影响中心静脉压测定的相关因素及护理干预

目的探讨影响中心静脉压测定的相关因素和护理干预措施。方法对69例心脏术后病人测量中心静脉压1650例次,观察患者中心静脉压的变化。结果中心静脉压符合病情者1466例次,占88.74%;不符合病情者184例次,占11.26%。结论中心静脉导管的位置、标准零点与病人体位、病人因素、机械通气、测压系统的通畅度、药物作用对CVP有直接影响,因此应加强护理,以减少护理因素对监测结果的影响。     

影响中心静脉压测定的相关因素及护理干预

目的 探讨影响中心静脉压测定的相关因素和护理干预措施.方法 对69例心脏术后病人测量中心静脉压1650例次,观察患者中心静脉压的变化.结果 中心静脉压符合病情者1466例次,占88.74%;不符合病情者184例次,占11.26%.结论 中心静脉导管的位置、标准零点与病人体位、病人因素、机械通气、测压系统的通畅度、药物作用对CVP有直接影响,因此应加强护理,以减少护理因素对监测结果的影响.     

食管癌术后中心静脉压变化的影响因素及对策

总结食管癌术后中心静脉压变化的影响因素及对策。胸腔内压力增高、输入液体及药物、中心静脉导管插入深度、测压时体位、心律失常等因素皆可影响中心静脉压数值。护士要采取措施避免胸腔内压增高及输入液体、药物的干扰,重视中心静脉导管护理,予平卧位测压,加强病情观察及护理,以提高中心静脉压测量的正确性。     

中心静脉压监测的影响因素及护理现状

分析和综述了各因素对中心静脉压的影响,其中包括机械通气、体位、输液通道、中心静脉导管、胸内压等因素,并总结护理措施,使中心静脉压监测更准确,减少并发症发生,增加患者的安全性和舒适性。     

中心静脉压测定的影响因素及其处理

本文通过分析各个不同因素如：静脉回流量、血容量、右心功能、血管阻力、正压通气、心包腔内压力等对中心静脉压的影响,阐述了中心静脉压测定在临床上的重要地位及作用,并分阶段、分类别介绍了不同情况下植入导管的护理对策以及导管留置期间的护理要求,比较全面地总结了中心静脉压测定中容易出现的各种问题,能够对今后的临床应用起到一定的指导作用。     

影响重症急性胰腺炎中心静脉压监测结果的相关因素及护理干预

目的分析影响重症急性胰腺炎中心静脉压监测结果的相关因素,并探讨其护理干预方法。方法分析2009年1月2010年1月156例重症急性胰腺炎患者中心静脉压监测结果与病情的吻合情况,了解其相关影响因素。结果共监测2478例次,中心静脉压符合病情者2014例次,占81.27%,不符合病情者464例次,占18.73%,其中护理人员因素133例次（5.37%）,测压装置因素130例次（5.25%）,患者病情因素201例次（8.11%）。结论重症急性胰腺炎中心静脉压监测结果受多种因素影响,通过护理干预可减少对监测结果的影响,从而为分析、判断病情提供准确的参考依据。     

中心静脉压的监测与护理的研究进展

分析和综述了中心静脉压与周围静脉压的关系及各因素对中心静脉压的影响,其中包括体位、机械通气、中心静脉导管、胸内压、腹内压等因素,并总结护理措施,使中心静脉压监测更准确,减少并发症发生,增加患者的安全性和舒适性。     

三通管对测量中心静脉压的影响及对策

目的:探讨连接三通管测量中心静脉压时对结果的影响,以减少测量中心静脉压的误差,提高测量危重病人中心静脉压的准确性和可靠性。方法:对22例病人在连接三通管前、后进行中心静脉压测量,行自身对照,分析测量结果有无差异性。结果:连接三通管后测得的中心静脉压高于连接前(P0.01)。结论:采用手工测量中心静脉压时,应去除三通连接管,减少测量中心静脉压数值的误差,更好地指导对危重病人临床补液和用药及病情观察。     

不同体位对心功能不全患者中心静脉压监测的影响

目的观察心功能不全患者体位改变对中心静脉压监测的影响。方法对27例心功能不全患者在3个时段先后采用平卧位、半卧位测量中心静脉压,将观察数据行统计分析。结果 3个时段两种体位测出的中心静脉压值其差异无统计学意义;中心静脉压变化与心功能分级、射血分数及应用血管活性药物无明显关系。结论体位改变对心功能不全患者中心静脉压监测影响不大。     

ICU患者中心静脉导管堵塞的相关因素研究

目的 探讨ICU患者中心静脉导管堵塞的影响因素,为降低导管堵塞风险及提高护理质量提供循证证据.方法 采用自行设计《中心静脉导管调查表》和《中心静脉导管评估表》对209例ICU患者置管情况进行调查.结果 209例患者中有39例发生堵塞,堵塞率为18.66%.多因素分析结果表明,股静脉置管、中心静脉压>13mmHg是中心静脉导管堵塞的危险因素.附加装置正压输液接头为保护因素.结论 ICU患者中心静脉导管堵塞的发生与其置管部位、留置时间、封管液种类、附加装置类别、微量泵泵速、患者年龄、中心静脉压、凝血酶原时间、血小板数量、输液种类以及穿刺次数密切相关.其中股静脉置管和中心静脉压>13mmHg是中心静脉导管堵塞的危险因素,正压输液接头为保护因素.为降低中心静脉导管堵塞的风险,临床工作中应综合考虑以上相关因素,做好预见性护理.     

