肿瘤化疗患者浅静脉留置针细菌培养结果分析

目的分析肿瘤患者浅静脉留置针周围皮肤及针尖细菌感染的特点,以更好地指导护理工作.方法对143例需静脉化疗的肿瘤患者进行浅静脉留置针穿刺后,采集留置针周围皮肤及针尖部标本进行细菌培养阳性结果分析.结果细菌检出以革兰氏阳性菌为主;143例286例次中,皮肤检出38例次,检出率26.6%;针尖检出20例次,检出率14.0%;留置时间≤4 d组的细菌总检出率为11.1%,5～7 d组的细菌总检出率为46.9%,两者比较,差异有显著性意义(P<0.01);>7 d组的细菌检出率为88.2%,与前两组比较,差异有显著性意义(P<0.01,P<0.05).结论肿瘤化疗浅静脉留置针留置时间越长,被细菌污染的可能性越大;应加强置管护理,加强局部皮肤的清洁消毒工作;留置时间最好控制在4 d左右.     

肿瘤化疗患者浅静脉留置针细菌培养结果分析

目的分析肿瘤患者浅静脉留置针周围皮肤及针尖细菌感染的特点，以更好地指导护理工作。方法对143例需静脉化疗的肿瘤患者进行浅静脉留置针穿刺后，采集留置针周围皮肤及针尖部标本进行细菌培养阳性结果分析。结果细菌检出以革兰氏阳性菌为主；143例286例次中．皮肤检出38例次，检出率26．6％；针尖检出20例次。检出率14．0％；留置时间≤4d组的细菌总检出率为11．1％，5～7d组的细菌总检出率为46．9％，两者比较。差异有显著性意义（P〈0．01）；〉7d组的细菌检出率为88＋2％．与前两组比较。差异有显著性意义（P〈0．04，P〈0．05）。结论肿瘤化疗浅静脉留置针留置时间越长。被细菌污染的可能性越大；应加强置管护理，加强局部皮肤的清洁消毒工作；留置时间最好控制在4d左右。     

血液病患者浅静脉留置针细菌污染及临床特点分析

目的探讨血液病患者浅静脉留置针菌群污染特点,为针对性地预防提供依据。方法对135例采用浅静脉留置针化疗的血液病患者拔针后其针尖行细菌培养。结果135例中,21例(15.56%)细菌污染,且以革兰氏阳性菌为主;留置时间越长、白细胞计数越低,其感染率越高,差异有显著性意义(P<0.05)。结论对血液病浅静脉留置针化疗患者应加强置管护理,留置针置管时间以患者白细胞计数而定。     

PICC置管在乳腺癌化疗中的临床应用

目的探讨经外周置入中心静脉导管与浅静脉留置针在乳腺癌化疗中的临床效果。方法把139名乳腺癌化疗的随机分为2组,观察组50例给予PICC;对照组89例给予浅静脉留置针,比较2组并发症发生率及留置时间的长短。结果 PICC组并发症如静脉炎明显少于浅静脉留置针组,差异有统计学意义(P<0.05)。留置时间明显长于浅静脉留置针组,差异有统计学意义(P<0.01)。结论 PICC并发症比较少,留置时间长,操作简单安全,无不良作用,无痛苦,值得临床推广应用。     

腹腔化疗和外周静脉化疗对晚期胃肠道恶性肿瘤患者生存质量的影响

目的比较经腹腔化疗及外周静脉化疗对晚期胃肠道恶性肿瘤患者生存质量的影响。方法对无法切除的晚期消化道肿瘤采用经腹腔化疗（60例）、外周静脉化疗（32例）两种不同的化疗方式，分别于术前和术后2、5、10、20、30周测定胃肠道生活质量(GQLI)指数。结果术前、术后2、5周两组GQLI指数差异不明显，术后10、20、30周两组GQLI指数差异有显著性意义，P<0.01；静脉化疗组患者GQLI指数明显下降。腹腔化疗组的1年生存率高于外周静脉化疗组，P<0.05。结论经腹腔化疗较外周静脉化疗能提高晚期消化道肿瘤患者的生存质量。     

