阐述了重返重症监护病房的概念、发生率、相关危险因素及风险预测模型等方面国内外研究现状,以期降低ICU重返率,为临床诊疗和护理提供参考依据.

使用静脉血栓栓塞(VTE)风险预测工具,正确识别患者VTE发生的风险并对风险进行分层是后续采用合适预防措施的关键.本文对儿童静脉血栓栓塞的危险因素及风险预测工具进行综述,以期为临床及早发现儿童血栓高风险患者并采取有效预防措施提供依据.

目的:本试验旨在研究两种单硝酸异山梨酯缓释片在人体中的生物等效性.方法:采用双周期随机自身交叉试验设计.分别给予受试者受试制剂或参比制剂(均含单硝酸异山梨酯60 mg),采用气相色谱法测定给药后不同时间的单硝酸异山梨酯的血药浓度.计算药动学参数.结果:(1)单硝酸异山梨酯参比制剂(R)与受试制剂(A)的主要药代动力学参数Cmax(772.95±106.68 vs.767.84±108.54)ng/mL、Tmax(5.78±0.81 vs.5.72±0.83)h、AUC0-36(11219.57±1731.61 vs.10897.97±1670.59)ng·h-1·mL-1和AUC0→∞(12432.67±2050.36 vs.11865.56±1937.85)ng·h-1·mL-1均较为接近;(2)Tmax经非参数检验,两种制剂间差异无统计学意义(P>0.05);(3)AUC0-36、AUC0→∞和Cmax在不同制剂间和不同周期间差异无无统计学意义(P<0.05);(4)受试制剂AUC0-36和AUC0→∞的90％可信区间均未超出参比制剂相应AUC0-36和AUC0→∞的80％ ～125％的范围;(5)受试制剂的Cmax的90％可信区间,也未超出参比制剂Cmax的70％ ～143％的范围.受试制剂对参比制剂的平均相对生物利用度F(以AUC0-36作为评价依据)为102.9％.结论:受试制剂单硝酸异山梨酯缓释片与等剂量的参比制剂在人体的吸收速度和吸收量差异无统计学意义,两药具有生物等效性.

通过对化疗不良反应预警系统构建及应用进行综述,并从化疗不良反应预警系统的概述、化疗不良反应预警系统的具体功能模块内容及护士在预警系统应用的作用方面进行介绍,总结相关的经验,以期为临床护理实践提供指导与借鉴.

对PICC相关性血栓的危险因素及风险预测模型进行总结,以期为临床预防PICC相关性血栓提供参考.

Objective To explorethe efficacy of anticoagulation therapy with peripherally inserted central venous catheter (PICC) for prevention of venous thrombosis in patients with lung cancer with hypercoagulability. Methods During the period from August 2015 to December 2016,30 patients in our hospital were enrolled as the observation group, and 30 patients from May 2014 to July 2015, with lung cancer treated with PICC catheter in our hospital were selected as the control group.In the control group, PICC during intubation by conventional methods to prevent the occurrence of venous thrombosis;while in the observation group with the additional treatment before and after anticoagulant therapy catheter based on routine prevention. Venous thrombosis incidence and the indwelling time of PICC were compared between two groups. Results The incidence of thrombosis in observation and control groups was 0 and 20% respectively,with significant difference between the two groups(P=0.024).The PICC retention time in observation group and control group was 95.5 (21.00, 117.25) days and 108 (97.00,130.25) days, the difference between the two groups was statistically significant (Z =-2.249, P = 0.025). Conclusions Anticoagulation treatment with PICC catheter before and after in hypercoagulability lung cancer patients can significantly improve the hypercoagulable state of patients,effectively prevent venous thrombosis,and prolong the PICC retention time.

