Real-World Study on the Treatment of Macular Edema in Central Retinal Vein Occlusion Using Traditional Chinese Medicine(TCM)and Its Medication Guidelines

Object:The aim is to evaluate how effective Traditional Chinese Medicine(TCM)is in treating patients who have central retinal vein occlusion with macular edema(CRVO-ME)in a real-world study.Furthermore,the objective of the research was to examine the TCM prescription trends in the management of CRVO-ME.Method:A single-center real-world study(RWS)was carried out over a span of 19 years,following the established design.The study encompassed 113 patients diagnosed with CRVO-ME.Out of these,74 patients received TCM treatment,while the remaining individuals underwent a combined therapy involving TCM and anti-VEGF drugs through intravitreal injection.The patients were matched using propensity score matching(PSM).The result measured in the RWS was BCVA.The oral prescriptions for CRVO-ME that led to observable and effective outcomes were collected.Excel and the TCM Inheritance Auxiliary Platform V2.5 were utilized to optimize mutual information,hierarchical clustering based on entropy,and other techniques to extract medication regulations and features.Result:After applying PSM,each group comprised 29 cases.Both groups exhibited improved BCVA following treatment;however,there was no statistically significant distinction in BCVA or effectiveness between the two groups(all P>0.05).Apart from the analysis of oral prescriptions for CRVO-ME,the investigation pinpointed the most frequently used TCMs,namely Flos Carthami,Semen Persicae,Radix Angelica sinensis,Radix Rehmanniae,and Radix et Rhizoma Notoginseng.Frequently utilized medications tended to possess cold,warm,or mild attributes and exhibited a taste profile that was either bitter or sweet.The primary meridians associated with the medicines employed in treating CRVO-ME were liver,spleen,stomach,heart,and lung.Through the application of association rule analysis,it was discerned that there were 195 commonly employed combinations of medicines.Additionally,a complex system entropy cluster analysis unveiled 13 key combinations of medicines.By employing an unsupervised entropy hierarchical clustering analysis,a novel prescription was formulated.Conclusion:Within a real-world population of CRVO-ME patients,TCM exhibited its effectiveness.The treatment approach for CRVO-ME predominantly involved the regulation of qi(Qi is an exceedingly subtle substance within the human body,brimming with vitality and ceaseless motion.It constitutes the fundamental element that shapes and sustains the various processes of human life.)and blood as well as the resolution of dampness.The oral prescriptions frequently targeted the meridians of liver,spleen,stomach,heart,and lungs.

Long-term outcomes of anti-VEGF treatment with 5+PRN regimen for macular edema due to central retinal vein occlusion

AIM:To assess the long-term outcomes of treating macular edema(ME)associated with central retinal vein occlusion(CRVO)with a regimen of“5+pro re nata(PRN)”.METHODS:This retrospective study included 27 eyes of 27 patients with ME associated with non-ischemic CRVO(non-iCRVO group,n=15)and ischemic CRVO(iCRVO group,n=12).The eyes were treated with five consecutive intravitreal injections of conbercept or ranibizumab,followed by reinjections as needed or PRN.Retinal laser photocoagulation or intravitreal dexamethasone implants(DEX)were implemented in both groups when necessary.The best-corrected visual acuity(BCVA,logMAR)and central retinal thickness(CRT)were recorded at baseline,at 1,2,3,4,5,6,and 12mo,and at the final visit.The efficacy rates of BCVA and CRT before and after treatment were calculated.The number of injections at each visit and the incidence of adverse events were also recorded.RESULTS:The patients,aged 59.4±15.1y,were followed up for 24.7±8.8mo(range:15-42mo).After treatment,BCVA improved significantly from 1.04±0.56 logMAR at baseline to 0.59±0.36 logMAR(P=0.038)at the final visit in all patients.Both the non-iCRVO and the iCRVO groups achieved improved BCVA compared to the baseline at all visit points,but there was no statistical significance(P=0.197 and 0.33,respectively).The mean CRT was statistically reduced compared to baseline at all visit points in all the eyes and in both groups(all P<0.001).The apparent effective rate was 22.22% for BCVA and 37.04% for CRT after the first injection,48.15%for BCVA and 62.96% for CRT after 5 consecutive injections,and 74.08% for BCVA and 100% for CRT at the end of follow up.The average number of injections in all patients was 9.0±2.4 at 12mo and 14.9±8.1 finally with no statistical significance between both groups(P>0.05).Laser treatment was applied to all eyes in the iCRVO group,while only 5 patients in the noniCRVO group.Six patients in the non-iCRVO group and 3 patients in the iCRVO group had a drug switch.DEX was applied to 4 eyes in the non-iCRVO group and 5 eyes in the iCRVO group.CONCLUSION:The 5+PRN anti-vascular endothelial growth factor(VEGF)regimen is found to be safe and effective for both iCRVO and non-iCRVO,especially in the iCRVO group.The best regimen for such patients needs to be further investigated.Adjuvant laser therapy and DEX are necessary in some cases.

