皮肤软组织扩张器水囊内液体污染状况与皮瓣质量相关性探讨

目的：研究皮肤软组织扩张器水囊内流体污染状况与皮瓣质量的关系。方法：对３３个囊内液体进行细菌培养和对３３个皮瓣进行临床血循环观察对比,结果：皮肤软组织扩张器水囊内液体污染状况与皮瓣血循环有显相关性,Ｐ〈０．０１。结论：水囊用时要严格灭菌,每次注水要无菌操作,甲硝唑注射液做水囊内介质可降低阳性率。     

皮肤软组织扩张器水囊内液体污染的调查及预防

作者随机检查的30只皮肤软组织扩张器水囊内液体标本,其埋植期为20～65天,注水次数为8～20次。发现3只水囊内液体有细菌生长,菌种为霉菌、革兰氏阳性杆菌及真菌。但埋植时间最长和注水次数最多者并无细菌生长。提示囊内液体污染与埋植时间及注水次数无必然联系。而扩张器使用首消毒不彻底、所注入的生理盐水有污染或注水时无菌操作不严是造成囊内液体污染的原因。囊内液体污染可致皮瓣感染而影响手术效果。预防措施为:①严密消毒扩张器。②严格执行无菌操作。③向囊内注入抗生素。     

股前外侧游离皮瓣修复皮肤与软组织缺损术15例的术后护理

目的总结股前外侧游离皮瓣修复皮肤与软组织缺损的护理要点。方法对15例行游离皮瓣移植术后患者进行密切观察和护理,分析导致游离皮瓣血循环危象的主要因素,并对此采取相应的解决方法。结果 15例足部毁损伤后行游离皮瓣移植术后发生血管危象4例;15例皮瓣全部成活,经过6个月以上的随访,15例患者功能和外形良好。结论股前外侧游离皮瓣移植术后血循环危象发生率较高。通过术前、术后综合有效的观察和护理,可以早期发现和及时处理皮瓣血循环危象,预防性降低皮瓣血循环危象的发生率。     

受区合并骨折的下肢游离皮瓣移植术后的护理

目的总结受区合并骨折的小腿及足部皮肤缺损行游离皮瓣移植术后诱发血循环危象的因素及护理要点，提高该病的临床护理效果。方法对21例伴小腿骨折的小腿及足部皮肤缺损行游离皮瓣移植术后患者进行密切观察和护理，总结导致游离皮瓣血循环危象的因素主要是：情绪紧张、寒冷、血肿及敷料的压迫导致血流受阻，感染、体位不妥及过早活动、便秘、吸烟等。逐一对这些护理问题及其对策进行分析，总结各种护理问题相应的解决方法。结果21例伴小腿骨折的小腿及足部皮肤缺损行游离皮瓣移植术后发生血管危象11例，8例行手术探查重新吻合血管，6例成活，2例坏死。结论伴小腿骨折的小腿及足部皮肤缺损行游离皮瓣移植术后血循环危象发生率较高。通过术前、术后综合有效的观察和护理可以早期发现和及时处理皮瓣血循环危象，预防性降低皮瓣血循环危象的发生率。     

一次性球囊扩张器的制作与使用

在腹腔镜下肾脏手术中，以往使用进口一次性水囊扩张器建立气腹环境。水囊内注入50mL～80mL无菌生理盐水，注射完毕再用50mL注射器一管一管地抽出水囊内的液体，然后手术。此操作既烦琐又费时，而且进口的一次性水囊扩张器价格昂贵。现介绍一种简易的一次性球囊扩张器，经临床使用，效果满意。     

非充盈法观测游离皮瓣移植术后血循环状况研究

皮瓣移植术后必须持续监护血液循环，绝大部分的血循环危象是可以纠正的，关键是及时发现和正确判断。报告11例游离皮瓣移植中，均因皮瓣的皮肤色素沉着或其它原因导致难以观测皮瓣的皮包和循环充盈度，采用特异性的观测方法来判断移植皮瓣的血循环情况，本组11例正确判断率为100％。作者认为在皮瓣充盈不明显的条件下，综合其它有价值的观测手段，可以早期和及时的判断是否有皮瓣的血循环危象的发生。     

扩张皮瓣修复局部晚期乳腺癌术后软组织缺损的围手术期护理

目的总结应用邻近扩张皮瓣修复局部晚期乳腺癌术后胸壁软组织缺损的围手术期护理方法。方法对13例局部晚期乳腺癌(locally advanced breast cancer,LABC)患者接受新辅助化疗前使用水囊扩张器扩张皮瓣,4个疗程新辅助化疗后行乳腺癌改良根治术并一期修复手术后胸壁软组织缺损。治疗过程做好水囊扩张期间注射壶、腹壁扩张皮瓣和注水的护理工作,皮瓣修复后做好皮瓣生长护理工作。结果患者均顺利完成水囊扩张器植入术,并完整修复胸壁软组织缺损,未出现皮瓣坏死,随访6~24个月未发现肿瘤转移。结论扩张皮瓣修复LABC手术后胸壁软组织缺损围手术期间,扩张器植入后皮瓣扩张过程皮瓣护理及手术修复后创面护理是手术成功的重要因素。     