目的 探讨化疗并发症预警模型在乳腺癌患者中的应用效果.方法 2017年6月-12月,将某三级甲等医院乳腺内科接受化疗的乳腺癌患者随机分为试验组和对照组,每组各60例.试验组在出院时、出院后2周通过手机APP进行化疗并发症及相关知识的指导,对照组行常规的电话随访指导及咨询服务,对比两组在化疗并发症、生活质量方面的差异.结果 两组白细胞减少、血小板减少及恶心、呕吐发生率和生活质量总得分及各维度得分比较,差异有统计学意义(P＜0.05),两组腹泻、便秘发生率比较,差异无统计学意义(P＞0.05).结论 应用化疗并发症预警模型对乳腺癌患者化疗并发症进行监控及管理,能降低其化疗并发症发生率,提高其生活质量.

声音让演员重新落脚"声、形、台、表"专业素养的"声",传递艺术回归本源正向价值观,有别于当前流行的剧本化、戏谑化的浮躁娱乐活动形式.《声临其境》直观地传达出节目本意和视听效果,使得节目从形式到内容都很好地由声入境,取得了较好的传播效果.

“互联网+”的热潮推动了网络视频媒体平台的蓬勃发展,网综由此应运而生,腾讯出品的《创造101》作为一档时兴的“女团竞演生存类”网综,突破了传统选秀节目的话语结构和叙事范式,其火爆程度创造了崭新一轮的“粉丝变现”,成为网综后起之秀.因此,本文根据传播相关理论,探究该综艺在流量变现方面的创新策略和传播效果.

目的 探索复方聚乙二醇电解质散联合腹部按摩预防肺癌患者顺铂化疗所致便秘的临床效果.方法 选择2016年7月~10月我院收治的120例肺癌顺铂化疗患者,将其随机分成对照组和观察组,每组60例.对照组采用常规预防方法.观察组在常规方法的基础上,于化疗前1天预防性口服聚乙二醇电解质散1次,从化疗当天开始每天口服聚乙二醇电解质散,每天2次,连续服用3天;从化疗当天开始每天进行腹部按摩,连续5天.参照美国国家癌症研究所常见不良反应事件评价标准(CTCAE)4.0版,记录化疗当天至化疗后第7天患者的便秘发生率、便秘分级及灌肠次数.结果 观察组和对照组的便秘发生率分别为8.33%和26.67%,2级及以上便秘发生率分别为1.67%和13.33%,观察组均显著低于对照组(P<0.05).此外,观察组灌肠率明显低于对照组(P<0.05).结论 复方聚乙二醇电解质散联合腹部按摩预防肺癌患者顺铂化疗所致便秘的临床效果好.

The aim of this randomized controlled study was to investigate the effects of a novel external catheter fixation method for chemotherapy using inferior epigastric arterial catheterization for cervical cancer.Patients diagnosed with cervical cancer were randomly divided into a control group (n = 32) and a treatment group (n = 33). Patients in the control group underwent a traditional fixation method using a haemostat, elastic band and abdominal bandage. Patients in the treatment group underwent an improved fixation method using an indwelling needle and membrane cover. We used a visual analogue scale (VAS) to evaluate each patient's comfort score and also recorded the incidence of needlestick injury and the length of injection time in each group. The VAS scores measured before and after chemotherapy in the treatment group were lower than in the control group. The incidence of needlestick injury in the treatment group was significantly lower than in the control group. The length of injection time in treatment group was significantly lower than in the control group. Compared with the traditional fixation method, the improved fixation method not only increased patient comfort but also reduced both the risk of needlestick injury and the length of injection time. This improved technique deserves increased clinical use.

目的：通过对留置PICC患者治疗间歇期实施跟踪护理，提高患者带管的安全性。方法选取104例PICC患者，随机分为实验组和对照组。两组均接受院内常规健康教育和导管维护，实验组在此基础上实施出院后跟踪护理。观察两组患者在留置PICC期间导管相关并发症的发生率。结果实验组通过实施跟踪护理在留置PICC期间发生导管相关性感染、堵管、静脉炎等并发症明显低于对照组（P<0.05），患者满意度为84.62%，明显高于对照组的63.46%（P<0.05）。结论跟踪护理的实施明显提高了留置PICC治疗间歇期患者带管的安全性，提高了患者的满意度。