Central Retinal Vein Occlusion in Healthy Young Adults Following COVID-19 Vaccination: Case Series

Our aim is to report 4 cases of central retinal vein occlusion following COVID-19 vaccine administration. In this case series, 4 patients between 23-32 years of age presented to us with unilateral central retinal vein occlusion after 2-15 days of getting vaccinated against COVID-19. One patient was a known case of hypertension and 1 was hypothyroid. All the patients had disc swelling, flame shaped haemorrhages, dilated and tortuous blood vessels in the retina. One patient had cystoid macular edema and was treated with intravitreal ranibizumab. As there were no positive systemic risk factors or incidents, COVID-19 vaccines might have an association with the central retinal vein occlusion in these cases. .

Intravitreal injection of bevacizumab alone or with triamcinolone acetonide for treatment of macular edema caused by central retinal vein occlusion

AIM: To compare the efficacy and safety of intravitreal bevacizumab alone versus bevacizumab combined with triamcinolone acetonide in eyes with macular edema caused by central retinal vein occlusion (CRVO) in Chinese patients. METHODS: Seventy-five eyes of 75 patients were enrolled in this prospective, randomized, consecutive study. Thirty-six patients in group 1 were treated with an intravitreal injection of bevacizumab (1.25mg/0.05mL), and 39 patients in group 2 were treated with intravitreal bevacizumab (1.25mg/0.05mL) combined with triamcinolone acetonide (2mg/0.05mL). The main outcomes of the mean best corrected visual acuity (BCVA), central retinal thickness (CRT), and intraocular pressure (IOP) were measured. RESULTS: In group 1, the mean BCVA improved from 37.78 +/- 6.14 (baseline) to 48.06 +/- 3.86, 46.48 +/- 4.77 and 44.18 +/- 5.78 at four, six and twelve weeks post-injection, respectively (P<0.01, P=0.03, P=0.04). In group 2, the mean BCVA improved from 35.92 +/- 6.20 (baseline) to 50.69 +/- 4.22, 48.76 +/- 5.59 and 45.70 +/- 6.56 at the same time points (P<0.01 each). However, there was no significant differences in the mean BCVA (F=0.043, P=0.836) and CRT (F=0.374, P=0.544) between these two groups. During the follow-up, five patients in group 1 and six patients in group 2 with high IOP were controlled with anti-glaucoma drugs. CONCLUSION: Intravitreal injection of bevacizumab alone or combined with triamcinolone acetonide has a short beneficial effect in Chinese patients with macular edema caused by CRVO, but there is no significant difference between the two groups.

Predictors of short-term outcomes related to central subfield foveal thickness after intravitreal bevacizumab for macular edema due to central retinal vein occlusion

AIM：To investigate the predictive factors for shortterm effects of intravitreal bevacizumab injections on central subfield foveal thickness（CSFT）in patients with macular edema（ME）secondary to central retinal vein occlusion（CRVO）.·METHODS：This was a retrospective study in 60 eyes treated with intravitreal bevacizumab injections for ME due to CRVO.Follow-up was three months.The Early Treatment Diabetic Retinopathy Study（ETDRS）score and CSFT measured by spectral-domain optical coherence tomography（SD-OCT）were used to observe the changes in best-corrected visual acuity（BCVA）.Baseline BCVA,CSFT,age,CRVO duration and the presence of cystoid macular edema（CME）or subretinal fluid（SRF）were analyzed as potential predictive factors of the effects of intravitreal bevacizumab injections.·R ESULTS：BCVA improved from 0.9 log MAR at baseline to 0.6 log MAR at 3mo,which was associated with a significant reduction in CSFT from 721μm to 392μm 3mo after injection.About 50%of CME cases and more than90%of SRF cases responded to treatment with a complete resolution at 3mo.Age（=0.036）and low baseline CSFT（=0.037）were associated with a good 3-month prognosis.Patients〉60 years old achieved better CME resolution（=0.031）and lower CSFT at 3mo（305μm 474μm,=0.003）.·CONCLUSION：Intravitreal bevacizumab significantly improved visual acuity and CSFT in patients with CRVO after 3mo.Older age and lower baseline CSFT were good predictors of short-term CSFT outcomes.The retinal thickness response to bevacizumab might depend on the resolution of CME rather than SRF.

