植入式静脉输液港术后急性皮下水肿患者的护理

植入式静脉输液港简称输液港(venous port access,VPA),是一种可置入皮下且长期留置在体内的静脉输液装置,为需要长期输液治疗的患者提供了可靠的静脉通道,可用于输注高浓度化疗药物、完全肠外营养液、血液制品及血样的采集等,减少了因反复穿刺给患者带来的痛苦,同时防止了刺激性药物对静脉的损伤,是肿瘤患者常选用的输液通道之一。我科于2013年6月收治1例经典型结节硬化型霍奇金淋巴瘤患者,于2014年6月22日在介入科行输液港植入术,经输液港进行静脉输液治疗过程中出现输液港注射座周围皮肤急性水肿,经消肿护理后周围皮肤恢复正常。现将护理体会报告如下。     

皮下水肿超声表现三例

水肿是临床常见的体征.现将3例典型皮下水肿的超声图像特点介绍如下. 例1男,73岁,因患糖尿病、糖尿病性肾病、血管病变,临床表现为全身性水肿,可见阴囊及阴茎水肿(图1,2),下肢明显水肿(图3,4,动态图1).     

B超诊断胎儿皮下水肿1例

孕妇,32岁。一般情况良好,G3P2,孕24周。在我院做B超示:胎头光环,双顶径6.0cm,胎头皮厚1.0cm,可见胎心搏动和胎动,胎儿整个皮下有一层中低回声,羊水量过多,胎儿胸腔探及1.6cm深度的液 性暗区回声。 B超诊断为胎儿皮下水肿合并胎儿胸腔积液,引 产后证实。     

皮下水肿患者静脉穿刺技巧

近年来，我们总结出一种为皮下水肿患者静脉穿刺的方法，效果满意。现报告如下。 方法：选择血管，在穿刺点上方6cm处扎止血带，用拇指指腹在穿刺点上、下方按压，使局部皮肤形成一3—4cm的凹陷，血管即变得清晰且位置变浅。迅速消毒皮肤，在1min内完成穿刺，妥善固定。对于皮肤表面无法观察到血管的患者，     

戊二醛致术后局部皮下水肿

戊二醛是一种新型高效、低毒的消毒剂,主要用于畏热医疗器械的灭菌,灭菌后的医疗器械必须用灭菌蒸馏水将残留在器械上的戊二醛冲洗干净。因戊二醛对人体组织、黏膜皮肤均有刺激和固化作用,伤口接触戊二醛可影响愈合过程,所以,切勿将残留戊二醛带入伤口。我院曾发现 5例术后     

自制纱布烟卷在皮下水肿病人行动-静脉穿刺前的巧用

直接动-静脉穿刺是血液透析、血浆置换等治疗时常用的建立血管通路的方法,多次治疗病人常因伴有水肿或皮下血肿导致穿刺失败,2012年2月我院采取动脉穿刺前均使用自制纱布烟卷压迫穿刺部位,提高了穿刺成功率,现介绍如下。     

硫酸镁外敷佐治重症心源性水肿46例

我们近10年应用50％硫酸镁溶液外涂或外敷水肿部位佐治心源性水肿取得良好效果，现将其中46例重症心源性水肿患者治疗效果报告如下。[第一段]     

1例气管切开合并全身重度水肿重症急性胰腺炎患者的皮肤护理

重症急性胰腺炎（severeacutepancreatitis,SAP）是腹部最危重的疾病之一,其发病急、变化快、病情重,预后差,并发症多,病死率高,其中急性呼吸窘迫综合征（acuterespiratorydistresssyndrome,ARDS）和多器官功能障碍综合征（multipleorgandysfunctionsyndrome,MODS）是其常见并发症。     

急性脑梗死合并全身皮下气肿患者的急救护理

在对1例急性脑梗死合并全身皮下气肿患者的急救护理过程中，通过给予胸腔闭式水封瓶引流正压持续排气（以下简称胸腔闭式引流），及局部皮下粗针穿刺间断放气减压、呼吸机维持患者呼吸运动的正常进行、保证水电解质和酸碱平衡，了解患者心理并给予疏导，满足患者的需求，准确记录生命体征和出入量等，使患者减轻痛苦，脱离危险。在抢救急性脑梗死合并全身皮下气肿的过程中，除了积极治疗原发病还要迅速进行胸内减压、保持呼吸道通畅，给予细致、全面的护理是很关键的一环。     

胰岛素导致全身水肿1例

患者,男,69岁,主因进行性双下肢无力2周入院。既往患糖尿病17年,口服格列康胺(商品名：糖适平),血糖控制良好。有冠心病,陈旧性前壁心肌梗死病史3年,平时口服硝酸异山梨酯(商品名：消心痛)及地高辛(商品名：狄戈辛)。否认高血压病史。无肝炎、结核病史,无特殊嗜好。入院时查体：血压150／80mmHg(1mmHg-0．133kPa);自动体位,言语流利。口唇无发绀,伸舌居中。     

