鱼骨图在老年患者外周静脉置管中的应用效果

目的探讨鱼骨图在老年患者外周静脉留置管中的应用效果。方法将120例老年住院患者随机分为对照组与干预组各60例。对照组采用常规方法行外周静脉置管．干预组应用鱼骨图进行外周静脉留置针程序护理。结果干预组一次穿刺成功率显著高于对照组（P〈0．05）；置管后并发症发生率显著低于对照组（P〈0．01）；留置时间显著长于对照组（P〈0．01）。结论鱼骨图能提高老年患者外周静脉留置针一次穿刺成功率．减少置管后并发症．王正长詈管留器时间.     

鱼骨图在老年患者外周静脉置管中的应用效果

目的探讨鱼骨图在老年患者外周静脉留置管中的应用效果。方法将120例老年住院患者随机分为对照组与干预组各60例。对照组采用常规方法行外周静脉置管,干预组应用鱼骨图进行外周静脉留置针程序护理。结果干预组一次穿刺成功率显著高于对照组(P<0.05);置管后并发症发生率显著低于对照组(P<0.01);留置时间显著长于对照组(P<0.01)。结论鱼骨图能提高老年患者外周静脉留置针一次穿刺成功率,减少置管后并发症,延长置管留置时间。     

气管插管病人胃管置入方法研究

目的 探讨气管插管病人胃管置入方法。方法 将264例气管插管病人随机分为卡弗放气组(A组)、卡费不放气组(B组)、头部前倾组(C组)和镇静状态下牵拉气管组(D组)各66例；观察并比较一次置管成功率，置管前后HR、SpO2及置管过程中呛咳发生率。结果①一次置管成功率比较，A组与B组差异无显著性意义(P＞0．05)，C组显著低于A、B组(均P＜0．05)，D组显著高于其它各组(均P＜0．01)。②置管后HR、SpO2与各自置管前相比，B、D组无显著性意义(均P＞0．05)，A、C组HR明显加快、SpO2明显降低(P＜0．05，P＜0．01）；C组置管过程中呛咳发生率显著高于其他各组(均P＜0．01)。结论 对气管插管病人在镇静状态下牵拉气管的同时置入胃管准确性高、不良反应少。     

超声引导下颈内静脉置管在婴儿心脏手术中的应用

目的 探讨超声引导下颈内静脉置管术在婴儿心脏手术中的临床应用.方法 选择年龄30d～1岁,体重3.70～12.0 kg行先天性心脏病手术的患儿40例,随机均分为两组.观察组(A组)在超声引导下将颈内静脉置于屏幕中央,用18G BD静脉留置针穿刺血管,置静脉外套管后,放入引导钢丝,然后置入中心静脉导管;对照组(B组)选择右颈内静脉中路或后路,用18G BD静脉留置针穿刺,回血通畅后经静脉外套管置入引导钢丝,最后置入中心静脉导管.记录两组穿刺置管时间、穿刺总成功率、一次穿刺成功率、失败率及并发症.结果 A组穿刺置管时间明显短于B组(P＜0.05).A组穿刺总成功率100%,明显高于B组的80%(P＜0.05);A组一次穿刺成功率90%,显著高于B组的65%(P＜0.01);A组无失败病例,B组失败率20%;A组的穿刺并发症低于B组,但差异无统计学意义.结论 超声引导下婴儿颈内静脉穿刺置管,提高了成功率,能有效降低并发症,并缩短穿刺置管时间,有较高的临床应用价值.     

地塞米松预防肿瘤病人PICC置管后血栓的临床研究

目的:研究地塞米松预防肿瘤病人PICC置管后血栓的作用.方法:113例留置PICC的肿瘤病人分为2组,观察组采用常规护理的基础上,置管后使用地塞米松磷酸钠注射液5毫克连续3天静脉输入;对照组采用常规护理,未采用地塞米松.两组病人置管后均采用超声监测PICC血管,观察是否有血栓形成,比较血栓发生率的差异.结果:观察组的血栓发生率低于对照组(P＜0.05).结论:肿瘤病人置管后连续3天使用地塞米松可降低PICC置管后血栓的发生率.     

原液压力封管与肝素液封管的效果观察

目的：寻找一种简便可行的静脉留置套管针封管方法。方法：将102例行静脉留置套管针的病人随机分为压力组（51例，146例次，采用原液压力法进行封管）和肝素组（51例，162例次，采用肝素液进行封管）。结果：两组输液情况，封管时间、置管时间比较，差异无显著性意义（均P＞0．05）。结论：原液压力封管法能替代传统的肝素液封管法，且具有操作简便、节省资源等优点。     

老年患者静脉留置针穿刺置管方法的改进

目的 探讨老年患者静脉留置针穿刺1管的方法.以提高穿刺置管的成功率.方法 选择住院老年患者64例,随机分成观察组和对照组各32例,对照组采用传统静脉留置针操作方法,观察组在此基础上,采用左手固定皮肤,右手送管的方法,并且根据血管情况决定送管长度,进行静脉穿刺置管操作.结果 观察组穿刺置管成功率94.6%,疼痛发生率6.8%,对照组分别为79.2%、27.8%.两组比较,差异有显著性意义(均P＜0.01).结论 对老年血管条件不佳的患者,采用单手送管并根据血管情况决定送管长度的方法置管,可提高穿刺成功率,减轻疼痛.     

