ObjectiveTo explore the influence of three central venous catheter biomedical materials (polyurethane, silicone, and polyvinyl chloride) on the proliferation, apoptosis, and cell cycle of Xuanwei Lung Cancer-05 (XWLC-05) cells so as to provide the basis for clinical choice of central venous catheter. MethodsXWLC-05 cells were cultured and subcultured, and the cells at passage 3 were cultured with polyurethane, silicone, and polyvinyl chloride (1.0 cm × 1.0 cm in size), and only cells served as a control. At 24, 48, and 72 hours after cultured, MTT assay was used to detect the cellular proliferation and flow cytometry to detect the cell cycle and apoptosis. At 72 hours after cultured, inverted microscope was used to observe the cell growth. ResultsInverted microscope showed the cells grew well in control group, polyurethane group, and silicone group. In polyvinyl chloride group, the cells decreased, necrosed, and dissolved; residual adherent cells had morphologic deformity and decreased transmittance. At 24 and 48 hours, no significant difference in proliferation, apoptosis, and cell cycle was found among 4 groups (P gt; 0.05). At 72 hours, the proliferations of XWLC-05 cells in three material groups were significantly inhibited when compared with control group (P lt; 0.05), and the cells in polyvinyl chloride group had more significant proliferation inhibition than polyurethane group and silicone group (P lt; 0.05), but there was no signifcant difference in proliferation inhibition between polyurethane group and silicone group (P gt; 0.05). Compared with the control group, three material groups had significant impact on the rate of apoptosis and cell cycle: polyvinyl chloride group was the most remarkable, followed by silicone group, polyurethane group was minimum (P lt; 0.05). ConclusionPolyvinyl chloride can significantly impact the proliferation, apoptosis, and cell cycle of XWLC-05 cells; polyurethane has better biocompatibility than polyvinyl chloride and silicone
目的 探讨神经外科危重患者经外周静脉置入中心静脉导管（PICC）的常见并发症发生原因，同时总结并发症有效预防措施及护理对策。 方法 纳入2009年9月－2012年9月期间行PICC的190例神经外科重症住院患者，统计并发症发生率，对其原因进行分析，并开展针对性预防和护理。 结果 本组患者PICC置管后有75例发生不同类型并发症，其中置管时并发症17例，包括导管异位8例，送管困难6例，穿刺失败3例，发生率为9%；导管留置期间并发症58例，包括穿刺点渗血、渗液16例，意外拔管12例，静脉炎10例，导管部分脱出9例，导管堵塞7例，导管相关性感染3例，导管相关性静脉血栓1例，发生率为30.5%。根据其发生的不同原因，采取积极的治疗和护理措施，并发症得以治愈，降低了并发症发生率。 结论 规范护理流程，加强临床培训，熟悉和掌握PICC并发症的预防和护理措施，可提高PICC置管、使用的安全性。
目的 了解成都市肿瘤科医护人员经外周静脉留置中心静脉导管术（PICC）认知现状，为今后开展PICC相关知识培训提供科学依据。 方法 2009年12月－2010年1月采用自行设计的问卷对成都市5家三甲医院的肿瘤科医护人员309名（医生134名，护士175名）进行PICC认知态度现状调查。 结果 成都市三甲医院肿瘤科医护人员PICC认知呈中等偏低的水平，护士PICC知识的掌握高于医生（P＜0.05），护士PICC态度得分优于医生（P＜0.05）。94.84%的医护人员知道PICC技术；只有8.38%的肿瘤科医护人员接受过PICC专业培训。不同文化程度、年龄、工龄、职业与PICC认知之间的差异存在统计学意义（P＜0.05）。 结论 三甲医院肿瘤科医护人员对PICC技术有一定的了解，但总体认知仍有待提高，需加强PICC相关知识培训，进一步提高医护人员PICC认知水平，以利于肿瘤专科开展PICC技术，促进肿瘤护理的专业化发展。
ObjectiveTo investigate the effect of suprapubic catheterization(SPC) by using central venous catheter (CVC) on the perioperative complications in middle and low rectal cancer surgery. MethodsThe clinical data of 141 patients with middle and low rectal cancer underwent operation in Shengjing Hospital of China Medical University from April 2012 to January 2015 were collected. There were 65 patients performed SPC by using CVC, 76 patients performed routine transurethral catheterization(TUC). The incidences of bacteriuria and urinary retention, recatheterization rate, duration of catheterization, and catheter-related pain were analyzed and compared between these two groups. Results①Compared with the TUC, the SPC by using CVC could significantly reduce the incidence of bacteriuria(P=0.002), espe-cially in female(P=0.006), ≥60 years old(P=0.001), low rectal cancer(P=0.003), open surgery(P=0.018), Miles(P=0.016), and Dixon(P=0.032).②There was no significant difference in the incidence of urinary retention(P=0.464) between the SPC by using CVC and the TUC.③Compared with the TUC, the SPC by using CVC could significantly reduce the inci-dence of recatheterization rate(P=0.001), especially in the patients with male(P=0.016), ≥60 years old(P=0.008), low rectal cancer(P=0.019), laparoscopic surgery(P=0.013), and Miles(P=0.037).④Compared with the TUC, the point of catheter-related pain was significantly lower in the SPC by using CVC(P=0.001), no matter males(P=0.005) or females(P=0.010), aged 60 years and older(P=0.023) or younger(P=0.034), middle rectal cancer(P=0.017) or low rectal cancer(P=0.046), open surgery(P=0.033) or laparoscopic surgery(P=0.021), Dixon(P=0.019) or Miles(P=0.035).⑤The duration of catheterization was similar between the SPC by using CVC and the TUC(P=0.597). ConclusionSPC by using CVC is a safer, more effective and more acceptable method of bladder drainage in middle and low rectal cancer surgery as compared with routine TUC.
