碘伏对腹膜透析管的消毒效果研究

将国产碘伏与进口消毒液Amuktn对腹膜透析管道（O型管组）的消毒效果进行比较。结果显示,2组腹膜炎发生率经X2检验,差异无显著性,同时碘伏对O型管组无明显影响。说明碘伏可代替昂贵的进口消毒液Amuktn对腹膜透析管组（O型管组）进行消毒,从而减轻患者经济负担。     

品管圈活动降低儿科血液肿瘤病房响铃频次

目的 探讨品管圈活动在降低儿科血液肿瘤病房响铃频次的作用.方法 成立品管圈,确立＂降低病房响铃次数＂为活动主题,进行现状把握,目标设定,要因分析及对策制定和实施.结果 病房响铃频次由改善前的335次/周,降低至改善后的79次/周,护士人际沟通、团队精神、工作主动性等有明显提升.结论 品管圈活动对降低儿科血液肿瘤病房响铃频次效果显著.     

改良腹膜透析换液操作流程的规范化培训与考核效果

目的探讨腹膜透析专科护士对腹膜透析患者进行改良换液操作流程的规范化培训与考核的效果。方法将原有百特公司的换液操作法改良为八步操作、五步接管法,对我中心2005年新入组接受CAPD治疗的95位患者进行规范化培训与考核,并建立相应的管理体系。结果经规范化培训后的考核合格率及出院后1个月首诊复考合格率为100%,因操作不当引起的腹膜炎发生率为零。结论对腹膜透析患者进行规范化的换液操作培训与考核,可确保患者换液安全,避免腹膜透析相关性腹膜炎等问题的发生,从而提高透析质量。     

透出液蛋白丢失与连续性非卧床腹膜透析患者营养不良-炎性反应-动脉硬化综合征的相关性

Objective To investigate the impact of peritoneal albumin leakage on malnutrition-inflammation-atherosclerosis (MIA) syndrome in continuous ambulatory peritoneal dialysis (CAPD) patients. Methods A cross-sectional study of a cohort of 130 CAPD patients without edema or active infection was performed. In order to identify peritoneal transport characteristics in CAPD patients, a standard peritoneal equilibration test (PET) was carried out. For malnutrition and inflammation, serum albumin and high-sensitivity C-reactive protein (hs-CRP) levels were measured. Mean-carotid artery intima media thickness (IMT) was used to determine atherosclerosis. Residual glomerular filtration rate (rGFR) was defined as the average of 24-hour urinary urea and creatinine clearances. Results Pearson and Spearman correlation analysis showed that peritoneal albumin leakage amount was positively correlated with age, body mass index, night dwell time, blood glucose, 4 h D/P creatinine levels and hs-CRP levels (r=0.204, P<0.05 ;r=0.314, P<0.01; r=0.265, P<0.01; r=0.212, P<0.05; r=0.401, P<0.01; r=0.216, P<0.05); whereas it was negatively correlated with diastolic perssure, serum albumin levels, glucose level of dialyzate and peritoneal Kt/V (r=-0.209, P<0.05; r=-0.123, P<0.05; r=-0.271, P<0.01; r=-0.212, P<0.01). Overall, there was no correlation between peritoneal albumin leakage and IMT. Patients was significantly greater (P<0.01), and there was a positive correlation between peritoneal albumin leakage amount and IMT (r=0.650, P<0.01). Conclusions Peritoneal albumin leakage is significantly associated with peritoneal transport characteristics, malnutrition and inflammatory state in CAPD patients. High peritoneal albumin leakage amount is a risk factor for atherosclerosis in patients with rGFR less than 1 ml·min-1(1.73 m2)-1.     

