护士在静脉给药中的作用

护士给药对住院患者而言,是整个用药过程中的最后一环,是给药的直接执行者,由于诸多原因可造成在给药对象、药物品种、药物配伍、给药途径、给药技术等方面发生失误而使患者受损,尤其是静脉用药过程中,有效的观察可及时发现问题,是提高临床护理质量的关键。1护士在静脉给药中的     

护士在静脉给药中的作用

护士给药对住院患者而言,是整个用药过程中的最后一环,是给药的直接执行者,由于诸多原因可造成在给药对象、药物品种、药物配伍、给药途径、给药技术等方面发生失误而使患者受损,尤其是静脉用药过程中,有效的观察可及时发现问题,是提高临床护理质量的关键.     

不同静脉给药途径在化疗患者中的应用效果观察

目的:探讨不同静脉给药途径在化疗患者中的应用及效果.方法:将265例化疗患者分为A组103例、B组89例、C组73例,A组采用经皮外周静脉插管(PICC)或经锁骨下中心静脉置管、B组采用外周静脉留置针、C组采用常规静脉穿刺,分别采用含长春瑞滨、多柔比星、紫杉醇等药物的方案化疗4～6个周期.观察并比较三组静脉炎发生情况.结果:三组发生静脉炎比较差异均有统计学意义(P＜0.05,P＜0.01);A组3、4级静脉炎发生率显著低于B、C组(P ＜0.05,P＜0.01).结论:行PICC或锁骨下中心静脉置管能明显降低化疗患者静脉炎的发生率,提高护理质量,保障治疗顺利进行.     

综合医院不同专科静脉化疗安全给药现状调查

[目的]了解综合医院不同专科化疗安全给药现状。[方法]采用自行设计的调查表对本院不同专科护士对化疗安全知识的认知以及不同专科病人对静脉化疗通路的选择情况和影响病人选择经外周静脉置入中心静脉导管（PICC）作为化疗通路的原因进行调查。[结果]45名肿瘤专科护士对各项化疗安全知识的认知率在80%以上;除了对化疗性静脉炎的预防和处理方面,55名非肿瘤专科护士对各项安全知识的认知率均显著低于肿瘤专科护士（P〈0.05或P〈0.01）;肿瘤专科选择 PICC 作为化疗通路的病人达56.6%,显著高于非肿瘤专科病人（19.6%）;除了常见影响肿瘤病人选择PICC的因素如对并发病、生活质量、医疗费用和维护的担心外,对化疗渗漏的不了解、医生是否推荐和病人所在病区PICC的使用情况也会对非肿瘤专科病人的选择产生影响。[结论]大型综合医院管理者应重点加强对非肿瘤专科医护人员的化疗安全给药的相关知识培训,同时加强医护配合和对 PICC的宣传,消除病人疑虑和担忧,尽可能保证病人的化疗安全。     

综合医院不同专科静脉化疗安全给药现状调查

[目的]了解综合医院不同专科化疗安全给药现状。[方法]采用自行设计的调查表对本院不同专科护士对化疗安全知识的认知以及不同专科病人对静脉化疗通路的选择情况和影响病人选择经外周静脉置入中心静脉导管(PICC)作为化疗通路的原因进行调查。[结果]45名肿瘤专科护士对各项化疗安全知识的认知率在80%以上;除了对化疗性静脉炎的预防和处理方面,55名非肿瘤专科护士对各项安全知识的认知率均显著低于肿瘤专科护士(P0.05或P0.01);肿瘤专科选择PICC作为化疗通路的病人达56.6%,显著高于非肿瘤专科病人(19.6%);除了常见影响肿瘤病人选择PICC的因素如对并发病、生活质量、医疗费用和维护的担心外,对化疗渗漏的不了解、医生是否推荐和病人所在病区PICC的使用情况也会对非肿瘤专科病人的选择产生影响。[结论]大型综合医院管理者应重点加强对非肿瘤专科医护人员的化疗安全给药的相关知识培训,同时加强医护配合和对PICC的宣传,消除病人疑虑和担忧,尽可能保证病人的化疗安全。     

不同静脉给药方法治疗破伤风患者的临床效果研究

目的:探讨不同静脉给药方法治疗破伤风患者的临床效果.方法:将30例破伤风患者随机分为治疗组16例和对照组14例,治疗组采用冬眠Ⅰ号合剂静脉留置针分次缓慢定时推注,对照组采用冬眠Ⅰ号合剂静脉输液治疗.观察两组患者的治疗效果及感受.结果:治疗组在静脉推注定时给药后1～5min内抽搐症状得到控制,对照组在静脉输液后5～12min内抽搐症状得到缓解,且治疗组患者家属满意度高于对照组(P<0.05),治疗组护士的支持率明显高于对照组(P<0.05).结论:冬眠Ⅰ号合剂静脉留置针分次缓慢定时推注法效果明显优于静脉输液治疗法.     

