手足小静脉逆行穿刺采血兼输液的效果观察

目的观察两种不同方向穿刺法完成采血、输液的效果。方法对118例住院采血兼输液的患者采用自身对照法。患者入院当天或危重抢救时采用逆行法，即选择手足处比较充盈的小静脉逆行穿刺采血，然后将头皮针连接输液装置输液。于第2天或下一次采血、输液时采用传统法即在一侧手足处行静脉输液，在对侧肢体肘正中静脉采血后送检。结果逆行法完成采血兼输液所需时间明显优于传统法（P〈0．01）；标本溶血、凝血及输液情况两种方法比较，差异无显著性意义（均P〉0．05），两种方法均能达到采血、输液目的。结论逆行穿刺法能省时、省力，减轻患者痛苦，扩大静脉选择范围。     

泛红试验联合负压法用于老年肥胖患者外周静脉穿刺

目的探讨泛红试验联合负压穿刺在老年肥胖患者外周静脉穿刺中的应用效果。方法选择500例门诊静脉输液治疗的老年肥胖患者,采用随机数字表法随机分成两组各250例,采用传统握拳法行手背静脉穿刺为常规法组,采用泛红试验联合负压穿刺为联合法组。比较两种方法静脉穿刺一次成功率、血管清晰情况、穿刺后回血情况。结果两种方法一次穿刺成功率、穿刺时血管清晰度、穿刺后回血情况比较,差异有统计学意义(均P0.01)。结论泛红试验联合负压穿刺法可以有效地提高老年肥胖患者血管充盈度,加快回血速度,提高穿刺成功率。     

小儿股静脉采血不同定位方法效果观察

目的:探讨提高小儿股静脉穿刺采血的成功率、减少反复穿刺痛苦,避免邻近器官损伤的方法。方法:选择我院460例1天～3岁的患儿,做股静脉穿刺采集血标本,观察组230例采用新的股静脉穿刺定位法,对照组230例采用扪及股动脉搏动的传统方法进行股静脉穿刺定位法,比较两种方法的一次穿刺成功率。结果:观察组一次性穿刺成功225例,出现淤血或小血肿5例,对照组一次性穿刺成功185例,出现淤血或小血肿24例。结论:新定位法进行股静脉穿刺采血成功率明显高于传统扪及股动脉搏动定位股静脉穿刺采血方法。     

真空采血法与传统采血法临床应用效果比较

目的探讨高效、安全采集血标本方法。方法将76例行颈外静脉穿刺采血幼儿、58例体表小静脉穿刺采血婴儿、160例体表静脉采血成人分别随机分为两组各38、29、80例,分别采用真空采血系统和传统一次性注射器采血法进行采血,比较两种方法采血一次成功率和标本质量合格率。结果真空采血系统采血一次成功率及标本质量符合率均显著高于传统采血法(P<0.01,P<0.05)。结论真空采血系统应用范围广,安全,采血标本质量好。     

回压静脉法在静脉穿刺困难患者中的应用

目的 提高静脉血管充盈不佳患者的穿刺成功率,减轻患者痛苦.方法 采用自身对照法,对112例静脉穿刺困难患者按输液单双日采用不同方法进行静脉穿刺.双日采用传统方法如握拳、拍打局部使静脉充盈后进行静脉穿刺(传统法);单日采用从静脉远心端向近心端推压3～6次后行静脉穿刺(回压法).比较两种方法浅静脉充盈程度及一次穿刺成功率.结果 回压法浅静脉充盈良好率显著高于传统法(P＜0.01),一次穿刺成功率回压法与传统法比较,差异有显著性意义(P＜0.05).结论 回压静脉穿刺方法可提高静脉穿刺成功率.     

