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1.
中心静脉导管相关性脓毒症分析   总被引:6,自引:0,他引:6  
我们对实施经皮穿刺中心静脉插管术的病人进行临床观察 ,探讨经皮穿刺中心静脉插管术后感染因素及防治对策。1 材料与方法1998~ 2 0 0 0年在我院外科行经中心静脉导管 (CVC)输液共 10 38例。选取有临床感染征象而无其它感染灶者 5 5例作为本研究对象。其中原发病为恶性肿瘤 31例 ,急性胰腺炎14例 ,胆道结石 5例 ,其它外科疾病 5例。按置管用途分为 :静脉营养 34例 ,术中监护及监测中心静脉压 6例 ,化疗 12例 ,普通输液 3例。中心静脉导管留置时间 4~ 43天 ,平均17 6天。以Seldinger法进行颈内或颈外静脉插管。本研究分中心静…  相似文献   

2.
颈外静脉穿刺置管在大量输液中的应用   总被引:4,自引:0,他引:4  
目的 探讨颈外静脉穿刺置管用于大量输液患者的效果,以寻找最佳输液途径.方法 将需大量输液(每日补液量≥2 500 ml)的100例患者随机分为观察组和对照组各50例,观察组采用颈外静脉留置针输液,对照组采用四肢浅静脉留置针输液.结果 两组患者一次置管成功率比较,差异无显著性意义(P>0.05);两组平均留置时间,导管脱落、导管堵塞、液体渗漏、静脉炎、补钾疼痛的发生率比较,差异有显著性意义(P<0.05,P<0.01).结论 颈外静脉穿刺置管用于大量输液,可减少静脉置管并发症,且可延长留置时间.  相似文献   

3.
颈外静脉穿刺置管在大量输液中的应用   总被引:10,自引:2,他引:8  
目的探讨颈外静脉穿刺置管用于大量输液患者的效果,以寻找最佳输液途径。方法将需大量输液(每日补液量≥2500m1)的100例患者随机分为观察组和对照组各50例,观察组采用颈外静脉留置针输液,对照组采用四肢浅静脉留置针输液。结果两组患者一次置管成功率比较,差异无显著性意义(P〉0.05);两组平均留置时间,导管脱落、导管堵塞、液体渗漏、静脉炎、补钾疼痛的发生率比较,差异有显著性意义(P〈0.05,P〈0.01)。结论颈外静脉穿刺置管用于大量输液,可减少静脉置管并发症,且可延长留置时间。  相似文献   

4.
颈外静脉穿刺插管术125例护理分析   总被引:7,自引:0,他引:7  
颈外静脉是颈部最粗大的浅静脉,位于颈外侧皮下,管腔较粗(成人直径约1cm),血流畅通,不易塌陷,一般透过皮下可以看见。颈外静脉穿刺插管术(下简称颈穿),为抢救休克病人、供给静脉内高营养和应用具有血管刺激性抗癌药物开辟了一个简便安全的途径,对长期输液的病人可避免反复穿  相似文献   

5.
我院外科自1975年3月至1984年12月,共施行颈部大静脉穿刺插管术630例,获得了满意的效果,总结如下。选用颈部大静脉计有:颈内静脉穿刺插管402例,锁骨下静脉穿刺插管182例,颈外静脉穿刺插管46例。置管时间景长者120天,最短者1天,平均置管时间为21天,插管失败9例(占1.42%),成功率为98.58%。发生各种并发症共16例(占2.53%),计有:感染及败血症9例,气胸1例,空气吸入及空气栓塞2例,管栓1例,局部血肿2例,皮下气肿1例,共计16例。我院进行颈部大静脉穿刺插管的器械,均由我院  相似文献   

6.
颈外静脉留置针通道在上消化道大出血患者输液中的应用   总被引:7,自引:0,他引:7  
目的 提高上消化道大出血患者静脉输液护理质量.方法 将64例上消化道大出血患者随机分为观察组和对照组各32例.采用22 G静脉留置针,观察组行颈外静脉穿刺置管.对照组行前臂静脉穿刺置管.观察两组留置针穿刺效果和留置效果.结果 观察组一次穿刺成功率及经留置针采血成功率显著高于对照组(均P<0.01),穿刺时间显著短于对照组(P<0.01),留置时间显著长于对照组(P<0.01),外渗及并发症总发生率显著低于对照组(P<0.05,P<0.01),单通道1 h液体补充量显著多于对照组(P<0.01).结论 应用颈外静脉留置针通道能有效提高上消化道大出血患者静脉输液护理质量,有利于患者的救治.  相似文献   