川芎嗪和地塞米松对狼疮肾炎患者PBMC IL-12表达及合成Ig的影响

应用细胞培养技术 ,采用半定量RT PCR法和ELISA检测等方法 ,以正常人为对照 ,观察川芎嗪 (33μg/ml)和地塞米松 (10 5mol/L )对培养的狼疮肾炎 (LN )活动期、静止期外周血单个核细胞 (PBMC )表达IL 12和产生免疫球蛋白 (Ig)的影响。结果表明 ,LN活动期、静止期较正常对照组IL 12蛋白、基因水平明显增高 (P <0 0 1) ,川芎嗪仅对活动期狼疮肾炎PBMCIL 12表达明显抑制 ,而地塞米松明显抑制狼疮肾炎PBMCIL 12表达 (P <0 0 1) ,两种药物对正常人对照IL 12表达及合成Ig无明显抑制作用 (P >0 0 5 ) ,川芎嗪和地塞米松均明显抑制狼疮肾炎活动期及静止期Ig合成 (P <0 0 1或 <0 0 5 )。提示 :狼疮肾炎患者有高水平的IL 12 ,川芎嗪、地塞米松通过下调狼疮肾炎IL 12表达及Ig的合成 ,减轻狼疮肾炎的发生和发展。     

地佐辛复合右美托咪定在清醒患者纤维支气管镜气管插管术中的应用

目的 探讨地佐辛复合右美托咪定在重症医学科清醒患者纤维支气管镜气管插管术中的镇痛镇静效果及安全性.方法 将本科2015年1月至2016年12月180例需行气管插管机械通气的清醒患者采用随机数字表法分为A、B、C三组,各60例.A组静脉泵注咪达唑仑0.1 mg/kg;B组静脉泵注地佐辛0.1 mg/kg+咪达唑仑0.05 mg/kg;C组静脉泵注地佐辛0.1 mg/kg+右美托咪定1μg/kg.观察并比较插管前(T1)、插管时(T2)、插管后10 min(T3)患者心率(HR)、呼吸频率(RR)、平均动脉压(MAP)、指端血氧饱和度(SpO2)以及插管过程中患者躁动情况(MAAS评分)、气管插管后10 min患者的镇静效果(Ramsay评分)、转入时疾病严重程度评分(APACHEⅡ评分).结果 3组T3时间点HR均较T1时间点显著下降[A组:(99.0±5.2)次/min比(101.2±7.6)次/min,P＜0.05;B组:(97.3±6.1)次/min比(103.0±9.5)次/min,P＜0.05;C组:(94.4±7.2)次/min比(100.0±8.8)次/min,P＜0.05].3组RR在T2时间点均较同组T1时间点显著下降[A组:(27.1±2.6)次/min比(28.5±3.6)次/min,P＜0.05;B组:(26.3±2.8)次/min比(28.1±3.3)次/min,P＜0.05;C组:(25.1±3.5)次/min比(27.6±3.1)次/min,P＜0.05].B组T3时间点MAP较同组T1、T2时间点下降[(71.2±8.8) mmHg(1 mmHg=0.133 kPa)比(74.3±8.0) mmHg,P＜0.05;(71.2±8.8) mmHg比(74.3±8.8) mmHg,P＜0.05].C组T2时间点MAP较同组T1、T3时间点下降[(68.4±8.1) mmHg比(73.2±6.3),P＜0.05;(68.4±8.1) mmHg比(72.8±7.6) mmHg,P＜0.05].T1时间点,3组HR、RR、MAP差异无统计学意义(均P＞0.05).T2时间点,C组MAP较A、B两组显著下降[(68.4±8.1)mmHg比(73.6±8.6),P＜0.05;(68.4±8.1) mmHg比(74.3±8.8) mmHg,P＜0.05].T3时间点,C组HR较A、B两组显著下降[(94.4±7.2)次/min比(99.0±5.2)次/min,P＜0.05;(94.4±7.2)次/min比(97.3±6.1)次/min,P＜0.05].插管过程中B、C两组MAAS评分均显著低于A组[(3.2±1.0)比(3.9±1.0),P＜ 0.05;(3.0±1.0)比(3.9±1.0),P＜0.05],但B、C组间差异无统计学意义(P＞0.05).气管插管后10 min,A组Ramsay评分显著低于B、C两组[(2.4±0.9)比(2.7±0.9),P＜0.05;(2.4±0.9)比(2.8±0.9),P＜0.05],但B、C两组比较差异无统计学意义(P＞0.05).结论地佐辛复合咪达唑仑或右美托咪定较单纯使用咪达唑仑可显著改善清醒患者气管插管的耐受性并提高镇静效果;地佐辛复合右美托咪定用于清醒患者气管插管镇痛镇静效果确切.     