三种下肢静脉穿刺置管方法效果比较

目的 寻找下肢静脉最佳的穿刺置管方法.方法 将经下肢化疗的85例肿瘤患者分为三组.外周深静脉组23例,选择内踝大隐静脉起始处或小腿内侧,以15°～30°角进针行静脉穿刺,置入16 G PICC导管至大隐静脉末段或股静脉,经X线拍片证实导管尖端位置正确后接通输液装置输液;股静脉组41例,选择股动脉搏动最明显部位的内侧0.5 cm处,针头指向患者头部、与皮肤呈30°～45°角穿刺,王入16 G单腔中心静脉导管输液;外周留置针组21例,采用18～22 G贝朗留置针,选择下肢浅静脉行静脉穿刺王管输液.结果 三组一次置管成功率及操作平均耗时、化疗性静脉炎发生率总体比较差异有统计学意义(P<0.05,P<0.01),股静脉组成功率最低且耗时最多,外周留置针组化疗性静脉炎发生率最高;外周深静脉组导管平均留置时间显著短于股静脉组(P<0.05),两组并发症发生率比较差异无统计学意义(P>0.05),但股静脉组发生严重感染1例.结论 为预防化疗性静脉炎,应避免使用外周静脉而选择深静脉给药.外周深静脉置管与股静脉穿刺王管比较,操作简单、一次操作成功率高、耗时少,无严重并发症,是下肢深静脉置管较理想的方式.     

负压技术在静脉留置针穿刺困难患者中的应用

目的提高静脉留置针穿刺困难者的一次穿刺成功率。方法将200例需行静脉留置针穿刺的患者随机分为对照组和观察组,各100例。对照组按常规穿刺,观察组采用负压技术穿刺,即将容量为2ml的吸球和三通接头接上留置针,使之穿刺时形成负压,再行穿刺。结果两组静脉穿刺回血率、一次成功率比较,差异有显著性意义(χ2=18.32、27.56,均P<0.01);留置针保留时间比较,差异无显著性意义(P>0.05);两组颈外静脉、大隐静脉穿刺回血率、一次穿刺成功率比较,差异有显著性意义(χ2=18.26、18.26、5.00、5.00,P<0.01或P<0.05);两组股静脉一次穿刺成功率比较,差异有显著性意义(P<0.01)。结论负压技术可提高留置针穿刺回血率和一次穿刺成功率。     

大小型号留置针临床应用效果比较

目的探讨大小型号静脉留置针的临床效果。方法将113例患者以应用小号型留置针进行静脉穿刺56例为观察组;以应用大号型留置针进行静脉穿刺57例为对照组。结果观察组并发症发生率、置管成功率,留置时间平均分别为16.1%、94.7%、3.95 d,对照组分别为:35.1%、82.5%、3.32 d,观察组临床效果明显优于对照组(P<0.01)。结论合理应用小号型留置针进行静脉穿刺,可提高静脉穿刺成功率,且留置时间长、并发症少,效果肯定。     

代温灸膏局部敷贴对静脉留置针留置效果的影响

目的探讨代温灸膏局部敷贴对静脉留置针留置效果的影响。方法将80例行浅静脉留置针置管输液的患者随机分为两组各40例,对照组在留置针处用输液贴固定;观察组加用代温灸膏在静脉穿刺上方0.5～1.0cm处沿血管走向敷贴。结果静脉炎发生率观察组(45.0%)显著低于对照组(75.0%);留置时间观察组(≥5d为80.0%)显著长于对照组(52.5%),两组比较,均P<0.01。结论用代温灸膏局部敷贴可以明显降低静脉炎的发生率,延长置管时间。     

颈外静脉与四肢浅静脉留置针在院前急救中的效果比较

目的 探讨颈外静脉与四肢浅静脉留置针在院前急救中的应用效果,以迅速建立静脉通路,并为后续治疗提供最佳输液途径.方法 将140例危重患者随机分为对照组和观察组各70例,对照组行四肢浅静脉留置针输液,观察组采用颈外静脉留置针输液.结果 观察组能快速建立静脉通道,易固定,穿刺时间短,穿刺成功率高,与对照组比较,差异有显著性意义(P＜0.01).结论 颈外静脉留置针在院前急救中能快速建立静脉通道,输液效果好.     