BACKGROUND:Olmesartan is an angiotensin II receptor antagonist and is effective and well tolerated in the treatment of arterial hypertension. Probenecid is a well-established hypouricemic agent for the treatment of hyperuricemia and gout.OBJECTIVE:The goal of this study was to examine the impact of coadministration of probenecid on the pharmacokinetic parameters and tolerability of olmesartan in healthy volunteers.METHODS:In a randomized, open-label, 2-way crossover study, 12 volunteers received 2 oral treatments (olmesartan alone or olmesartan plus probenecid) separated by 4 days. Blood samples were obtained for a 48-hour pharmacokinetic evaluation after drug administration. Tolerability was assessed by monitoring vital signs and laboratory tests before and after administration of the study drug.RESULTS:Pharmacokinetic parameters were evaluated in 6 male and 6 female healthy volunteers (mean age, 22 [range, 20-25] years]; weight, 56.0 [range, 51.0-60.0] kg). Probenecid coadministration increased olmesartan Css-av, AUC0→∞, and AUC0-48 by 40%, 50%, and 50%, respectively (P = 0.018, 0.000, 0.000, respectively), but there was no statistical significance for Tmax, t1/2, Css-max, and Css-min between olmesartan plus probenecid and olmesartan alone (P = 0.697, 0.053, 0.521, and 0.734, respectively). No serious adverse event (AE) was reported during the study. The proportion of volunteers with AEs in the olmesartan plus probenecid period (5 of 12 [42%]) was higher than that in the olmesartan-alone period (1 of 12 [8%]). All of the AEs during the olmesartan plus probenecid period were abnormal routine urine test results. The AE in olmesartan-alone period was dizziness. All AEs were classified as mild and considered to be at least possibly related to treatment. All volunteers recovered from the AEs by 2 weeks after the end of the study.CONCLUSIONS:Probenecid increases the exposure speed of olmesartan by increasing the AUC0-48, AUC0→∞, and Css-av. The combined treatment of olmesartan medoxomil with probenecid may increase the occurrence of genitourinary side effects. ClinicalTrials.gov identifier: NCT01907373.

经外周中心静脉置管(peripherally inserted central catheter,PICC)为患者提供了一条无痛性输液通道,其导管前端定位于上腔静脉,血流量大,可迅速降低液体渗透压及药物浓度,尤其适合肿瘤化疗患者长期治疗的需要,已被广泛应用于临床[1].但是PICC在使用过程中,操作和护理不当以及患者的个体差异等因素会引起一系列相关并发症,机械性静脉炎就是常见并发症之一[2] .本例患者PICC置管后发生机械性静脉炎,采取多种治疗护理方法仍未取得较好的效果,3周期化疗结束后拔除导管,未达到预期目的,给患者造成痛苦和经济损失.现报道如下:

OBJECTIVE:To investigate the metabolism of lansoprazole in healthy volunteers. METHODS:12 healthy volunteers were given single dose of lansoprazole(15,30,45 mg),and the plasma concentration of lansoprazole was determined by LC-MS/MS. RESULTS:Phamarcokinetic parameters of lansoprazole in 11 healthy volunteers after given single dose(15,30,45 mg)were as follows:t 1/2 (1.44±0.19)h,(1.56±0.31)h and(1.64±0.34)h;c max (854.8±115)ng/ml,(1 562±276)ng/ml and (2 348±448)ng/ml;t max (0.56±0.15)h,(0.52±0.050)h and(0.56±0.084)h;AUC 0-12 h (1 465±438)ng·h /ml,(2 894±516)ng· h/ml and(5 208±1 112)ng· h /ml;AUC 0-∞ (1 502±434)ng·h/ml,(2 934±517)ng·h /ml and(5 264±1 139)ng· h /ml;Vd (21.80±4.64)L,(23.30±4.02)L and(20.64±3.67)L;CL(10.74±2.99)L/h,(10.55±2.06)L/h and(9.02±2.49)L/h;MRT 0-12 h (1.97±0.31)h,(2.02±0.31)h and(2.21±0.36)h;MRT 0-∞ (2.17±0.31)h,(2.16±0.34)h and(2.32±0.40)h. Severe accumulation of lansoprazole was found in a volunteer. CONCLUSIONS:Single dose of lansoprazole with intravenous dripping at low,medium and high doses are all in line with linear pharmacokinetic characteristics. There are significant difference in t 1/2 of lansoprazole in female and male volunteers at low dose,and there is no gender difference among other pharmacokinetic parameters.

