双止血带法在慢性阻塞性肺病患者静脉留置针穿刺中的应用

目的探讨双止血带法对慢性阻塞性肺病患者浅静脉静脉留置针穿刺成功率的影响。方法将280例慢性阻塞性肺病患者随机分为实验组和对照组,实验组采用双止血带法进行浅静脉静脉留置针穿刺,对照组采用传统的单止血带法进行浅静脉静脉留置针穿刺。结果实验组一次穿刺成功率为95．0％,对照组为74．3％,实验组一次穿刺成功率显著高于对照组（χ2=24．14,P〈0．01）。结论采用双止血带法可提高慢性阻塞性肺病患者浅静脉静脉留置针穿刺成功率。     

手术患儿在颈外静脉留置套管针的探讨

目的：为减轻患儿反复静脉穿刺的痛苦，提高患儿术前静脉穿刺一次性成功率，缩短术前准备时间。方法：将100例手术患儿随机分为对照组和实验组，各50例。对照组采用四肢静脉留置套管针输液，实验组采用颈外静脉留置套管针输液。结果：实验组穿刺时间最短（P〈0．001），一次性穿刺成功率高（P〈0．005），有显著性差异，实验组方法明显优于对照组。结论：颈外静脉留置套管针具有减轻患儿痛苦，提高一次穿刺成功率，缩短术前准备时间，术后方便患儿起床活动等优点，只要颈部条件允许的患儿均可适用。     

穿刺技巧与血管充盈度对留置针穿刺成功率的影响

目的 探讨穿刺技巧与血管充盈度对留置针穿刺成功率的影响.方法 将140例手术患者随机分为实验组(70例)和对照组(70例),其中血管充盈者分别为41例和39例.实验组采用单纯外套管推入法,对照组采用外套管针芯并入法.比较2组首次穿刺成功率及不同血管充盈度下的首次穿刺成功率.结果 实验组和对照组首次穿刺成功率比较,差异有统计学意义(P<0.01).实验组中血管充盈度对首次穿刺成功率的影响无统计学意义(P＞0.05),对照组中血管充盈良好者的首次穿刺成功率高于充盈不良者,差异有统计学意义(P<0.01).结论 根据血管充盈情况和患者病情,采用不同的穿刺方法.在浅静脉充盈良好的情况下,2种方法均可采用;对于血管充盈不良者应选用单纯外套管推入法.     

颈外静脉留置针应用于大量输液的体会

目的　比较经颈外静脉输液与四肢浅静脉输液在大量输液中的应用及优越性。方法　 60例经颈外静脉穿刺并留置针为实验组 ,60例经四肢静脉穿刺并留置针为对照组 ,记录置管成功率、操作时间、留置时间、液体流速及并发症。结果　实验组一次置管成功率为 93 .3 % ,对照组为 88.3 % ,P<0 .0 1 ;实验组平均操作时间 2 .6min,对照组为 3 .1 min,P<0 .0 1 ;实验组平均留管时间为 1 2 0 h,对照组 61 h,P<0 .0 1 ;实验组并发症为 6.7% ,对照组为 2 8.3 % ,P<0 .0 1 4,留置套管针最大流速可达 97ml/min[1 ] ,能满足重危病人快速补液的要求。结论　实验组较对照组一次置管成功率高 ,节省时间和人力 ,留置针时间长 ,并发症低 ,病人痛苦少 ,在临床上值得推广应用     

正压穿刺置管在静脉留置针患儿中的应用及效果

目的:探讨正压穿刺置管在静脉留置针患儿中的应用方法及临床效果.方法:将100例拟行静脉留置针穿刺的患儿随机分成实验组和对照组各50例.对照组采用常规穿刺方法,实验组采用正压穿刺置管,观察两组一次穿刺成功率.结果:实验组一次穿刺成功率高于对照组(P<0.05).结论:对静脉留置针患儿应用正压穿刺法,可避免反复静脉穿刺,减轻患儿痛苦,提高穿刺置管成功率.     

静脉留置针在婴幼儿CT增强扫描中的应用

目的观察静脉留置针在婴幼儿CT增强扫描中的应用效果。方法行CT增强扫描的婴幼儿252例随机分成实验组和对照组,各126例。实验组采用静脉套管留置针穿刺,对照组采用一次性蝶翼穿刺针穿刺。结果实验组穿刺一次成功率为100.00%,高于对照组的88.89%,差异有统计学意义(P0.01);实验组无穿刺相关不良反应,对照组主要为造影剂渗漏16例(12.70%)和血肿10例(7.94%)。结论在婴幼儿CT增强扫描中静脉留置针穿刺,可降低静脉穿刺的渗漏率,提高一次穿刺成功率,避免血肿和静脉炎的发生。     

静脉留置针置入法的改进

静脉留置针置入方便、快捷，但有时外套管不能进入血管腔，甚至使外套管撕裂，影响患者的抢救治疗。现简介一种改进置入法。1材料与方法1．1材料：静脉留置针1根，心内科介入诊断或治疗使用过的静脉或动脉介入器中导丝1根，消毒备用，5ml一次性注射器1副，一次性消毒手套1副。1．2方法：以颈内静脉为例介绍置入方法：患者头转向左侧，穿刺部位消毒。打开手套外包装纸，将所需型号导丝（见附表）和注射器放入手套外包装纸内，戴手套后将注射器与留置针联接，采用自己所熟悉的进路法，持续复压进针，见回血后将外套管稍进1～2mm，左手固定留置…     

