上消化道肿瘤的护理配合

目的 总结内镜下黏膜剥离术(ESD)治疗上消化道肿瘤的护理配合方法.方法 对62例上消化道肿瘤患者行ESD治疗,术中护士按标记、黏膜下注射、边缘切开、剥离、创面处理5个步骤配合术者完成手术过程,并加强术前、术中及术后护理,观察随访治疗效果及患者预后情况.结果 62例患者经治疗和密切的护理配合,59例成功,3例未成功,成功率为95.1％;平均住院日6.2d.1例于术后2周出现迟发性出血经转外科手术治疗,均无其他严重并发症发生.结论ESD术前做好患者心理护理及完善术前准备,术中与术者密切配合、加强患者病情监护,术后加强病情观察及健康教育等有效的护理配合,有助于顺利完成本中操作,减少并发症,促进患者术后康复.     

泡沫硬化剂注射治疗下肢静脉曲张患者的护理

对52例下肢静脉曲张患者采用聚桂醇泡沫硬化剂注射治疗,结果所有病例成功注射聚桂醇泡沫硬化剂,未出现深静脉血栓形成、肺栓塞等严重并发症。注射后2～3d出院。1个月后复查治疗效果显著47例,行二次治疗4例,1例复发。提出注射前做好物品准备、皮肤护理及心理护理等,注射时严格遵守无菌操作原则、注射剂量准确,注射后做好肢体、注射部位护理,并发症的预防及处理,是保证治疗顺利进行及治疗效果的措施之一。     

自然流产夫妇巨细胞病毒抗体测定的临床意义

目的：探讨自然流产病人ＨＣＭＶ抗体测定的临床意义。方法：用市售ＨＣＭＶ－Ｉｇ的间接ＥＬＩＳＡ试剂盒测定病人血清中的ＨＣＭＶ－Ｉｇ滴度。结果：４２例ＲＳＡ病人、３３例早孕对照组、３７例正常对照组ＨＣＭＶ－ＩｇＧ、ＨＣＭＶ－ＩｇＭ抗体测定结果为：１０倍稀释的血清ＨＣＭＶ－ＩｇＧ在３组标本中的检出率分别为８８．１％、８７．９％和８３．５％;血清ＨＣＭＶ－ＩｇＭ抗体检出率分别为８３．３％、６６．７％和６７．７％;血清１００倍稀释时,ＲＳＡ组两种类别ＨＣＭＶ抗体的阳性检出率分别为２８．６％和３８．１％,对照组的ＨＣＭＶ－ＩｇＧ检出率分别为１５．２％和２．７％;ＨＣＭＶ－ＩｇＭ分别为６．１％和２．７％;血清１０００倍稀释,ＨＣＭＶ的两种类别抗体仅实验组有较低的检出率（分别为９．５％和７．１％）外,两个对照组均未检出阳性病例。结论：早孕妇女反复自然流产与ＨＣＭＶ感染有密切关系,对早孕妇女进行ＨＣＭＶ抗体调查时,血清１∶１０００稀释对结果的判定有重要价值。     

Preliminary results of cytotoxic monoclonal antibody treatment in pancreatic adenocarcinomas and biliary tract carcinomas

Fifteen patients with biliopancreatic carcinoma were treated by monoclonal antibodies (12 pancreatic adenocarcinomas, 3 bile duct carcinomas). In 7 cases, a tumor resection was associated with immunotherapy: 5 partial pancreatic resections for stage III and IV disease, according to Hermreck's classification, and 2 biliary resections (Whipple resection for distal duct tumor, biliary and liver resection for proximal bile duct tumor). We use the 17-1.A antibody, an IgG-2a murine monoclonal antibody, either isolated (6 cases) or in association with other monoclonal antibodies (4 cases) or gamma IFN (5 cases). All of these patients underwent leukapheresis. Response to 17-1.A therapy was evaluated by laboratory tests (CA 19-9) and by morphological investigations (US, CT, radioimmunolocalization scanning). The median survival of patients with unresectable pancreatic carcinoma (7 cases), was 7.4 months. For pancreatic adenocarcinoma, treated by resection associated with immunotherapy (5 cases), the median survival was 21 months. Monoclonal antibody therapy was effective in a third of evaluated pancreatic adenocarcinomas (4 clear objective responses) but only transiently except in one patient still alive after 57 months. The low rate of therapeutic responses may been attributed to inadequate doses and the development of human anti-murine antibodies.     

胶原贴敷料对面部激光脱毛术后皮肤护理的疗效观察

目的:观察胶原贴敷料对面部激光脱毛术后皮肤护理的效果。方法:将55例面部多毛患者随机分为两组。治疗组:29例,于激光脱毛术后外用胶原贴敷料;对照组:26例,除冰敷外不予特殊处理。术后随访1周,观察两组间皮肤修复效果及局部不适反应发生率。结果:治疗组的主观及客观皮肤不适症状发生率均明显低于对照组,组间比较差异有统计学意义(P0.05),治疗组未出现过敏等不良反应。结论:面部激光脱毛术后应用胶原贴敷料可明显促进皮肤修复,减轻局部不适反应的发生。     