Pharmacokinetics and pharmacodynamics of sequential intravenous and subcutaneous teicoplanin in critically ill patients without vasopressors

Objective To compare the pharmacokinetic parameters of sequential intravenous and subcutaneous teicoplanin in the plasma of surgical intensive care unit patients.Design and setting Prospective, randomized, crossover study in the surgical ICU of a university hospital.Patients Twelve patients with a suspected nosocomial infection, a serum albumin level higher than 10 g/l, body mass index less than 28 kg/m², and estimated creatinine clearance higher than 70 ml/min.Interventions Teicoplanin was first administered intravenously as a loading dose of 6 mg/kg per 12 h for 48 h and then continued at a daily dose of 6 mg/kg. On the fourth day patients were randomized in two groups according to the order of the pharmacokinetic studies.Measurements and results Serial plasma samples were obtained to measure teicoplanin levels. Compared with a 30-min intravenous infusion the peak concentration of teicoplanin after a 30-min subcutaneous administration occurred later (median 7 h, range 5–18) and was lower (16 µg/ml, 9–31; vs. 73, 53–106). Despite large and unpredictable interindividual differences no significant differences between subcutaneous and intravenous administration were observed in: trough antibiotic concentrations (10 µg/ml, 6–24; vs. 9, 5–30), the area under the teicoplanin plasma concentration vs. time curves from 0 to 24 h (AUC_0–24h; 309 µg/ml per minute, 180–640; vs. 369, 171–955), the proportion of the dosing interval during which the plasma teicoplanin concentration exceeded 10 µg/ml (96%, 0–100%; vs. 79%, 13–100%), and the ratio of AUC_0–24h to 10 (77, 45–160; vs. 92, 43–239).Conclusions In critically ill patients without vasopressors a switch to the subcutaneous teicoplanin after an initial intravenous therapy seems to give comparable pharmacodynamic indexes of therapeutic success.     

危重患者早期肠内营养相关并发症分析

目的 观察综合性ICU危重症患者早期肠内营养支持中，相关并发症的发生及其相关因素。方法 119例入住ICU接受早期肠内营养支持患者，入ICU后根据24小时内各项监护指标及血常规、血气分析及肝肾功能检查，进行APACHE-Ⅱ评分。观察肠内营养量、速度、血清白蛋白(Alb)及肠内营养的耐受情况。总结各种肠内营养并发症的发生率。结果 随APACHE-Ⅱ评分的增加，肠内营养耐受的最大维持量降低、达最大维持量的时间延长、相关并发症的发生率增加。腹泻发生与Alb水平呈负相关，与APACHE-Ⅱ评分呈正相关。肠内营养并发症中以腹泻最为常见。结论 肠内营养相关并发症与疾病严重程度、血清蛋白水平等因素相关，一些危重患者无法过渡到完全肠内营养(TEN)，而需以静脉营养(PN) 肠内营养(EN)形式实现营养支持。     

早期肠内营养对危重患者的影响

目的通过对危重患者入院24～48h内早期肠内营养支持的研究，了解其对危重患者的影响。方法选择我院综合性ICU中的危重患者，随机分为实验组和对照组。实验组在入院24～48h内开始肠内营养；对照组在入院48h后开始肠内营养。检测两组患者的营养指标、感染发生率、机械通气时间。结果共有206例危重患者进入实验。实验组的热量摄入、氮平衡优于对照组，感染发生率降低。结论早期肠内营养能更好地改善危重患者的营养摄入，降低感染发生率。     

Polymicrobial bacteremia in critically ill patients

Objective To characterize the epidemiology of polymicrobial bacteremia (PMB) among critically ill patients.Design Prospective clinical study.Setting University medical center.Patients All patients with positive blood cultures in a medical-surgical ICU.Measurements PMB represents 8.4% of all true bacteremia in our ICU. Most of these patients were post-operative but none had malignancies or significant immunodepression. Over three-quarters of the episodes were nosocomial. No significant differences in factors associated with PMB were found when they were compared with a cohort of 154 monomicrobial episodes. Enterobacteriaceae were the most common organisms. Intravascular devices (42.8%) were the most common source of PMB, followed by intra-abdominal origin (21.4%). The overall mortality was 7.1%, a lower rate than has previously been described.Conclusions We suggest catheter replacement in patients who develop PMB and improving techniques of catheter maintenance in order to reduce its incidence.     

Coagulation biomarkers in critically ill patients

This article discusses coagulation biomarkers in critically ill patients where coagulation abnormalities occur frequently and may have a major impact on the outcome. An adequate explanation for the cause is important, since many underlying disorders may require specific treatment and supportive therapy directed at the underlying condition. Deficiencies in platelets and coagulation factors in bleeding patients or patients at risk for bleeding can be achieved by transfusion of platelet concentrate or plasma products, respectively. Prohemostatic treatment may be beneficial in case of severe bleeding, whereas restoring physiological anticoagulant pathways may be helpful in patients with sepsis and disseminated intravascular coagulation.     

