西安市儿童医院儿科重症监护病房中心静脉置管相关并发症及危险因素分析

目的分析西安市儿童医院儿科重症监护病房(PICU)中心静脉导管(CVC)置管相关并发症的发生率和影响因素。方法回顾性分析2020年6月至2021年2月西安市儿童医院PICU住院的行CVC置管患儿310例的临床资料, 统计分析CVC置管相关并发症发生情况及危险因素。结果 310例患儿共置入334个CVC, 其中102例(30.54%)出现CVC置管相关并发症。与CVC置入相关的并发症为导管感染(13.17%)、导管错位(8.38%)、穿刺部位渗出(4.79%)、导管闭塞(2.99%)、意外移除(0.60%)及中心静脉血栓形成(0.60%)。82例(24.55%)CVC因并发症拔管。CVC置管入路为股静脉、颈内静脉、锁骨下静脉等三组中心静脉血栓形成发生率差异有统计学意义(χ2=7.06, P=0.029);置管时间越长, 总并发症发生率越高, 如导管相关性感染(χ2=7.17, P=0.028)、穿刺点渗液及阻塞(χ2=8.59, P=0.014)、中心静脉血栓形成(χ2=6.78, P=0.034)。经回归分析显示, 患儿的缝线脱落、置入部位出血是导管相关并发症的主要危险因素, 差异有统...     

恶性肿瘤患者PICC相关静脉血栓的危险因素研究

目的 分析恶性肿瘤患者外周静脉置入中心静脉导管(peripherally inserted central catheter,PICC)之后发生静脉血栓的危险因素.方法 回顾性分析2019年1～10月收治的应用PICC的304例恶性肿瘤患者的临床资料,分析PICC置管后静脉血栓形成的危险因素.结果 304例患者中,发生...     

镇静镇痛剂在儿科危重症的应用

儿科重症监护病房危重患儿和机械通气患儿常因病痛及治疗的疼痛而引起焦虑恐惧现象,如离开父母、陌生的环境、有创性操作检查、机械通气、扰乱正常睡眠周期。由于机械通气,肌松剂应用,使我们不容易从表情来判断患者的不适程度。如果我们不能解除患者的疼痛,患者体耗增加加重机体缺氧和气体交换甚至导致体内导管滑脱、气道损伤、气胸等并发症。     

肺癌并静脉血栓栓塞症的危险因素分析

目的 总结我院38例肺癌合并静脉血栓患者的临床资料,探讨其发生的危险因素.方法 对2010年4月至2015年7月本院38例肺癌合并静脉血栓患者(血栓组)与同期76例不存在静脉血栓的肺癌患者(非血栓组)的临床资料进行回顾性病例-对照分析.单因素分析后,对有可能有意义的因素进行多因素Logistic回归分析,查找肺癌合并静脉血栓的危险因素.结果 单因素分析显示腺癌、ⅢB～Ⅳ期、D二聚体增高、中心静脉置管、CEA增高是发生静脉血栓的危险因素(P＜0.05).多因素回归分析显示腺癌、ⅢB～Ⅳ期、D二聚体增高是肺癌发生静脉血栓的独立危险因素(P＜0.05).结论 肺腺癌、肿瘤晚期、D二聚体增高是肺癌合并静脉血栓的高危因素.     

ICU患者肺部感染相关危险因素分析

目的：探讨ICU患者肺部感染的相关危险因素,加强ICU肺部感染控制和预防工作,有效降低肺部感染发生率。方法回顾性分析226例入住ICU患者的资料,统计肺部感染发生率,并对相关暴露因素分别进行单因素χ2检验和Logistic回归分析。结果226例中发生肺部感染58例,感染率为25.66%。Logistic回归分析显示肺部感染的独立危险因素有年龄〉65岁、机械通气时间〉3d、入住ICU时间〉7d、有创操作、糖尿病、雾化吸入次数≥2次、单间病房、仰卧位和规范使用抗菌药物（P〈0.05）。结论 ICU患者肺部感染的发生率相对偏高,并且与多种因素有关,应对不可控的危险因素加强临床监护工作,对可控因素进行积极的干预,以降低肺部感染的发生率。     