Ocular hypertension in patients with central/hemicentral retinal vein occlusions： cumulative prevalence and management

AIM： To prospectively evaluate the cumulative prevalence and the management of ocular hypertension（OH） in patients with unilateral acute central/hemicentral retinal vein occlusions（C/HCRVOs） over the course of 3 y. METHODS： The study included 57 patients with unilateral acute C/HCRVOs. All patients underwent a comprehensive ophthalmological examination of both eyes. OH associated with C/HCRVO in patients showing a score 〉5% for the risk of conversion to primary open angle glaucoma（POAG） was treated with OH medication. The treatment aimed for a decrease in intraocular pressure（IOP） to 〈21 mm Hg with a 〉22% reduction from the initial values. The cumulative prevalence of OH and the effectiveness of treatment assessed by the cumulative prevalence of conversion from OH to POAG, were estimated. RESULTS： Fifteen patients had OH associated with C/HCRVOs, the cumulative prevalence of OH was 29.4%（95% confidence interval, 16.9-41.9）. The mean value of the risk score of OH conversion to POAG for the 5 subsequent years was 11.7%±5.4%. The IOP significantly decreased from 25.67±2.16 mm Hg to 18.73±2.96 mm Hg. None of the OH patients converted to POAG during the follow-up period. CONCLUSION： The increased cumulative prevalence of OH in C/HCRVO patients indicates that OH is a risk factor for the appearance of venous occlusion. Patients with OH associated with C/HCRVO must be considered to be at high risk for conversion to POAG. Treatment with OH medications prevented conversion to POAG during the 3-year follow-up.

Efficacy of conbercept after switching from bevacizumab/ranibizumab in eyes of macular edema secondary to central retinal vein occlusion

AIM: To explore the efficacy of conbercept after switching from bevacizumab/ranibizumab in eyes of central retinal vein occlusion(CRVO) through optical coherence tomography angiography(OCTA). METHODS: Patients with prior treatment of a minimum of three consecutive intravitreal injections of either bevacizumab or ranibizumab, followed by injection of conbercept, were recruited. The minimal follow-up period after switching was 12 mo. Central retinal thickness(CRT), best-corrected visual acuity(BCVA), the interval of injections was reviewed. Perfusion density(PD) and vascular length density(VLD) of superficial and deep capillary plexus were acquired from OCTA images before and after switching. RESULTS: Twenty-four eyes were included. CRT significantly decreased from 460.71±153.23 μm(before switching) to 283.92±38.27 μm at the end of follow-up(P<0.001). However, BCVA gained to some extent(from 0.98±0.33 to 0.76±0.42 log MAR) but the difference was not significant(P=0.070). After switching to conbercept the injection interval extended from 5.2±2.3 wk to 8.3±3.9 wk(P=0.012). At the end of follow-up, PD of deep retinal layer decreased significantly compared with before switching(from 34.62%±5.27% to 33.26%±5.82%, P=0.016), similar result was found in VLD of deep retinal layer but not in PD or VLD in superficial layer.CONCLUSION: In cases of refractory macular edema secondary to CRVO, switching to conbercept improves macular thickness and extends interval of injection. Retinal microvasculature cannot improve with treatment of conbercept.

