[目的]心电图引导下行PICC导管置入,探讨P波与QRS主波关系对PICC导管尖端准确定位的临床指导作用.[方法]将接受PICC置管的病人665例随机分为观察组和对照组.观察组采用B超引导下进行PICC导管置入,依据心电图P波与QRS主波振幅变化进行PICC导管尖端定位;对照组采用单纯B超引导下行PICC导管置入后直接行X线定位.比较两组PICC尖端位置及置管成功率.[结果]观察组PICC导管尖端到达上腔静脉与右心房交界处的准确率明显高于对照组(P<0.05),导管异位率明显低于对照组(P<0.05),导管二次修剪率明显低于对照组(P<0.05),P波振幅在QRS主波振幅1/2～2/3高度时,导管尖端位于上腔静脉与右心房交界处,可显著提高PICC尖端定位准确性;当P波振幅在QRS主波振幅1/2高度以下时,胸部X线显示导管尖端仍位于最佳位置.[结论]采用心电图引导PICC尖端定位置管显著优于单纯B超引导下改良赛丁格技术PICC置管,异位率和二次修剪率均低,当P波振幅在QRS主波振幅1/2高度以下时,胸部X线显示导管尖端仍位于最佳位置,提示在临床PICC置管中应考虑到疾病对心电图P波的影响.

坏疽性脓皮病(pyoderma gangrenosumm,PG),是以皮肤破坏性溃疡为特点的反应性炎症性皮病[1] ,PG发病原因不明,多数学者认为是一种免疫性疾病. 据报道,临床上有近一半的患者常伴发系统性疾病,包括炎性肠病、类风湿性关节炎、血管炎、慢性活动性肝炎及血液系统疾病等[2]. 骨髓增生异常综合征( MDS)是造血干细胞克隆性疾病,骨髓出现病态造血,患者主要表现为贫血,常伴有出血和感染,部分病例可转化为急性白血病[3]. 本科于2017年8月收治1例骨髓增生异常综合征合并坏疽性脓皮病患者,经过精心治疗和护理,最终溃疡面愈合,患者好转出院,现将护理体会汇报如下.

目的:探讨护士长/护理管理团队在护士克服工作倦怠和培养心理韧性中的作用.方法:采用便利抽样法,对某三级甲等医院内科专业护士进行描述性问卷调查.结果:通过内容分析发现,可以降低护士职业倦怠的护士长/护理管理团队的管理行为包括:多鼓励少批评,榜样的作用,及时沟通,营造良好的科室氛围,增加业务培训及外出学习交流的机会,缩短考试与检查及非工作时间会议等.结论:培养护士的工作韧性是护士长/护理领导团队构建健康的工作环境和维护稳定的护士队伍的重要因素;鼓励性的认可,心理疏导和工作支持可以减轻护士工作倦怠.尽管护士工作倦怠是一个很严重的问题,但此项调查显示,护士长对减轻护士工作倦怠起不可忽略的作用.

多发性骨髓瘤(multiple myeloma,MM)是好发于中老年人的一种恶性克隆性浆细胞病,发病率占所有人类肿瘤的1％,占血液系统恶性肿瘤的13％,在过去的20年其中位生存期已从3年增长至6年[1].

目的 观察多发性骨髓瘤(MM)患者血小板与淋巴细胞比值(PLR)变化,并探讨其与患者临床病理特征和预后的关系.方法 选择MM患者180例(MM组)、体检健康者90例(对照组),采集静脉血,采用XN-9000血液分析仪及其配套试剂计数血小板和淋巴细胞,计算PLR.利用受试者工作特征(ROC)曲线确定PLR诊断MM的cut off值,以其cut off值为界值将MM患者分为低PLR者和高PLR者,比较二者年龄、性别、血红蛋白、β2微球蛋白、乳酸脱氢酶、国际分期系统(ISS)分期、免疫分型等临床病理参数和生存期.结果 MM组PLR明显低于对照组(P<0.05).ROC曲线结果显示,PLR诊断MM的cut off值为117.92.180例MM患者中,低PLR者108例、高PLR者72例.与高PLR者比较,低PLR者血清白蛋白明显降低(P<0.05),二者其余临床病理参数比较P均>0.05.低PLR者中位生存期为16个月,高PLR者为24个月,二者比较P<0.05.结论 MM患者PLR明显降低,低PLR者预后更差.PLR可初步评估MM患者预后.

Objective To observe the effects of Stichopus japonicus acidic mucopolysaccharide (SJAMP) on apoptosis-related protein expression in liver cancer tissues of tumor-bearing mice.Methods Fifty hepatocarcinoma-bearing mice were established by subcutaneous injection of tumor cells in the right axillary, and then they were randomly divided into the negative control group (injected with normal saline), positive control group (injected with 5-FU 20 mg/kg), low-dose SJAMP group (6.25 mg/kg SJAMP 0.2 mL), medium-dose SJAMP group (12.5 mg/kg SJAMP 0.2 mL), and high-dose SJAMP group (25 mg/kg SJAMP 0.2 mL).The mice were all intervened for 12 days.The mice were sacrificed, and we weighed the tumor and calculated the tumor inhibition rate.HE staining was used to observe the pathological changes of tumor tissues.The expression of Caspase-3, Caspase-9, cytochrome C, Smac protein, survivin and NF-κB was detected by immunohistochemistry.Results The tumor inhibition rate of the high-dose SJAMP group was higher than that of the low-dose and medium-dose SJAMP groups (P<0.05).The decreased cell density and nuclear division as well as increased necrotic area were found in the positive control group, medium-dose and high-dose SJAMP groups.Compared with the negative control group, the expression of Caspase-3, Caspase-9, cytochrome C,and Smac protein increased in the medium-dose, high-dose SJAMP groups and positive control group (P<0.05), while the expression of survivin and NF-κB significantly decreased (all P<0.05).Conclusion The medium-dose and high-dose SJAMP can effectively up-regulate the expression of pro-apoptotic gene, down-regulate the expression of apoptosis inhibiting gene, thus inhibit the growth of tumor-bearing mice.