1例小腿内侧带血管皮瓣修复前臂的护理

用移植皮瓣修复皮肤缺损在国内外已取得广泛推广。皮瓣移植术是针对组织创伤严重伴组织缺损、血循环欠佳的局部进行修复的整形术。吻合血管的皮瓣移植成功的关键是将皮瓣内的小血管和受区的小血管予以接通，使皮瓣的营养立即由受皮区供应。现将1例小腿内侧带血管皮瓣修复前臂的护理体会介绍如下。     

双腔尿管拔除困难3例分析

双腔尿管因不需外固定、可留置时间长，得到广泛应用，拔管困难少见。现报道3例如下。 1 病例介绍 [例1]病人，男，23岁，因醉酒后10h急性尿潴留而留置双腔尿管。酒醒后膀胱刺激征明显，要求拔管。拔管时水囊内液体吸出困难，压力开关通畅。用力抽吸时只有极少量液体吸出。复抽20余次后，突有25mL液体流出，拔管成功。剪开水囊，见注水管内口对应处囊壁有内口形状压痕。     

岛状皮瓣移位术后的护理

目的　探讨岛状皮瓣移位术后的护理方法及其效果。方法　分析术后皮瓣发生血循环危象及其抢救成功的原因 ,找到恰当的护理方法。结果　本组共 15例 ,仅有 3例皮瓣发生血循环危象 ,其中动脉性危象 2例 ,静脉性危象 1例 ,经及时处理均恢复正常血循环。结论　正确的术后护理能够及时发现异常情况 ,以便及时处理 ,防止皮瓣发生不可逆转的血液循环障碍 ,保证皮瓣存活。     

血袋保养液在抗-HCV酶免试剂应用中的影响

目的了解血袋内装保养液在国产抗-HCV酶免试剂应用中,对检测结果的影响程度。方法取效期内使用的CPDA血袋保养液按1:7比例混合抗-HCV低值阳性血清,在同一微板、同样加样手法条件下,平行做未稀释血清、稀释后血清、血袋保养液各20孔,重复及对照试验各做3孔。结果血袋保养液对抗-HCV检测结果本底无影响,对低值阳性血清即弱阳性标本影响较大,在一定范围内可造成结果的漏检。结论采集血液后留取血样标本或重验标本,应考虑到有无血袋内装保养液或其它溶液的影响,以减少结果的不准确性。     

A comparison of field techniques used to pressure-infuse intravenous fluids

Application of pressure infusion bags may increase intravenous (IV) flow rates three-fold. Commercially available pressure infusers, manual squeezing of the IV fluid bag, inflating a blood pressure (BP) cuff around the bag, and kneeling on the bag have been used by prehospital personnel attempting to augment fluid infusion rates. To test the efficacy of each these methods, seven experienced paramedics were asked to employ each method in two trials using a 1-liter bag of saline through a 14-gauge, 5.7cm catheter and a standard administration set. Gravity flow from 80 cm served as the control. Pressure infusers generated flow rates of 257+/-54 ml/min and 296+/-53 ml/min when inflated to 300 mmHg and maximum pressure respectively. This rate was 2-2.5 times that of gravity flow (123+/-2 ml/min) and significantly greater than those rates obtained by any other method (p less than .0005). Manually squeezing the bag also was significantly better than was gravity flow with flow rates of 184+/-46 ml/min and 173+/-40 ml/min achieved by each of two different squeezing methods (p less than .01). Neither blood pressure (BP) cuff application and inflation (135+/-28 ml/min) nor kneeling on the bag (125+/-36 ml/min) was better than gravity alone. These results indicate that pressure infusers should be used to the exclusion of other field methods of supplying infusion pressure. If pressure infusers are not available, manually squeezing the bag is the only alternative acceptable in the field.     