ICU导管相关血流感染危险因素分析与干预

目的：观察医院重症监护病房（ICU）静脉导管相关血流感染（CRBSI）的危险因素,为采取干预措施提供科学的政策依据。方法：对观察组67例CRBSI的危险因素进行回顾性分析,并采取干预措施;同期选择ICU静脉导管置管未发生CRBSI的患者作为对照组。结果：观察组导管留置时间长于对照组（P〈0.05）,置管部位与CRBSI发生差异无统计学意义（P〉0.05）。结论：CRBSI的预防重点要尽可能避免置管或早期拔管,严格无菌操作,精通置管技术,加强日常监测和护理,避免交叉感染。     

经股静脉置中心静脉导管在ICU的应用

中心静脉导管在ICU的应用极为重要，它与患者的生命息息相关。正确的穿刺和严格的护理是保证ICU重危病人抢救成功的关键，因此，自2000年7月起，我们实行了股静脉穿刺，共成功经股静脉置中心静脉导管68例，效果良好，现予以总结并报道如下。1 临床资料1.1 一般资料68例患者，男43例，女25例，年龄18~75岁，平均53岁，其中神经外科35例，普外科14例，神经内科5例，胸外科6例，瘤外科5例，骨外科3例。1.2 材料中心静脉导管是国产单腔硅胶管。1.3 方法股静脉穿刺点选择，用物准备，消毒及穿刺方法同常规。1.4 结果68例患者分别以左、右侧股…     

ICU老年患者中心静脉导管发生院内感染的相关因素分析

目的 分析重症监护病房（ICU）老年患者中心静脉导管（CVC）发生院内感染的相关危险因素.方法 2009年1月～2013年5月在本院ICU住院并且行CVC治疗的400例老年患者,根据是否发生院内感染分为感染组和对照组,采用多因素非条件Logistic回归分析分析相关危险因素.结果 400例ICU老年患者CVC发生院内感染46例,院内感染的发生率为11.50％.多因素结果筛选出ICU老年患者CVC发生院内感染的相关危险因素有患糖尿病（OR=4.864,95％CI：0.526～6.643）,其他部位感染（OR=3.453,95％CI：0.368～5.334）,住ICU时间＞10 d（OR=2.137,95％CI：0.441～3.422）,留置管时间＞5 d （OR=2.456,95％CI：0.793～3.467）.结论 ICU老年CVC患者发生院内感染情况较为严重,患有糖尿病、其他部位感染、住ICU时间＞10 d、留置管时间＞5 d是ICU老年患者CVC发生院内感染的危险因素.     

肿瘤患者PICC并发血栓危险因素的调查分析

目的 调查肿瘤患者经外周静脉置入中心静脉导管(PICC)后并发血栓的可能危险因素,探讨降低肿瘤PICC患者并发血栓对策.方法 选取我院收治的肿瘤PICC患者80例作为研究对象,所有患者均随访观察至撤管.对所有患者进行随访跟踪收集相关指标,按照患者是否并发血栓将其分为观察组(18例)和对照组(62例),对两组的可能影响P...     

卵巢癌术后静脉血栓栓塞形成危险因素分析

目的 探讨卵巢癌患者术后合并静脉血栓栓塞(VTE)形成的危险因素。方法 回顾性分析2018年1月至2020年3月中国科学技术大学附属第一医院(安徽省立医院)收治的51例卵巢癌患者的临床资料,根据术后是否发生合并VTE,分为卵巢癌合并VTE组(17例)与卵巢癌未发生VTE组(34例)。分析两组患者的一般临床资料、凝血功能实验室指标、手术相关情况及术后发生VTE的危险因素,采用受试者工作特征(ROC)曲线评估不同危险因素预测术后发生VTE的诊断价值。结果 两组患者年龄、体质指数、绝经、肿瘤分期、输血量等进行比较,差异均有统计学意义(P<0.05)。卵巢癌合并VTE组患者的D-二聚体、纤维蛋白原(FIB)水平高于卵巢癌未发生VTE组,活化部分凝血活酶时间(APTT)水平较低,差异有统计学意义(P<0.05)。经logistic回归分析,D-二聚体、FIB、APTT是卵巢癌患者术后形成VTE的危险因素(P<0.05)。ROC曲线分析表明,D-二聚体、FIB、APTT联合具有预测卵巢癌术后发生VTE的诊断价值。结论 D-二聚体、FIB、APTT是卵巢癌患者术后并发VTE的危险因素,且D-二聚体、FIB、APTT联合预测对卵巢癌患者术后早期发现血栓的形成具有临床诊断意义。     