家庭腹膜透析现状调查与分析

目的 为了掌握和探讨腹膜透析病人出院后家庭腹膜透析的现状、环境与自我护理能力,为今的腹膜透析社区护理基础,针对患存在的问题及时处理和补救。方法 随机抽样,追踪随访,科学记录,统计分析,信息反馈,指导透析。结果 病人的透析环境及设备基本上能满足要求,大多数病人能正确操作,能正确执行无菌技术和换液程序,生活质量尚可。但也存在一些不足之处：大多数病人对于换液地点不能进行消毒或隔离,有个别病人出现水肿,     

美国科罗拉多大学附属医院居家透析中心腹膜透析护理工作模式及借鉴

本文主要介绍美国科罗拉多大学医院居家透析中心腹膜透析护理工作模式,包括:居家透析中心的情况、设置与布局、工作人员的分工、腹膜透析护理的工作模式(透析前教育、置管情况、培训、门诊随访、居家随访),探讨其工作模式对我国腹膜透析护理的启示.该模式在中心布局、工作人员配置、透析前教育、居家随访及提高社会支持等方面为我们提供了借鉴作用.     

透出液蛋白丢失与连续性非卧床腹膜透析患者营养不良-炎性反应-动脉硬化综合征的相关性

Objective To investigate the impact of peritoneal albumin leakage on malnutrition-inflammation-atherosclerosis (MIA) syndrome in continuous ambulatory peritoneal dialysis (CAPD) patients. Methods A cross-sectional study of a cohort of 130 CAPD patients without edema or active infection was performed. In order to identify peritoneal transport characteristics in CAPD patients, a standard peritoneal equilibration test (PET) was carried out. For malnutrition and inflammation, serum albumin and high-sensitivity C-reactive protein (hs-CRP) levels were measured. Mean-carotid artery intima media thickness (IMT) was used to determine atherosclerosis. Residual glomerular filtration rate (rGFR) was defined as the average of 24-hour urinary urea and creatinine clearances. Results Pearson and Spearman correlation analysis showed that peritoneal albumin leakage amount was positively correlated with age, body mass index, night dwell time, blood glucose, 4 h D/P creatinine levels and hs-CRP levels (r=0.204, P<0.05 ;r=0.314, P<0.01; r=0.265, P<0.01; r=0.212, P<0.05; r=0.401, P<0.01; r=0.216, P<0.05); whereas it was negatively correlated with diastolic perssure, serum albumin levels, glucose level of dialyzate and peritoneal Kt/V (r=-0.209, P<0.05; r=-0.123, P<0.05; r=-0.271, P<0.01; r=-0.212, P<0.01). Overall, there was no correlation between peritoneal albumin leakage and IMT. Patients was significantly greater (P<0.01), and there was a positive correlation between peritoneal albumin leakage amount and IMT (r=0.650, P<0.01). Conclusions Peritoneal albumin leakage is significantly associated with peritoneal transport characteristics, malnutrition and inflammatory state in CAPD patients. High peritoneal albumin leakage amount is a risk factor for atherosclerosis in patients with rGFR less than 1 ml·min-1(1.73 m2)-1.     

脑室引流管的观察及护理

脑室引流是经颅骨钻孔穿刺侧脑室 ,放置引流管将脑脊液引流至体外 ,其主要目的有 :①抢救因脑脊液循环受阻所致的颅内高压危急状态 ,如 :枕骨大孔疝 ;②进行脑室系统的检查 ,以明确诊断和方位 ;③脑室内手术后安放引流管 ,引流血性脊液 ,减轻脑膜刺激症状及蛛网膜粘连 ,术后早期还可以起到控制颅内压的作用[1] ;④颅内感染经脑室注药冲洗 ,消除颅内炎症。现将我科 43例脑室引流管的护理经验总结如下。1　临床资料本组病例 43例 ,其中女性 16例 ,男性 2 7例 ,最大年龄 75岁 ,最小年龄 8岁 ,其中肿瘤 3 8例 ,外伤 4例 ,寄生虫 1例。2　观察及…