回压静脉法在静脉穿刺困难患者中的应用

目的提高静脉血管充盈不佳患者的穿刺成功率,减轻患者痛苦。方法采用自身对照法,对112例静脉穿刺困难患者按输液单双日采用不同方法进行静脉穿刺。双日采用传统方法如握拳、拍打局部使静脉充盈后进行静脉穿刺（传统法）;单日采用从静脉远心端向近心端推压3～6次后行静脉穿刺（回压法）。比较两种方法浅静脉充盈程度及一次穿刺成功率。结果回压法浅静脉充盈良好率显著高于传统法（P〈0.01）,一次穿刺成功率回压法与传统法比较,差异有显著性意义（P〈0.05）。结论回压静脉穿刺方法可提高静脉穿刺成功率。     

婴幼儿静脉留置针间接采血法可行性探讨

目的探讨婴幼儿静脉留置针间接采血方法在临床应用的可行性。方法将180例患儿随机分为观察组和对照组各90例,对照组采用四肢浅表静脉直接采血法,观察组采用留置针间接采血法,比较两种采血方法首次穿刺成功率、血标本质量(溶血、凝血)及并发症发生率等。结果两组首次穿刺成功率均较高,两组比较,差异无显著性意义(P>0.05);两组血标本质量及皮下出血发生率比较,差异有显著性意义(P<0.05,P<0.01)。结论婴幼儿静脉留置针间接采血方法能减轻患儿的痛苦、确保血标本质量,且安全、并发症少。     

两种不同采血方法对心肌酶谱值影响的对比与相关研究

选择５０例急性心肌梗行静脉溶栓治疗的患者，采用直接静脉采血和输液静脉处取血的方法，每例分别采取对照和实验两组血进行对比和相关研究。结果：两组血清酶活性对比有显著性差异，而两组标本方程：Ｙ＝ａ＋ｂＸ即可得到对照组标本值。结论：输液静脉处取血所得心肌酶谱值代这方程后可以准确反映心肌酶谱值，替代静脉采血法。     

卡扣式止血带在老年患者静脉采血中的应用

目的:探讨应用卡扣式止血带对老年患者静脉采血穿刺成功率的影响。方法:选200例老年患者,按采血的先后顺序贯以序号,单号为实验组采用卡扣式止血带,双号为对照组采用乳胶管止血带,均选择肘部静脉。观察两组患者扎止血带后静脉充盈明显程度及对静脉穿刺成功率的影响。结果:实验组静脉充盈明显程度及静脉穿刺成功率与对照组比较差异均有统计学意义(P<0.01,P<0.05)。结论:卡扣式止血带用于老年患者静脉采血中穿刺成功率明显提高。     

静脉采血不同方法对心肌损伤生化和免疫学指标测定的影响

目的 探讨不同静脉采血方法对心肌损伤生化和免疫学指标测定值的影响.方法 选择50例急性心肌梗死行静脉溶栓治疗的患者,采用同源配对设计,对同一患者,分别采用常规方法采血和输液管处采血,获得不同采血方式的心肌酶谱资料.结果 两种方法采血其所得值比较,差异有统计学意义(P＜0.05,P＜0.01),两种方法采血所得值呈正相关...     

Perioperative and long-term morbidity and mortality after above-knee and below-knee amputations in diabetics and nondiabetics

We performed a retrospective review of a vascular surgery quality assurance database to evaluate the perioperative and long-term morbidity and mortality of above-knee amputations (AKA, n = 234) and below-knee amputations (BKA, n = 720) and to examine the effect of diabetes mellitus (DM) (181 of AKA and 606 of BKA patients). All patients in the database who had AKA or BKA from 1990 to May 2001 were included in the study. Perioperative 30-day cardiac morbidity and mortality and 3-yr and 10-yr mortality after AKA or BKA were assessed. The effect of DM on 30-day cardiac outcome was assessed by multivariate logistic regression and the effect on long-term survival was assessed by Cox regression analysis. The perioperative cardiac event rate (cardiac death or nonfatal myocardial infarction) was at least 6.8% after AKA and at most 3.6% after BKA. Median survival was significantly less after AKA (20 mo) than BKA (52 mo) (P < 0.001). DM was not a significant predictor of perioperative 30-day mortality (odds ratio, 0.76 [0.39-1.49]; P = 0.43) or 3-yr survival (Hazard ratio, 1.03 [0.86-1.24]; P = 0.72) but predicted 10-yr mortality (Hazard ratio, 1.34 [1.04-1.73]; P = 0.026). Significant predictors of the 30-day perioperative mortality were the site of amputation (odds ratio, 4.35 [2.56-7.14]; P < 0.001) and history of renal insufficiency (odds ratio, 2.15 [1.13-4.08]; P = 0.019). AKA should be triaged as a high-risk surgery while BKA is an intermediate-risk surgery. Long-term survival after AKA or BKA is poor, regardless of the presence of DM.     

