目的构建血液病患者经外周静脉置入中心静脉导管(PICC)导管异位风险因素评估体系,为血液病患者中心静脉血管通路异位预防提供参考依据。方法自2022年7月成立课题研究小组,通过文献回顾,检索PubMed、Web of Science等国内外数据库及网站中发表的与PICC导管异位风险相关的文献,经全文筛选和提取,纳入血液病患者PICC导管异位风险评估体系条目池;通过进一步课题组专家讨论,结合循证依据,拟定体系函询条目;采用Delphi专家函询法,构建适用于血液病患者的PICC导管异位风险的评估体系标准。结果邀请25名函询专家:女24名,男1名,年龄(48.36±6.82)岁。经过2轮专家函询和修订,得出血液病患者PICC导管异位风险因素包含4项Ⅰ级指标:患者因素、治疗因素、导管相关因素、操作因素,11项Ⅱ级指标,25项Ⅲ级指标。2轮专家函询问卷有效回收率分别为84%、100%;Kendall协调系数分别为0.22和0.55(均P<0.05);专家权威系数为0.93。结论血液病患者PICC导管异位风险评估体系专家认可度高,一致性好,具有临床实践与指导价值。
侵袭性真菌感染是免疫功能低下患者发病和死亡的主要原因,尤其是在那些造血干细胞移植、器官移植或者接受化疗的急性白血病患者中更为常见。三唑类抗生素是侵袭性感染的主要预防或治疗药物,其抗菌谱广、毒性较小、耐受性较好,用于治疗念珠菌和曲霉菌,特别是免疫缺陷型患者中的常见药物,可显著降低其死亡率。但由于其本身也作用于哺乳动物细胞色素P450酶系,易与其他药物发生相互作用产生毒性。本文综述了三唑类药物(伊曲康唑、氟康唑、伏立康唑、泊沙康唑和艾沙康唑)的作用方式及药物相互作用、药物治疗监测等,并强调了其相似性和差异性的临床意义。Fungal infections are a major cause of morbidity and mortality in immunocompromised patients, especially in those undergoing hematopoietic stem cell transplantation, organ transplantation, or acute leukemia undergoing chemotherapy. Triazole antibiotics are the main prophylactic or therapeutic drugs for invasive infections. However, they feature a broad antimicrobial spectrum, minimal toxicity, and good tolerability. It is used to treat candidiasis and aspergillosis, particularly in immunocompromised patients, where it can significantly reduce mortality rates. However, because they also act on the mammalian cytochrome P450 enzyme line, it is easy to interact with other drugs to produce toxicity. This review summarizes the mode of action, drug interaction, and therapeutic monitoring of triazole drugs (itraconazole, fluconazole, voriconazole, posaconazole, and oxaconazole), and highlights the clinical significance of the similarities and differences.