Central venous pressure monitoring

PURPOSE OF REVIEW: The proper use of central venous pressure requires a good understanding of basic measurement techniques and features of the waveform. RECENT FINDINGS: If attention is not paid to proper leveling of the transducer and consideration of transmural pressure then major errors are made in the use of central venous pressure. Besides the information gained from the relationship of changes in central venous pressure to changes in cardiac output, there is also much information to be obtained by examining the waveforms of the central venous pressure tracing. Examples are given of rhythm disorders, tricuspid regurgitation, cardiac tamponade, cardiac restriction, and decreased thoracic compliance. SUMMARY: There is much more to the measurement of central venous pressure than the simple digital value on the monitor and the actual waveform should always be examined.     

两种不同方法监测中心静脉压的研究

目的 探讨传统的简易中心静脉压测定法和通过压力传感器监测中心静脉压两种方法的差异性,为临床推广应用提供依据.方法 对我院2008年6月至2009年9月150例实施体外循环心脏直视术患者术前、术后同时采用两种方法测定的中心静脉压值进行比较.结果 两种方法测量所得的中心静脉压值差异无统计学意义(P＞0.05).结论 简易中心静脉测压方法既方便又直观,能提高抢救成功率,在基层医院值得推广.压力传感器可连续、动态监测中心静脉压,节省时间,减少护理工作量,便于在大中型医院推广使用.

Abstract：

Objective To explore the difference of the traditional simple measurement of central venous pressure and pressure sensor measurement of central venous pressure.Methods The values were compared which were measured by two methods before and after open heart surgery in 150 cases from June 2008 to September 2009.Results The central venous pressure value measured by two methods had no statistically difference(P＞0.05).Conclusions Simple measurement method of central venous pressure is convenient and intuitive,which can improve the success rate and in primary hospitals should be promoted.Pressure sensors can continuously,dynamically monitor central venous pressure,save time,reduce nursing workload. It should be promoted in the medium and large hospitals.     

肝硬化并发上消化道出血的危险因素分析

目的了解肝硬化并发上消化道出血的相关危险因素,为预防和控制疾病提供可靠的依据.方法对130例肝硬化患者进行病例对照研究.结果肝硬化并发上消化道出血与食道静脉曲张(0R=3.942,P=0.001)、肝功能分级(0R=1.028,P=0.003)、门脉高压性胃病(0R=3.862,P=0.002)有显著性关系.结论肝硬化并发上消化道出血的危险因素是食道静脉曲张、肝功能分级、门静脉内径、门脉高压性胃病.     

A new method for chronic intraventricular measurement of intracranial pressure

A new simple method, which allows rapid access to the ventricular system to monitor intracranial pressure, is described. One of the lateral ventricles is punctured percutaneously, with a hand drill operated by a flash-light battery, and a lumbar puncture needle (20 gauge) attached to a water manometer or to a strain gauge connected to a venous pressure monitor.     

严重烧伤病人采用股静脉压预测中心静脉压的临床研究

目的　监测大面积烧伤病人体内血容量 ,提高抢救成功率。方法　在 5 0例大面积烧伤病人身上同时测量中心静脉压和股静脉压各 3 0 0次 ,作直线相关与回归分析。结果　同一病人身上股静脉压与中心静脉压呈正相关关系 ,r =0 .83 90 (P <0 .0 1) ,回归方程是 :Y(中心静脉压 ) =-0 .14 5 + 0 .792X(股静脉压 )。结论　同一病人身上用股静脉压的测量估计中心静脉压的测量具有可行性和科学性     

What you need to know about central venous lines

A central venous line is a device that is inserted into the superior vena cava or right atrium. There are a number of reasons why such a device may be used. Two of the main reasons are to monitor central venous pressure and for the rapid infusion of fluids. This article discusses the types of central venous devices, the insertion of the catheter, the manual and electronic measurement of central venous pressure, and the complications that can occur when the device is in place. The nurse's role in caring for a patient with a central venous line is discussed, as is the removal of the catheter.     