Tamoxifen and risk of idiopathic venous thromboembolism

Aims To evaluate a possible positive association between tamoxifen treatment and the risk of developing idiopathic venous thromboembolism (VTE) in women with breast cancer in the absence of clinical risk factors for venous thromboembolism other than breast cancer itself.
Methods Using information from the large UK-based General Practice Research Database, we identified, within a cohort of more than 10 000 women with breast cancer, all women who developed a first-time diagnosis of deep vein thrombosis or pulmonary embolism of uncertain cause between January 1, 1991 and December 31, 1996. In a case-control analysis, we compared their tamoxifen exposure experience prior to the thromboembolic event with that of a randomly selected group of control women with breast cancer who were matched to cases on age, year of the breast cancer diagnosis and calendar time.
Results We identified 25 cases of idiopathic VTE and 172 controls, all of whom had breast cancer, but were otherwise free from other risk factors for VTE. Past tamoxifen exposure was not materially associated with an elevated risk of developing VTE, and we therefore combined never and past users as reference group. The relative risk estimate of VTE for current tamoxifen exposure, as compared with never and past use combined, was 7.1 (95% CI 1.5–33), adjusted for body mass index, smoking status and hysterectomy status. High body mass index was an independent predictor of VTE itself.
Conclusions Our study provides evidence that current use of tamoxifen increases the risk of idiopathic venous thromboembolism.     

预见性护理对预防ICU危重症患者导管相关性感染的效果分析

目的探析预见性护理对预防ICU危重症患者导管相关性感染的效果。方法选取2018年1月~2019年6月在ICU接受治疗的50例危重症患者进行研究,随机分为对照组与观察组。对照组给予常规护理,观察组给予预见性护理,对两组导管相关性感染发生率、置管时间、住院时间及护理满意度进行统计对比。结果观察组导管相关性感染发生率为4.00%,对照组为16.00%,观察组显著低于对照组(P<0.05)。观察组置管时间、住院时间均显著短于对照组(P<0.05)。观察组护理满意度为96.00%,对照组为80.00%,观察组显著高于对照组(P<0.05)。结论ICU危重症患者应用预见性护理后,可显著减少导管相关性感染的发生,加快患者康复,提高患者护理满意度。     

Statins and the risk of idiopathic venous thromboembolism

AIMS: To evaluate the association between current statin use and the risk of idiopathic venous thromboembolism (VTE). METHODS: A population-based retrospective follow-up with a nested case-control analysis using the General Practice Research Database. RESULTS: There were 72 cases of idiopathic VTE. Using normolipidaemic nonuse as the reference group, the adjusted relative risks for idiopathic VTE for current/recent statin use, past statin use, past other lipid-lowering drug use, and hyperlipidaemic nonuse were 0.8 (0.3, 2.7), 2.4 (0.6, 10.0), 1.8 (0.4, 7.4), and 0.9 (0.4, 2.0) in the follow-up analysis, and were 1.1 (0.3, 4.3), 3.7 (0.6, 24.1), 2.0 (0.3, 11.6), and 0.4 (0.2, 1.2) in the case-control analysis. CONCLUSIONS: Current statin use was not associated with a reduced risk of idiopathic VTE.     

