静脉血标本采集失败的原因分析及护理对策

目的：调查和分析体检中心护士在为体检人员采集静脉血标本时不能一次成功的原因，并提出相应护理对策。方法：自制静脉采血失败原因分析调查表，对34名护士共148例次静脉采血失败的原因进行分析。结果：与护士技术操作有关109例次，与真空采血管和采血针头问题有关31例次，与体检人员有关8例次。结论：提高护士的技术操作、解决采血器的问题、做好体检者心理评估和护理，可提高静脉采血成功率，减轻患者的痛苦，从而体现人性化护理服务。     

超声造影剂增强疗效结合超声高强度聚焦治疗的实时影像监控研究

目的探讨微泡造影剂联合高强度聚焦超声治疗对实时监控超声声像图的影响。方法对20只山羊肝脏进行自身前后对照分组,观测靶区HIFU定点辐照前后的超声声像图面积和灰阶变化,并比较声像图面积与实际损伤的凝固性坏死灶最大切面面积。结果HIFU辐照后,全氟显组靶区声像图面积、灰阶值及形成的凝固性坏死灶最大切面面积均较对照组明显增高(P<0.05)。实际损伤切面面积与辐照结束后即刻、2min、5min及10min时的声像图比较,其比值分别为0.33±0.12、0.55±0.21、0.72±0.15、0.94±0.23。结论微泡造影剂可明显增强HIFU对山羊肝脏的作用效应,通过观察HIFU辐照过程中的声像图变化,可实时指导HIFU治疗和判断治疗效果。     

两种静脉采血方法的比较

目的 探讨提高静脉采血穿刺成功率的方法与效果.方法 将100例静脉采血穿刺患者随机分为对照组与实验组,每组50例.实验组采用BD针进行静脉采血穿刺,对照组按常规法进行静脉采血穿刺.结果 对照组与实验组在疼痛情况、穿刺成功率及退针成功率方面比较,差异有统计学意义(P＜0.05),实验组个体疼痛感低于对照组,在穿刺成功率及退针成功率方面均高于对照组. 结论 BD 针静脉采血穿刺可有效减轻患者穿刺时的疼痛,提高穿刺成功率.     

Evaluation of a novel kit (TF-Test) for the diagnosis of intestinal parasitic infections

Intestinal parasitic infections are currently a source of concern for Public Health agencies in developing and developed countries. Since three ovum‐and‐parasite stool examinations have been demonstrated to provide sensitive results, we designed a practical and economical kit (TF‐Test) that is now commercially available (Immunoassay Com. Ind. Ltda., São Paulo, Brazil). This kit allows the separate collection of three fecal specimens into a preservative solution. The specimens are then pooled, double‐filtered, and concentrated by a single rapid centrifugation process. The TF‐Test was evaluated in four different laboratories in a study using 1,102 outpatients and individuals living in an endemic area for enteroparasitosis. The overall sensitivity found using the TF‐Test (86.2–97.8%) was significantly higher (P<0.01) than the sensitivity of conventional techniques such as the Coprotest (NL Comércio Exterior Ltda, São Paulo, Brazil) and the combination of Lutz/Hoffman, Faust, and Rugai techniques (De Carli, Diagnóstico Laboratorial das Parasitoses Humanas. Métodos e Técnicas, 1994), which ranged from 48.3% to 75.9%. When the above combined three specimen technique was repeated with three specimens collected on different days, its sensitivity became similar (P>0.01) to that of the TF‐Test. The kappa index values of agreement for the TF‐Test were consistent (P<0.01), being higher and ranking in a better position than conventional techniques. The high sensitivity, cost/benefit ratio, and practical aspects demonstrate that the TF‐Test is suitable for individual diagnosis, epidemiological inquiries, or evaluation of chemotherapy in treated communities. J. Clin. Lab. Anal. 18:132–138, 2004. © 2004 Wiley‐Liss, Inc.     