不同静脉给药方法治疗破伤风患者的临床效果研究

目的：探讨不同静脉给药方法治疗破伤风患者的临床效果。方法：将30例破伤风患者随机分为治疗组16例和对照组14例，治疗组采用冬眠Ⅰ号合剂静脉留置针分次缓慢定时推注，对照组采用冬眠Ⅰ号合剂静脉输液治疗。观察两组患者的治疗效果及感受。结果：治疗组在静脉推注定时给药后1～5min内抽搐症状得到控制，对照组在静脉输液后5—12min内抽搐症状得到缓解，且治疗组患者家属满意度高于对照组（P〈0．05），治疗组护士的支持率明显高于对照组（P〈0．05）。结论：冬眠Ⅰ号合剂静脉留置针分次缓慢定时推注法效果明显优于静脉输液治疗法。     

麻醉诱导时芬太尼的不同给药方法对其诱发患者咳嗽的影 响

目的 评价麻醉诱导时芬太尼不同给药方法对其诱发患者咳嗽的影响.方法 择期全身麻醉的手术患者420例,采用随机数字表法将其分为常规组（A组）、预注射组（B组）、稀释组（C组）和后注射组（D组）,每组105例.4组麻醉诱导时,其中芬太尼采用常规、预注射、稀释和后注射4种麻醉诱导注药完毕后2 min行气管插管.气管插管时观察患者咳嗽、异丙酚注射痛的发生情况,于麻醉诱导前、诱导后、咳嗽时、气管插管时记录心率和有创动脉压.结果 A、B、C、D组芬太尼诱发患者咳嗽的发生率分别为35.2％、7.6％、9.5％、1.9％.与A组比较,其他各组患者咳嗽发生程度降低（P＜0.05）;与B组和C组比较,D组患者咳嗽发生程度降低（P＜0.05）.4组心率、有创动脉压、预防异丙酚注射痛比较差异均无统计学意义（均P＞0.05）.结论 麻醉诱导时芬太尼稀释给药、预注射药给或后注射给药均可明显降低其诱发咳嗽的发生,其中后注射给药效果最佳.     

六西格玛管理法在静脉化疗给药管理中的应用

目的降低静脉化疗给药错误发生率,提高护理质量。方法采用六西格玛管理法定义、测量、分析、改进和控制5个步骤,优化静脉化疗给药流程,对关键点进行细节改进。结果静脉化疗给药错误发生率降低（P〈0．01）。结论应用六西格玛管理法对静脉化疗给药进行流程优化和细节管理,有效降低了静脉化疗给药错误发生率,提高了护理质量。     

Effects of intravenous anesthetic agents on middle cerebral artery blood flow velocity during induction of general anesthesia

Objective. Our objective was to quantify the effects of intravenous anesthetics on values measured by or derived from transcranial Doppler sonography (TCD) during induction of general anesthesia.Methods. We recorded blood flow velocity in the middle cerebral artery (V-MCA) before, during, and after induction of general anesthesia in six groups of young patients without intracranial pathology (n=10 each) using TCD. Patients were randomized to receive either 2 mg/kg propofol, 1.5 mg/kg methohexital, 5 mg/kg thiopental, 0.3 mg/kg etomidate, 2 µg/kg fentanyl and 0.15 mg/kg midazolam, or 1.5 mg/kg ketamine and 0.15 mg/kg midazolam intravenously. At 2 min after injection, each patient was intubated and given isoflurane 0.8% and nitrous oxide 66% in oxygen. Ventilation was set to achieve an end-tidalPco ₂ of 40 mm Hg. V-MCA, arterial blood pressure, heart rate, hematocrit, andPco ₂ (venous samples) were measured before and 1, 3, 5, 10, and 30 min after induction of anesthesia.Results. The preinduction data were not different between groups. At 1 min after injection, propofol, thiopental, methohexital, and etomidate significantly decreased V-MCA. TCD values were only slightly affected following fentanyl/midazolam. Ketamine/midazolam induced a modest rise in V-MCA. After endotracheal intubation, V-MCA increased in all groups, and slowly declined thereafter.Conclusions. Under the circumstances of our study, values derived from TCD measurements responded differently to the agents used to induce general anesthesia in nonneurosurgical patients.     