胸腰椎骨折椎弓根内固定断裂与植骨融合方式的相关性分析

[目的]探讨胸腰椎骨折椎弓根螺钉内固定系统内固定术后,椎弓根螺钉断裂与植骨融合方式之间的关系,以探讨胸腰椎骨折植骨融合的最佳方式。[方法]回顾性研究1995年5月~2005年12月本院脊柱外科收治的胸腰椎骨折病人197例,其中A组单纯内固定(不植骨)患者14例,B组“H”形椎板植骨21例,C组横突间植骨67例,D组椎间、椎内联合横突间植骨95例。[结果]术后随访6~32个月,内固定断裂12例,其中A组4例,B组3例,C组5例,D组0例,4组中D组内固定断裂率显著低于其他3组(P<0.05)。[结论]椎间、椎体内联合横突间植骨重建脊柱三柱的稳定性,符合人体生物力学原理,能有效降低内固定断裂的发生。     

On the measurement of the functional properties of the CFTR

A number of methods are currently employed to assess the functional properties of CFTR channels and their response to pharmacological potentiators, correction of the defective CFTR trafficking, and vectorial introduction of new proteins. Here we review the most common methods used to assess CFTR channel function. The suitability of each technique to various experimental conditions is discussed.     

The Measurement of the Inclination Angle of the Hamate and Analysis of the Inclination Angle for the Rotation Deformity of the Little Finger in the Fixation of the Carpometacarpal Joint

ObjectiveComplex base fractures of the fifth metacarpal bone and dislocation of the fifth carpometacarpal joint are more prone to internal rotation deformity of the little finger sequence after fixation with a transarticular plate. In the past, we have neglected that there is actually a certain angle of external rotation in the hamate surface of transarticular fixation. This study measured the inclination angle of the hamate surface relative to the fifth metacarpal surface for clinical reference.MethodsIn a prospective single‐center study, we investigated the tilt angle of 60 normal hamates. The study included thin‐layer computed tomography (CT) data from 60 patients from the orthopaedic clinic and inpatient unit from January 2017 to March 2020, including 34 men and 26 women who were 15~59 years old, average 35 years old. The CT data of 60 cases in Dicom format of the hand was input into Mimics and 3‐Matics software for three‐dimensional (3D) reconstruction and measuring the angle α between hamate surface and the fifth metacarpal surface. According to the possible placement of the transarticular plate on the fifth metacarpal surface, we measured the angle β between the hamate surface 1 and the fifth metacarpal surface and the angle γ between the hamate surface 2 and the fifth metacarpal surface.ResultsThe average angle between the hamate surface and the fifth metacarpal surface was 11.66°. The hamate surfaces 1 and 2 have an external rotation angle of 7.30° and 7.51° on average with respect to the fifth metacarpal surface, respectively. There is no statistically significant difference in the angles between the two groups (P > 0.05).ConclusionsThe horizontal angle of the dorsal side of the hamate is different from the back of the fifth metacarpal surface, and the hamate has a certain external rotation angle with respect to the fifth metacarpal surface. No matter how the transarticular plate is placed, the plate always has a certain external rotation angle relative to the fifth metacarpal surface. When the fixation is across the fifth carpometacarpal joint, if the plate does not twist and shape, it will inevitably cause internal rotation of the fifth metacarpal, resulting in internal rotation deformity of the little finger sequence.     

