ABSTRACT
This paper reviewed three aspects of risk factors of catheter-related thrombosis in critically ill children with central venous access devices, including the child's own factors, catheter-related factors and external factors. It summarized the main research advances of preventive measures such as the strengthen assessment of pre-catheterization, drug and mechanical prevention of thrombosis, control of catheter-related other complications, thrombus screening routinely, risk assessment model is used. It is to provide experience for early clinical identification and formulation of preventive measures, so as to reduce the occurrence of catheter-related thrombosis in critically ill children and promote the central venous access device used safely in PICU.
ABSTRACT
Objective To explore how the different intervention measures affect the outcome of central venous catheter-related thrombosis (CRT) in children. Methods A retrospective analysis was carried out to collect the clinical data of patients with CRT from the nursing management system of the Children′s Hospital Affiliated to Zhejiang University School of Medicine which reported by each nursing unit from January 1,2015 to December 31,2015. Results Totally 108 cases were included (72 boys and 36 girls), median age of 24.5 months (ranged from 1 month to 14 years old). Nearly 42.59% (46/108) patients suffered from neurological diseases. Nearly 55.56%(60/108) CRT was detected in the first week after catheterization. Once CRT conformed, there were four kinds clinical intervention options applied. Intervention 1: thrombolytic therapy with urokinase combined anticoagulation with nadroparin calcium. Intervention 2: anticoagulant therapy only. Intervention 3: thrombolytic therapy alone. Intervention 4: no medications. The differences of effective between the four kinds of intervention were statistically significant (χ2=13.380, P=0.004). The single-factor regression analysis was done to each relevant factor. Finally the multivariate regression analysis showed four factors had impacts upon the results. The factors were as follows:gender (OR=10.400, 95%CI 1.879-57.563, P=0.007);interval (OR=1.107, 95%CI 1.035-1.184, P = 0.003), size of thrombus(OR = 1.562,95%CI 1.033-2.362,P=0.035; Intervention 2 (OR =11.757, 95% CI 2.254- 61.327, P = 0.003), intervention 4 (OR = 35.397, 95% CI 3.493-358.760, P =0.003). Conclusions The earlier and small size thrombus is more soluble. Thrombolytic therapy or combined anticoagulation is more effective. It is recommended that if no contraindications presents, thrombolytic combined with anticoagulant therapy should start early standardized treatment.
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Objective To develop the severity score of pediatric hand foot and mouth disease (HFMD),guide health care providers in the early detection and intervention of critical ill cases,in order to improve the survival rate and reduce the incidence of complications and mortality.Methods Based on PCIS,the severity score of HFMD in children was designed by adding fever and nervous system damage symptoms,which was the common symptoms of severe cases.The data of the cases who admitted in April 2008 to November 2010 (group A,88 cases) was retrospectively analyzed to evaluate the validity and credibility of the score.The score were prospectively applied to all of the HFMD cases who admitted from May 2011 to October 2013(group B,118 cases),delivering corresponding treatment and care measures based on scoring result as well.At last the outcome of the two groups was compared.Results It exhibited quite good consistency between the scores and the clinical condition of patients with HFMD.The general information of two groups was not significantly different,but the survival rate,the incidence of neurological sequel and the mortality between two groups were significantly different by x2 test.Conclusions The score can objectively and accurately assess the severity of HFMD in children.Clinical application of this scoring method to assess the children with HFMD can identify critical ill cases as early as possible.Corresponding intervention delivering in time may improve the outcome.It is proved to have positive clinical value to increase the survival rate,decrease the incidence of neurological sequel and the mortality of critical ill HFMD cases,and is worthy of clinical application in pediatric department.
ABSTRACT
Cell adhesive molecular P-selectin was cloned, expressed and anchored on CHO cell membrane through GPI for selection specific antibodies. Total human platelet RNA was extracted and the functional segment of P-selectin gene was cloned by RT-PCR. The P-selectin functional segment gene was cloned into a eukaryotic expression vector pMCEw2-GPI containing an attenuated neo gene together with a downstream GPI, which was synthesized by overlapping PCR. The recombinant plasmid pMCEw2-GPI-P-selectin was then transfected to CHO(dhfr-) cells and screened with G418. ELISA, western-blot and immunofluorescence were carried out to detect the stability of P-selection expression on cell membrane. These results provided a necessary basis for the following study of selection the antibodies targeting P-selectin.