Microvascular changes after conbercept therapy in central retinal vein occlusion analyzed by optical coherence tomography angiography

AIM: To investigate microvascular changes in eyes with central retinal vein occlusion(CRVO) complicated by macular edema before and after intravitreal conbercept injection and evaluate correlations between these changes and best-corrected visual acuity(BCVA) and retinal thickness. METHODS: Twenty-eight eyes of 28 patients with macular edema caused by CRVO were included in this retrospective study. All patients received a single intravitreal conbercept injection to treat macular edema. BCVA and the results of optical coherence tomography angiography(OCTA) automatic measurements of the vessel density in the superficial(SCP) and deep retinal capillary plexus(DCP), the foveal avascular zone(FAZ) area, the FAZ perimeter(PERIM), the vessel density within a 300-μm wide ring surrounding the FAZ(FD-300), the acircularity index(AI), the choriocapillaris flow area, and retinal thickness were recorded before and at one month after treatment and compared with the results observed in age-and sexmatched healthy subjects. RESULTS: The vessel density in the SCP and DCP, the FD-300, and the flow area of the choriocapillaris were allsignificantly lower in CRVO eyes than in healthy eyes, while the AI and retinal thickness were significantly higher(all P<0.05). After treatment, retinal thickness was significantly decreased, and the mean BCVA had markedly improved from 20/167 to 20/65(P=0.0092). The flow area of the choriocapillaris was also significantly improved, which may result from the reduction of shadowing effect caused by the attenuation of macular edema. However, there were no significant changes in SCP and DCP vessel density after treatment. The flow area of the choriocapillaris at baseline was negatively correlated with retinal thickness.CONCLUSION: OCTA enables the non-invasive, layerspecific and quantitative assessment of microvascular changes both before and after treatment, and can therefore be used as a valuable imaging tool for the evaluation of the follow-up in CRVO patients.

Different Dosages of Intravitreal Triamcinolone Acetonide Injections for Macular Edema Secondary to Central Retinal Vein Occlusion

Purpose:.To study the effect of intravitreal injections of triamcinolone acetonide (TA) for the treatment of macular edema secondary to central retinal vein occlusion.(CRVO).in a sample of Chinese patients from Shaanxi province. Methods:.The 50 eyes from 50 patients were separated into three TA treatment groups:.17 patients were given 4 mg/0.1 ml,.19 patients were given 8 mg/0.2 ml,.and 14 patients were given 16 mg/0.4 ml. Patients were followed up for 12 months. Foveal thickness, intraocular pressure (IOP), and best-corrected visual acuity (BCVA) were measured. Results:.Macular edema responded well both anatomically and functionally to the TA injections. After the initial intravitreal injection,.macular edema recurred at 2-4 months in the low-dose group.(4 mg),.at 3-5 months in the medium-dose group (8 mg), and at 6-9 months in the high-dose group (16 mg)..No significant difference in BCVA or in foveal thickness were observed between the first intravitreal injection and the re-injection. There was no increase in IOP after re-injection of 16 mg TA,.if the patient did not have an elevated IOP after the initial intravitreal injection of 4/8 mg TA. Conclusion: A low dosage of TA (4 mg) administered via intravitreal injection might be useful as an initial treatment for macular edema secondary to CRVO..A higher dosage of TA (16mg) can be used if there is no IOP elevation with the initial TA injection.

Correlation between macular ganglion cell-inner plexiform layer thickness and visual acuity after resolution of the macular edema secondary to central retinal vein occlusion

AIM： To examine the thickness of the ganglion cell-inner plexiform layer（GCIPL） in eyes with resolved macular edema（ME） in non-ischemic central retinal vein occlusion（CRVO）, applying spectral-domain optical coherence tomography（SD-OCT）, and its relationship with visual acuity.METHODS： The retrospective observational case-control study included 30 eyes of non-ischemic CRVO patients with resolved ME（ME eyes） after treatment, and 30 eyes of non-ischemic CRVO patients without ME（non-ME eyes）. The macular GCIPL thickness, peripapillary retinal nerve fiber layer（p RNFL） thickness and central macular thickness（CMT） were measured on a SD-OCT scan. Linear regression analyses were performed to determine the correlation between the thickness of each and the visual acuity（VA）.RESULTS： No significant difference in average GCIPL thickness, mean pR NFL thickness and CMT were observed between ME group and non-ME group（P=0.296, 0.183, 0.846）. But, minimum GCIPL thickness was reduced in ME eyes compared with non-ME eyes（P=0.022）. Final VA significantly correlated with the minimum GCIPL thickness in ME eyes（r=-0.482, P=0.007）, whereas no correlation was found with average GCIPL thickness, average pR NFL thickness and mean CMT.CONCLUSION： Minimum GCIPL thickness is reduced in ME eyes compared with non-ME eyes, and correlated with the VA in non-ischemic CRVO. These results propose that inner retinal damage occurring in patients with ME secondary to non-ischemic CRVO may lead to permanent visual defect after treatment.