目的 探讨建立PICC置管培训示教室在本科生临床护理教学中的效果.方法 将学生随机分成两组,对照组采用传统教学法,实验组学生充分利用PICC置管培训示教室所提供的有利条件,进行更加形象具体的临床护理实习与实践.检测两组学生对PICC置管维护的临床操作实践能力,调查学生对PICC置管培训示教的认可程度.结果 实验组学生成绩明显高于对照组,理论知识比较P＜0.05,操作技能比较P＜0.01,差异有统计学意义.结论 PICC置管示教室可以提供给学生更加直观的学习环境,增强学生对PICC置管的整体掌握能力,提高教学质量.

<正>我院自2007年2月至2011年6月共应用ATG治疗再生障碍性贫血15例,在应用过程中发现ATG对循环系统的影响不容忽视。我们曾报道过ATG致窦性心动过缓的病例,经近两年的观察,我们发现ATG还可导致房颤的发

<正>重型再生障碍性贫血(SAA)的免疫抑制治疗(IST)是不宜行造血干细胞移植病人的主要治疗方法,其经典治疗药物是抗淋巴细胞球蛋白或抗胸腺细胞球蛋白(ALG或ATG),有效率为40%~70%,IST治疗后有40%~80%病

植入综合征(ES)也叫毛细血管渗漏综合征(CLS),是骨髓移植后常见的一组症状和体征,其主要表现是发热、红皮样皮疹及非心源性肺水肿.自体骨髓移植后ES的发生率为7%～55%,而外周血干细胞移植后ES的发生率则高于自体骨髓移植.2008年9月,我院对1例骨髓增生异常综合征(MDS-RA)病人实施同基因外周血造干细胞移植术,移植后出现高热、红皮样皮疹等症状,临床诊断为ES,经过积极治疗和精心护理好转出院,现将护理体会报告如下.

2006年1月～8月,我们对64例急性白血病患者施行PICC置管,为预防穿刺点发生感染,对穿刺点的换药方法进行研究.现报告如下.

ObjectiveTo find an effective method of preventing oral-cavity fungal infection in patients with leukemia receiving chemotherapy.MethodsSixty-four patients were randomly divided into two groups,A and B,with 32 patients in each group.Dobell solution was given to those in group A for gargle,six times a day;for those in group B,50 g/L sodium bicarbonate and Dobell were applied for gargle alternatively,six times a day.The infection was observed one and two weeks later.Results Mouth fungal infection occurred in six cases in group A and none in group B one week later,and eight and three cases two weeks later in groups A and B,respectively.The difference between the two groups was significant(χ~2=7.48,P<0.05).Conclusion(Alternate gargling) with 50 g/L sodium bicarbonate and Dobell is effective in the prevention of fungal infection in oral cavity in patients with leukemia after receiving high-dose chemotherapy.

血栓性血小板减少性紫癜(TTP)是一种少见的病因未明的疾病,其主要临床特征是血小板减少、微血管性溶血性贫血、中枢神经系统症状、肾脏受累及发热.病情多凶险,病死率高达54%.我们成功抢救TTP病人1例,现报告如下.

Objective To explore the psychological status of acute leukemia(AL) patients at preliminary diagnosis, and to observe the effect of psychological intervention. Methods Fifty-five patients who had been diagnosed as AL were divided into experimental group and control group. A SCL-90 questionnaire was used for evaluation and analysis. Results The scores of the patients in the experimental group were obviously lower than those in the control ( t=4.17-10.86, P 0.01). The common symptoms of the patients were obsessive-compulsive disorder, sensitivity in interpersonal relationship, depression, anxiety, hostility, fear, paranoia and psychiatric disorder. Conclusion The AL patients have serious psychological disorders, so psychological intervention in time is of particular importance.

高白细胞白血病通常指WBC》100×109/L的白血病,常伴有高粘滞综合征的症状,易发生颅内出血,缓解率低,死亡率高.化疗时常因加大化疗药物剂量而损伤正常造血干细胞及其他重要器官,由于大量白血病细胞在短期内被破坏,其细胞分解产物可造成机体损害,甚至危及患者生命.为减少高白细胞白血病治疗过程中的副作用,我们在行外周血白血病细胞去除术后加用联合化疗治疗高白细胞白血病,疗效满意,报告如下.

我国肝炎病毒携带及感染者高达10%,近几年,肝炎预防研究多集中于疫苗接种[1,2].血液病病人由于免疫力低下,不适于疫苗接种,因此,预防显得尤为重要,而目前,国内外对该类病人如何预防肝炎病毒感染研究较少.本研究旨在探讨健康教育对血液病病人预防肝炎病毒感染的意义,现报告如下.

我们应用自制药液治疗褥疮22例,效果较好,现将其护理体会报告如下.