Study On Focal Vascular Changes At Different Time And Drug Intervention Of Vincristine Induced Phlebitis

Objectives:1. To overview the systematic reviews or meta-analysis of the intervention of chemotherapeutics induced phlebitis, provide the evidence for clinic practice and support of the basic research later.2. To study the development of chemotherapeutics induced phlebitis at the early stage, explore the effects of Xianchen on phlebitis induced by vincristine, provide the new reliable basis for preventing phlebitis in clinical settings.Methods:1. Overviews of reviews on the intervention of chemotherapeutics induced phlebitisCollected and selected the systematic reviews or meta-analysis which focused on the intervention of chemotherapeutics induced phlebitis including the Cochrane Library, JBI, Pub Med, OVID, Springerlink, CBM, CNKI and Wanfang database and so on. Used the index words “phlebitis/inflammation”, “treatment/prevent/intervene”, “system review/review/meta-analysis” and formulated the inclusion and exclusion criteria. Extracted and collated the basic information, methodology, results of the reviews, and the OQAQ was used to evaluate the methodological quality. The main evaluation index including total efficient, incidence, and adverse reactions, then used descriptive methods for collating, analysis and summary.2. Study on focal vascular changes at different time and drug intervention of vincristine induced phlebitisBasic experiment was divided into three stages, each stage of vincristine induced phlebitis model was established. The first stage was to determine pathological based site, there were 6 rabbits, 24 hours after test fluid infusion, three sites were examined by the pathological diagnostic criteria, then confirmed the site of sampling. Second stage had 36 rabbits, divided randomly into 6 groups, 0 hour, 1 hour, 3 hours, 6 hours, 12 hours, 18 hours after infusion of vincristine into the experimental rabbits, observed the development of phlebitis through visual observation and pathological diagnostic criteria. The third part had 30 rabbitis, divided into five groups randomly, group of Hirudoid(bid), group of Xianchen(daily), group of Xianchen(bid), group of Xianchen(tid) and blank control group. After infusion, the intervenetion drugs were used on rabbits based on the development of phlebitis at different time. Two days after intervention, evaluated the degree and level of venous injury through above two methods.Results:1. Overviews of reviews on the intervention of chemotherapeutics induced phlebitisTotal 15 literatures were finally chose, one was written in English, the methods of intervention included drug intervention, patches(Sanyrene, comfeel transparent paste) and evidence-based nursing. Drug intervention included tradional medicine(Ruyi Jinhuang Power, potato, aloe vera) and Hirudoid. Various interference effects of the methods were better than magnesium sulfate, Hirudoid was better than Ruyi Jinhuang Power. According to the standard of OQAQ, methodological quality evaluation scores were three to seven. Data analysis results showed heterogeneity of systematic reviews or meta-analysis that about the intervention of chemotherapeutic induced phlebitis was low(I2﹤50%). The evaluation indexes contained international indexes(INS, WHO chemotherapy drug skin toxicity grading standard) and self rating standard. There were 3 studies about intervention time of systematic reviews, and 2 studies considered the relationship between intervention time and grade of phlebitis. 6 studies referred to time of intervention, but did not analysis, and others ignored it. There were nine studies of systematic reviews or meta-analysis of intervention reported the adverse reactions. All literatures did not evaluate the begin time of intervention and economics.2. Study on focal vascular changes at different time and drug intervention of vincristine induced phlebitis2.1 After 24 hours, the model of vincristine induced phlebitis, three based sites of pathology testing showed that there was no statistical difference among the sites for degrees of inflammation(P>0.05), selected pathology based site which was the vein puncture point 1 cm to the direction of the rabbits’ ears for sampling.2.2 Redness occurred after infusion of Vincristine through visual observation, and after 3 hours disappeared. However, 12 hours after infusion the redness appeared again, and the dark red appeared along the vein after 18 hours. There were significant differences(P<0.05) between 3 hours and 24 hours, 6 hours and 24 hours, 12 hours and 24 hours through visual observation. There were no significant differences(P>0.05) among inflammatory cells, edema and thrombosis based on pathological diagnostic criteria, the loss of venous endothelial cells from histopathological evaluation demonstrated significant differences among groups(P<0.05), and it became worse 24 hours after infusion. In this study, the thrombosis occurred early.2.3 There were significant differences(P<0.05) between Hirudoid group and control group, Xianchen groups and control group, interventions alleviated the level of phlebitis. There were no significant differences(P>0.05) between Hirudoid group and Xianchen groups, phlebitis in Xianchen group(daily) was worse than Xianchen group(tid)(P<0.05) through visual observation after interventions two days. There were on significant differences among inflammatory cells(P>0.05). However, the curative effect of loss of venous endothelial cells, edema and thrombosis, there were significant differences among groups(P<0.05). Compared with the control group, effects of Hirudoid group(bid), Xianchen group(bid), Xianchen group(tid) were better in the loss of venous endothelial cells(P<0.05). Xianchen group(tid)(P<0.05) had better intervention in edema than others(P<0.01). About the intervention of thrombosis, Hirudoid group(bid) and Xianchen group(tid) had better effect than other groups(P<0.05).Conclusions:1. The effect of traditional Chinese medicine(Ruyi Jinhuang Powder, Jinhuang Paste), Hirudoid, potato, aloe vera, Sanyrene, comfeel transparent dressing, which better than magnesium sulfate. However, the quality of systematic reviews or meta-analysis for the intervention was variable, and the methodological quality defects. Evaluation of intervention time was omissions. Evaluation indexes were diversiform, and lack of unified evaluation index. Evaluation of safety and economics need further research.2. The inflammatory reaction of phlebitis appeared early and the thrombus of vein occurred at early stage. Xianchen can be used to treat phlebitis induced by vincristine, particularly it had significant effective in treatment of edema, and there was remarkable dose response relationship. However, its mechanism still needs further study in later experiment.