基于Caprini评分的肝切除术患者静脉血栓栓塞风险因素分析

目的以Caprini风险评估模型评分为参考分析肝切除术患者术后发生静脉血栓栓塞症的危险因素。方法采用回顾性研究方法,收集本院310例接受肝切除手术患者的临床资料,以Caprini风险评估模型进行评分,并通过单因素及多因素分析,对Caprini风险评估模型中的危险因素及肝切除手术相关因素进行筛选,发现影响肝切除术患者静脉血栓栓塞症风险的危险因素。结果单因素及多因素Logistic回归分析显示,手术时间3h、肝恶性肿瘤、深静脉血栓和(或)肺栓塞史为肝切除手术患者发生静脉血栓栓塞症的独立危险因素。Caprini风险评估模型评分静脉血栓栓塞症组患者得分(6.77±1.81)分,非静脉血栓栓塞症组得分(3.62±2.25)分(P=0.02)。Caprini风险评估模型评分≥7分时,发生静脉血栓栓塞症的风险明显增加。结论肝切除术患者术后静脉血栓栓塞症发生的危险因素是手术时间3h、肝恶性肿瘤、深静脉血栓和(或)肺栓塞史,随着Caprini评分的增加静脉血栓栓塞症的风险逐渐升高。     

Pulmonary artery pressure versus pulmonary capillary wedge pressure and central venous pressure in shock

Evidence is presented from 43 dogs and 30 patients that under conditions of severe hemorrhagic, traumatic or septic shock, there may be partial obstruction of the pulmonary microcirculation due to disseminated intravascular coagulation (DIC) particularly in the pulmonary venules. This may cause the left atrial pressure to fall and the pulmonary artery pressure to rise, in some cases drastically. Pulmonary edema may result. This dangerous rise in pulmonary artery pressure is not reflected by the wedged pulmonary artery catheter which will monitor only the status of the left heart. Central venous pressure (CVP) may remain within normal limits even after pulmonary artery pressure has risen to dangerous levels with the development of pulmonary edema. It is only with right ventricle failure against the high pulmonary pressure that CVP rises. It is concluded that pulmonary artery pressure measurements are very important in monitoring intravenous fluid administration in severe shock. Wedged pulmonary artery pressures monitor the left heart but may be misleading if taken alone. Central venous pressure gives a delayed response to fluid overload.     

Pulmonary artery pressure measurement in patients with elevated pressures: effect of backrest elevation and method of measurement.

OBJECTIVE: To determine whether pulmonary artery pressure measurement is accurate if the head of the bed is elevated; to compare the end-expiratory graphic recording and digital monitor methods for pulmonary artery pressure measurement; to determine whether either mean arterial pressure or mixed venous oxygen saturation changes during backrest elevation. DESIGN: Nonrandomized clinical trial. SETTING: A six-bed cardiac surgical intensive care unit of a 540-bed federal facility. POPULATION: Twenty-five postoperative cardiac surgical patients with elevated pulmonary artery pressures (systolic higher than 35 mm Hg). INTERVENTIONS: In supine patients pulmonary artery pressures were measured at each of the following backrest elevations: 0, 20, 30, 45 and again at 0 degrees. Measurements were obtained once during mechanical ventilation and once during normal breathing after extubation. MAIN OUTCOME MEASURES: End-expiratory graphic recording of pulmonary artery pressures; digital monitor values of pulmonary artery pressures; mean arterial pressure; and mixed venous oxygen saturation. RESULTS: No statistical difference was found in pulmonary artery pressures measured at each of the backrest elevations during mechanical ventilation or normal breathing after extubation. Pulmonary artery diastolic and pulmonary capillary wedge pressures obtained with the digital monitor method were significantly lower than the end expiratory graphic recording method during normal breathing after extubation but not during mechanical ventilation. No changes in mean arterial pressure or mixed venous oxygen saturation occurred during backrest elevation. CONCLUSIONS: These results show that pulmonary artery pressures can be measured accurately with the head of the bed in an elevated position. The data indicate that obtaining pulmonary artery pressure measurements from the digital display of the bedside monitor is accurate when respiratory wave form fluctuations are minimal but may lead to inaccurate values with prominent respiratory fluctuations. Further research is needed to validate this finding in different patient populations and with other models of monitoring equipment.     

肝移植术后患者早期有效循环监测分析及护理对策

目的 了解肝移植患者术后24 h内心率、血压及中心静脉压的变化规律,分析其影响因素,总结肝移植术后有效循环监测及护理措施,为规范肝移植术后护理程序提供依据.方法 采用多功能心电监护仪,记录147例肝移植患者术前、术后返回ICU及术后2,6,12,24 h等时间点心率、血压及中心静脉压,并进行统计分析.结果 肝移植患者术后24 h内的心率较术前明显加快(P<0.01);术后转入ICU后即刻血压较术前变化不大(P>0.05),术后2 h血压与术后入ICU时比较明显降低(P<0.01),到术后24 h有所回升;中心静脉压变化未见统计学意义(P>0.05).结论 肝移植患者术后循环波动较大,应加强肝移植患者术后循环监测,给予预见性护理.