临床护理路径在心血管患者静脉留置针中的研究分析

目的:提高静脉留置针使用有效期,保证心血管患者得到及时用药,有效开放静脉抢救通道。方法:建立了心血管患者静脉留置针的临床护理路径(Clinical Nursing Pathway,CNP)。选择我院2018年1-12月期间接诊的静脉留置针心血管患者为研究对象,共100例,随机分组,即对照组(50例,常规护理)与实验组(50例,在常规护理基础上辅以临床护理路径),比较两组护理效果,包括留置时间、不良反应情况、患者满意度等。结果:护理后,两组患者留置时间无明显差异,但实验组不良反应发生率、静脉炎发生率低于对照组,差异有统计学意义(P<0.05);实验组满意度、一次性置管成功率高于对照组,而非计划性拔管率则低于对照组,差异有统计学意义(P<0.05)。结论:心血管患者静脉留置针护理中辅以临床护理路径,可减少不良反应,预防静脉炎,延长置管时间,提高护理满意度,值得优选。     

Flow dynamics through spinal needles

We examined the flow pattern produced when liquid dye was actively injected into a fluid medium at various flows through five different commonly used spinal needles. At all flows, the Whitacre-type needles produced a directional stream exiting at an angle from the longitudinal axis. At intermediate rates the stream developed tracks which disappeared at faster rates. The Quincke needle always produced an undeviated stream of dye and did not form tracks at any flow rate. When a perspex plate (representing the spinal cord) was interposed in front of the needle, the dispersion of dye was always unidirectional from the Whitacre needle and bidirectional from the Quincke needle. The dye adhered to the surface of the plate as a concentrated film at slow rates and at faster rates it dispersed turbulently for both types of needle.     

<Emphasis Type="Italic">Susuks</Emphasis> (charm needles) in the craniofacial region

Objectives  We conducted a study to determine the numbers of susuks (charm needles) and their distribution in the craniofacial region of susuk wearers, and the sex, racial affiliation, and age of the wearers. In addition, we sought to determine whether the presence of susuks posed any potential hazard to patients undergoing magnetic resonance imaging (MRI). Methods  We studied various radiographs of 33 susuk wearers (age range, 33–69 years) and investigated the most common sites of insertion in the craniofacial region. A susuk was also suspended inside a 1.5-T MRI machine to determined whether it was attracted by the machine’s magnet. Results  The largest number of susuks that we observed in the craniofacial region was 39 pins, and susuks were particularly numerous in Malay Muslim women. Other sites with susuks were the maxillofacial region (except the temporomandibular region) and the forehead. The susuks showed no ferromagnetic characteristics. Conclusions  As susuks are made from gold, they are generally biocompatible with human tissue and do not cause problems to their wearers. Gold and the other minor metal constituents found in susuks have no ferromagnetic characteristics and therefore pose no hazard to patients undergoing MRI.     

马尾松松针中木脂素类化学成分的研究

目的研究松科(Pinaceae)植物马尾松(P.massoniana Lamb.)松针(pine needles)水煎液中的化学成分。方法利用Diaion HP-20,Toyopearl HW-40和硅胶等柱色谱技术进行分离纯化,根据化合物的理化性质和光谱数据进行结构鉴定。结果从马尾松针水煎液镇痛作用较强的正丁醇萃取部位分离得到3个木脂素类化合物,其化学结构分别确定为化合物7(massonianoside D): (7S,8r)-4,9′-二羟基-3,3′-二甲氧基-7,8-二氢苯骈呋喃-1′-丙醇基新木脂素-9-O-α-L-鼠李糖苷;化合物8(异落叶松脂素):4,4′,9,9′-四羟基-3,3′-二甲氧基-7-苯基四氢萘木脂素;化合物9(异落叶松脂素-9-O-木糖苷):4,4′,9′-三羟基-3,3′-二甲氧基-7-苯基四氢萘木脂素-9-O-β-D-木糖苷。结论化合物7为新化合物,化合物8,9为首次从本植物中分离得到。     

Comparison of the flow characteristics of irrigants with standard and Max‐i‐Probe needles

The objectives of this study were to determine the direction and pattern of flow of irrigating solutions inside simulated root canals with different irrigation needles; and to determine whether different needle designs increase the likelihood of irrigating solution passing through the apical foramen. Two types of needles were compared: a standard needle with a bevel and an open end, and a needle with a side opening and closed rounded tip. Observations of irrigant flow within the canals indicated that the side‐venting needle can be dangerous if the needle gauge is small and it reaches the full length of the canal, since this allowed irrigants to flow into the periapical area. With the standard needle, the fluid did not go beyond the tip of the needle when minimal irrigating pressure was employed. As the size of canal increased, the fluid did not extrude beyond the tip of both needles. However, if the needles bound in the canals, then the fluid was forced away from the needle tip, and the pressure applied to the syringe was directly proportional to the distance the fluid flowed away from the needle tip. Both side‐venting and standard needles can be used for irrigation safely and effectively if a dynamic irrigation technique (moving the needle up and down inside the canals while irrigating) is employed.     