浅静脉留置针穿刺中双止血带双交叉结扎法的临床研究

目的探讨浅静脉穿刺双止血带双交叉结扎法对浅静脉留置针穿刺止血带结扎成功率、静脉血管充盈度及静脉穿刺成功率的影响。方法将300例静脉血管充盈度差、在消化内科住院接受静脉输液的患者浅静脉穿刺时采用止血带单、双交叉结扎法进行对比研究,共穿刺600例次,平均每例穿刺2次。采用自身对照法,分单、双日组,双日组为实验组,单日组为对照组,实验组采用双止血带双交叉结扎法,对照组采用止血带单交叉结扎法。结果观察组止血带的一次结扎成功率、不同时间的静脉血管充盈度及静脉穿刺成功率明显高于对照组(P<0.05)。结论浅静脉留置针穿刺双止血带双交叉结扎法,能提高止血带一次结扎的成功率,改善静脉血管的充盈度,从而提高浅静脉留置针穿刺的成功率及护理的工作效率,为病人的治疗与抢救赢得时间。     

改进静脉留置针穿刺方法应用于老年患者的效果观察

目的 探讨静脉留置针在老年患者静脉输液过程中的穿刺方法,提高一次穿刺成功率.方法 对600例需要进行留置针穿刺的老年患者,随机分成2组,每组300例,对照组采用外套管与针芯分别送入血管至留置针根部的方法穿刺,实验组采用外套管与针芯一起送入血管至留置针根部的方法穿刺,观察穿刺成功率.结果 2组穿刺成功率比较,实验组高于对照组,有统计学意义(P<0.05).结论 外套管与针芯一起送人血管至留置针根部的穿刺方法,操作简单、方便、易行,能提高一次穿刺成功率,减轻老年患者再次穿刺的痛苦,减少人力物力资源.     

低血容量性休克病人建立套管针静脉通路的方法研究

[目的]研究二次穿刺法在低血容量性休克病人快速建立套管针静脉通路中的作用与效果。[方法]将64例急诊就诊的低血容量性休克病人随机分为实验组和对照组。实验组采用二次穿刺法，对照组采用传统穿刺方法。观察两种方法套管针穿刺次数与成功率、建立有效套管针通路所需时间、病人血管的保护程度、病人的医疗费用。[结果]两种方法套管针穿刺1次成功率、建立有效套管针通路所需时间、病人血管的保护程度、病人的医疗费用方面差异有统计学意义（P〈0．05）。[结论]二次穿刺法在低血容量性休克病人建立套管针静脉通路中的速度快、病人痛苦小并且费用少，可明显提高套管针1次穿刺成功率，达到良好的抢救效果。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Molecular characterization of virulence and antimicrobial resistance profile of Shigella species isolated from children with moderate to severe diarrhea in northeastern Brazil

Molecular characterization of virulence and antimicrobial resistance profiles were determined for Shigella species isolated from children with diarrhea in Fortaleza, Brazil. Fecal specimens were collected along with socioeconomic and clinical data from children with moderate to severe diarrhea requiring emergency care. Shigella spp. were isolated by standard microbiological techniques, and we developed 4 multiplex polymerase chain reaction assays to detect 16 virulence-related genes (VRGs). Antimicrobial susceptibility tests were performed using disk diffusion assays. S. flexneri and S. sonnei were the predominant serogroups. S. flexneri was associated with low monthly incomes; more severe disease; higher number of VRGs; and presence of pic, set, and sepA genes. The SepA gene was associated with more intense abdominal pain. S. flexneri was correlated with resistance to ampicillin and chloramphenicol, whereas S. sonnei was associated with resistance to azithromycin. Strains harboring higher numbers of VRGs were associated with resistance to more antimicrobials. We highlight the correlation between presence of S. flexneri and sepA, and increased virulence and suggest a link to socioeconomic change in northeastern Brazil. Additionally, antimicrobial resistance was associated with serogroup specificity in Shigella spp. and increased bacterial VRGs.     

护理干预对面部中重度寻常型痤疮的临床疗效影响分析

目的研究护理干预对面部中重度寻常型痤疮的临床疗效影响。方法选取本院在2014年4月~2016年7月诊治的136例面部中重度寻常型痤疮患者,随机分为研究组与对照组,每组68例;所有患者均依据其情况给予对应的治疗,其中对照组在治疗期间给予常规护理,研究组在对照组的基础上再给予综合性护理干预,比较两组的治疗效果及护理满意度情况等。结果患者在接受治疗和护理后,研究组中度与重度患者的治疗效果较对照组均明显提高(P0.05),研究组护理满意度较对照组明显增高(P0.05)。结论对面部中重度寻常型痤疮患者在其治疗期间给予综合性护理干预,具有良好的效果。