目的探讨“四体系一平台”护理管理模式预防重症监护病房(intensive care unit,ICU)中心导管相关血流感染(central line associated blood stream infection,CLABSI)的效果,降低CLABSI发生率。方法采用不同病例前-后对照研究,选取2019年...目的探讨“四体系一平台”护理管理模式预防重症监护病房(intensive care unit,ICU)中心导管相关血流感染(central line associated blood stream infection,CLABSI)的效果,降低CLABSI发生率。方法采用不同病例前-后对照研究,选取2019年9月至2021年8月本院4个外科ICU病区收治的5968例患者作为研究对象,其中2019年9月至2020年8月收治的2852例患者设为实施前组,2020年9月至2021年8月收治的3116例患者设为实施后组。实施前组应用常规护理管理方法,实施后组应用“四体系一平台”护理管理模式。比较两组患者CLABSI发生率,实施前后护士输液附加装置更换合格率、手卫生依从性;两组患者置管最大无菌屏障合格率、皮肤消毒合格率。结果应用“四体系一平台”护理管理模式后,患者CLABSI率由1.96‰(29/14765)降至0.97‰(17/17458),两组比较,差异具有统计学意义(χ^(2)=5.504,P=0.019);护士输液附加装置更换合格率(92.86%v 99.73%,χ^(2)=264.498,P<0.001)、手卫生方法正确率(99.02%v 99.73%,χ^(2)=32.342,P<0.001)、手卫生依从性(99.18%v 99.49%,χ^(2)=5.664,P=0.019)、最大无菌屏障合格率(95.93%v 99.69%,χ^(2)=10.399,P=0.002)、皮肤消毒合格率(93.61%v 98.80%,χ^(2)=67.630,P<0.001)均较实施前组提高,两组比较,差异有统计学意义。结论“四体系一平台”护理管理模式有利于促进ICU护士在导管维护时的规范性、有效性和依从性,降低ICU患者CLABSI率。展开更多
Sphingosine 1-phosphate （S1P）, a pleiotropic lysophospholipid, regulates signal transduction pathway via Gprotein-coupled receptors termed S1P1-5 in several types of the cells including lymphocytes. Higher levels of...Sphingosine 1-phosphate （S1P）, a pleiotropic lysophospholipid, regulates signal transduction pathway via Gprotein-coupled receptors termed S1P1-5 in several types of the cells including lymphocytes. Higher levels of S1P4 mRNA as well as S1P1 mRNA are expressed in lymphoid tissues such as the spleen, thymus, lymph nodes, and Payer＇s patches. In contrast to S1P1 that plays an essential role in lymphocyte egress, little is known about the role of S1P4 in immune system. In this study, we found that S1P at 10 to 100 nM significantly induced the cell migration and the significant levels of S1P1 and S1P4 mRNA were expressed in mouse CD4 T cells, D10.G4.1 mouse Th2 cells, and EL-4.IL-2 mouse thymoma cells. In D10.G4.1 and EL-4.IL-2 cells, S1P-induced migration was almost completely inhibited by pretreatment with pertussis toxin, Clostoridium difficile toxin B, and （S）-enantiomer of FTY720-phosphate, a potent agonist at S1P1 and S1P4. The members of the Rho family small GTPase, Cdc42 and Rac were activated by S1P stimulation in these cells. The transfection with dominant negative or constitutively active forms of Cdc42 and Rac revealed that the activation of both Cdc42 and Rac is essential for S1P-induced migration of these cells. The immunoprecipitation assays using CHO cells co-expressing both S1P4 and S1P1 receptors indicated that S1P4 and S1P1 are associated on the cell surface. These results suggest that the association of S1P4 and S1PI plays an important role in migratory response of mouse T cells toward S1P.展开更多
文摘Sphingosine 1-phosphate （S1P）, a pleiotropic lysophospholipid, regulates signal transduction pathway via Gprotein-coupled receptors termed S1P1-5 in several types of the cells including lymphocytes. Higher levels of S1P4 mRNA as well as S1P1 mRNA are expressed in lymphoid tissues such as the spleen, thymus, lymph nodes, and Payer＇s patches. In contrast to S1P1 that plays an essential role in lymphocyte egress, little is known about the role of S1P4 in immune system. In this study, we found that S1P at 10 to 100 nM significantly induced the cell migration and the significant levels of S1P1 and S1P4 mRNA were expressed in mouse CD4 T cells, D10.G4.1 mouse Th2 cells, and EL-4.IL-2 mouse thymoma cells. In D10.G4.1 and EL-4.IL-2 cells, S1P-induced migration was almost completely inhibited by pretreatment with pertussis toxin, Clostoridium difficile toxin B, and （S）-enantiomer of FTY720-phosphate, a potent agonist at S1P1 and S1P4. The members of the Rho family small GTPase, Cdc42 and Rac were activated by S1P stimulation in these cells. The transfection with dominant negative or constitutively active forms of Cdc42 and Rac revealed that the activation of both Cdc42 and Rac is essential for S1P-induced migration of these cells. The immunoprecipitation assays using CHO cells co-expressing both S1P4 and S1P1 receptors indicated that S1P4 and S1P1 are associated on the cell surface. These results suggest that the association of S1P4 and S1PI plays an important role in migratory response of mouse T cells toward S1P.