Correlation between obstructive sleep apnea and central retinal vein occlusion

To investigate the possible correlation between obstructive sleep apnea(OSA) and central retinal vein occlusion(CRVO). Thirty consecutive patients with a recent(<3 mo)CRVO and an age-and sex-matched group of 30 control subjects were recruited. All subjects underwent full-night polysomnography to measure apnea-hypopnea index(AHI)and oxygen desaturation index(ODI). The average AHI and ODI were significantly higher in CRVO patients(AHI:13.86±8.63, ODI: 9.21±4.47) than in control subjects(AHI:8.51±6.36, ODI: 5.87±3.18;P=0.008 and 0.001 respectively).Additionally, the AHI was positively correlated with body mass index(BMI;r=0.476, P=0.017) and ODI(r=0.921,P<0.01) in both CRVO and control subjects. According to AHI scores, twenty-two(73.33%) CRVO patients had OSA and 12(40.00%) control subjects had OSA, a difference that was statistically significant(P=0.019). OSA may be a risk factor for or a trigger of CRVO development.

Radiation Retinopathy Associated with Central Retinal Vein Occlusion

Purpose: To report a case of radiation retinopathy associated with central retinal vein occlusion. Methods: The clinical features and fundus fluorescein angiography of this case were analyzed. Results: The patient had been treated with radiotherapy for her nasopharyngeal carcinoma, and presented with sudden visual loss in the left eye. The funduscopic examination and fluorescein angiography showed the features of radiation retinopathy in both eyes, and central retinal vein occlusion in the left eye. Conclusions: Radiation retinopathy can be associated with central retinal vein occlusion in the same eye, and it seems that the endothelial cell loss caused by radiation retinopathy may lead to retinal vein occlusion.

Bilateral Central Retinal Vein Occlusions Combined with Artery Occlusions in A Patient with Acquired Immune Deficiency Syndrome

Purpose: This is the first report of a bilateral nonischemic central retinal vein occlusionscombined with artery occlusions in a patient with acquired immune deficiency syndrome(AIDS). Methods: Case report. Results: A 22-year-old Chinese(male) with a positive human immunodeficiency virus(HIV) infection developed bilateral nonischemic central retinal vein occlusions combinedwith artery occlusions and severe vision loss. The manifestations of the fundus andfluorescein angiography were similar in both eyes.Conclusion: This case report provides the evidences that central retinal vein and arteryocclusions are probably part of the spectrum of AIDS vascular diseases.

Intraocular pressure modifications in patients with acute central/hemicentral retinal vein occlusions

Intraocular pressure(IOP)modifications in patients with acute central/hemicentral retinal vein occlusions(RVOs)consist in IOP reductions and increases.The IOP reduction is due to a transitional hyposecretory phase of the aqueous humor,that increases gradually until 3 mo after the venous occlusion onset,and then finally disappears after month 4 th.The IOP increases lead to the ocular hypertension and glaucoma.The possible pathogenetic correlations between ocular hypertension/glaucoma and acute central/hemicentral RVOs have been classified into three groups:1)the venous occlusion precedes the ocular hypertension/glaucoma causing neovascular glaucoma and secondary angle-closure glaucoma without rubeosis;2)the ocular hypertension and the glaucoma precede the venous occlusion and favor its appearance(ocular hypertension,primary angle-closure,primary angle-closure glaucoma,and open angle glaucomas);and 3)the venous occlusion and the ocular hypertension/glaucoma are mostly age dependent appearances due to common vascular and collagen alterations,lacking a causal connection between the 2 conditions.

Mediterranean Spotted Fever Complicated with Thrombosis of the Left Central Retinal Vein: A Case Report and Literature Review

We describe a case of Mediterranean spotted fever complicated with thrombosis of the left central retinal vein. A 41-year-old woman patient living in the city Scodra was referred to our hospital in October 2017 for high fever 40&deg;C, muscular and articular pains, severe headache, maculopapular rash, chills, photophobia and visual loss in his left eye. Ocular examination showed vision acuity: OD 8/10, OS 2/10. Funduscopic examination complemented with fluorescein angiography showed: optic nerve papilla with clear contours, diffuse hemorrhages in the contest off retinal vein thrombosis, white retinal lesions, vascular sheathing and macular cystoids edema. R. conorii antibodies were identified by ELISA anti Rickettsia conorii IgM, IgG and Weil-Felix Ox-19 test. Investigation of other infective agents and the immunological panel were negative. After treatment with doxycycline 200 mg/day for 10 days vision acuity was OD: 8/10 OS: 6/10;FO: There are less hemorrhages in fluorescein angiograph and OCT showed a reduced macular cystoids edema. Mediterranean spotted fever should be considered in the differential diagnosis of a patient who presents with an acute febrile disease accompanied by maculopapular rash especially in the seasons of spring, summer or autumn.

