股静脉穿刺联合静脉推注输血在消化道大出血病人抢救中的应用

建立有效的静脉通路、及时扩充血容量是抢救消化道大出血病人的关键,消化道出血病人因急性失血或慢性长期失血,导致机体处于极度衰竭状态,周围静脉血液循环不良,致使周围静脉穿刺困难,无法达到快速有效补充血容量.我科应用股静脉穿刺联合静脉推注输血抢救100例消化道大出血休克病人,取得了满意效果.现介绍如下.     

静脉切开的指征是什么？常选什么部位？

答：静脉切开适用于抢救严重失血、休克、脱水、中毒或感染，而周围静脉穿刺困难或失败的病人，争取抢救时机，使输液通畅。     

股静脉留置针输液抢救失血性休克的护理体会

失血性休克多见于大血管破裂，腹部损伤所致的肝、脾破裂，胃、十二指肠出血，门静脉高压所致的食管、胃底静脉曲张破裂出血等。通常在迅速失血超过全血总量的20％时，即出现休克。失血性休克的治疗主要集中在补充血容量和积极处理原发病两个方面，及时、快速和足量补给失血量，能使休克迅速得到纠正，为积极处理原发病及手术赢得了宝贵的时间。我科于2003年以来，在病人大出血休克，外周浅静脉穿刺困难的紧急情况下采取了开放式静脉穿刺留置快速补充血容量，抢救病人42例，成功率达100％，现将体会总结如下。     

双止血带"低瓶高调"法在抢救上消化道大出血病人建立静脉通道中的应用

[目的]探讨双止血带"低瓶高调"法在抢救上消化道大出血病人建立有效静脉通道中的应用价值.[方法]将128例上消化道大出血病人随机分为实验组66例和对照组62例,实验组采用双止血带"低瓶高调"法进行静脉穿刺,对照组采用传统输液法进行静脉穿刺,两组病人在抢救时均选择上肢静脉作为穿刺部位,观察两组病人静脉充盈程度及穿刺成功率.[结果]实验组充盈明显或饱满发生率及穿刺成功率与对照组比较,差异有统计学意义(P＜0.01).[结论]双止血带"低瓶高调法"可明显提高上消化道大出血病人静脉充盈程度及穿刺成功率.     

难穿刺静脉的处理方法

静脉穿刺是医院看起来技术含量不高，但又是必不可少的一项操作，无论是静脉补液给药，或是采血检验，都必须要用到此项操作，特别是在危重病人的抢救或大出血、严重脱水病人的紧急抢救时刻，静脉穿刺的成功尤为重要。为了提高静脉穿刺的成功率，尽快建立静脉通道，给抢救赢得时间，减少病人的痛苦，现将笔者在工作中摸索的部分难穿刺静脉的处理方法与大家共同讨论。     

颈外静脉留置针抢救消化道大出血的临床应用

目的 探讨颈外静脉留置针在抢救消化道大出血患者中的应用效果.方法 将64例消化道大出血患者按入院单双号随机分为观察组和对照组各32例,观察组采用颈外静脉留置针穿刺置管输液,对照组采用四肢浅静脉留置针穿刺置管输液,观察两组病人在输液效果和穿刺成功率及留置时间的差异.结果 观察组输液效果优于对照组,穿刺成功率高,留置时间长,与对照组比较,差异有统计学意义(P＜0.05).结论 颈外静脉留置针在消化道大出血患者抢救中能快速建立静脉通道,输液效果良好.     

双止血带结扎法对上消化道大出血病人建立静脉通道效果的研究

[目的]探讨双止血带结扎法对上消化道大出血病人建立静脉通道对静脉穿刺成功率、重新静脉穿刺率效果的影响.[方法]将60例静脉血管充盈度不良、上消化道大出血、住院静脉输液的病人随机分为实验组和对照组,每组30例,实验组采用双止血带结扎法,对照组采用传统的单止血带结扎法.[结果]实验组静脉穿刺成功率明显高于对照组(P＜0.05).[结论]双止血带结扎法对上消化道大出血病人建立静脉通道能明显提高静脉穿刺成功率,减少静脉重新穿刺率,为病人的治疗与抢救赢得时间,减轻病人的痛苦.     

双止血带结扎法对上消化道大出血病人建立静脉通道效果的研究

[目的]探讨双止血带结扎法对上消化道大出血病人建立静脉通道对静脉穿刺成功率、重新静脉穿刺率效果的影响。[方法]将60例静脉血管充盈度不良、上消化道大出血、住院静脉输液的病人随机分为实验组和对照组,每组30例,实验组采用双止血带结扎法,对照组采用传统的单止血带结扎法。[结果]实验组静脉穿刺成功率明显高于对照组（P〈0.05）。[结论]双止血带结扎法对上消化道大出血病人建立静脉通道能明显提高静脉穿刺成功率,减少静脉重新穿刺率,为病人的治疗与抢救赢得时间,减轻病人的痛苦。     

分娩时静脉穿刺部位的选择

产后大出血是产科较为常见的疾病，也是产妇死亡的主要原因。治疗原则：首先是建立静脉通道，补充血容量，纠正失血性休克，尤为关键。故临床上常规手背浅静脉穿刺经常因为产妇宫缩过强、用力不当、循环血容量不足、静脉塌陷，而导致液体外漏、脱出、阻塞或移位，静脉穿刺失败。     

