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Comparison of Two Catheter Implantation Methods in Administering Amphotericin B in Patients with Hematological Malignancies with Fungal Infections

目的：通過經外周靜脈穿刺中心靜脈置管（PICC）或鎖骨下靜脈置管與前臂靜脈留置針在血液病患者并發深部真菌感染時應用兩性霉素B中的比較，探討如何減少患者靜脈炎及并發癥發生率和再次靜脈穿刺的發生率，從而提高患者生活質量。方法：80例血液病患者分為兩組，40例PICC置管或鎖骨下靜脈置管組為A組，40例前臂靜脈留置針為B組，記錄靜脈炎、疼痛發生情況、留置時間。結果：A組留置時間30～68天，B組留置時間1～5天；A組靜脈炎率5%，B組靜脈炎率45%；A組疼痛率5%，B組疼痛率35%；結論：在血液病患者并發深部真菌感染時應用兩性霉素B治療中，選用PICC置管或鎖骨下靜脈置管效果明顯優于前臂靜脈留置針，值得臨床推廣。

180例血液科住院患者護理滿意度調查分析及對策

目的：通過調查找出護理工作的薄弱環節，分析原因提出對策，提高護理服務質量。方法：對2007年1~12月血液科住院患者的護理滿意度進行調查，選擇住院3天以上、神志清楚、能閱讀文字或可以正確回答問題的患者，每月10日發放調查表15份，調查內容包括護士長接待、服務態度、巡視病房、指導服藥、護理技術、入院宣教、健康教育、病房環境及護理總體評價。結果：病房環境滿意度為88.7%；其他項目滿意度均在96.0%以上。結論：隨著我國醫療體制改革的不斷深入，患者對住院環境、疾病知識介紹、護理技術等要求也在不斷提高。

Short-term Peripheral Red Cells Parameters Observation after Stem Cell Transplantation in Patients with Hematonosis

目的:觀察血液病患者造血干細胞移植后外周血細胞參數的近期動態變化,了解骨髓恢復情況。方法:使用SE-9500血細胞分析儀對28例血液病患者造血干細胞移植前后血液進行檢測,觀察移植后一個月內各參數的變化。結果:28例外周血干細胞移植前后各細胞參數的觀察發現,紅細胞平均容積(MCV)、紅細胞平均血紅蛋白含量(MCH)、紅細胞平均血紅蛋白濃度(MCHC)和紅細胞體積發布寬度(RDW-CV%)等參數其結果在干細胞移植前后進行比較,雖然有變化,但無顯著性差異(Pgt;0.05);紅細胞計數(RBC)、血紅蛋白(HGB)、紅細胞壓積(HCT)、網織紅細胞絕對數(RET)、低熒光強度網織紅細胞百分率(LFR%)、高熒光強度網織紅細胞百分率(HFR%)和中熒光強度網織紅細胞百分率(MFR%)等參數變化較大,有顯著性差異(Plt;0.05)。RBC、HGB和HCT在移植后第14天降至最低,以后逐漸升高;在干細胞移植后第7天RET＃、MFR％和HFR％降至最低,LFR％相對增高,隨著干細胞移植后骨髓功能逐漸恢復,RET＃也隨之升高,HFR在第14天升至最高,MFR在第21天升至最高。結論:觀察干細胞移植后外周血細胞參數的變化,對了解干細胞移植后骨髓的恢復有一定的臨床價值,本次結果表明HFR可作為了解骨髓恢復的早期指標。

Diagnostic Value of T-SPOT.TB Assay in Patients with Hematological Disorders and Tuberculosis

ObjectiveTo evaluate the diagnostic value of T-SPOT.TB assay in patients with hematological disorders and tuberculosis. MethodsA total of 82 patients with hematological disorders and suspected tuberculosis diagnosed between March 2012 and April 2013 received T-SPOT. TB assay in the peripheral blood mononuclear cells. ResultsThe positive detection rate of T-SPOT.TB assay for patients with hematological disorders and tuberculosis was 59.09% (13/22), which was higher than the positive detection rate of anti-TB antibody test[13.64% (3/22)]. The sensibility and specificity of T-SPOT.TB assay for patients with hematological disorders and tuberculosis was 59.09% (13/22) and 68.33% (41/60), respectively. ConclusionT-SPOT.TB assay is of great value on diagnosis of tuberculosis for patients with hematological disorders and suspected tuberculosis. The diagnostic value of T-SPOT.TB assay is more important for tuberculosis infected patients; it can be used as an accessorial diagnostic method for patients with hematological disorder and suspected tuberculosis.