Importance of Tourmaline Gneiss and Vein near Main Central Thrust in Sikkim Darjeeling Himalaya

Lingtse gneiss (LGn) and Higher Himalayan crystallines (HHC) comprise parts of main central thrust (MCT) in the Darjeeling Sikkim Himalaya. Tourmaline bearing gneiss and quartz tourmaline veins are reported in immediate contact with the LGn and some lesser Himalayan rocks in this study. Their importance is inferred via their comparative occurrence, micro-texture and chemistry. Flow of ductile crust was proposed to expose deep crustal rocks in the Himalayas in form of these gneissic rocks. Generation of paragneissic HHC from the protolith like the lesser Himalayan rocks like biotite-muscovite schist was proposed and documented in previous studies. The main central thrust where the principal motion is reported to date at circa 20 Ma appears in the contact regions of the HHC and lesser Himalayan rocks. Whether the tourmaline bearing gneiss or veins is a product during the episode of generation of the Higher Himalayan crystallines, which is taken as a component of the higher Himalayan crystallines episode remains a question as both concordant and discordant tourmaline bearing gneiss and/or quartzo-feldspahic veins appear respectively. The mm-cm scale tourmaline in the occasionally discordant quartz tourmaline veins shows strong zonation and less effects of shearing. Those are strongly zoned indicating magmatic hydrothermal character. The matrix tourmaline shows a separate composition. However, evidences of a less prominent shearing in them might signify rejuvenation. Lower temperature activity and fluid movement in this thrust zone are signified from the microstructure signifying that the high grade main central thrust was probably rejuvenated during or after the veining.

重症患者导管相关性血流感染的病原菌分布与影响因素分析

目的探讨重症患者导管相关性血流感染(catheter-related bloodstream infection,CRBSI)的病原菌分布及影响因素。方法回顾性分析2019年7月1日至2022年7月2日期间在简阳市人民医院重症医学科接受中心静脉置管患者的临床资料,依据患者是否发生中心静脉CRBSI分为CRBSI组与非CRBSI组。对CRBSI组患者行病原菌种类分析,同时比较两组临床资料信息,并将有统计学意义的变量纳入多因素Logistic回归分析,明确接受中心静脉置管患者发生CRBSI的危险因素,通过受试者工作特征曲线(ROC)构建重症患者发生CRBSI的预测模型。结果共纳入接受中心静脉置管患者293例,其中CRBSI组38例、非CRBSI组255例。38例CRBSI患者共检出病原菌52珠,其中革兰氏阳性菌占比50.00%(26/52),以金黄色葡萄球菌19.23%(10/52)、表皮葡萄球菌7.69%(4/52)为主;革兰氏阴性菌占比44.23%(23/52),以大肠埃希菌17.31%(9/52)、肺炎克雷伯杆菌13.46%(7/52)为主;真菌占比5.77%(3/52),均为白色念珠菌。CRBSI组年龄≥60岁、合并糖尿病、置管部位为股静脉或颈内静脉、静脉营养液输液、置管前应用抗菌药物者占比显著高于非CRBSI组;CRBSI组BMI、入院时APACHEⅡ评分显著高于非CRBSI组,置管时间显著长于非CRBSI组,P值均<0.05。多因素Logistic回归分析结果显示,年龄≥60岁、高BMI、合并糖尿病、入院时高APACHEⅡ评分、置管部位为股静脉或颈内静脉、置管时间长、输液类型为静脉营养液、置管前应用抗菌药物为重症患者发生CRBSI的危险因素。ROC分析表明,BMI、入院时APACHEⅡ评分、置管时间均能用于重症患者发生CRBSI的预测,曲线下面积分别为0.778、0.919、0.975(P<0.05)。结论重症患者中心静脉置管后CRBSI的病原菌以金黄色葡萄球菌、大肠埃希菌较为多见,同时CRBSI的发生与年龄、BMI、置管天数、置管部位等因素关系密切,临床治疗过程中应当予以关注。