自制负压在静脉输液中的应用技巧

在静脉输液的过程中,经常会遇到病人休克、腹泻、末梢循环不良、失血导致循环血容量不足而引起静脉穿刺失败,从而耽误抢救时间,延误抢救用药,引起护患纠纷。此时,头皮针头有时往往在血管里而不回血或回血很慢,导致操作者判断失误而致针头刺过血管壁,造成穿刺失败。为了减少这一情况的发生,     

Use of crystepin in combination with obsidan in patients with diabetes mellitus with arterial hypertension

Examination included 70 patients with diabetes mellitus in combination with arterial hypertension of different origin (II stage essential hypertension and symptomatic renal arterial hypertension). Crystepin (2-3 tablets per 24 h) in combination with beta-adrenoblocker obsidan (40-80 mg/24 h) was used for treatment. Basic hemodynamic parameters and the state of the renin-aldosterone system were determined. The hemodynamic hypotensive effects in these patients due to the influence of the above therapy are uniform and depend on the form of attendant arterial hypertension. The hypotensive effect of crystepin used in combination with obsidan was more pronounced in patients with diabetes and II stage essential hypertension than that in those with diabetes and renal hypertension. The concentration of aldosterone and renin activity of blood plasma in patients with diabetes and arterial hypertension during treatment with crystepin and obsidan had no regular connection with the hemodynamic parameters.     

硝酸甘油联合托拉塞米在高血压危象并发急性肺水肿患者的应用

目的研究硝酸甘油联合托拉塞米治疗高血压危象合并急性肺水肿的效果。方法选取我院收治的高血压危象合并急性肺水肿患者80例作为研究对象。随机分为对照组40例,采用托拉塞米治疗;试验组40例,采用硝酸甘油联合托拉塞米治疗。比较两组患者治疗效果、临床指标改善程度及并发症发生率。结果治疗后对照组患者血压、呼吸频率及氧分压改善程度均低于试验组,且治疗有效率(77.5%)低于试验组(92.5%),差异显著(P0.05);对照组患者并发症发生率(20.0%)高于试验组(7.5%),差异显著(P0.05)。结论采用硝酸甘油联合托拉塞米在治疗高血压危象合并急性肺水肿安全性高,可减少并发症,改善治疗效果,提高患者生活质量。     

Satisfaction with upper-extremity surgery in individuals with tetraplegia

OBJECTIVE: To measure the satisfaction of individuals with tetraplegia with their upper-extremity reconstructive surgery. DESIGN: Survey. SETTING: Two Spinal Cord Injury Model Systems centers. PARTICIPANTS: Sixty-seven individuals with spinal cord injury at the C4 through C8 motor level (107 arms). INTERVENTIONS: Participants had upper-extremity surgery to improve function. The surgical procedures included tendon transfers for elbow extension, wrist extension, hand grasp, and pinch or hand grasp neuroprosthesis. MAIN OUTCOME MEASURE: A survey was mailed to participants, who were asked to respond to statements such as, "If I had it to do over, I would have the hand/arm surgery again," using a 5-level Likert scale (ranging from strongly agree to strongly disagree). RESULTS: Seventy percent of the participants were generally satisfied with the results of their upper-extremity surgery, 77% reported a positive impact on their lives, 68% reported improvements in activities of daily living (ADLs), 66% reported improved independence, 69% reported improvement in occupation, 71% reported improved appearance or neutral, 78% reported their hand worked as well (or neutral) as it did when surgery was first performed, and 86% reported postoperative therapy as being beneficial. CONCLUSIONS: Upper-extremity surgery had a positive impact on life, increased ability to perform ADLs and to be independent, and improved quality of life.     

Observations with Rabenid in patients with locomotor disease

By examining 139 patients suffering from locomotor diseases the author could observe the characteristic accompanying diseases as well as high uric acid level in 40 cases. She analyses the current opinions on hyperuricaemia and reports on her observations with uricosuric and antithrombotic coated Rabenid tablet (RG). She found sulfinpyrazone to be effective and valuable in the examined indication field.     

休克状态下PSVT多种药物转复成功1例

1 临床资料 患者女，77岁，主因心慌、乏力、大汗六小时就诊。查体，急性面容，血压波动在70～86/37～54mmHg；心率：160次/分；呼吸：26次/分；口唇紫绀，双肺呼吸音清；心率齐，心电图示阵发性室上心动过度，无预激综合症和房颤；血生化示电解质正常。     

Changes in myocardial function in patients with hypertension during treatment with minipress

Altogether 33 patients with arterial hypertension were investigated to study changes of left ventricular systolic phasic analysis, caused by prazosin therapy. Two groups were identified on the basis of these changes: indices in the 1st group (intrasystolic index, myocardial tension index, Blumberger coefficient) improved, in the 2nd group they deteriorated. The antihypertensive effect of prazosin should be assessed not only by the level of BP reduction but also by changes of left ventricular systolic phasic analysis. In the deterioration of indices of left ventricular systolic phasic analysis during a test with single administration of prazosin, antihypertensive therapy should be reconsidered.