ObjectiveTo investigate the clinical significance of ultrasound-guided puncture and catheterization combined with choledochoscopy for debridement and drainage in treatment of patients with severe intra-abdominal infection (SIAI).MethodsThe clinical data of 7 patients with SIAI who underwent the debridement and drainage under ultrasound-guided puncture and catheterization combined with choledochoscopy from January 1, 2015 to December 31, 2017 in this hospital were retrospectively analyzed. The drainage sinus tracts were dilated for all patients. Then the choledochoscope was inserted into the infected areas along the dilated sinus tract. Finally, the drainage tube was placed under the guidance of the choledochoscope.ResultsOf the 7 patients, 6 patients were cured by this treatment, 1 case was converted to open surgery because the symptoms of illness were not improved. No relevant complications occurred. All patients were discharged after improvement of the disease. Currently, all cases were survival and no infection remained or recurred after follow-up to June 28, 2019.ConclusionsUltrasound-guided puncture and catheterization combined with choledochoscopy for debridement and drainage in treatment of SIAI is simple, safe, and effective. It could be used as an effective treatment for SIAI or alternative to open surgery.
目的 探讨经大隐静脉-穿通支静脉入路行深静脉置管溶栓术(catheter-directed thrombolysis，CDT)治疗混合型下肢深静脉血栓形成(deep venous thrombosis，DVT）的临床疗效。 方法 对42例急性混合型下肢DVT患者，经踝大隐静脉-穿通支静脉入路，将溶栓导管置入深静脉行CDT治疗。回顾性分析该42例患者的临床资料，评价其溶栓疗效。 结果 42例患者均成功经大隐静脉-穿通支静脉入路行CDT治疗。溶栓时间为5～7 d、(4.22±1.43) d；术后所有患者的肢体肿胀均明显好转；大腿周径差由术前的（7.76±1.72）cm缩减为术后的（2.21±0.91) cm（t=14.18，P＜0.01），小腿周径差由术前的（4.45±1.33）cm缩减为术后的(1.43±0.69）cm（t=11.92，P＜0.01），静脉通畅度评分由术前的12分降为术后的3分（Z=-3.03，P＜0.01）。术后发生穿刺处渗血2例，血尿2例，少量咯血1例。38例获访3～26个月，中位数为15个月。随访期间，1例发生支架远端重度狭窄，1例对侧下肢发生DVT。 结论 经大隐静脉-穿通支静脉入路行CDT治疗混合型下肢DVT，其操作简便，溶栓效率高，是临床值得推广的溶栓途径之一。
To report a case of a 1-year-old female child admitted to the hospital with recurrent convulsions and diagnosed as West syndrome, also known as infantile spasms (IS). The child had been experiencing convulsions for 4 months prior to admission, characterized by forward head tilt and flexion of the limbs, with 8 ~ 10 episodes per day. After admission, West syndrome was identified by EEG and imaging evaluation, and adrenocorticotropic hormone (ACTH) shock therapy was started on day 5 of admission, supplemented with peripherally inserted central catheter (PICC), gastric protection, calcium and potassium supplementation and other supportive measures. During the course of treatment, the nursing team implemented meticulous monitoring and assessment to ensure that the child's vital signs were stabilized, and potential side effects were detected and treated in a timely manner. After 14 days of treatment, the child had no further spasticity episodes during 3 ~ 14 days, and was discharged from the hospital with continued oral hormone intake and regular follow-up. During the nursing process, the nursing staff provided psychological support and education to the child and her family to help the family understand the disease and enhance their ability to manage it. In addition, personalized nutritional support and monitoring were provided to ensure the healthy growth of the child. The successful management of this case not only enhanced the quality of clinical care, but also provided useful reference and inspiration for similar cases.
ObjectiveTo explore the influence of evidence-based nursing care of catheterization on the incidence of urinary tract injury and urinary tract infection in patients with spinal cord injury and long-term indwelling catheters.MethodsFrom July 1st, 2017 to November 30th, 2018, 100 patients with spinal cord injury indwelling catheters in Department of Spinal Surgery were prospectively selected as the research objects. According to the admission time, patients admitted between July 2017 and February 2018 were assigned into the control group (n=50), and patients admitted between March 2018 and November 2018 were assigned into the observation group (n=50). Traditional catheter placement was used in the control group, while evidence-based catheter placement was used in the observation group. The incidences of catheter-related urethral injury and urinary tract infection after the catheterization were compared between the two groups.ResultsThere was no statistically significant difference in gender, age, diagnosis, or length of hospital stay between the two groups (P>0.05). Catheter placement was performed 57 times in the control group and 59 times in the observation group during hospitalization. After catheterization, the incidences of urethral hemorrhage and gross hematuria in the control group [22.80% (13/57) and 15.78% (9/57), respectively] were higher than those in the observation group [both were 1.69% (1/59)], with statistical differences between the two groups (P<0.05). The incidence of urinary tract infection in the control group differed from that in the observation group [42.0% (21/50) vs. 18.0% (9/50), P=0.009].ConclusionThe evidence-based urinary catheterization method for patients with spinal cord injury and long-term indwelling catheter can effectively prevent catheter-related urinary tract injury, reduce the incidence of catheter-related urinary tract infection during hospitalization, and improve the quality of clinical care.