无痛诊疗技术在超声PICC置管患儿中的应用效果研究

目的探讨无痛诊疗技术在超声引导下儿童经外周静脉穿刺中心静脉置管术(peripherally inserted central catheter,PICC)中的应用效果。方法选取笔者医院2021年1月至2023年1月拟行PICC的患儿82例,用随机数字表法将其分为对照组、观察组,每组41例;对照组行常规超声引导下PICC置管术,观察组行无痛诊疗技术超声引导下PICC置管术;对比两组置管成功率、置管完成时间,患儿疼痛程度[儿童疼痛行为量表(children’s pain behavior scale,FLACC)],耐受度[Houpt行为量表(Houpt behavior scale,HBS)],依从性[Frankl量表(Frankl scale,FCS)]及家属满意度。结果观察组置管成功率较对照组高,置管时间较对照组短,差异有统计学意义(P<0.05);观察组FLACC评分较对照组低,HBS评分、FCS评分较对照组高,差异有统计学意义(P<0.05);观察组家属总满意度较对照组高,差异有统计学意义(P<0.05)。结论无痛诊疗技术用于超声引导下儿童PICC置管术可提高置管成功率,缩短置管时间,减轻患儿疼痛程度,增强耐受性、依从性,提升家属满意度。

乳腺癌患者外周中心静脉导管相关上肢深静脉血栓形成的抗凝治疗

目的总结分析乳腺癌患者发生外周中心静脉导管(PICC)相关上肢深静脉血栓(DVT)形成的诊治经验。方法收集2021年6月至2023年3月北京市海淀医院收治的发生PICC相关上肢DVT的134例乳腺癌患者的临床资料,根据抗凝治疗方案的不同将患者分为低分子肝素组(n=65)和利伐沙班组(n=69)。比较两组患者的乳腺癌专科信息和启动抗凝治疗后3个月的随访结果。结果两组患者的临床分期、肿瘤部位、手术情况、放疗情况比较,差异均无统计学意义(P﹥0.05)。治疗后3个月随访结果显示,两组患者的导管功能失用率、上肢DVT复发率、出血发生率比较,差异均无统计学意义(P﹥0.05)。两组患者均发生了轻微出血。治疗前,两组患者的D-二聚体水平比较,差异无统计学意义(P﹥0.05);治疗后4、12周,两组患者的D-二聚体水平均较本组治疗前下降,差异均有统计学意义(P﹤0.05),但两组患者的D-二聚体水平比较,差异均无统计学意义(P﹥0.05)。结论低分子肝素与利伐沙班治疗乳腺癌患者PICC相关上肢DVT的疗效与安全性相当,但利伐沙班可能更方便患者出院后使用。

PICC带管出院患者导管居家维护模式的可行性研究分析

目的 观察PICC带管出院患者导管居家维护模式的可行性。方法 将我院2021年1月至2022年12月收治的60例PICC带管肿瘤患者随机分为观察组30例,对照组30例。对照组(n=30)给予常规返院导管维护,观察组(n=30)给予导管居家维护,对比两组的单次维护费用及时间、平均留置时间、导管相关并发症发生情况及维护依存性。结果 观察组单次维护费用为(58.17±5.64)元,低于对照组的(132.78±9.85)元,两组单次维护费用比较,差异具有统计学意义(t=-36.004,P=0.000);观察组单次维护时间(81.13±7.62)min,较对照组的(203.34±15.67)min更短,差异具有统计学意义(t=-38.416,P=0.000)。观察组PICC平均留置时间为(141.82±13.56)d,对照组PICC平均留置时间为(137.43±14.08)d,两组PICC平均留置时间比较,差异未见统计学意义(t=1.230,P=0.224)。观察组导管相关并发症发生率36.67%,对照组26.67%,两组导管相关并发症比较,差异没有统计学意义﹙χ^(2)=0.693,P=0.405﹚。观察组能按时进行PICC导管维护者为28例,按时维护依存率为93.33%,高于对照组的70.00%,差异存在统计学意义﹙χ^(2)=5.455,P=0.020﹚。结论 PICC带管出院患者导管居家维护模式具有一定可行性,在不增加导管相关并发症及延长留置时间的前提下,可以有效地减少维护费用、缩短维护时间,提高患者维护依存性。