在资源有限的环境中管理 HIV 合并隐球菌性脑膜炎患者中两性霉素 B 诱导性静脉炎：一项前瞻性队列研究。
Management of amphotericin-induced phlebitis among HIV patients with cryptococcal meningitis in a resource-limited setting: a prospective cohort study.
机构信息
Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.
Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, USA.
出版信息
BMC Infect Dis. 2019 Jun 26;19(1):558. doi: 10.1186/s12879-019-4209-7.
BACKGROUND
Amphotericin-induced phlebitis is a common infusion-related reaction in patients managed for cryptococcal meningitis. High-quality nursing care is critical component to successful cryptococcosis treatment. We highlight the magnitude and main approaches in the management of amphotericin-induced phlebitis and the challenges faced in resource-limited settings.
METHODS
We prospectively determined the incidence of amphotericin-induced phlebitis during clinical trials in Kampala, Uganda from 2013 to 2018. We relate practical strategies and challenges faced in clinical management of phlebitis.
RESULTS
Overall, 696 participants were diagnosed with HIV-related cryptococcal meningitis. Participants received 7-14 doses of intravenous (IV) amphotericin B deoxycholate 0.7-1.0 mg/kg/day for induction therapy through peripheral IV lines at a concentration of 0.1 mg/mL in 5% dextrose. Overall, 18% (125/696) developed amphotericin-induced phlebitis. We used four strategies to minimize/prevent the occurrence of phlebitis. First, after every dose of amphotericin, we gave one liter of intravenous normal saline. Second, we rotated IV catheters every three days. Third, we infused IV amphotericin over 4 h. Finally, early ambulation was encouraged to minimize phlebitis. To alleviate phlebitis symptoms, warm compresses were used. In severe cases, treatment included topical diclofenac gel and oral anti-inflammatory medicines. Antibiotics were used only when definite signs of infection developed. Patient/caregivers' education was vital in implementing these management strategies. Major challenges included implementing these interventions in participants with altered mental status and limited access to topical and oral anti-inflammatory medicines in resource-limited settings.
CONCLUSIONS
Amphotericin-induced phlebitis is common with amphotericin, yet phlebitis is a preventable complication even in resource-limited settings.
TRIAL REGISTRATION
The ASTRO-CM trial was registered prospectively. ClincalTrials.gov : NCT01802385 ; Registration date: March 1, 2013; Last verified: February 14, 2018.
背景
两性霉素 B 诱导的静脉炎是隐球菌性脑膜炎患者常见的输液相关反应。高质量的护理是隐球菌病成功治疗的关键组成部分。我们强调了在资源有限的环境中管理两性霉素 B 诱导的静脉炎的重要性和主要方法以及所面临的挑战。
方法
我们前瞻性地确定了 2013 年至 2018 年在乌干达坎帕拉进行的临床试验中两性霉素 B 诱导性静脉炎的发生率。我们讲述了在临床管理静脉炎中遇到的实际策略和挑战。
结果
共有 696 名参与者被诊断为 HIV 相关隐球菌性脑膜炎。参与者通过外周静脉线接受 7-14 天剂量的静脉注射两性霉素 B 去氧胆酸盐 0.7-1.0mg/kg/天，浓度为 0.1mg/mL，在 5%葡萄糖中。总的来说，18%（125/696）发生了两性霉素 B 诱导的静脉炎。我们使用了四种策略来尽量减少/预防静脉炎的发生。首先，在每次给予两性霉素 B 后，我们给予 1 升静脉注射生理盐水。其次，我们每三天轮换一次静脉导管。第三，我们将 IV 两性霉素 B 输注 4 小时。最后，鼓励早期活动以尽量减少静脉炎。为缓解静脉炎症状，使用了热敷。在严重的情况下，治疗包括局部双氯芬酸凝胶和口服抗炎药。只有在出现明确的感染迹象时才使用抗生素。患者/护理人员的教育对于实施这些管理策略至关重要。主要挑战包括在精神状态改变和资源有限的情况下难以获得局部和口服抗炎药的参与者中实施这些干预措施。
结论
两性霉素 B 诱导的静脉炎很常见，但即使在资源有限的情况下，静脉炎也是一种可预防的并发症。
试验注册
ASTRO-CM 试验是前瞻性注册的。ClincalTrials.gov：NCT01802385；注册日期：2013 年 3 月 1 日；最后验证：2018 年 2 月 14 日。
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