风险管理联合积极心理护理预防PICC置管患者机械性静脉炎风险的价值

目的研究风险管理联合积极心理护理在预防经外周静脉置入中心静脉导管（PICC）置管患者机械性静脉炎风险中的价值。 方法选择2020年5月至2020年10月首都医科大学附属北京世纪坛医院收治的116例PICC置管的肿瘤患者作为研究对象,将其随机分为观察组（58例）和对照组（58例）。对照组按照PICC置管的常规护理方法进行护理,观察组在对照组的基础上使用风险管理联合积极心理护理。记录2组PICC置管时间、一次穿刺成功率、一次置管成功率;记录置管后1周两组机械性静脉炎发生情况。 结果与对照组相比,观察组置管操作时间较短（P＜0.05）;与对照组相比,观察组机械性静脉炎发生率较低,（P＜0.05）。 结论采用风险管理联合积极心理护理的方案对PICC患者进行护理能降低机械性静脉炎的发生率,具有推广价值。     

Nodular granulomatous phlebitis of the skin: a fourth type of tuberculid

We present five cases of granulomatous phlebitis of the skin and compare them with a case of miliary tuber-culosis with granulomatous phlebitis. All five patients were hypersensitive to purified protein derivative, but without active tuberculosis. Although anti-tuberculous drugs were effective, no tubercle bacilli were isolated from the skin. Clinically, subcutaneous nodules were felt along the course of the leg vein. Histologically, epithelioid cell granulomas with Langhans' giant cells were observed within the walls of the cutaneous veins. In a later stage, granulomatous panniculitis was often associated. Using the polymerase chain reaction method, Mycobacterium tuberculosis DNA was detected in four of the five cases of granulomatous phlebitis of the skin. Granulomatous phlebitis of the skin seems to represent a relatively early phase of delayed-type hypersensitivity reactions to Mycobacterium tuberculosis and may represent a distinct entity different from other types of tuberculid—a new tuberculid. Nevertheless, before making the diagnosis, the possibility of true tuberculosis must always be excluded. Nodular granulomatous phlebitis of the skin would be an appropriate name for the newly described condition.     

Identifying Risk Factors for Anthracycline Chemotherapy-induced Phlebitis in Women with Breast Cancer: An Observational Study

AimsAnthracycline chemotherapy administered via a peripheral cannula results in severe anthracycline chemotherapy-induced phlebitis (ACIP) in about 20–30% of patients. Administering chemotherapy via a central venous catheter (CVC) prevents ACIP. However, CVCs are associated with an increased risk of thrombosis and sepsis. Our aim was to identify risk factors associated with severe ACIP and to provide evidence about the individual risk of developing symptoms.Materials and methodsA prospective observational study of 263 women with breast cancer receiving peripheral administration of anthracycline chemotherapy at a UK cancer centre was conducted between May 2016 and January 2018. Data were collected at baseline and every 3 weeks following each chemotherapy treatment, using both healthcare professional- and participant-reported symptom assessments.ResultsAfter three cycles of chemotherapy, 27% of participants experienced severe ACIP. Factors associated with symptom severity were identified as: arm used for chemotherapy administration, epirubicin dose, age, pre-existing hypertension, comorbidity, ethnic group and pain during chemotherapy administration. The sequence of arm used for chemotherapy administration was the single most significant factor (P < 0.001). When alternating arms were used no other risk factor was influential. Where alternating arms were not used, younger age and higher dose were associated with higher-grade symptoms, with age being more influential than dose. The cumulative effect of increasing symptom severity with repeated cycles was also identified (P < 0.001).ConclusionIt is recommended that a CVC is not routinely required for women with breast cancer who have not undergone an axillary node clearance and receive chemotherapy in alternate arms. The need for a CVC for women who are planned to receive all anthracycline chemotherapy cycles in the same arm should be assessed in the light of peripheral venous access assessment and the key risk factors of age, dose and number of cycles.     

南风Ⅰ号外用防治长春瑞宾所致静脉炎的临床研究

目的观察新型中药复方制剂——南风Ⅰ号防治长春瑞宾所致静脉炎的临床疗效.方法选择以长春瑞宾为主的联合化疗方案第1、8天给药的患者,将自身2次化疗同一注射部位分成预防组和对照组,对预防组患者给予中药南风Ⅰ号涂剂;将已发生静脉炎的患者随机分成治疗组和对照组,治疗组给予南风Ⅰ号外敷治疗,对照组给予硫酸镁外敷对照进行临床观察.结果采用STATA 8.0软件进行统计分析,卡方检验比较预防组和对照组之间以及治疗组和对照之间的差异,均具有显著的统计学意义（P＜0.01）.结论新型中药复方制剂——南风Ⅰ号对防治长春瑞宾所致静脉炎具有一定的疗效.     