目的:观察常规处理联合季德胜蛇药外敷处理化疗药外渗的护理效果.方法:2012年3月至2013年8月,对5例因静脉使用化疗药物所致外渗的患者,在局部封闭、间断冷敷等常规处理的基础上使用季德胜蛇药外敷.结果:4例经外敷24～ 48h后局部红肿减退、疼痛完全消失.1例经外敷96h后局部红红肿、疼痛完全消失.5例患者1周后局部组织炎症完全消失,出院后随访3个月,均无并发症发生.结论:在常规处理的基础上使用季德胜蛇药外敷处理化疗药外渗疗效好,值得临床推广使用.

OBJECTIVE:By analyzing polymorphism of the XRCC1gene to clarify the relationship between the polymorphism of the XRCC1gene and FOLFOX4adjuvant chemotherapy in postoperative colon cancer patients.METHODS:A total of 76postoperative colon cancer patients were enrolled,age from 21to 75years old,the median age was 57years,included 20phaseⅡ patients and 56phaseⅢ patients which all recived six cycles of FOLFOX4adjuvant chemotherapy.The pyrophosphoric acid sequencing method was used to analyze polymorphism of XRCC1and the Cox model was used to analyze the effect of FOLFOX4adjuvant chemotherapy in colon cancer.RESULTS:There were three allelotype of the XRCC1-A399Gin 76patients and gene frequency separately were G/G 64.5%(49/76),G/A 30.3%(23/76),A/A 5.3%(4/76).The relapse rate were 12/49in G/G,12/23in G/A,2/4in A/A.The relapse rate of G/G genotype was less than that of G/A+A/A genotype(24.5%vs 51.9%,P=0.023).The single-factor-analytic of Cox model showed that there had relationship between TNM stage,depth of invasion,XRCC1-A399Gpolymorphism and curative effect of FOLFOX4adjuvant chemotherapy(P<0.05).There had no relationship between sex,age,position and curative effect of FOLFOX4adjuvant chemotherapy(P>0.05).The multiple-factor-analytic of Cox model showed that the TNM stage was an independent predictor of FOLFOX4adjuvant chemotherapy in colon cancer patients.CONCLUSION:There is relationship between XRCC1-A399Ggene polymorphism and curative effect of FOLFOX4adjuvant chemotherapy.

<正>白癜风是一种后天性色素脱失性皮肤黏膜病[1],具有难治愈、易复发等特点。笔者自2008年3月～2012年2月采用内外合治法治疗本病218例,疗效满意,现报告如下。1临床资料本组218例中,男70例,女148例;年龄7～75

<正>新药I期临床试验病房是进行新药I期临床试验的场所。本院于2006年通过国家食品药品监督管理局资格认定,成立新药I期临床研究病房。新药I期临床研究是选择健康志愿者为受试对象进行新药研究,为初步的临床药理学及人体安全性评价试验,观察人体对新药的耐受程度和药代动力学,为制定给药

目的 建立在人血浆中测定左亚叶酸钙可靠的检测方法.方法 应用高效液相- 紫外检测色谱法,内标为对氨基苯甲酸,流动相为乙腈∶甲醇∶磷酸盐缓冲液(50 mM,pH4.0)= 8∶6∶86,流速为1 mL·min-1,柱温为30℃,进样量为20 μL,检测波长为290 nm,血浆样品采用液液萃取的方法提取.结果 目标色谱峰分离效果好,无内源性杂峰干扰.提取回收率均大于90%,测定血药浓度线性范围为50.0~10 000 ng·mL-1(r2= 0.9998),最小检出限25.0 ng·mL-1.各项稳定性考察均合格.结论 本法准确,灵敏度较高,可用于注射用左亚叶酸钙在人血浆中的检测和注射用左亚叶酸钙的人体内研究.