肝素帽固定部位对静脉留置针留置效果的影响

目的探讨静脉留置针肝素帽固定部位对留置针回血、堵管发生率及留置时间的影响。方法将60例静脉留置针患者随机分为两组，各30例。对照组将肝素帽固定在穿刺点下方或水平位置，观察组将肝素帽固定在穿刺点上方3～4cm处。结果观察组留置针回血率、堵管发生率显著低于对照组（均P〈0．01），留置时间显著长于对照组（P〈0．01）。结论静脉留置针肝素帽固定于穿刺点上方，可减少置管并发症，延长置管时间。     

颈外静脉留置针的临床应用

目的探讨颈外静脉留置针的临床应用,以减轻患者痛苦,保护血管和维护稳定的静脉输液。方法对106例患者通过颈外静脉留置套管针输液观察穿刺部位及输液情况。结果留置套管针输液3~9 d,未发现局部或全身感染等症状。结论穿刺前做好解释工作,能得到患者的积极配合;正确选择穿刺部位,术中严格无菌操作,掌握置管时间和熟练的操作技术是颈外静脉留置针的关键环节;置管期间,精心护理病人及置管部位,对保证输液顺利具有重要作用。     

正压静脉留置针两种封管液的效果分析

目的:比较生理盐水、肝素钠2种静脉留置针封管液的效果.方法:将120例静脉留置针输液患者分成A组和B组,各60例.A组用生理盐水封管,B组用肝素钠溶液封管.观察静脉留置针的留置时间的差异,堵管、回血、外渗和静脉炎的发生率.结果:两组静脉留置针留置时间及堵管、回血、外渗和静脉炎的发生率无统计学意义(P>0.05).结论:生理盐水与肝素钠稀释液用于静脉留置针封管效果无明显区别.     

Reduction of Plasma Fibrinogen, Immunoglobulin G, and Immunoglobulin M Concentrations by Immunoadsorption Therapy with Tryptophan and Phenylalanine Adsorbents

Abstract Immunoadsorption (1A) therapy with tryptophan (TR-350) or phenylalanine (PH-350) adsorbents has been used to reduce the concentration of serum antibodies in human lymphocyte antigen (HLA)-immunized patients. Other forms of plasma purification have been reported to reduce the level of fibrinogen, which affects the blood properties. In this study we investigated the effects of IA therapy using both adsorbents on plasma fibrinogen and immunoglobulins G and M in 13 patients (8 patients were treated with TR-350, and 5 patients were treated with PH-350). During each session 1 plasma volume (2.8 ± 0.4 L of plasma) was processed through the immunocolumn and then returned to the patient together with the blood cells. Compared with the pretreatment values, the plasma fibrinogen, IgG, and IgM concentrations were significantly reduced after IA therapy (p < 0.01 for TR-350; p < 0.04 for PH-350). There was a positive correlation between the degree of reduction of plasma proteins and the number of IA treatments given. A nonpara-metric test (Wilcoxon's signed-rank test or the Mann-Whitney test) was used for statistical analysis. We conclude from our study that IA therapy effectively lowers the plasma levels of fibrinogen, IgG, and IgM and thus can be considered a valuable alternative to other blood purification methods.     

The multiply injured child

Blunt trauma is the principal cause of childhood death in many developed countries. This review outlines the differences between adults and children with respect to resuscitation and treatment of orthopaedic injuries in a child with polytrauma. Recent advances in techniques of fracture stabilization are reported.     

Development of Selective Low-Density Lipoprotein (LDL) Apheresis System: Immobilized Polyanion as LDL-Specific Adsorption for LDL Apheresis System