项七针治疗椎动脉型颈椎病和对椎-基底动脉血流动力学的影响

目的 观察项七针治疗椎动脉型颈椎病的疗效和对椎-基底动脉血流动力学的影响。方法 将病人随机分为项七针组38例和颈夹脊组34例，进行症状评分和经颅彩色多普勒检查椎-基底动脉血流速指标。结果 经治疗2个疗程后，项七针组总有效率为89．47％，颈夹脊组为76．47％，两组差异有统计学意义（P〈0．05）；项七针组治疗后椎-基底动脉平均血流速度（MV）、椎-基底动脉搏动指数（PI）、阻力指数（RI）的改变与颈夹脊组比较均有统计学意义（P〈0．05）。项七针组疗效和改善脑供血方面均优于颈夹脊组。结论 运用针灸治疗椎动脉型颈椎病，可收到一定的临床疗效，且在改善病人症状积分及椎-基底动脉血流速度等方面亦显示出较好好的治疗作用。     

Risk of transmission associated with sharing drug injecting paraphernalia: analysis of recent hepatitis C virus (HCV) infection using cross‐sectional survey data

Sharing injecting paraphernalia (containers, filters and water) poses a risk of transmitting the hepatitis C virus (HCV). The prevalence of, and risk of HCV from, such behaviour has not been extensively reported in Europe. People who inject drugs (PWID) were recruited in cross‐sectional surveys from services providing sterile injecting equipment across Scotland between 2008 and 2010. Participants completed a questionnaire and provided a blood spot for anonymous testing. Logistic regression was used to examine the association between recent HCV infection (anti‐HCV negative and HCV‐RNA positive) and self‐reported measures of injecting equipment sharing in the 6 months preceding interview. Twelve per cent of the sample reported sharing needles/syringes, and 40% reported sharing paraphernalia in the previous 6 months. The adjusted odds ratios (AOR) for sharing needles/syringes (+/− paraphernalia), and sharing only paraphernalia in the last 6 months were 6.7 (95% CI 2.6–17.1) and 3.0 (95% CI 1.2–7.5), respectively. Among those who reported not sharing needles/syringes, sharing containers and filters were both significantly associated with recent HCV infection (AOR 3.1, 95% CI 1.3–7.8 and 3.1, 95% CI 1.3–7.5, respectively); sharing water was not. We present the first study to apply a cross‐sectional approach to the analysis of the association between sharing paraphernalia and incident HCV infection and demonstrate consistent results with previous longitudinal studies. The prevalence of paraphernalia sharing in our study population is high, representing significant potential for HCV transmission.     

浅析脐针右降四针

[目的]通过临床四则有效案例,探讨与总结右降四针的作用以及在临床上的作用与适应症。[方法]通过研读《脐针疗法》《易医解密》等书籍,指导右降四针在临床上的应用。通过治疗妇女围绝经期综合征、咽喉肿痛、中风后遗症、失眠等疾病的4个案例,总结右降四针在临床上的应用。[结果]齐永教授认为右降四针通过其进针方位的不同,能达到滋阴作用,在调理阴虚症状及治疗发热中能起到很好的作用。所举的以右降四针治疗妇女围绝经期潮热汗出、咽喉肿痛、中风所致的下肢运动不利及失眠的案例也取得显著疗效。[结论]右降四针具有滋阴、补肾、取降的作用,并且取穴、施术方便,给临床治疗提供了新的思路和方法,值得学习和推广应用。     

丹参针预防髋部骨折术后静脉栓塞的疗效观察

目的 通过随机对照研究,观察丹参针在预防髋部骨折术后静脉栓塞治疗时的效果.方法 对我院2007年6月-2010年5月行髋部骨折手术的146例患者进行随访观察,其中男62例,女84例,年龄在19～89岁之间,平均72岁,治疗组术后第2天给予足量足疗程的丹参针,对照组术后第2天开始给予同等量的0.9%氯化钠溶液,两组对照,详细纪录患者的临床资料,术后行患肢深静脉顺行性造影,明确血栓发生部位、大小及数量,综合分析.结果 (1)对照组62例,术后深静脉血栓的发生率为33.9%(21/62例),其中中央型4例,周围型17例;(2)治疗组84例,其中男26例,女58例,术后给予丹参针1.2g/d,2周后造影查深静脉血栓的发生率为16.7%(14/84例),其中中央型3例,周围型11例.两组比较有显著性差异(P＜0.01).结论 下肢深静脉造影技术能准确发现深静脉血栓,临床症状与其无直接关联,观察治疗组和对照组造影示静脉栓子的情况,丹参能够明显降低静脉栓塞的发生率.     

芒针联合脊髓电刺激疗法治疗下肢缺血性疼痛及对患者疼痛与睡眠质量评分的影响

目的:探究芒针联合脊髓电刺激(SCS)疗法对下肢缺血性疼痛患者匹兹堡睡眠质量(PSQI)、视觉模拟评分(VAS)的影响。方法:选取下肢缺血性患者106例,按随机数字表法将患者分为SCS治疗组与联合治疗组各53例。其中SCS治疗组使用SCS疗法治疗,联合治疗组患者使用芒针联合SCS疗法治疗。红外热成像仪检测皮肤温差,多普勒血流控制仪检测踝肱指数(ABI),记录两组患者患肢冷感评分及麻木评分,记录患者间歇性跛行距离,经皮氧分压监测仪检测经皮氧分压(TcPO₂),VAS、PSQI评估患者疼痛状况与睡眠状况。结果:治疗后,与SCS治疗组相比,联合治疗组皮肤温差、踝肱指数均较高(P<0.05)。治疗后,与SCS治疗组相比,联合治疗组冷感评分、麻木评分均明显降低(P<0.05)。治疗后,与SCS治疗组相比,联合治疗组经皮氧分压、间歇性跛行距离均明显升高(P<0.05)。治疗后,与SCS治疗组相比,联合治疗组SAS评分、PSQI评分均较低(P<0.05)。治疗后,联合治疗组治疗有效率高于SCS治疗组(P<0.05)。结论:应用芒针联合SCS疗法对下肢缺血性疼痛患者进行治疗,能够有效改善患者病情,减轻冷感及麻木情况,改善皮肤组织的氧供量及下肢微循环,减轻患者疼痛,提高患者睡眠质量,效果明显。