介入诊疗股动脉和桡动脉穿刺的并发症及其护理

总结了介入诊疗股动脉和桡动脉穿刺并发症的原因与护理要点.包括:操作不当、大量使用抗凝剂、紧张、疼痛和术后下肢过早活动等,认为在介入诊疗过程中,充分的术前准备,积极的术中、术后监护处理,对保证患者手术顺利,预防或减少并发症有重要意义.     

婴幼儿桡动脉与股动脉穿刺采血的临床观察

目的 探索桡动脉与股动脉穿刺采血在婴幼儿中应用的临床效果.方法 将500例3岁以下的婴幼儿随机分成观察组和对照组,各250例.观察组采用桡动脉采血,对照组采用股动脉采血,分别记录一次穿刺成功率、损伤程度、操作时间和压迫止血时间.结果 采血成功率观察组95.2%,对照组87.2%;穿刺部位血肿发生率观察组6%,对照组20%;平均采血时间观察组(4.1±1.04)min,对照组(6.4±1.41)min;按压止血平均时间观察组(1.89±0.32)min,对照组(5.27±0.81)min,2组比较差异有统计学意义(均p<0.005).结论 婴幼儿桡动脉采血比股动脉采血一次成功率高,损伤程度轻,按压时间、操作时间短.     

桡动脉穿刺法在婴幼儿采血中的临床应用

目的 探讨桡动脉穿刺法在婴幼儿采血中的临床应用效果.方法 将106例需要采血的患儿随机分成2组,桡动脉组54例,股静脉组52例,对2组一次性穿刺成功率、穿刺处局部疼痛发生率、标本合格率3个指标进行比较.结果 桡动脉组一次性穿刺成功率94.4%,高于股静脉组80.8%(P＜0.05);桡动脉组穿刺处局部疼痛发生率3.7%,低于股静脉组19.23%(P＜0.05);桡动脉组标本合格率98.1%,高于股静脉组84.6%(P＜0.05).结论 桡动脉穿刺法是婴幼儿采血的最佳方法.     

足背动脉穿刺法在危重患者采血中的应用

目的 探索一种更为有效、安全的动脉穿刺采血方法.方法 对ICU收治的246例危重患者采取桡动脉(对照组)、足背动脉(观察组)穿刺采血的病例进行统计分析,并对临床效果进行评价.结果 2组不良反应率存在显著差异(p<0.05),采血成功率差异无统计学意义(p>0.05).结论 足背动脉穿刺采血不良反应率低,比桡动脉采血时对患者的不良影响明显要小,可以减轻患者痛苦、有踝部约束带时亦不影响采集,方便护士操作,节约护士的工作时间、减少工作强度,值得在ICU日常护理工作中推广.     

股静脉置管在急危重病人应用中的问题与对象

为减少和预防股静脉置管在急危重症患者应用中出现的问题和并发症.我ICU采用严格无菌操作、提高置管穿刺成功率,正压封管,向心性按摩和每日局部换药大大减少了股静脉置管所发生的皮下血肿、导管堵塞、静脉血栓形成、细菌污染.为此我们提出并且制定了相关问题的处理对策和方法,可大大减少并发症的发生,具有较高的临床使用价值.     

PICC置管在肿瘤患者化疗中的应用及护理

总结了PICC置管在肿瘤患者化疗中的应用及护理.包括为肿瘤化疗患者建立良好的静脉通道,保证药物准确输入,避免化疗药物产生的局部不良反应对患者造成痛苦.对35例患者进行PICC置管静脉输入化疗药.应用PICC35例,其中有1例于置管后1d自行拔管后,未再置管,其余34例顺利完成了化疗.认为PICC置管为肿瘤患者化疗用药提供了一条安全、简便的输液途径,较大程度提高了患者生活质量.     

无创与有创通气在COPD并呼吸衰竭的临床应用比较及护理体会

目的:观察无创通气与有创通气治疗慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭的临床疗效以及机械通气的合理护理.方法:80例COPD合并Ⅱ型呼吸衰竭患者,应用分层随机化法分为无创组和有创组各40例,两组均给予常规基础治疗.当患者需要机械通气时,无创组给予无创呼吸辅助,治疗效果不佳时更换为有创通气;有创组给予有创呼吸辅助.结果:治疗后两组血气分析结果均有显著改善,有创组改善程度优于无创组,但差异均无显著性(均P>0.05);两组患者死亡率差异无显著性;无创组插管率、住ICU时间、VAP发生率、住院费用较有创组明显降低,差异有显著性.结论:无创通气治疗COPD合并Ⅱ型呼吸衰竭无创伤、疗效确切,缩短住院治疗时间,降低住院费用和VAP发生率,能使部分患者免于气管插管,值得临床广泛应用.机械通气期间的合理护理干预对治疗结果有重要影响.     