下肢血栓性浅静脉炎的超声诊断

目的探讨血栓性浅静脉炎的声像图特征。方法回顾性分析下肢血栓性浅静脉炎患者52例,观察病变的位置、范围、形态、边界、回声特点、血流分布等。结果所有患者均表现为局部静脉曲张,管径增宽明显,管壁不均匀增厚,管壁回声增强,腔内可见低、等回声团,探头加压管腔不变形,病变区域内无明显血流信号,皮下组织水肿。结论下肢血栓性浅静脉炎的声像图表现具有一定的特征性,结合临床表现超声易做出正确诊断。     

湿热敷联合使用握力器降低经外周静脉穿刺中心静脉置管致机械性静脉炎的发生

目的探讨湿热敷联合使用握力器降低经外周静脉穿刺中心静脉置管(peripherally inserted central catheter,PICC)致机械性静脉炎发生的效果。方法方便抽样法选择2012年7月至2013年6月,上海市第六人民医院收治的行PICC置管的200例肿瘤化疗患者为研究对象,将2012年7-12月收治的100例患者作为对照组,2013年1-6月收治的100例患者作为观察组,对照组患者置管后常规进行湿热敷,观察组患者在对照组的基础上联合使用电子握力器,观察并比较两组患者机械性静脉炎的发生率。结果观察组患者机械性静脉炎的发生率低于对照组,分级情况优于对照组,差异均有统计学意义(均P0.01)。结论湿热敷联合使用握力器能有效降低PICC置管致机械性静脉炎的发生率。     

自制通脉膏治疗医源性静脉炎的效果

目的探讨应用自制通脉膏外敷治疗医源性静脉炎的临床效果。方法便利选取2010年2月至2013年9月发生的医源性静脉炎患者128例,按照住院单双号分为研究组和对照组各64例。研究组用自制通脉膏外敷,对照组用50%硫酸镁湿敷,比较两组患者的治疗效果及治愈时间。结果研究组除1例患者因用药当天出现局部皮肤过敏反应中止治疗外,其余患者均顺利完成治疗。研究组治愈率及总有效率均高于对照组,治愈时间短于对照组,差异均有统计学意义(P0.05或P0.01)。结论通脉膏制作简单,易于存放,使用安全,不良反应少,且价格低廉,是治疗医源性静脉炎的有效方法。     

温水泡手配合活络油外搽按摩运动预防化疗性静脉炎的效果观察

目的探讨采用温水泡手配合活络油外搽按摩运动预防化疗性静脉炎的方法及效果。方法以80例妇科化疗患者为观察对象,随机分为实验组和对照组各40例,对照组于每次化疗前常规滴注葡萄糖溶液500～1 000 ml进行水化,化疗后用生理盐水100 ml冲管。实验组:在常规护理的基础上,于每天化疗前用温水泡手及化疗后用活络油外搽按摩上肢并进行上肢上举、扩胸运动,观察记录两组患者化疗5个疗程内发生化疗性静脉炎的例数及疗效,以及静脉穿剌次成功率。结果实验组患者在化疗的5个疗程内发生化疗性静脉炎例数少,在静脉显露易见、弹性好、压痛轻、滴注通畅方面明显优于对照组,静脉穿剌成功率高,与对照组比较,p<0.01,有统计学意义。结论化疗前用温水泡手,化疗后用活络油外搽上肢血管行走部位,配合按摩上肢及增加上肢运动,可预防化疗性静脉炎,提高静脉穿剌成功率,减轻患者痛苦。     

红花液联合仙人掌外敷治疗胺碘酮致静脉炎的疗效观察

目的探讨红花液联合仙人掌外敷治疗胺碘酮致静脉炎的效果。方法将102例因应用胺碘酮静脉输液致静脉炎患者分为对照组50例和观察组52例,对照组采用50%红花液热敷,观察组采用红花液热敷后用仙人掌湿敷,观察两组患者治疗效果。结果观察组患者治疗总有效率为92.3%,对照组为72.0%,两组比较,χ2=6.275,P0.05,差异具有统计学意义。结论采用红花液热敷后用仙人掌湿敷的方法治疗胺碘酮致静脉炎效果较好,值得临床推广应用。