Differential effects of propofol and sevoflurane on QT interval during anesthetic induction

There have been conflicting reports on whether propofol prolongs, shortens, or does not change QT interval. The aim of this study was to determine the effect of target-controlled infusion (TCI) of propofol on heart rate-corrected QT (QTc) interval during anesthetic induction. We examined 50 patients undergoing lumbar spine surgery. Patients received 3 μg/kg of fentanyl and were randomly allocated to one of the following 2 groups. Group S patients received 5 mg/kg of thiamylal followed by sevoflurane, 5 % at the inhaled concentration. Group P patients received propofol using TCI system at 5 μg/mL for 2 min followed by 3 μg/mL. Tracheal intubation was performed after vecuronium administration. Heart rate (HR), mean arterial pressure (MAP), bispectral index score (BIS), and QTc interval in 12-lead electrocardiogram were recorded at the following time points: just before fentanyl administration (T1), 2 min after fentanyl injection (T2), 1 min after thiamylal injection or 2 min after the start of TCI (T3), just before intubation (T4), and 2 min after intubation (T5). BIS and MAP significantly decreased after anesthetic induction in both groups. HR decreased after anesthetic induction and recovered after tracheal intubation in group P, whereas it did changed in group S throughout the study period. QTc interval was shortened at T3 and T4 in group P, but prolonged at T3, T4, and T5 in group S, as compared with T1. Propofol TCI shortens QTc interval, whereas sevoflurane prolongs QTc interval during anesthetic induction.     

Application of intravenous low-intensity laser irradiation as part of anesthetic care during invasive surgery

The aim of this study was to evaluate the possibility of applying low-intensity He-Ne laser irradiation as part of a complex system of anesthetic care of patients during invasive surgery. The following technique of intravenous low-intensity laser irradiation (i.v. LILI) was used. A filament of He-Ne laser was introduced through the subclavian venous line into the ostium of the vena cava superior. The power output was 20 mV, the exposure period 30 minutes. The irradiation began 10-15 minutes before anesthesia was introduced. In some cases, a second session was required. The 61 patients enrolled in the study were divided into a study group of patients who were irradiated and into a control group of patients who did not receive i.v. LILI. It was shown that i.v. LILI decreases neuroautonomous strain on the patient. Under the influence of i.v. LILI the P 50 appears to increase, the index of tissue oxygen extraction does not change, and the data of the acid base balance tend to improve. Low plasma levels of 11 oxycorticosteroids and the plasma content of 5-HTA and histamine as well as moderate changes in plasma enzyme activity confirm the efficacy of protecting patients from surgical trauma by application of i.v. LILI.     

小剂量右美托咪定预处理抑制舒芬太尼诱发的呛咳

目的:评价麻醉诱导期使用小剂量右美托咪定预处理对舒芬太尼诱发呛咳的抑制作用。方法:105例全麻下行甲状腺次全切除手术患者被随机分成三组。对照组、实验组1(D1组)和实验组2(D2组)在麻醉诱导期分别接受生理盐水、0.25μg/kg右美托咪定和0.5μg/kg右美托咪定静脉注射。输注完毕后3组患者均给予0.3μg/kg舒芬太尼静脉注射。记录注射芬太尼后1 min内呛咳的发生情况和强度;记录各组从静脉输注右美托咪定到气管插管后1 min期间的BP和HR。结果:3组呛咳发生率分别为27.0%、8.3%和6.2%。与对照组相比,D1组和D2组的呛咳总发生率和中、重度呛咳发生率明显减少(P<0.05)。与对照组相比,D1组低血压和心动过缓的发生率无明显增加(P>0.05),但D2组的心动过缓发生率较对照组增多(P<0.05)。结论 :麻醉诱导期静脉注射小剂量右美托咪定可抑制舒芬太尼诱发呛咳,使气管插管更平稳。     

Continuous intravenous administration of fentanyl during multicomponent anesthesia in children]

136 anesthetic procedures during planned and emergency surgery in children have been analysed. It has been demonstrated that non-stop intravenous fentanyl injection with an automated syringe of "Lineomat" type ensures an adequate analgesia over a 2-10 h period. The adequacy of anesthesia was confirmed by the data of central and peripheral hemodynamics monitoring, acid-base balance, temperature gradient and clinical course. Non-stop injection of the analgesic made it possible to reduce the drug expenditure by 30% on average as compared to the theoretically calculated dose, as well as to free paramedical personnel and decrease their exposure to blood.     

护理专业化发展过程中的角色区别

文章总结了作为高级实践护士的临床护理专家和开业护士以及作为其前身的专科护士之间的区别,分别从其起源、概念和角色职能、培养认证、工作场所及处方权方面进行了阐述,以帮助护理人员正确认识护理专业中的多种角色。