危重患者目标血压监测在使用血管活性药中的应用研究

目的 探讨危重症患者在应用血管活性药物时目标血压监测的方法.方法选择2009年1月～12月微泵使用血管活性药的危重患者160例,将2009年1月～6月微泵使用血管活性药的80例病例作为对照组,2009年7月～12月微泵使用血管活性药的80例病例作为实验组.对照组按常规医嘱使用血管活性药物,血压低/高于正常值调节微泵血管活性药物的入速;实验组患者由医生与护士商讨,根据其基础血压、病情设立血压监测目标值,护理人员根据目标值调整血管活性药物的入速,比较2组患者的监测目标血压的达标率.结果对照组患者的监测目标血压的达标率为75%,实验组患者的监测目标血压的达标率为95%.实验组明显高于对照组,差异有统计学意义(P<0.05).结论血管活性药物在ICU较常用,作为药物治疗的执行者及监护者,护理人员起着关键的作用,而分析监测目标血压达标率低的原因、确立目标及制定相应对策,可以提高危重症患者使用血管活性药监测目标血压的达标率.     

锁骨下静脉与股静脉穿刺插管术在急诊抢救中的应用及比较

目的 比较锁骨下静脉与股静脉穿刺插管术在急诊抢救的应用效果.结果 采用回顾性对照研究,对48例锁骨下静脉穿刺插管及82例股静脉穿刺插管的插管时间、成功率及相关并发症等进行观察比较.结果股静脉穿刺插管术操作较简单,穿刺成功率高,插管时间短,并发症少.结论 相对比较而言,股静脉穿刺插管在抢救急、危、重症病人时不失为更理想的静脉通道.     

The value of arterial blood pressure measurement in assessing the prognosis in equine colic

Indirect arterial blood pressure was determined on 33 horses prior to surgical intervention for the diagnosis and/or correction of acute abdominal disorders and a relationship between low systolic blood pressure and non-survival was established. It is suggested that blood pressure determination should be used to augment other methods of clinical and laboratory examination in cases of equine colic.     

Effects of positive pressure on both femoral venous and arterial blood velocities and the cutaneous microcirculation of the forefoot

OBJECTIVE: The balance between the apparent beneficial effect and the risk of arterial ischaemia resulting from an external uniform compression is unclear. The purpose of this study was to determine the effects of a positive uniform compression on the lower limb circulation until a critical threshold was reached. METHODS: We used Doppler ultrasound to measure femoral venous and arterial blood velocities. The effects of positive pressure on cutaneous microcirculation were evaluated by laser Doppler flux (LDF), transcutaneous oxygen pressure (tcpO2) and transcutaneous carbon dioxide pressure (tcpCO2) on the forefoot of 17 healthy subjects. RESULTS: The results are expressed as median [lowest observed value-highest observed value]. Whereas the arterial femoral velocity (A.F.V.) decreased from 0.21 [0.08-0.36] to 0.17 [0.08-0.28] m s-1 for an external pressure as low as 10 mmHg (p < 0.001), the venous femoral velocity (V.F.V.) decreased from 0.13 [0.06-0.40] to 0.09 [0.05-0.34] m s-1 at 20 mmHg (p < 0.001). An increase of tcpCO2 from 39.8 [29.9-53.7] to 40.2 [30.0-55.5] mmHg (p < 0.05) and a decrease of LDF from 8.7 [3.1-25.9] to 5.5 [2.3-21.1] A.U. (p < 0.001) occurred at 10 mmHg. However, tcpO2 decreased only from 76.7 [40.2-91.2] to 64.6 [18.9-85.2] mmHg when the splint pressure reached 60 mmHg (p < 0.05). The observed parameters (LDF, tcpO2, V.F.V. and A.F.V.) decreased further (except for tcpCO2 which increased) up to the end of the study as the applied pressure was increased. CONCLUSION: Positive pressure on the full leg provided no significant beneficial effect on femoral venous blood velocity. Whereas we showed that for an external uniform pressure as low as 10 mmHg, significant impairments in both arterial inflow of the lower limb and microcirculation of the forefoot appeared in recumbent healthy young subjects.     

Early effect of carotid endarterectomy on arterial blood pressure measured with an ambulatory monitor

This article presents a patient with portal hypertension in whom an unusual localization for portosystemic collaterals have incidentally been found. Upper abdominal sonography revealed tubular structures filling the whole perirenal and partially the perihepatic area, and their venous nature was demonstrated with duplex Doppler sonography. Spiral CT angiography identified the right-sided retroperitoneal location and mesenteric-lumbar route of the collaterals. Upper gastrointestinal endoscopy with antral biopsy and percutaneous liver biopsy were performed. Laboratory results and specimen evaluation revealed chronic active hepatitis due to hepatitis-B infection. Attention is drawn to the abnormal location of these vessels, together with the noninvasive nature and competence of CT angiography in demonstrating vascular pathologies.     