Objective To study the catheter-related infection (CRI) in cancer patients treated with central venous catheterization. Methods A prospective study with 196 cancer patients was conducted to analyze the types of catheter-related infection and pathogen, as well as the relationship between CRI and the following factors: insert location, gender, age, remained time, or bone marrow suppression. Results Of the total 196 cases, 16 cases were diagnosed as CRI and the CRI rate was 8.2%. The types of CRI were five cases of pathogen colonization, four cases of insert location infection and seven cases of catheter-related bloodstream infection. Of the total 244 specimens, 20 were positive including 7 pathogenic bacteria in either Gram positive or Gram negative types, the dominating pathogens were staphylococcus aureus, staphylococcus epidermidis, acinetobacter baumannii and klebsiella pneumoniae. CRI was related to both insert location and age which were both the independent risk factors. Conclusion The concept of prevention should be set up, and the comprehensive measures should be taken to reduce CRI, such as choosing an appropriate insert location and complying with a strict catheter insert standard.
Objective To evaluate the flushing effects of normal saline (NS) and heparin saline (HPS) after central venous catheterization. Methods We searched PubMed, EMbase, The Cochrane Library (Issue 12, 2015), CBM, CNKI, VIP and WanFang Data to collect randomized controlled trials (RCTs) on the flushing effects of NS versus HPS after central venous catheterization from inception to December 2015. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then RevMan 5.3 software was used for meta-analysis. Results A total of 12 RCTs involving 2 092 patients were included. The results of meta-analysis showed that no significant differences were found between the two groups in occlusion rate (OR=1.58, 95%CI 0.79 to 3.14,P=0.19) and the catheter days (OR=–7.24, 95%CI –22.90 to 8.41,P=0.36), while the HPS group had more advantage than the NS group in decreasing the incidence of phlebitis (OR=2.57, 95%CI 1.52 to 4.34,P=0.000 4). Subgroup analysis revealed that HPS provided more superiority over NS in lessening the occlusion rate (OR=1.85, 95%CI 1.22 to 2.80,P=0.004), no significant difference was found when comparing NS to 10 units, and 100 units HPS (10 units: OR=1.51, 95%CI 0.94 to 2.43,P=0.09; 100 units: OR=1.51, 95%CI 0.63 to 3.60,P=0.09). Conclusion HPS appears to be more beneficial than NS, larger rigorously studies are needed for better understanding on the effects of NS and HPS.
ObjectiveTo compare the differences of incidence rate and severity of postthrombotic syndrome (PTS) of patients with lower extremity deep venous thrombosis (DVT) treated by catherter-directed thrombolysis (CDT) or via peripheral vein thrombolysis (PVT).MethodsThe patients with unilateral lower extremity DVT who had received anticoagulant and thrombolytic therapy in the Nanchong Central Hospital from January 2012 to January 2015 were collected. These patients were divided into CDT group and PVT group according to the different thrombolysis methods, and then the thrombolytic rates, thrombolytic complications, and the incidence rate and severity of PTS of 5-year follow up results were calculated and compared.ResultsA total of 137 cases of DVT were collected, 79 in the CDT group and 58 in the PVT group. There were no significant differences in the gender, age, course of disease, thrombus type, and other baseline data between the two groups (P>0.05). The thrombolytic rate of the CDT group was (78.6±16.3)% and PVT group was (27.3±12.1)%, the difference was significant (t=21.14, P<0.001). The rate of thrombolytic complications between the PVT group and CDT group had no statistical significance (32.8% versus 21.5%, χ2=2.18, P=0.134). The 5-year follow up was completed in 116 cases, 74 patients from the CDT group and 42 patients from the PVT group respectively, the result showed that the incidence rate of the PTS in the CDT group was lower than that in the PVT group (35.1% versus 88.1%, χ2=30.28, P<0.001), and theseverity of PTS in the CDT group was milder than that in the PVT group too (Z=16.52,P<0.001).ConclusionFrom the results of this study, CDT is able to increase thrombolytic rate and effectively reduce incidence rate and severity of PTS.