The Interpretation of Diagnosis and Treatment Guideline of Invasive Fungal Disease in Patients with Hematological Diseases

Application of metagenomic next-generation sequencing in diagnosis and treatment of severe infection of hematological disorder

Objective To explore the clinical value of metagenomic next-generation sequencing (mNGS) in the diagnosis and treatment of severe and complex infection of malignant hematological disorder. Methods The mNGS test results, traditional etiology test results and general clinical data of inpatients with malignant hematological disorder in the Department of Hematology, the Affiliated Hospital of Southwest Medical University between June 2020 and February 2022 were retrospectively analyzed. To explore the clinical application value of mNGS in the diagnosis and treatment of severe complicated infection of hematological disorder. Results A total of 21 patients were included. The samples included 18 peripheral blood samples, 2 pleural fluid samples and 1 alveolar lavage fluid sample. In the included patients, through mNGS, pathogenic bacteria were directly detected in 17 patients, including 8 fungi, 9 bacteria and 10 viruses, of which 9 were mixed infections. The positive rate (81.0% vs. 33.3%, P=0.002), sensitivity (85.7% vs. 30.0%), granulocytopenia (9 vs. 3 cases, P=0.031) and the types of pathogen (Z=?3.416, P=0.001) detected by mNGS were all higher than those by traditional method. The infection control of 17 patients improved in varying degrees after adjusting the treatment plan according to the test results. ConclusionsmNGS has significantly higher detection rate and sensitivity for bacteria, fungi, viruses and mixed infections. Compared with the traditional method, mNGS has more efficient characteristics. Its clinical application can further improve the diagnosis and treatment efficiency of severe complicated infection of malignant hematological disorder, and thus improve the survival rate of patients.

綜合干預措施對提高血液病房醫護人員手衛生依從性的影響

目的對血液科醫護人員手衛生的依從性進行調查分析，通過綜合干預措施提高醫護人員的手衛生依從性。 方法由經過專門培訓的醫院感染管理科專職人員，在醫護人員不知情的情況下，按照統一的調查表，觀察醫護人員手衛生的執行情況。2012年第1季度-第3季度為基線調查階段，2012年第4季度-2013年第1季度為干預階段，采取綜合干預措施，2013年第2季度-第4季度為評估干預效果階段。 結果干預前醫護人員手衛生依從率為41.32%，干預后提高到70.41%，差異有統計學意義（P＜0.01）。其中醫生手衛生的依從率從31.58%提高到65.00%，護士手衛生的依從率從40.76%提高到74.64%。 結論綜合干預措施可提高醫護人員手衛生依從性。

Prognostic value of red cell volume distribution width in hematological malignancies: a meta-analysis

Objective To explore the prognostic value of red cell volume distribution width (RDW) for hematological malignancies. Methods PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Wanfang, Chongqing VIP, and SinoMed were searched for related literatures on myelodysplastic syndrome, leukemia and other hematological malignancies and pretreatment RDW from the establishment of databases to April 5, 2022. The main statistical indicators were Hazard ratio (HR) and its 95% confidence interval (CI). Stata 12.0 SE software was used for analysis, and Q test was used to evaluate literature heterogeneity. Subgroup pooled analysis was used to evaluate the prognostic value of RDW. Results A total of 7 articles were included, with a total of 804 patients. A fixed-effect model was selected for meta-analysis, and the results showed that patients with elevated pretreatment RDW had worse overall survival [HR=2.91, 95%CI (2.01, 4.22), I2=0%, P=0.714]. The results of subgroup analysis for different types of diseases showed that in myelodysplastic syndrome group [HR=2.61, 95%CI (1.28, 5.31), I2=22.0%, P=0.258)], chronic myeloid leukemia group [HR= 3.24, 95%CI (1.91, 5.51), I2=0%, P=0.546], and adult T-cell leukemia/lymphoma group [HR=2.64, 95%CI (1.22, 5.70)], the overall survival rate of patients with elevated pretreatment RDW were worse. Sensitivity analysis showed that the study was stable and there was no heterogeneity in the overall study result.Conclusion Elevated pretreatment RDW is associated with overall survival and can be used as an indicator for evaluating the prognosis of hematological malignancies, but large sample studies are still needed to determine the best predictive cutoff for various diseases.

優質護理服務對惡性血液病患者焦慮抑郁的影響

目的　討論優質護理服務對惡性血液病患者焦慮及抑郁的影響。 方法　2011年10月－2012年1月對58例惡性血液病患者從人文關懷角度施以關心和心理干預，并加大健康教育宣傳力度，提供全程化、無縫隙護理。并采用Zung焦慮自評量表（SAS）和抑郁自評量表（SDS）對入、出院時患者焦慮及抑郁情況進行問卷調查。 結果　患者入院時SAS、SDS得分顯著高于我國常模值（P＜0.01），出院患者焦慮及抑郁得到改善和緩解，與入院相比SAS、SDS得分差異有統計學意義（P＜0.01）。 結論　惡性血液病患者存在焦慮抑郁情緒，通過優質護理服務可改善其焦慮抑郁狀況。