循证护理在经颈静脉肝内门腔分流术护理中的应用

目的探讨肝硬化经颈内静脉肝内门腔分流术的常见护理问题及应用循证护理解决方法。方法通过观察18例经颈内静脉肝内门腔分流术患者的术前、术后出现的或潜在的并发症,进行临床评估,应用循证护理的概念,确定护理问题,提供护理干预。结果通过循证护理的干预,患者出现的并发症得到有效护理并改善症状。结论循证护理改变了临床护士以往凭经验和感觉为主的习惯和行为,解决了临床护理工作中遇到的问题,对提高护理质量有所帮助。     

Deep vein thrombosis

Occlusive clot formation in the veins causes venous thrombosis, the site most common in the deep veins of leg, called deep vein thrombosis. The clot can block blood flow and when it breaks off, called an embolism which in turn can damage the vital organs. Venous thrombosis occurs via three mechanisms ie, Virchow's triad. The mechanisms are decreased flow rate of blood, damage to the blood vessel wall and an increased tendency of the blood to clot. There are several factors which can increase a person's risk for deep vein thrombosis. The symptoms of deep vein thrombosis in the legs are pain, swelling and redness of the part. One variety of venous thrombosis is phlegmasia alba dolens where the leg becomes pale and cool. Investigations include Doppler ultrasound examination of the limb, D-dimer blood test, plethysmography of the legs, x-rays to show vein in the affected area (venography). Hospitalisation is necessary in some cases with some risk factors. The mainstream of treatment is with anticoagulants, mostly low molecular weight heparin for 6 months. Deep venous thrombosis is a rising problem. Early diagnosis and treatment is associated with a good prognosis.     

肿瘤患者经外周静脉置入中心静脉导管后静脉血栓形成行超声引导血管穿刺技术对其的影响

目的探究肿瘤患者经外周静脉置入中心静脉导管(PICC)时用超声引导血管穿刺技术对其静脉血栓形成的影响。方法对我院2014年1月至2015年5月接收的恶性肿瘤实施PICC的150例患者进行研究分析,随机将其分为两组,其中对照组70例患者在其肘部静脉处实施盲穿法将PICC导管置入;治疗组80例患者在贵要静脉处进行穿刺,通过超声的引导将PICC导管置入。观察两组患者置入PICC导管后静脉血栓形成的情况。结果观察组患者应用超声引导置入PICC导管其静脉血栓发生率为3.75%,明显低于对照组的15.71%,(P0.05)。结论对恶性肿瘤患者置入PICC导管应用超声引导,可使患者置入PICC导管后静脉血栓形成减低,临床应用效果甚佳。     

肝癌并发门静脉、肠系膜上静脉、下腔静脉瘤栓及脾转移1例

1 临床资料患者男性,77岁,因上腹胀2月余于2004年3月2日入院。体格检查:慢性病容,全身皮肤巩膜无黄染,浅表淋巴结不大,颧部毛细血管扩张,心肺无异常。腹部膨隆,腹肌稍紧,无明显压痛及反跳痛,肝脾扪及不满意,移动性浊音阳性。双下肢膝以下凹陷性水肿。实验室检查:红细胞(RBC)3.2×1012/L,血红蛋白(Hb)104.00 g/L,白细胞(WBC)4.3×109/L,血小板(PLT)76×109/L;肝功能:谷丙转氨酶(ALT)61.8 u/L,谷草转氨酶(AST)115.2 u/L,总蛋白(TP)64.10 g/L,前白蛋白(PAB)135.2 u/L,白蛋白(ALB)31.79 g/L,球蛋白(GOL)32.40 g/L,白球比例(A/G…     

实时超声引导锁骨下静脉中心静脉置管穿刺术及其临床应用

目的 评估超声引导锁骨下静脉中心静脉置管的有效性、安全性.方法 总结2007 年9 月-2011 年11 月间行超声引导下锁骨下静脉置管97 例资料,并分析穿刺成功率、进针次数、置管穿刺所需时间及并发症发生率.结果 置管成功率100%,进针次数1-3(1.5±0.6) 次.操作时间15-30(19.2±5.5)min,2 例(2%) 中心静脉导管误入颈内静脉内,1 例(1%) 置管后41d 形成血栓,10 例(10%) 于置管后1-80(32.9±25.7)d 发生感染.结论 超声引导锁骨下静脉中心静脉置管是一种安全有效的方式.     

