双腔带Cuff导管在血液透析中的应用

目的 分析双腔带Cuff导管在血液透析中应用的适应症、保留时间、并发症及透析充分性。方法 回顾性分析了我科1999年3月至2001年9月局麻下行右颈内静脉双腔带Cuff导管插管的病人25例,其中男性11例,女性14例,年龄20—80岁,原发病糖尿病肾病16例(64％)。结果 双腔带Cuff导管的平均保留时间72.5±23.4天,平均透析次数 48.2±12.6次,平均透析时间160±36.8小时,KT/V为1.1-1.5,再循环率为3.8％,并发症主要为栓塞和感染。结论 1.双腔带Cuff导管可作为一种临时血透通路和永久血透通路之间的过渡,也可作为一种永久血透通路,尤适合于血管条件差、心血管病情不稳定病人。2.它保留时间长,再循环率低;基本满足透析充分性。     

Use of A Neonatal Blood Pressure Cuff to Monitor Blood Pressure In The Adult Finger – Comparison With A Standard Adult Arm Cuff

Background. There are few suitable methods for monitoring blood pressure continously (or intermittently) for research in adult stroke patients, who are ill but do not justify invasive intensive care monitoring. Method. We tested a neonatal arm blood pressure in adults by placing it on the forefinger (finger cuff). We compared the repeatability of the finger cuff with blood pressure measured by a standard adult arm cuff using the oscillometric technique in 168 ambulatory outpatients attending a cerebrovascular disease clinic. Results. The mean difference between sequential mean blood pressure readings with the finger cuff was 0.55 mm Hg (95% confidence interval (CI) –14.36 to 15.47 mm Hg), and for the arm cuff was 3.31 mm Hg (95% CI –23.33 to 16.71 mm Hg). Measurements made with the arm cuff were shown to affect subsequent arm cuff readings made within a few minutes of the first. The mean difference between the finger cuff and arm cuff mean blood pressure readings was 0.03 mm Hg (95% CI –26.07 to 26.14 mm Hg) and agreement was better when the blood pressure was measured with the finger cuff first rather than the arm cuff. However, although there was no difference in the mean blood pressure recordings both systolic and diastolic blood pressure measurements differed systematically between arm and finger cuff. Conclusion. The reproducibility of sequential blood pressure measurements made with the finger cuff was better than with the arm cuff. The performance of the finger cuff compared with that of the arm cuff was sufficiently good to encourage use of the finger cuff in research involving automatic intermittent monitoring to observe sequential blood pressures over time in stroke patients. However, measurements of systolic and diastolic pressure were not the same with the two cuffs and further work on calibration of the finger cuff would be useful.     

Effects of 8 Weeks’ Specific Physical Training on the Rotator Cuff Muscle Strength and Technique of Javelin Throwers

[Purpose] For maximum efficiency and to prevent injury during javelin throwing, it is critical to maintain muscle balance and coordination of the rotator cuff and the glenohumeral joint. In this study, we investigated the change in the rotator cuff muscle strength, throw distance and technique of javelin throwers after they had performed a specific physical training that combined elements of weight training, function movement screen training, and core training. [Subjects] Ten javelin throwers participated in this study: six university athletes in the experimental group and four national-level athletes in the control group. [Methods] The experimental group performed 8 weeks of the specific physical training. To evaluate the effects of the training, measurements were performed before and after the training for the experimental group. Measurements comprised anthropometry, isokinetic muscle strength measurements, the function movement screen test, and movement analysis. [Results] After the specific physical training, the function movement screen score and external and internal rotator muscle strength showed statistically significant increases. Among kinematic factors, only pull distance showed improvement after training. [Conclusion] Eight weeks of specific physical training for dynamic stabilizer muscles enhanced the rotator cuff muscle strength, core stability, throw distance, and flexibility of javelin throwers. These results suggest that specific physical training can be useful for preventing shoulder injuries and improving the performance for javelin throwers.     

老年维持性血液透析患者直接留置带Cuff导管的可行性研究

目的：探讨老年维持性血液透析（MHD）患者直接留置带Cuff导管（PDLC）的可行性。方法：对9例65岁以上的MHD患者，10例次透析即予留置PDLC，并随访。结果：5例次为急诊置管，5例次为择期置管：手术时间平均35min，成功率为100％；导管使用时间平均为13个月，平均再循环率为5．3％，平均尿素氮下降率（URR）为71％，平均KT／V达1．49；未发生导管相关感染和导管堵塞。结论：老年MHD患者可以直接采用PDLC作为长期血管通路。     