7.
我院对进行骨髓移植治疗的病人,因静脉输液及成份输血等需要,常规由颈外静脉做中心静脉插管。其中第7例病人在移植后拔管时发生导管断入上腔静脉。现报告如下。病例简介患者俞××,男,26岁,以急性淋巴细胞白血病于1987年3月10日收住本科,经联合化疗完全缓解,于1987年7月20日进行异基因骨髓移植治疗。移植前1周由颈外静脉做中心静脉插管,具体方法:  相似文献   

8.
目的总结改良塞丁格尔技术PICC置管行乳腺癌术后化疗的体会。为接受化疗患者建立安全、有效、痛苦小的静脉通道,降低频繁静脉穿刺、采血。减少化疗药物外渗而致的静脉炎、局部组织坏死等并发症发生率。方法将255例术后行健侧PICC插管化疗的乳腺癌患者分为2组,其中对照组204例经肘窝外周静脉穿刺,观察组51例行改良赛丁格尔技术穿刺。比较2组的效果。结果对照组一次置管成功率92%,导管留置时间为26~112 d,平均为69 d,少数患者出现轻微并发症,经积极处理后均好转。观察组一次置管成功率为99%,导管留置时间为34~146 d,平均为83 d,未发生并发症,2组比较,差异有统计学意义(P0.05)。结论改良塞丁格尔技术PICC置管操作快速、方便,穿刺成功率高,维护简单,导管留置时间长,并发症低,为乳腺癌患者术后化疗用药提供了一条安全、方便的输液途径。  相似文献   

9.
目的:探讨后腹腔镜手术治疗成人重复肾输尿管畸形的临床经验及手术疗效。方法:回顾分析2006年11月至2011年9月为18例成人重复肾输尿管畸形患者行后腹腔镜手术的临床资料,其中男6例,女12例,平均(30.2±7.8)岁。18例重复肾均位于肾上极,其中左侧13例,右侧5例。结果:18例手术均顺利完成,无一例中转开放手术,围手术期无严重并发症发生。手术时间平均(103±24.5)min,术中出血量平均(45.3±21.6)ml,术中肾静脉损伤1例,术后发生尿漏1例,术后平均住院(5.5±1.7)d。平均随访(41.3±15.5)个月,患者术前原有症状消失,肾功能正常,术后3个月复查CTU或MRU检查,未见重复肾。结论:后腹腔镜重复肾输尿管切除术安全、有效,具有患者创伤小、康复快的优点,可作为治疗成人重复肾输尿管畸形的首选方法。  相似文献   

10.
静脉留置导管血液透析的体会   总被引:2,自引:0,他引:2  
1994年以来,我们对78例急、慢性肾功能衰竭(ARF、CRF)患者采用静脉穿刺留置导管行血液透析,现报告如下。 资料与方法 1. 资料:男52例,女26例,年龄14~88岁,其中 ARF 8例,CRF 70例。 2.置管:用 Quinton双腔管,11.5Fu x19. 5 cm,置于右或左锁骨下静脉。 3. 方法:本组病例一般采用透析前床边插管,插入留置管后即行透析治疗。 结果 血流量平均(250±40)ml/min,静脉内留置时间平均 45(5~180)d,使用次数平均26(1~60)次,插管口局部感染3例…  相似文献   

11.
Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI2) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI2), TXB2 (stabile metabolite of thromboxane A2) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI2 release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB2 (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI2 release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A2, presumably contributing to hemodynamic stability within 30 min after MT.  相似文献   

12.
Don Dame 《Artificial organs》1996,20(5):613-617
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.  相似文献   

13.
Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H2O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg−1 followed by 0.15 mg · kg−1 · h−1, n=8) or verapamil (0.1 mg · kg−1 followed by 0.3 mg · kg−1 · h−1, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.  相似文献   

14.
Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.  相似文献   

15.
Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.  相似文献   

16.
Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.  相似文献   

17.
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.  相似文献   

18.
Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.  相似文献   

19.
20.
Abstract: Photopheresis is a technique in which peripheral blood mononuclear cells, in the presence of a photoacti-vatable compound, are exposed extracorporeally to ultraviolet A light and reinfused, inducing a host autoregula-tory immune response. Experimental work and ongoing clinical studies are helping to define the role of this novel, safe, and non-toxic immunomodulating technology in the field of transplantation.  相似文献   

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