The Finapres 2300e finger cuff. The influence of cuff application on the accuracy of blood pressure measurement

Blood pressure measurements associated with malapplication of a finger cuff were compared with contemporaneous intra-arterial pressure data in seven volunteers to determine the influence of cuff application on the accuracy of the Finapres 2300e. Systolic readings in all cuff positions differed from arterial line data by more than the recommended standard and tight and loose cuff applications under and over-read respectively, in all subjects. The results show the Finapres to be sensitive to small degrees of finger cuff malapplication which contribute to the bias on direct arterial comparison and limit the reliability of the instrument in clinical practice.     

Arterial blood pressure measurement with oscillometric instruments in newborns and infants

Non-invasive blood pressure measurements by the auscultatory method do not provide reliable, reproducible blood pressure values in many neonates because the Korottkoff sounds are often very difficult to detect. This resulted in the development of many alternative indirect methods. Devices utilizing the Doppler ultrasound technique have not found wide acceptance. Since the introduction of automated oscillometric blood pressure monitors, arterial blood pressure has been increasingly brought into discussion as an indicator of the circulatory state. This is the first study to investigate the similarity and reproducibility of the data obtained with five oscillometric devices for measurement of blood pressure in neonates. MATERIALS AND METHODS. Since investigations on the technical performance are not practical in the clinical setting of a neonatal or pediatric ward, we used two simulators, the CuffLink (Dynatech, Nevada, USA) and a device developed by the PTB (Physikalisch-Technische Bundesanstalt). While the latter uses oscillations originally obtained from neonates, the CuffLink uses artificial and therefore ideal signals for the blood pressure monitors. The signals used for the PTB simulator were obtained from three neonates with an average age of 2 months and a weight of 3.5 kg, 4.4 kg, and 7.8 kg. The following blood pressure monitors were studied: Hoyer/Colin, BP-1001; Datex, Cardiocap II; SpaceLabs, model no. 90426; Hewlett-Packard, NBP M1008A; Critikon, Dinamap 1846. Before the measurements were started, the cuff pressure display of each monitor was checked according to a verification procedure. Although the 4 mmHg margin of error was not exceeded, the results were corrected. RESULTS. The results of the measurements show significant differences between the blood pressure monitors from the various manufacturers, with the differences for the ideal signals of the CuffLink-Simulator being less pronounced than those for the PTB simulator. Direct comparison of results is therefore often impossible. The standard deviation, taken from 20 measurements per monitor and simulation, is below 4 mmHg for both simulators. We can therefore conclude that the reproducibility of data is satisfactory and the emerging trend is reliable. DISCUSSION. The difference between the results of the PTB simulator and the CuffLink are probably due to the method of evaluation and the identification of artifacts of each blood pressure monitor. This is also confirmed by the studies of Mieke et al. The manufacturers should provide devices that display comparative results and improve the algorithms for detection of artefacts, increasing the accuracy of their blood pressure monitors. This could be done with the help of simulators. Considering the pathophysiological characteristics of neonates and infants, the systematic differences between the five monitors have to be regarded as serious.     

The effect of arterial pressure on the ocular pressure-volume relationship in the rabbit

The purpose of this study was to quantify the effect of mean arterial pressure (MAP) on the ocular pressure-volume relationship. The experiments were performed in pentobarbital anesthetized rabbits instrumented with occluders on the thoracic aorta and inferior vena cava to control MAP which was measured via a cannula in the central ear artery. To vary the ocular volume and measure the intraocular pressure (IOP), two 23 gauge needles were inserted through the pars plana into the vitreous: one needle was connected to a saline-filled syringe and the other needle was connected to a pressure transducer. In one group of animals (n = 5), pressure-volume curves were determined at MAPs of 100, 80, 60, 40 and 20 mmHg and post mortem by cumulative saline injections (2 microliters) every 1-1.5 sec. In a second group (n = 7), pressure-volume curves were obtained at MAPs of 80, 60 and 40 mmHg and post mortem by saline infusion at 0.5 microliter sec-1 until the IOP reached 100 mmHg. The infusion protocol was repeated in a third group (n = 11) where the choroidal flux and the concentration of moving blood cells (CMBC) were measured by a laser Doppler flowmeter as indices of choroidal blood flow and the blood volume, respectively. MAP had three primary effects on the ocular pressure-volume relationship: (1) the baseline IOP varied exponentially with MAP, (2) the steepness of the initial portion of the pressure-volume curves was MAP-dependent and (3) the curves exhibited a 'plateau' as the IOP approached the prevailing MAP at MAPs > or = 40 mmHg. All of the curves in the living eye intersected and became indistinguishable from the post mortem curve when the IOP exceeded the prevailing MAP. The flux and CMBC measurements indicated that the MAP-dependence of the initial portion of the curves was due to failure of choroidal autoregulation and diminished increases in choroidal blood volume at the lower MAPs, and that the plateau portion of the curves was due to expulsion of blood from the eye. It is concluded that MAP has a significant effect on the ocular pressure-volume relationship.