颈内静脉隧道式Cuff血液透析导管移位的相关因素分析

目的探索维持性血液透析患者(Maintenance hemodialysis patient,MHP)使用颈内静脉隧道式Cuff血液透析导管发生移位的相关因素,为临床Cuff血液透析导管置入定位和护理提供参考意见。方法对我院使用颈内静脉隧道式Cuff血液透析导管的186例次MHP进行回顾性分析,收集患者的一般资料(年龄、性别、原发疾病等),生化指标(血肌酐、尿素氮、血清白蛋白等),人体测量指标(肱三头肌皮褶厚度、上臂肌围、肌肉组织质量等),根据置入导管是否有移位分为A组(移位组)和B组(未移位组),比较两组患者上述临床资料差异,进行Logistic回归分析。结果 A组56例(30.1%),B组130例(69.9%)。Cuff血液透析导管移位单因素分析显示:两组患者的年龄、C-反应蛋白、血清白蛋白、蛋白质分解率、肱三头肌皮褶厚度、上臂肌围、肌肉组织质量和肌肉组织指数比较,差异均有统计学意义(P0.05)。Logistic回归分析,患者年龄、C-反应蛋白是发生Cuff血液透析导管发生移位的危险因素(OR=1.062,OR=1.206,P均0.05)。上臂肌围、肌肉组织质量是发生Cuff血液透析导管发生移位的保护因素(OR=0.976,OR=0.791,P均0.05)。结论建议高龄、微炎状态、上臂肌围小、肌肉组织质量小的患者在放置颈内静脉隧道式Cuff血液透析导管时Cuff距离皮肤出口的距离适当增加或适当延长导管拆线时间。血液透析期间加强患者护理营养干预有助于降低Cuff血液导管移位风险。     

1例Cuff导管皮下隧道出口感染患者的护理

正目前大多数维持血液透析治疗的患者是以自身血管动静脉内瘘或人工血管动静脉内瘘为长期血管通路,但随着我国老龄化趋势不断加快,现代人生活水平提高,糖尿病、高血压等疾病发病率增高,一些患者自身血管条件无法建立内瘘或是多次内瘘失败而选择留置时间较长的颈内cuff隧道式中心静脉导管。感染是中心静脉置管最常见的并发症,常给患者到来很大的痛苦。临床上给予有效措施积极控制感染能使患者的生活质量和长期生存率有所提高。本科于2015年10月发生1例cuff导管     

血液透析患者18例带Cuff的中心静脉置管的应用

目的：探讨带Cu ff的中心静脉置管在血液净化患者中的应用,及其导管相关并发症的预防与处理。方法：分析中心静脉置管相关并发症的发生率,比较中心静脉置管组与动静脉内瘘组血液透析效果。结果：置管成功率100%,使用12个月以上者15例,中心静脉置管组与动静脉内瘘组的透析效果比较无显著性差异。结论：对于血管条件差无法建立自体动静脉内瘘或心功能不全不宜造瘘者,带Cu ff的中心静脉留置导管是一种较安全、有效的血管通路。敏感抗生素封管等治疗可延长留置双腔导管的使用时间。     

维持性血液透析患者带Cuff的中心静脉导管功能障碍原因及护理

总结25例维持性血液透析患者发生中心静脉导管功能障碍的原因及护理.导管功能障碍主要原因为导管隧道段打折、导管血栓堵塞、出口处感染、隧道感染及菌血症等.护理重点为对导管功能障碍患者做好对症护理,同时积极采取预防措施,维护导管功能,延长导管使用时间.25例患者经抗感染治疗及对症处理后导管功能障碍解除,导管保留使用.     

带Cuff深静脉双腔导管在老年血液净化患者中的应用

老年患者因急、慢性肾功能衰竭而接受各种形式的血液净化治疗逐渐增多，而如何及时有效建立血管通路，是进行血液净化治疗的关键步骤之一。本院自2003年1月至2007年6月对54例老年患者，57例次经皮下隧道留置带涤纶扣（Cuff）深静脉单针双腔管，作者就此临床技术的应用作回顾分析。     

老年维持性血液透析患者带Cuff长期深静脉置管并发症的护理

总结老年维持性血液透析患者带Cuff长期深静脉置管并发症的护理体会。留置带Cuff皮下隧道长期深静脉置管的老年维持性血液透析患者57例，发生血流不畅15例次、导管相关感染4例次、导管破损1例次、导管脱出1例次、导管出口皮肤过敏2例次，经给予重新定位、溶栓、抗感染、抗过敏、重新置管等处理后均继续带管使用。     

改良皮肤管理对带Cuff血透导管置管者感染预防的效果

目的 探讨改良皮肤管理策略在预防带Cuff血透导管感染中的应用效果。方法 选取2017年1月—2018年5月在桂林市人民医院血液透析中心行血液透析治疗且使用带Cuff血透导管的患者作为研究对象。以2017年1—8月的60例患者作为对照组,给予常规护理;以2017年9月—2018年5月的62例患者作为观察组,在常规护理基础上给予改良皮肤管理。比较两组患者血透导管感染发生率、非计划性拔管率以及患者对护理工作的满意度。结果 观察组患者的血透导管感染率、非计划拔管率均低于对照组,且患者对护理工作的满意度比较优于对照组(P0.05)。结论 改良皮肤管理能有效降低带Cuff血透导管患者的导管感染率及非计划拔管率,提高患者对护理工作的满意度,对提升临床护理质量有积极促进作用。     

