两种不同静脉穿刺法在老年患者中的应用效果比较

【目的】比较手臂下垂距穿刺点较近处扎止血带结合进针角度改变静脉穿刺法与常规静脉穿刺法在老年患者中的应用效果。【方法】选择112例心内科输液治疗的老年患者,采用自身对照法,由同一护士在同一患者身上隔日交替实施上述两种静脉穿刺方法,比较其疼痛程度及一针穿刺成功率。【结果】老年患者使用手臂下垂近扎止血带结合进针角度改变静脉穿刺法,疼痛程度明显降低,一针穿刺成功率明显提高（P〈0．05）。【结论】手臂下垂近扎止血带结合进针角度改变穿刺法能有效降低老年患者静脉穿刺的疼痛程度,显著提高老年患者一针穿刺成功率。     

离心静脉穿刺在长期输液老年病人中的应用

[目的]探讨离心静脉穿刺在长期输液老年病人中的应用。[方法]将136例长期输液老年病人随机分为观察组与对照组,每组68例,观察组采用离心静脉穿刺输液法,对照组采用常规向心静脉穿刺输液法,观察两组病人一次成功、针稳定性及最大液体流速与最小液体流速时输入液体的滴数。[结果]观察组病人穿刺一次成功率高于对照组,液体渗漏发生率低于对照组(P0.05);两组对液体流速的比较,差异无统计学意义(P0.05)。[结论]在长期输液老年病人中应用离心静脉穿刺的效果优于常规向心静脉穿刺。     

老年慢性病患者逆行静脉穿刺的效果观察

目的 探讨逆行静脉穿刺的临床应用效果,为长期静脉输液或浅静脉穿刺困难的老年患者提供良好的穿刺途径,提高手背浅静脉的利用率.方法 选择静脉输液患者80例,随机分为试验组和对照组各40例.试验组采用逆行(离心)穿刺,对照组采用常规方法 (向心)穿刺,两组均选用手背浅静脉为穿刺部位,比较1次穿刺成功率、穿刺部位渗出、肿胀率和疼痛评分.结果 试验组的1次穿刺成功率高于对照组(P＜0.01),局部渗出、肿胀率低于对照组(P＜0.01),疼痛评分低于对照组(P＜0.01).结论 逆行静脉穿刺可提高老年慢性病患者穿刺成功率,降低肿胀、渗出率,减轻患者的疼痛.     

手指、足趾静脉离心性穿刺输液的探讨

目的 探索在手指、足趾静脉进行离心性静脉穿刺输液的可行性。 方法 2008年8月-2011年3月406例患者根据入院日期单双日分为试验组和对照组。试验组采用手指足趾离心性静脉穿刺法,对照组采用手背向心性静脉穿刺。比较2组一次穿刺成功率和输液成功率。 结果 2种一次穿刺成功率和输液成功率比较,差异无统计学意义。 结论 手指、足趾离心性静脉穿刺输液的方法可解决长期静脉输液患者静脉穿刺困难的问题。     

改良静脉穿刺法与疼痛及穿刺成功率的相关性研究

目的 探讨改良静脉穿刺法对减轻患者穿刺疼痛和提高一次穿刺成功率的效果.方法 采用自身对照法对106名患者进行研究.按日期分为单日输液和双日输液,单日输液采用传统静脉穿刺法设为对照组,双日输液采用改良静脉穿刺法,设为观察组,每例观察4次,自身对照各2次,共观察424次.比较两组穿刺方法患者疼痛反应程度和静脉一次穿刺成功率.结果 观察组在穿刺时的疼痛反应程度明显轻于对照组(P<0.01),一次穿刺成功率也明显高于对照组(P<0.01).结论 改良静脉穿刺法具有无痛、微痛、微创、快速、准确的特点,且能减少对静脉的损伤,延长静脉的使用寿命,在临床中具有重要的使用价值,并易于为护理人员掌握.     

手背逆行静脉穿刺在老年门诊输液患者中的应用

目的:探讨手背逆行静脉穿刺在老年门诊输液患者中的应用方法及临床效果。方法:将120例老年门诊输液患者随机分为观察组和对照组各60例,对照组采用常规手背顺行穿刺法,观察组采用手背逆行穿刺法。观察比较两组患者一次穿刺成功率、液体滴速、液体渗漏率、手部活动情况、疼痛率及舒适度。结果:两组一次穿刺成功率、液体渗漏率、手部活动情况、疼痛率及舒适度比较差异均有统计学意义(P<0.05)。结论:对老年输液患者采用手背逆行静脉穿刺可提高一次穿刺成功率,减少液体渗漏,减轻疼痛,患者感觉较为舒适。     

给指握拳法在老年消瘦患者静脉穿刺中应用的效果评价

目的 探讨给指握拳法在老年消瘦患者静脉穿刺中的应用效果.方法 将360例老年消瘦患者随机分为A、B 2组各180例,A组采用给指握拳法,B组采用传统握拳法进行静脉穿刺,穿刺部位均选取手背静脉.观察比较2组患者静脉穿刺一次成功率和患者疼痛程度.结果 A组静脉穿刺一次成功率明显高于B组,但疼痛程度低于B组.结论 采用给指握拳法对老年消瘦患者进行静脉穿刺提高了一次成功率,减轻了患者的痛苦.     