Abstract: Low-density lipoprotein (LDL) is widely recognized as one of the major risk factors for developing coronary heart diseases. Despite intensive development of LDL-lowering drugs, there still exist those patients with refractory hyperlipidemia whose plasma LDL levels are not sufficiently lowered by drugs. LDL apheresis, direct removal of plasma LDL from circulating blood, is thought to be the most promising treatment for such refractory patients. Various techniques, such as the use of an im-munoadsorbent utilizing an anti-LDL antibody, have been used in an attempt to achieve the selective removal of LDL. However, none were widely used because of complications, poor selectivity, and so forth. To establish a safe and effective LDL apheresis system, we chose a synthetic affinity adsorbent as the LDL-removing device. Synthetic polyanion compounds were used as the affinity ligands for LDL adsorbent to simulate the anion-rich sequence of LDL binding sites in the human LDL receptor. Among various polyanion compounds, those polyanions with sulfate or sulfonate groups and hydrophilic backbone were found to have strong affinity for LDL. In contrast, polyanions with carboxyl groups showed poor affinity. Dextran sulfate (DS) was selected as the affinity ligand of LDL adsorbent for its high affinity and low toxicity. The influence of its charge density and molecular weight on its affinity for LDL was suitable. The affinity rapidly increased as the charge density increased, then, reached a constant value. Little affinity was found for either the DS monomer (glucose sulfate) or DS with a molecular weight higher than 10⁴ daltons whereas DS with molecular weights in the midrange showed strong affinity. DS with a midrange molecular weight was immobilized on cellulose hard gel to give LDL adsorbent clinical application. The adsorbent demonstrated an excellent selectivity for LDL and very low density lipoprotein (VLDL) in vitro. Adsorption of high-density lipoprotein and major plasma proteins was almost negligible. Additional study of the LDL-binding mechanism revealed that DS directly interacts with positively charged sites on LDL, which demonstrates that the nature of the interaction is the same as that of LDL receptor. An LDL adsorption column (Liposorber) packed with an LDL adsorbent and polysulfone hollow-fiber plasma separator (Sulflux) was developed as an efficient LDL apheresis system. Clinical investigation proved that this system is capable of intensively lowering the plasma LDL level without affecting major plasma components.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Artificial organs 2010: a year in review

In this Editor's Review, articles published in 2010 are organized by category and briefly summarized. As the official journal of The International Federation for Artificial Organs, The International Faculty for Artificial Organs, and the International Society for Rotary Blood Pumps, Artificial Organs continues in the original mission of its founders "to foster communications in the field of artificial organs on an international level."Artificial Organs continues to publish developments and clinical applications of artificial organ technologies in this broad and expanding field of organ Replacement, Recovery, and Regeneration from all over the world. We take this time also to express our gratitude to our authors for offering their work to this journal. We offer our very special thanks to our reviewers who give so generously of time and expertise to review, critique, and especially provide such meaningful suggestions to the author's work whether eventually accepted or rejected and especially to those whose native tongue is not English. Without these excellent and dedicated reviewers the quality expected from such a journal could not be possible. We also express our special thanks to our Publisher, Wiley-Blackwell, for their expert attention and support in the production and marketing of Artificial Organs. In this Editor's Review, that historically has been widely received by our readership, we aim to provide a brief reflection of the currently available worldwide knowledge that is intended to advance and better human life while providing insight for continued application of technologies and methods of organ Replacement, Recovery, and Regeneration. We look forward to recording further advances in the coming years.     

Avaliação do clube de revista de anestesiologia por meio de mudanças semânticas

Background and objectives

The interactive approach of a journal club has been described in the medical education literature. The aim of this investigation is to present an assessment of journal club as a tool to address the question whether residents read more and critically.

Methods

This study reports the performance of medical residents in anesthesiology from the Clinics Hospital – University of São Paulo Medical School. All medical residents were invited to answer five questions derived from discussed papers. The answer sheet consisted of an affirmative statement with a Likert type scale (totally disagree–disagree–not sure–agree–totally agree), each related to one of the chosen articles. The results were evaluated by means of item analysis – difficulty index and discrimination power.

Results

Residents filled one hundred and seventy three evaluations in the months of December 2011 (n = 51), July 2012 (n = 66) and December 2012 (n = 56). The first exam presented all items with straight statement, second and third exams presented mixed items. Separating “totally agree” from “agree” increased the difficulty indices, but did not improve the discrimination power.

Conclusions

The use of a journal club assessment with straight and inverted statements and by means of five points scale for agreement has been shown to increase its item difficulty and discrimination power. This may reflect involvement either with the reading or the discussion during the journal meeting.     

Soluble TNFα Receptors Are Increased in Chronic Renal Insufficiency and Hemodialysis and Inhibit Neutrophil Priming by TNFα

Abstract: The oxidative burst of neutrophils from azotemic patients is refractory to priming by tumor necrosis factor-α (TNFα). Soluble TNFα binding proteins (TNFR) accumulate in the plasma of azotemic patients. To test the hypothesis that these increased sTNFR concentrations inhibit TNFa priming of oxidative burst activity, we measured plasma sTNFR concentrations in nondialyzed azotemic patients, hemodialysis patients, and normal subjects, and determined TNFa priming of fMet-Leu-Phe-stimulated superoxide production in neutrophils incubated in plasma with differing levels of sTNFR. These sTNFR concentrations increased significantly as creatinine clearance decreased and were significantly greater in hemodialysis patients than could be accounted for by loss of renal function alone. TNFα primed superoxide production by normal neutrophils in normal plasma, but this effect was significantly reduced in plasma with increased concentrations of sTNFR. Neutrophils from azotemic and hemodialysis patients were refractory to priming by TNFα in autologous plasma, and incubation in normal plasma only partially corrected this defect. We conclude that sTNFR accumulate as a result of the loss of renal function and hemodialysis and inhibit TNFα priming of neutrophils in azotemic and hemodialysis patients, but that these cells also have an intrinsic functional defect.