多排螺旋CT静脉血管成像评估植入Cuff导管后的中心静脉

目的 探讨多排螺旋CT静脉血管成像（MDCTV）对评估双腔带Cuff中心静脉导管植入术后,导管相关功能障碍的应用价值。方法 回顾性收集110例双腔带Cuff中心静脉导管植入术后慢性肾衰竭患者,均接受胸部MDCTV检查。观察静脉导管术后相关的CT特征,包括导管置入位置、导管尖端位置、血栓形成情况及相应位置、中心静脉狭窄或闭塞情况、侧支循环形成。结果 MDCTV示Cuff导管主要从右侧颈内静脉置入（102/110,92.73%）,其次是左侧颈内静脉（5/110,4.55%）、右侧锁骨下静脉（2/110,1.82%）以及右侧头臂静脉（1/110,0.91%）。导管尖端主要位于右心房（57/110,51.82%）和上腔静脉（47/110,42.73%）,少数在下腔静脉内（6/110,5.45%）。中心静脉留置导管术后血栓发生率为58.18%（64/110）。不同导管尖端位置血栓发生率差异无统计学意义（P>0.05）。血栓组（64例）留置导管时间明显长于非血栓组（46例）,差异有统计学意义（P<0.05）。血栓主要发生于上腔静脉（41/64,64.06%）、右侧头臂静脉（23/64,35.94%）及右侧颈内静脉（14/64,21.86%）,少许见于左侧头臂静脉（3/64,4.69%）、左侧颈内静脉（3/64,4.69%）和右侧锁骨下静脉（2/64,3.13%）。中心静脉发生狭窄或闭塞者共68例（68/110,61.82%）,其中有22例累及多条静脉,其主要发生于右侧头臂静脉（45/68,66.18%）及右侧颈内静脉（28/68,41.18%）。结论 MDCTV技术可以较全面地评估中心静脉留置的带Cuff双腔导管。     

无切口水囊扩张法拔除血液透析用带Cuff带隧道导管的临床应用

目的探讨总结无切口水囊扩张血液透析用隧道导管拔除法的方法、并发症和效果。方法 2015年1月～2017年12月煤炭总医院肾内科应用无切口水囊扩张法(水囊组)拔除血液透析带Cuff带隧道导管34例,传统开放式(传统组)切开拔除血液透析带Cuff带隧道导管24例,均符合带Cuff带隧道中心静脉留置导管拔除指证。结果 2组患者在性别、年龄构成和导管留置时间上差异无统计学意义(P值分别为0.897,0.690,0.689)。传统方法拔管组24例患者平均手术时间(20.63±7.05)min,术中出血量约为(10.18±4.16)ml;水囊扩张拔管组34例患者平均手术时间(5.44±2.65)min,术中出血量平均(4.04±2.46)ml,2组间2项观察指标均有统计学意义(P值分别为0.001,0.001),术后渗血及血肿发生率传统组为12.5%(3/24),水囊组为2.94%(1/34)。感染并发症未发生,2组间无统计学差异。结论无切口水囊扩张法拔除血液透析带Cuff带隧道导管具有降低手术难度,缩短手术时间,降低术中出血量等优点,安全有效。     

Does the orientation of the distal radioulnar joint influence the force in the joint and the tension in the interosseous membrane?

OBJECTIVE: To investigate the effect of change in the orientation of the distal radioulnar joint on the force in the joint and the strain in the interosseous membrane. DESIGN: Biomechanical study in fresh frozen cadavers. BACKGROUND: The articular surfaces of the distal radioulnar joint may be orientated in parallel with the long axis of the forearm (a Type I joint) or at an oblique angle opening distally to the ulnar side (a Type II joint). METHODS: Three cadaveric upper limbs were held on a custom built frame allowing measured rotation and axial loading across the wrist. Measurements of force in the distal radioulnar joint and strain in the interosseous membrane were taken and repeated after replacement of the distal radioulnar joint with prosthetic Type I and Type II joints. FINDINGS: The force in the joint and the strain in the interosseous membrane increased with increasing load across the wrist (P < 0.0001). The force in the Type I joint was reduced compared to the normal or Type II joint. This difference was greater with increasing load and was significant at 8 kg (P < 0.001). The strain in the interosseous membrane was maximal at neutral forearm rotation and decreased with increasing pronation and supination. INTERPRETATION: The force in the joint is greater with the Type II distal radioulnar joint. We believe this compressive force increases joint stability and this orientation of the articular surfaces should be considered in the design of a total distal radioulnar joint arthroplasty.     

Does the positive keying of the TAS inflate the absorption-hypnotizability link?

The search for correlates of hypnotic responsiveness has been largely unsuccessful, with the notable exception of the construct "absorption." The Tellegen Absorption Scale (TAS) has been shown to correlate with hypnotic responsiveness, particularly if the two measures are administered in the same testing context or setting. The present study set out to determine whether the all-true, positively keyed format of the TAS inflates the absorption-hypnotizability link. With a sample of 466 participants, the authors show that wording the TAS items in either a positive or negative direction does not affect the correlation between the TAS and the Harvard Group Scale of Hypnotic Susceptibility, Form A.