目的 研究肿瘤经外周穿刺中心静脉导管置入术(peripherally inserted central catheter,PICC)置管处患者继发皮肤损害的菌群耐药性及复方黄柏液涂剂治疗对导管相关并发症和炎性反应的影响.方法 本研究采用回顾性研究,主要以2020年12月至2021年12月海安市人民医院收治的40例PICC置管处继发皮肤损害患者作为研究对象,根据患者治疗手段的差异分为两组,各20例.对照组根据药敏情况采取相应的抗生素治疗,观察组联合采用复方黄柏液涂剂.分析肿瘤患者PICC置管处继发皮肤损害菌群的分布,研究两组患者的导管相关并发症及炎性反应之间的差异.结果 PICC置管处继发皮肤损害病原菌感染主要以革兰阳性菌和革兰阴性菌为主,真菌感染较少.凝固酶阴性葡萄球菌、肺炎链球菌、金黄色葡萄球菌主要对青霉素、苯唑西林及氨苄西林耐药.鲍曼不动杆菌、阴沟肠杆菌、大肠埃希菌主要通过对亚胺培南以及阿米卡星耐药.观察组患者发生导管相关血流感染、穿刺口感染、导管移位和脱出、管端细菌定植情况低于对照组(P<0.05).两组患者经过治疗后,白细胞介素-1β、肿瘤坏死因子-α和白细胞介素-6水平均显著下降,且观察组低于对照组(P<0.05).结论 肿瘤患者PICC置管处继发皮肤损害菌群主要以革兰氏阴性菌为主,对PICC置管处继发皮肤损害患者的治疗中采取复方黄柏液涂剂,患者的治疗效果显著,炎性反应显著下降.

Objective:To investigate the effect of 1M3S nursing management mode combined with transcatheter arterial chemoembolization (TACE) on intestinal microecological distribution in patients with primary liver cancer.Methods:A total of 115 patients with primary liver cancer in Hai′an people′s Hospital from January 2017 to January 2020 were enrolled. Patients were divided into two groups according to the admission time. Patients ( n=56) receiving routine nursing care from January 2017 to December 2018 were set as control group, patients ( n=59) receiving 1M3S nursing management from January 2019 to January 2020 were set as observation group. Another 34 healthy individuals were set as healthy group from January 2017 to January 2020 in Hai′an People′s Hospital. The general data were collected in all three groups, and the serum levels of endotoxin (ET), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were detected. Fecal samples were collected, and 16S rDNA sequencing method was used to analyze the fecal flora structure and species relative abundance among groups, and alpha diversity was analyzed. Results:At the level of phylum, the dominant phylum of the three groups were Bacteroidetes, Proteobacteria and Firmicutes. After TACE, the ET, ALT and AST levels were (9.67±2.12) ng/L, (53.24±8.47) U/L, (55.48±8.15) U/L in the control group, (4.36±2.15) ng/L, (45.31±8.36) U/L, (47.25±8.21) U/L in the observation group ( t value was 13.328, 5.052, 5.392, P<0.05). Compared with the control group, there was an increase in the relative abundance percentage of Firmicutes( t value was 16.426, P<0.01) and Lachnospiraceae in the observation group ( t value was 4.527, P<0.01), and a decrease in the relative abundance percentage of Proteobacteria ( t value was 8.462, P<0.001) after intervention. Conclusions:TACE can affect the intestinal bacteria in patients with primary liver cancer, resulting in a decrease in the relative abundance of Proteobacteria, Lachnospiraceae, and an increase in the relative abundance of Firmicutes, while application of 1M3S nursing management mode can effectively reduce the level of endotoxin, improve liver function, and reduce the imbalance of intestinal flora caused by TACE.

[目的]采用网络药理学的方法分析葛花治疗酒精性肝损伤的有效成分、作用靶点和信号通路,探讨其治疗酒精性肝损伤的作用机制.[方法]通过TCMSP、Swiss Target Predicition数据库并结合文献获取葛花的化学成分和作用靶点,结合DisGeNET、OMIM、DrugBank数据筛选葛花治疗酒精性肝损伤的作用靶点;运用Cytoscape3.7.2软件构建葛花有效活性成分-作用靶点网络,使用String数据库构建蛋白相互作用网络,运用DAVID平台对靶点进行GO富集分析和KEGG富集分析.[结果]从葛花中筛选出18个有效活性成分,199个作用靶点,其中31个靶点与ALD相关,GO富集分析结果涉及222个生物过程、15个细胞组分和32个分子功能富集,KEGG富集分析得到48条信号通路,主要富集于NOD样受体信号通路、细胞色素P450对外源性药物代谢的影响、Toll样受体信号通路、TNF信号通路、炎症性肠病、FoxO信号通路、MAPK信号通路、HIF-1信号通路等,这些作用通路可能是葛花治疗ALD的活性途径.[意义]初步对葛花治疗ALD的作用机制进行了研究,葛花可以通过多成分、多靶点、多条通路来发挥治疗ALD的作用.

目的 观察布地奈德联合槐杞黄颗粒对哮喘患儿肺功能和免疫功能的影响.方法 选取哮喘患儿82例,随机分为对照组和观察组各41例.对照组用布地奈德雾化吸入治疗,在此基础上,观察组加用槐杞黄颗粒治疗.对比组间总有效率、不良反应发生率,比较治疗前后炎症因子水平和肺功能指标.结果 观察组治疗总有效率97.56％,明显高于对照组80.49％(x2=6.12,P=0.01);治疗后,观察组血清IL-4和IL-8水平低于对照组,差异有统计学意义(P＜0.01),IFN-γ水平高于对照组(P＜0.01),FVC、FEV1、FEV1/FVC高于对照组,差异有统计学意义(P＜0.01).结论 布地奈德联合槐杞黄颗粒治疗小儿哮喘,疗效确切,能降低机体炎症反应,改善肺功能.

目的 探讨综合护理干预在经皮肝动脉化疗栓塞术治疗肝癌中的效果.方法 选择我院收治的肝癌80例患者为研究对象,均在我院确诊后首次行经皮肝动脉化疗栓塞术治疗.随机分为观察组和对照组,每组各40例患者,对照组患者进行常规护理干预,观察组患者进行综合护理干预,比较两组焦虑状况和生活质量评分.结果 术前、术后,观察组焦虑评分显著低于对照组(P<0.05);观察组患者的生活质量(物质生活状态、心理功能、社会功能、躯体功能)评分均高于对照组(P<0.05).结论 综合护理干预可减轻皮肝动脉化疗栓塞术治疗中过着的心理焦虑状况,提高肝癌患者的生活质量.

目的:探讨肝癌患者行介入术后并发低血钾症的护理效果.方法:选取2016年11月至2017年6月本院接诊的150例肝癌介入术患者,按照患者入院顺序将前75例作为对照组,后75例为观察组,观察组采用优质护理模式、对照组采用常规护理模式,对比两种护理方法的效果.结果:观察组治疗有效率高于对照组(P＜0.05);观察组满意度高于对照组(P＜0.05).结论:肝癌患者行介入术后并发低血钾症的护理中采用优质护理干预措施,能够提高患者的整体治疗有效率,并且提升患者的治疗满意度.