利奈唑胺在重症感染患者中的药动学

目的:研究重症感染患者静脉滴注和鼻饲2种不同给药途经下利奈唑胺的药动学特点。方法:本研究为前瞻性研究,2013年8月-2014年3月使用利奈唑胺治疗的6例ICU患者,根据给药途径不同,分为静脉滴注组4例,鼻饲管给药组2例,2组均给予利奈唑胺600 mg/q12h,于给药后第5天的0,0.5,1,2,3,4,6,8,12 h采取静脉血1 mL,监测利奈唑胺的血药浓度。结果:6例患者的C_min变化范围为3.59~19.82 μg·mL^-1,其中2例超过了安全临界值10 μg·mL^-1,AUC_{0-12 h}变化范围为116.7~305.5 μg·h^-1·mL^-1,C_min与AUC_{0-12 h}具有很强的相关性(r=0.997,P=0.001)。结论:重症感染患者利奈唑胺药动学参数个体差异较大,应根据PK/PD相关参数制定合理的给药方案,预防细菌耐药,保证临床治疗效果,减少不良反应。     

The impact of antipsychotics as a risk factor for thromboembolism

Patients with schizophrenia are predisposed toward developing cardiovascular disease. Although neuroleptics affect the cardiovascular system, it is also important to consider the consequences of the disease itself such as lower physical activity due to living on disability pension, inadequate nutrition, and/or nicotine addiction, being more common among patients with schizophrenia versus the general population. All these factors combined lead to an increased risk of death caused by cardiovascular conditions in schizophrenic patients. Individuals receiving typical antipsychotic drugs have been reported to have elevated concentrations of antiphospholipid antibodies, including anticoagulants and anticardiolipin antibodies. The presence of both antibodies is associated with an increased risk for thromboembolism. It is also likely that mental illness is accompanied by increased procoagulant activity. Patients with acute psychosis have been shown to have a statistically significant increase in the concentrations of D-dimer, P-selectin, and in the expression of platelet glycoprotein IIb/IIIa receptors. Learning about causes and mechanisms of venous thromboembolism could help to reduce or neutralize the adverse effects of antipsychotic treatment and facilitate the identification of appropriate markers necessary to monitor changes and provide preventive care against hazardous and potentially fatal complications such as deep venous thrombosis and pulmonary embolism. Before atypical neuroleptic treatment is administered to hospitalized patients, all possible risk factors for thromboembolism should be considered to allow the application of lower risk drugs. Also, other preventive measures should be taken into account, including hydration, compression stockings, regular exercise of lower extremities, and low-molecular-weight heparin injections.     

Population pharmacokinetics of ceftriaxone in critically ill septic patients: a reappraisal

AIMS

To investigate the population pharmacokinetics of ceftriaxone in critically ill patients suffering from sepsis, severe sepsis or septic shock.

METHODS

Blood samples were collected at preselected times in 54 adult patients suffering from sepsis, severe sepsis or septic shock in order to determine ceftriaxone concentrations using high-performance liquid chromatography-ultraviolet detection. The pharmacokinetics of ceftriaxone were assessed on two separate occasions for each patient: on the second day of ceftriaxone therapy and 48 h after catecholamine withdrawal in patients with septic shock, or on the fifth day in patients with sepsis. The population pharmacokinetics of ceftriaxone were studied using nonlinear mixed effects modelling.

RESULTS

The population estimates (interindividual variability; coefficient of variation) for ceftriaxone pharmacokinetics were: a clearance of 0.88 l h⁻¹ (49%), a mean half-life of 9.6 h (range 0.83–28.6 h) and a total volume of distribution of 19.5 l (range 6.48–35.2 l). The total volume of distribution was higher than that generally found in healthy individuals and increased with the severity of sepsis. However, the only covariate influencing the ceftriaxone pharmacokinetics was creatinine clearance. Dosage simulations showed that the risk of ceftriaxone concentrations dropping below the minimum inhibitory concentration threshold was low.

CONCLUSIONS

Despite the wide interpatient variability of ceftriaxone pharmacokinetic parameters, our results revealed that increasing the ceftriaxone dosage when treating critically ill patients is unnecessary. The risk of ceftriaxone concentrations dropping below the minimum inhibitory concentration threshold is limited to patients with high glomerular filtration rates or infections with high minimum inhibitory concentration pathogens (>1 mg l⁻¹).