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目的 探讨不同病因所致急性重症胆管炎(ACST)的内镜、腹腔镜及其联合治疗的最佳方法,提出微创治疗急性重症胆管炎的系列性方案.方法 自2000年3月至2006年3月天津市南开医院微创外科中心收治急性重症胆管炎病人224例,首先行急诊内镜鼻胆管引流术(ENBD),待病人平稳渡过急性期后,根据不同病因和病情特点实施内镜、腹腔镜及其联合治疗.结果 224例ACST病人,急诊内镜成功219例,成功率97.8%,无严重并发症及死亡病例.183例胆管结石中,择期内镜胆管取石治疗122例,成功率95.1%;择期腹腔镜、胆管探查、一期缝合胆管治疗41例,成功率97.6%;择期内镜胆管内支架放置术姑息性治疗胆管结石23例,成功率100%;4例急诊行腹腔镜胆总管探查、T管引流术,成功率100%;胆管狭窄41例中,36例限期行内镜胆管狭窄逐级扩张+胆道内支架放置术;5例实施限期开腹根治手术.结论 内镜、腹腔镜联合、分阶段治疗实现了ACST的全程微创化治疗,手术耐受性好,风险低,提高了存活率和病因治愈率.     

Multidisciplinary treatment of head and neck cancer using BCG,OK-432, and GE-132 as biologic response modifiers

Since 1979, we have performed multidisciplinary treatment using intensive immunotherapy with biologic response modifiers (BRM) in combination with surgical treatment of oral cancer. Chemotherapy and radiotherapy were also included as part of the therapy. A historic control study was performed. Adjuvant therapy was administered by standardized methods, and the distribution of patients at various stages was similar between groups. The immunotherapy group showed a shorter treatment period, lower rates of recurrence, metastases, and side effects, greater histologic effects at the end of the first treatment, and a higher survival rate than the nonimmunotherapy group. Immunologically, immunotherapy tended to promote positive immune reactions and inhibit negative immune reactions. © 1994 John Wiley & Sons, Inc.     

骨外固定器行胫骨迁移治疗血栓闭塞性脉管炎的护理

目的总结利用骨外固定器行胫骨迁移治疗血栓闭塞性脉管炎的护理经验.方法对35例血栓闭塞性脉管炎37条患肢应用骨外固定器迁移胫骨治疗.术前积极处理患肢、有效的心理护理,术后严密观察,做好骨外固定器迁移胫骨的护理.结果 32例间歇性跛行距离增加;27例夜间静息痛均得到缓解;7例足趾缺血坏死中除3例术后患肢缺血加重截肢外,余4例患肢供血改善,坏死区域结痂愈合;总有效率91.9%.结论全面、准确地评估患者,完善术前准备及术后正确迁移指导可提高骨外固定器行胫骨迁移治疗血栓闭塞性脉管炎的有效性.     

Intravenous hyperalimentation. Effect on delayed cutaneous hypersensitivity in cancer patients

Effects of nutritional repletion with intravenous hyperalimentation (IVH) on sequential skin test reactivity were evaluated in 160 malnourished cancer patients undergoing chemotherapy (76 patients), surgery (49 patients), radiation therapy (20 patients) and supportive care (15 patients). In the chemotherapy group, 45 patients had negative reactions initially, and 25 patients (55%) had at least one skin test convert to positive in an average period of 19 days of IVH. In the surgery group, 23 patients (46%) were initially positive and remained positive, 13 patients (24%) converted from negative to positive, and 13 patients (30%) remained negative or converted to negative. Postoperative complications occurred in 25% of positive reactors, compared with 69% (p < 0.01) of negative reactors. In the radiation therapy group, the skin tests of six patients (30%) remained positive, three patients (15%) converted from negative to positive and the skin tests of nine patients (45%) remained negative. In the supportive care group, the skin tests of 73% of the patients either remained positive or converted to positive with IVH within an average period of 11 days of treatment. Nutritional therapy with IVH was associated with restored skin test reactivity in 51% of malnourished cancer patients undergoing oncologic therapy. Radiation therapy was generally immunosuppressive despite adequate nutritional repletion. In surgical patients, positive skin test reactivity correlated directly with a favorable response to operative therapy.     

Clinical experience with linezolid in conjunction with wound coverage techniques for skin and soft-tissue infections and postoperative osteomyelitis

Gram-positive organisms are emerging as possibly the most important nosocomial pathogens during the past decade. Methicillin-resistant Staphylococcus aureus (MRSA) is a frequent cause of infection in the postoperative patient. Burn victims are at high risk for developing vancomycin-resistant Enterococcus (VRE) and other multidrug-resistant microbial infections as a result of the immunocompromising effects of burn injury, prolonged intensive care unit stays, and broad-spectrum antibiotic therapy. To prevent serious and dreaded complications such as skin graft breakdown, delayed wound healing, loss of a limb, and even death, these infections require a combination of extensive antibiotic therapy and plastic surgical intervention. The objectives of this study were to report clinical experience with linezolid in addition to wound care, debridement, and wound coverage techniques for the treatment of S. aureus (including MRSA) and VRE infections. Forty patients received linezolid for infections of wound coverage such as an infected graft or flap, or received linezolid in conjunction with wound coverage techniques for a S. aureus or VRE infection. The median patient age was 53 years (range, 14-85 years), 55% were female, 28% of patients received intravenous (i.v.) linezolid only, 45% received i.v. with a switch to the oral formulation, and 28% received the oral formulation only. The clinical success rate of linezolid with adjuvant wound coverage techniques was 90.0% for osteomyelitis and was 100% for skin and soft-tissue infections. For infections of wound coverage, the clinical success rate was 83.3%. In conclusion, linezolid was an effective antibiotic for the treatment of S. aureus (including MRSA) and VRE infections in conjunction with wound coverage techniques. In addition, linezolid offers the option of treating these infections with an oral agent that is 100% bioavailable.