静脉留置针逆向穿刺在老年患者静脉输液中的应用

目的 探讨静脉留置针逆向静脉穿刺在血管条件较差的、长期输液的老年患者中的应用效果.方法 将140例反复多次住院的需要长期输液的慢性病患者随机分为研究组和对照组,研究组和对照组各70例.研究组采用逆向静脉穿刺置管输液;对照组采用传统的顺向静脉穿刺置管输液,比较2组的一次性穿刺成功率及输液过程中穿刺局部红、肿、疼痛的发生率.结果 研究组的一次性穿刺成功率明显高于对照组(P<0.05),穿刺局部红、肿、疼痛的发生率显著低于对照组(P<0.05).结论 静脉留置针逆向穿刺在老年患者输液中的应用是可行的、有效的,具有临床推广应用的价值.     

改良静脉穿刺在老年病人手背静脉穿刺中的应用

[目的]探讨老年病人手背静脉穿刺成功率的有效方法。[方法]采用自身对照法对210例老年病人进行研究,设定第1天输液为对照组,采用传统静脉穿刺方法进行静脉穿刺;第2天输液为观察组,采用改良的方法进行静脉穿刺。比较两组手背静脉穿刺一次穿刺成功率。[结果]两组一次穿刺成功率比较,差异均有统计学意义(P0.05),观察组一次静脉穿刺成功率明显高于对照组。[结论]对老年病人手背静脉穿刺进行改良,可提高一次穿刺成功率,提高了门急诊老年病人静脉输液效果。     

2种型号静脉输液针在老年患者中的应用

目的 比较2种型号静脉输液在老年患者静脉输液过程中的应用效果.方法 对136例接受静脉输液治疗的老年患者采用自身对照法,2d内分别用7号和5.5号静脉输液针在患者双侧手背静脉进行输液操作,比较使用2种型号静脉输液针进行输液时的静脉穿刺成功率、患者疼痛程度.结果 与应用7号静脉输液针相比,应用5.5号静脉输液针进行静脉穿刺,成功率较高,患者疼痛程度较轻(p均<0.05),差别有统计学意义.结论 应用5.5号静脉输液针为老年患者输液,有利于提高护理质量,减少由于输液造成的护患纠纷.     

Guns and Knives in New Mexico: Patterns of Penetrating Trauma, 1978–1993

Objective: To identify patterns of nonfatal and fatal penetrating trauma among children and adults in New Mexico using ED and medical examiner data.
Methods: The authors retrospectively sampled in 5-year intervals all victims of penetrating trauma who presented to either the state Level-1 trauma center or the state medical examiner from a 16-year period (1978–1993). Rates of nonfatal and fatal firearm and stabbing injury were compared for children and adults.
Results: Rates of nonfatal injury were similar (firearm, 34.3 per 100,000 person-years; stabbing, 35.1). However, rates of fatal injury were significantly different (firearm, 21.9; stabbing, 2.7; relative risk: 8.2; 95% confidence interval: 5.4, 12.5). From 1978 to 1993, nonfatal injury rates increased for children (p = 0.0043) and adults (p < 0.0001), while fatal penetrating injury remained constant. The increase in nonfatal injury in children resulted from increased firearm injury rates. In adults, both stabbing and firearm nonfatal injury rates increased.
Conclusions: Nonfatal injury data suggest that nonfatal violence has increased; fatal injury data suggest that violent death rates have remained constant. Injury patterns vary by age, mechanism of trauma, and data source. These results suggest that ED and medical examiner data differ and that both are needed to guide injury prevention programs.     

Interprofessional approaches to creating safe,high quality health care

Three supplementary perspectives are presented arguing that interprofessional collaboration is both necessary and desirable. Nonetheless, there are often too many serious intra-professional barriers and obstacles to interprofessional collaboration to make it successful. Some of these barriers, it is argued and illustrated, are found in the multiple ways in which professional identity is tacitly acquired and embodied in the practitioners' habitual, everyday practice. The paper then explores ways in which reflection, especially Second order reflection, can help to elucidate and overcome these obstacles, as well as increasing professional adaptability and competence.     

Systematic Reviews Published in the January 2011 Issue of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly as a DVD and monthly online. The January 2011 issue (first quarterly DVD for 2011) contains 4515 complete reviews, 1985 protocols for reviews in production, and 13,521 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 641,000 randomized controlled trials, and 14,018 cited papers in the Cochrane methodology register. The health technology assessment database contains over 9300 citations. One hundred and seven new reviews have been published in the last 3 months, of which five have potential relevance for practitioners in pain and palliative medicine.     

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.     

Prise en charge des entorses externes de cheville : étude clinique préliminaire sur l’efficacité du dispositif Myolux™

Ankle sprains are the most common injury of the musculoskeletal system and are associated with significant societal and economic impacts. It has been proven that classical therapeutic strategies may not be effective in preventing recurrent injuries: the recurrence rates reported in the literature can reach 73%. In order to provide an effective rehabilitation solution, a destabilizing orthosis was developed. This device is equipped with a mechanical articulator reproducing the subtalar mechanics and placed under the heel. In this paper, we present the main results of a preliminary clinical study conducted between 2004 and 2007. All subjects included in this study were treated with the abovementioned orthosis during 10 rehabilitation sessions of 30 minutes each. Data show a relatively low recurrence rate of 12% for the overall population. Moreover, it's of primary importance to note that this satisfactory ratio is largely reduced (3% of recurrence rate) for the 29 patients who performed one training session per month after the 10th initial rehabilitation sessions. Hence, the destabilizing orthosis appears to be an effective solution to prevent recurrent ankle sprains. However, joint protection requires long-term and regular training sessions. This result has motivated the development of a similar device allowing patients to perform training sessions at home. Finally, data obtained in this study are promising awaiting the final results of the comparative, multicentric and independent clinical trials currently managed by the Hospices Civils de Lyon.