ICU医师应用超声诊断危重患者气胸的价值研究

目的探讨ICU医师应用床旁超声诊断危重患者气胸的可行性及临床价值。方法2004—09～2005—07急诊ICU收治101例危重患者，由ICU医师进行床旁胸部超声检查，以“肺滑行”和“彗尾”征消失诊断气胸。在超声检查前后3h内行胸部CT和床旁X片检查，以CT结果为“金标准”比较超声和X片诊断气胸的价值。结果101例危重患者中，CT确诊气胸19例21侧，超声诊断17例18倒，X片诊断4例4侧，相应的诊断敏感性、特异性、阳性预测值、阴性预测值和准确度分别为85.7％时19.0％（P〈0.001）、98．9％对100％（P=0．499）、90．0％时100％（P=1．0）、98．4％对91．4％（P=0．002）和97.5％对91．6％（P=0．009）。超声与CT诊断气胸的一致性高于X片。结论ICU医师完成的超声检查诊断气胸具有较高的敏感性和特异性，为危重患者气胸的诊断提供了简单、快速而安全有效的手段。     

L-丙氨酰-L-谷氨酰胺强化的肠外营养支持在外科危重患者的应用

目的：探讨用L－丙氨酰－L－谷氨酰胺强化的肠外营养对外科危重患者营养支持的应用价值。方法：将24例外科危重患者随机分为两组，对照组单纯给予静脉营养，强化组除给予静脉营养外，按1．5mg/kg补充L－丙氨酰－L－谷氨酰胺。分别在静脉营养治疗的前1d，治疗后第4、7、14d测定氮平衡，营养指标，免疫功能指标和患者耐受性指标。结果：治疗7d后两组患者均由负氮平衡转为正氮平衡，营养指标，免疫功能指标明显增高，但强化组增高更明显／患者耐受性指标中，强化组无显著变化，对照组则出现血葡萄糖和总胆红素升高，结论：用L－丙氨酰－L－谷氨酰胺强化比单纯的肠外营养更明显改善危重患者的营养状况和免疫功能，提高患者的耐受性。     

晨间护理查房中危重病人存在的问题分析及对策

目的专科性小病房晨间集体护理查房,通过应用护理程序,明确危重病人存在的护理问题,保证危重病人的护理质量。方法护理查房与晨间交接班相结合对危重病人病情分析,提出重点需要解决的护理问题,落实护理措施。结果与结论晨间护理查房具有个体化、针对性、时效性;护理病历和特护记录在体现专科护理内容、病情监测重点、护理记录客观、连续完整等方面明显提高;强化了专科理论与技能,实现危重病人整体护理的持续改进,分担临床护理责任压力,是护理人员提高业务能力、综合职业素质的有效途径。     

连续性肾脏替代疗法治疗危重症患者的护理

目的 探讨连续性肾脏替代疗法治疗危重症患者的应用及临床护理措施.方法 选取2009年10月至201 1年6月于本院进行治疗的l00例危重症患者为研究对象,对其实施护理措施,将连续性肾脏替代疗法治疗前后患者的生化指标进行比较分析.结果 连续性肾脏替代疗法治疗后患者的生化指标较治疗前均有明显改善.结论 在连续性肾脏替代疗法治疗危重症患者的过程中实施有效、全面的护理能够很大程度上改善患者的生命指标,提高重症患者的存活率,值得在临床开展应用.     

Effect of ranitidine on gastric intramucosal pH in critically ill patients

Objective: To determine whether ranitidine a) increases the values of gastric intramucosal pH (pHi) in critically ill patients, as determined by tonometry; b) reduces the variability of these measurements. Design: Prospective, double blind, randomized, placebo-controlled study. Setting: General Intensive Care Unit of a teaching hospital. Patients: Twenty-five critically ill, mechanically ventilated patients requiring arterial catheter and nasogastric tube. Interventions: Tonometer placement; blind, random administration of intravenous ranitidine (50 mg) or placebo. Measurements and main results: Tonometer saline PCO₂ (PCO₂i), arterial blood gases, gastric juice pH and pHi were determined immediately before, and 2, 4, 6 and 8 h after, ranitidine (12 patients) or placebo (13 patients). Ranitidine significantly increased gastric juice pH, but did not affect PCO₂i or pHi; pHi was 7.34 ± 0.14 before ranitidine, and 7.30 ± 0.12, 7.31 ± 0.11, 7.31 ± 0.14 and 7.31 ± 0.12 – 2, 4, 6 and 8 h, respectively, after ranitidine administration (p = 0.55). Ranitidine did not modify the coefficients of variation of PCO₂i or pHi, either. No significant changes in gastric juice pH, PCO₂i or pHi were observed in the placebo group. Conclusions: In critically ill patients, ranitidine has no effect on pHi values, and does not increase the reproducibility of pHi measurements. Received: 24 October 1996 Accepted: 22 October 1997