ObjectiveTo investigate the influence of misplaced subclavian vein (SCV) catheter into the ipsilateral internal jugular vein (IJV) on transpulmonary thermodilution (TPTD) measurements and explore the possible mechanisms preliminarily.MethodsIn this prospective study, 408 patients in whom an SCV catheterization was indicated for TPTD monitoring were enrolled. A first set of TPTD measurements was collected at baseline in all patients (group 1, SCV catheters were correctly placed; group 2, SCV catheters were misplaced into the ipsilateral IJV). The parameters included mean transit time (MTt), downslope time (DSt), cardiac index (CI), global end-diastolic volume index (GEDVI) and extra-vascular lung water index (EVLWI). A second set of TPTD measurements was performed only in those with catheter misplacement immediately after the misplaced SCV catheters being corrected (Group 3). The differences in MTt, DSt, GEDVI and EVLWI between group 2 and 3 were recorded as ΔMTt, ΔDSt, ΔGEDVI and ΔEVLWI, respectively.ResultsGEDVI and EVLWI were significantly higher (all P<0.001) in group 2 than those in group 1, while CI was not significantly different (P>0.05) between these two groups. Multivariate logistic regression identified PaO2/FiO2 [adjusted odds ratio (OR) 1.492/10 mm Hg; 95% confidence interval (CI), 1.180 - 1.884; P<0.001], GEDVI (OR=1.307/10 mL/m2, 95% CI 1.131 - 1.511; P<0.001) and EVLWI (OR=3.05; 95%CI 1.593 - 5.840; P<0.001) as the 3 independent factors associated with the misplacement of SCV catheter into the ipsilateral IJV. In group 2, GEDVI [(1041±122)mL/m2 vs. (790±102)mL/m2, P<0.001], EVLWI [(20.3±4.0)mL/kg vs. (10.3±2.3)mL/kg, P<0.001], CI [(3.6±1.2)L·min–1·m–2 vs. (2.9±1.0)L·min–1·m–2, P<0.001], MTt [(38.2±13.3)s vs. (30.8±9.4)s, P<0.001] and DSt [(18.9±7.2)s vs. (13.2±4.9)s, P<0.001)] were significantly higher than those in Group 3. Multiple regression analysis demonstrated that ΔEVLWI (R2=0.86, P<0.001) was negatively correlated with ΔMTt (coefficient±SE, –0.52±0.12; P<0.001) and positively correlated with ΔDSt (coefficient±SE, 1.45±0.17; P<0.001).ConclusionsDuring TPTD measurements, indicator injection through an SCV catheter misplaced into the ipsilateral IJV results in an overestimation of CI, GEDVI and EVLWI. The increase in DSt might be a key factor in explaining the overestimation of EVLWI in patients with misplaced SCV catheters. Given that the accurate measurements of GEDVI and EVLWI are of utmost importance for guiding resuscitation and decision-making regarding fluids administration, immediate repositioning is required if a misplacement is suspected and confirmed by the chest X-ray.
ObjectiveTo explore the risk factors for central venous catheter (CVC)-related infections and its Countermeasures, as CVC is an important vascular access for blood purification and is widely used in clinical applications, but catheter-related infection is one of the common severe complications. MethodsWe retrospectively analyzed the clinical data of 725 patients with complicated infections of indwelling center venous double lumen catheter treated between January 2009 and December 2012. ResultsAmong all 725 cases, 15 had catheter-related infection. There were one case of subcutaneous tunnel infection (staphylococcus aureus by the secretion culture, negative for blood culture), and 14 cases of positive blood culture including 9 staphylococcus aureus cases, 3 escherichia coli cases, 1 colorless bacillus case and 1 stenotrophomonas maltophilia case. Eight cases were cured by antibiotic therapy while antibiotics were invalid in the other 7 cases resulting in tube withdrawing. ConclusionThe central venous catheter-related infections are related to medical service ability, catheter indwelling position, indwelling time, hemodialysis adequacy, patients' general condition and personal hygiene. Taking relative measures in view of each factor is the key to prevent infections.