Comparison of carpal tunnel injection techniques: A cadaver study

The purpose of the study was to evaluate the accuracy of injections into the carpal tunnel using three different portals in cadavers, and to define safe guidelines. In this study, 150 wrists of 75 cadavers (54 male, 21 female) were included. To compare three injection sites, 50 wrists of 25 cadavers were used for each technique; we used 23 gauge needles, and acrylic dye. The first injection technique: the needle was inserted 1cm proximal to the wrist crease and directed distally by roughly 45 in an ulnar direction through the flexor carpi radialis tendon. The second injection technique: the needle was inserted into the carpal tunnel from a point just ulnar to the palmaris longus tendon and 1cm proximal to the wrist crease. The third injection technique: the needle was inserted just distal to the distal skin crease of the wrist in line with the fourth ray. The first injection technique gave the highest accuracy rate, and this was also the safest injection site. Median nerve injuries caused by injection was seen mostly with the second technique. Although a steroid injection may provide symptomatic relief in patients with carpal tunnel syndrome, the median nerve and other structures in the carpal tunnel are at risk of injury. Because of that, the injection should be given using the correct technique by physicians skilled in carpal tunnel surgery.     

快速康复外科护理在结直肠癌NOSES手术患者中的应用探索

目的探讨快速康复外科护理对结直肠癌NOSES术患者术后恢复效果及心理状况的影响。 方法选取2018年5月至2019年3月在中国医学科学院肿瘤医院行结直肠癌NOSES手术的患者90例为研究对象。按照随机数字表法将其分为实验组和对照组,每组45例。实验组给予快速康复外科护理管理,对照组给予常规护理。观察术后首次排气、排便、离床活动、住院时间及患者焦虑抑郁程度的组间差异。 结果入院时,两组焦虑评分（t=0.744,P=0.461）和抑郁评分（t=-1.879,P=0.066）差异均无统计学意义,具有可比性。实验组在术后48 h焦虑评分低于对照组（t=-5.85,P<0.01）、抑郁评分低于对照组（t=-6.04,P<0.01）,差异有统计学意义。实验组术后首次排气时间短于对照组（t=-2.32,P=0.025）,首次排便时间短于对照组（t=-2.48,P=0.017）,首次离床活动时间早于对照组（t=-3.15,P=0.003）,平均住院时间短于对照组（t=-4.05,P<0.01）,差异均有统计学意义。 结论快速康复外科护理能够有效促进结直肠癌NOSES手术患者的术后恢复、改善焦虑抑郁状况,值得临床推广应用。     

结直肠癌腹腔镜经自然腔道取标本手术（NOSES IV式）术后并发症危险因素分析

目的探讨腹腔镜结直肠癌经自然腔道取标本手术（NOSES）术后发生并发症的相关危险因素。 方法采用回顾性病例对照研究方法,收集并分析自2014年1月~2019年6月在中国医学科学院肿瘤医院结直肠外科行结直肠癌NOSES IV式手术患者的临床病理资料。共纳入172例患者,分析患者一般资料、病理资料、术者经验、术中情况等临床资料与术后并发症的关系,应用χ²检验进行单因素分析,并将有意义因素纳入logistic回归模型进行多因素分析。 结果172例患者中,共21例（12.2%）患者出现术后并发症,常见并发症依次为腹盆腔感染（4.7%）、吻合口漏（3.5%）、腹腔出血（1.7%）、肺部感染（1.7%）、吻合口狭窄（1.2%）、直肠阴道瘘（1.2%）、肺栓塞（1.2%）、切口感染（1.2%）。单因素分析结果显示：肿瘤直径（χ²=5.144,P=0.023）、术者经验（χ²=4.412,P=0.042）、手术时间（χ²=4.713,P=0.030）是影响NOSES IV式术后出现并发症的相关因素。进一步将单因素分析有统计学意义的因素纳入Logistic回归分析,结果显示,手术时间（OR=3.317,95%CI：1.024~10.747;P=0.046）是NOSES IV式术后并发症发生的独立危险因素。 结论手术时间≥135 min是结直肠癌腹腔镜NOSES IV式术后并发症发生的独立危险因素。严格把握NOSES适应证、熟练灵活使用腔镜器械是降低NOSES术后并发症的有效保障。     

经自然腔道取标本手术在胃部不同疾病中的研究进展

随着微创技术的不断发展,腹腔镜技术在我国胃肠外科疾病的诊治中得到极大推广。在此基础上,经自然腔道取标本手术（NOSES）结合腹腔镜操作技术及微创理念,既达到了微创,同时美容效果更佳。然而,关于NOSES在胃部疾病的应用报道较少,本文将对NOSES在胃部不同疾病中的研究进展进行综述。