CT增强扫描病人两种注射针的应用效果分析

目的探讨CT增强扫描病人最佳注射针的应用效果。方法选取2009年10月南充市中心医院CT室增强扫描的病人200例,随机分为蝶形针组和留置针组,每组各100例,比较两组病人静脉穿刺成功率、静脉外渗率、病人满意率及成本。结果蝶形针组病人静脉穿刺成功率97%,静脉外渗率5%,病人满意率87%,成本4元;留置针组病人静脉穿刺成功率100%,静脉外渗率0,病人满意率95%,成本17.6元.两组比较,留置针组静脉外渗率、病人满意率均优于蝶形针组（P〈0.05）,但成本高于蝶形针组13.6元,静脉穿刺成功率两组无差异性（P〉0.05）。结论为了减少CT增强病人注射的并发症,保护病人血管,提高病人满意率,选用留置针较好。     

Pulmonary vein tachycardia after pulmonary vein isolation in patients with atrial fibrillation

Background Pulmonary vein (PV) isolation has been developed to treat patients with atrial fibrillation (AF), and the electrophysiological endpoint of PV isolation is the disappearance or dissociation of pulmonary vein potentials (PVPs). Pulmonary vein tachycardia (PVT) is the dissociated PV rhythm with a rapid rate. However, the characteristics and significance of PVT after pulmonary vein isolation in patients with AF remains unclear. Methods From June 2003 to June 2005, a total of 285 consecutive patients with drug refractory AF were included in this study, and they underwent segmental pulmonary vein ablation (SPVA) or circumferential pulmonary vein ablation (CPVA). PV isolation was the initial endpoint for both approaches with documenting disappearance or dissociation of PVPs. PVT was characterized as dissociated activities within PVs with a circle length (CL) of <300 ms, and was classified into organized PVT or disorganized PVT according to the variance of CL. Systematic follow-up was conducted after initial procedures. Continuous variables were analyzed by Student’s t test and categorical variables were analyzed by chi-square test.Results Three hundred and fifteen PVs were ablated in 85 patients underwent SPVA approach, 400 circular lesions surrounding ipsilateral PVs (including 790 PVs) were produced in the rest of 200 patients received CPVA approach. Electrical isolation was achieved in all of these PVs. Of these, PVPs were abolished in 89.8% (992/1105) of the ablated PVs, dissociated PV rhythms were documented in the rest 10.2 % (113/1105) of the treated PVs. Among the 113 dissociated PV rhythms, 28 met the criteria of PVT with mean CL of (155±43) ms (2 PVTs in 2 patients received SPVA, 26 PVTs in 18 patients underwent CPVA). PVT was more frequently documented in patients underwent CPVA approach [9.0% (18/200) vs 2.3% (2/85), P=0.04]. During the 6-month follow-up, it was indicated that no significant difference existed in AF free rate between patients with PVT and those without PVT (P=0.75). Conclusions PVT dissociated from LA activations can be documented after PV isolation, especially in patients underwent CPVA approach. However, PVT does not affect the follow-up results.     

肝破裂合并肝静脉及肝后下腔静脉损伤的手术治疗

目的:探讨严重肝破裂合并肝静脉及肝后下腔静脉损伤手术治疗的临床效果。方法:回顾性分析2005年1月至2010年12月收治的9例外伤性肝破裂合并肝静脉及肝后下腔静脉损伤手术治疗的病例资料。结果:本组9例患者中行肝右静脉破裂间断缝合修补术2例,肝右静脉缝扎术1例,肝左静脉缝扎术2例,肝后下腔静脉破裂修补术2例,肝周纱布填塞2例;治愈8例(88.9%),死亡1例(11.1%)。结论:术前合理的急救复苏、及时手术及正确的手术方式是提高肝破裂合并肝静脉及肝后下腔静脉损伤抢救成功的关键。     

内窥镜取大隐静脉技术应用于不同静脉管径下的对比性分析

目的   对比分析应用内窥镜取大隐静脉技术（ESVH）时静脉管径差异对手术进程及血管条件所造成的影响。方法   选取2011至2012年于我院进行的内窥镜取大隐静脉管径(SV)病例80例,根据术前超声测量的SV管径差异将病例分为A组（管径<3mm,19例）与B组（管径≥3mm,61例）,记录内窥镜手术所用时间及单纯采集静脉时间,及血管分支数、结扎分支数、修补分支数、桥血管长度等血管条件指标。术后光镜下观察两组静脉内膜结构,扫描电镜观察静脉内膜损伤,TUNEL法检测两组细胞近期凋亡。结果   小静脉管径组有更多的分支（A：12.9±3.2;B：6.3±4.1,P<0.05）,冠状动脉搭桥所用桥血管长度、各组修补所占比率差异无统计学意义（P>0.05）,两组内窥镜取SV耗时差异有统计学意义［A：（59.5±12.8）min;B：（41.9±15.4）min, P<0.05］,而其单纯静脉采集时间无差异（P>0.05）, 光镜和扫描电镜观察检测血管组织学差异,血管损伤组织学差异更显著（P<0.05）,TUNEL凋亡检测示近期血管凋亡水平差异无统计学意义（P>0.05）。结论   与大管径SV相比,管径<3mm的SV应用ESVH需要更长的手术时间,同时对血管也造成相应的损伤, 其采集更适合应用传统开放手术。