静脉输注甘露醇开放血脑屏障对抗生素透过血脑屏障的影响

目的　通过快速静脉输注甘露醇可逆性开放血脑屏障 (BBB) ,探知此方法能否增加抗生素透过BBB的量 ,在何时达到最高峰 ,其通透量增加后临床上有无不良反应。方法　采用自身配伍设计 ,共 6个样本组。对照组仅使用抗生素 ;其余 5组分别在使用甘露醇前 60、3 0min ,同时使用甘露醇后 3 0、60min使用抗生素 ,各组皆取使用抗生素后 1h的脑脊液测其抗生素浓度。抗生素选用头孢三嗪。结果　测量值经过q检验 ,经 2 0 %甘露醇处理前后的CSF中的头孢三嗪浓度差异有非常显著性。全组患者经临床观察未出现神经系统的不良反应。结论　经静脉快速输注2 0 %甘露醇后可以使透过BBB的水溶性抗生素的量增加 ,两者使用的顺序是在抗生素使用 3 0min内即给予甘露醇快速滴注。该方法不会增加低神经毒性抗生素在中枢神经系统的不良反应。     

Preservation of the pylorus and resection of the head of the pancreas

The historical evolution of the pylorus-preservation resection of the head of the pancreas is traced from the first resections early in this century to relative standardization of the operation, to a lowering of the operative mortality, and to an interest in improving nutritional status after resection. There are many theoretical advantages for the function of the upper gastrointestinal tract after pylorus and gastric preservation, such as maintenance of gastric capacitance and equilibration of osmotic pressure in gastric digestants, foodstuff digestion and absorption, and bowel motility. After the pylorus-preserving resection, gastric emptying is normal, pyloric function to prevent duodenal reflux is often normal, and gastric acids and serum levels of duodenal hormones are at normal levels, whereas after standard pancreatoduodenectomy, all of these are often abnormal. No prospective blinded studies have been published comparing nutritional values after the two operative procedures, but evidence is presented of a satisfactory result with regard to gastric capacitance, body weight gain, and lack of postgastrectomy symptoms. An undoubted advantage of the pylorus-preserving feature is a simplification of the operation. These gains are achieved without increase in operative mortality, without increase in the incidence of jejunal ulcer, and without theoretical or actual decrease in value of the procedure as a cancer operation, except in patients with duodenal carcinoma proximal to the ampulla of Vater.     

下颌全牙弓后移量及最后界的测量

目的：研究下颌牙弓的有效后移量及找寻下颌牙弓移动的后界。方法：选取涉及拔除下颌第三磨牙或下颌第三磨牙缺失的病例18例（男6例,女12例）。采用种植支抗牵引下牙弓向远中,治疗完成时所有病例均明确到达下颌牙弓后界,即下颌第二磨牙远中到达下颌升支前缘软组织交界处。应用治疗前后的曲断片测量下颌第二磨牙远中到升支前缘的距离。结果：下颌第二磨牙后移量为（3.49±1.21）mm;治疗后磨牙后间隙的长度为（4.43±0.97）mm。结论：下颌牙弓可确定性地实现整体后移;最大后移量由磨牙后间隙的长度决定;其最后界止于下颌第二磨牙远中与下颌升支前缘软组织交界处。     

Preservation of the pylorus in resection of the head of the pancreas

Whipple's pancreatoduodenectomy was the standard operation for diseases of the head of the pancreas for more than 40 years, but the results were vitiated in part by poor gastrointestinal function and malnutrition. Reintroduced in 1978, pylorus-preserving proximal pancreatoduodenectomy (PPPP) has had an increasing impact on pancreatic surgery as its benefits have been recognized: improved nutritional status, decreased incidence of postgastrectomy syndromes, and a technically easier operation. Postoperative mortality rates and 5-year survival rates are comparable with those of the classic Whipple procedure. PPPP is indicated for most patients with chronic pancreatitis of the pancreatic head. It is also appropriate for patients with periampullary cancer and for those with pancreatic cancer arising from the lower part of ‘the head and the uncinate process. More than 650 patients have now undergone PPPP: 31% for chronic pancreatitis and 66% for periampullary and pancreatic cancers. We assess the indications for PPPP, outline the operation, and review the results.