Body composition assessment and methodology in nonathletic and athletic adolescent and adult males and females

The purpose of this review is to outline methodology for assessing body composition utilizing anthropometric and densitometric techniques. The objective of body composition assessment is to measure body fat and lean body mass. The quantity of these components varies due to growth, physical activity, dietary regimens, and aging. Anthropometric techniques incorporate selected skinfolds, circumferences, skeletal widths, or other variables to estimate body composition within k2.0-4.0%. These techniques are adequate for field testing of groups or individuals, but are population specific. Densitometry measures body volume irrespective of physique, sex, or age. This laboratory technique estimates body composition within 1.0-2.0%, is more difficult to administer, but is not population specific. Some limitation exists with any present technique due to biological variability and incomplete research of reference body composition in children, females, and the aged. J Orthop Sports Phys Ther 1984;5(6):336-347.     

Postoperative nausea and vomiting and opioid-induced nausea and vomiting: guidelines for prevention and treatment

Postoperative nausea and vomiting (PONV) causes patient discomfort, lowers patient satisfaction, and increases care requirements. Opioid-induced nausea and vomiting (OINV) may also occur if opioids are used to treat postoperative pain. These guidelines aim to provide recommendations for the prevention and treatment of both problems. A working group was established in accordance with the charter of the Sociedad Espa?ola de Anestesiología y Reanimación. The group undertook the critical appraisal of articles relevant to the management of PONV and OINV in adults and children early and late in the perioperative period. Discussions led to recommendations, summarized as follows: 1) Risk for PONV should be assessed in all patients undergoing surgery; 2 easy-to-use scales are useful for risk assessment: the Apfel scale for adults and the Eberhart scale for children. 2) Measures to reduce baseline risk should be used for adults at moderate or high risk and all children. 3) Pharmacologic prophylaxis with 1 drug is useful for patients at low risk (Apfel or Eberhart 1) who are to receive general anesthesia; patients with higher levels of risk should receive prophylaxis with 2 or more drugs and baseline risk should be reduced (multimodal approach). 4) Dexamethasone, droperidol, and ondansetron (or other setrons) have similar levels of efficacy; drug choice should be made based on individual patient factors. 5) The drug prescribed for treating PONV should preferably be different from the one used for prophylaxis; ondansetron is the most effective drug for treating PONV. 6) Risk for PONV should be assessed before discharge after outpatient surgery or on the ward for hospitalized patients; there is no evidence that late preventive strategies are effective. 7) The drug of choice for preventing OINV is droperidol.     

Similarities and differences between female and male sexual functions and dysfunctions

Men and women have 23 pairs of chromosomes. They share 22 of them. In physiologic conditions they differ systematically in only one pair, the sexual one. Females (normally) have what is called an “XX” on the 23rd pair of chromosomes, whereas males have an “XY” pair. The striking sexual differences –anatomic, functional, reproductive, psychological and sociocultural - between men and women depends on or derive from the difference in one critical chromosome out of 46, which contains on average 2% of all the genetic code. Biochemical, neuroendocrine, hormonal, vascular, nervous, and metabolic similarities that both sexes share, based on the common 45 chromosomes and related biologically determined similarities contributing to the secret sexual symmetry between genders, is reviewed. Furthermore the role of the genetically determined brain and somatic gender dymorphism, contributing to gender sexual differences is analyzed. Neuroplasticity and psychoplasticity are praised as basic mechanisms that bridge together and re-shape the individual biological and psychological world through the continuous interaction with the environment. Enhancement of sexual differences in behaviour, meaning of, and motivation to sex by cultural constructs, by religious and social dynamics, and the continuous interaction of each person with a usually role-polarized society during the whole life span will be finally acknowledged. To contribute to a better understanding of the shared biological sexual similarities between genders and their dialectic and continuous relation with biological and socioculturally related sexual differences is the ultimate goal of this introductory article and the following papers of the series.