微球菌污染血液1例

微球菌是革兰阳性菌，广泛存在于空气、土壤、水及人体皮肤和呼吸通道，是临床上常见的污染菌。本文通过对一袋因血浆部分颜色发生变化而报废的库存全血进行细菌学检查，证实为玫瑰微球菌污染所致。提示采供血机构现均采用传统型密闭式一次性血袋进行采血，减少了对血液的污染，但如果采血环境、相关操作及物品消毒不严，也可能对所采集的全血或成份血造成污染。     

造口袋在肠瘘病人引流中的应用研究

目的观察造口袋用于肠瘘患者的引流效果。方法将41例术后吻合口瘘患者随机分为两组:A组为传统引流法,直接采用腹腔引流管接引流袋;B组采用造口袋与引流管配合使用。比较两组病人引流管口周围皮肤炎症发生率、腹部切口感染率、衣物污染率、切口敷料污染率、舒适度(采用诺丁汉健康量表)、每日换药经费情况。结果B组引流管周围皮肤炎症发生率、切口感染率、衣物污染率、切口敷料污染率明显低于A组(P<0.05),病人舒适度提高,换药经费也少于A组。结论造口袋用于肠瘘病人引流,可降低引流管周围皮肤炎症发生率、切口感染率,提高病人舒适度,并可减轻医护工作量及费用。     

Effect of a 3.6 o/o dextran Ringer acetate solution on moderately hypovolemic patients in intensive care

The effects of 1000 ml 3.6% dextran Ringer's acetate solution (Mw 61,800; infusion time 60 min) on circulation, blood and plasma volume, blood viscosity and renal function parameters were investigated, the renal elimination of dextran also being measured. During the entire investigation period no significant alterations of cardiocirculatory parameters, blood and plasma volume and rheological properties of blood could be demonstrated, the same holding true for kidney function values. Dextran excretion was about 33% three hours after the end of infusion, reaching 51% of the whole amount given 21 hours later. It has to be assumed that mainly macromolecular dextran components of less efficiency are retained intravascularly. Taking into consideration the practically absent volume expanding effect - even at the end of infusion period - this dextran solution cannot be recommended as a blood substitute during acute hemorrhage or as an "expander" in other shock states.     

Microarray kit analysis of cytokines in blood product units and segments

BACKGROUND: Cytokine concentrations in transfused blood components are of interest for some clinical trials. It is not always possible to process samples of transfused components quickly after their administration. Additionally, it is not practical to sample material in an acceptable manner from many bags of components before transfusion, and after transfusion, the only representative remaining fluid of the component may be that in the “segment,” because the bag may have been completely transfused. Multiplex array technology allows rapid simultaneous testing of multiple analytes in small‐volume samples. This technology was used to measure white blood cell (WBC) cytokine levels in blood products to determine 1) whether concentrations in segments correlate with those in the main bag and, thus, whether segments could be used for estimation of the concentrations in the transfused component and 2) whether concentrations after sample storage at 4°C for 24 hours do not differ from concentrations before storage, thus allowing for processing within 24 hours, rather than immediately after transfusion. STUDY DESIGN AND METHODS: WBC cytokines were measured in the supernatant from bags and segments of leukoreduced red blood cells (RBCs), nonleukoreduced whole blood, and leukoreduced plateletphereses using a human cytokine array kit (ProteoPlex, Novagen). RESULTS: Cytokine concentrations in RBCs and whole blood or plateletphereses stored at 4°C did not differ between bag and segment samples (all p > 0.05). There was no evidence of systematic differences between segment and bag concentrations. Cytokine concentrations in samples from plateletphereses did not change within 24 hours storage at 4°C. CONCLUSION: Samples from either bag or segment can be used to study cytokine concentrations in groups of blood products. Cytokine concentrations in plateletphereses appear to be stable for at least 24 hours of storage at 4°C and, thus, samples stored with those conditions may be used to estimate the cytokine concentrations of the component at the time of transfusion.     

Conjunctival oxygen tension is influenced by plasma and blood volume, and flow through the external carotid artery

An investigation of the feasibility and validity of measurement of the conjunctival oxygen tension as a monitor of peripheral circulation, blood and extracellular fluid volume and cerebral circulation was carried out in 7 healthy volunteers and 5 unconscious critical care patients with proven total cerebral infarction. The healthy volunteers were subjected to changes in hydration achieved by the administration of furosemide and subsequent rehydration by administration of normal saline. Conjunctival oxygen tension was found to be a sensitive indicator of changes in the degree of hydration presumably by its ability to detect changes in peripheral circulation depending upon circulating blood and extracellular fluid volume. A drawback is that other stimuli of the sympatho-adrenergic system such as temperature and pain, interfere with measurement in the conscious volunteer. In patients with presumed total brain infarction the conjunctival PO₂ cannot be used as a reliable monitor of cerebral blood flow because of varying perfusion of the palpebral conjunctiva from the external carotid artery in the occasional patient.     

Hypertension in the elderly

Hypertension in the elderly is a consequence of several aging processes, and it is important to understand characteristics of elderly hypertension for diagnosis and treatment. Hypertension in the elderly is characterized by isolated systolic hypertension and increased pulse pressure in response to aortic stiffness. Decline in barorelfex, left ventricular hypertrophy, and impaired control of body fluid volume also need to be considered in the treatment of elderly hypertension, as these alternations may result in reduced tissue circulation and blood flow reserve. Target blood pressure of the elderly is < 140/90 mmHg, as suggested by the results of recent mega-trials. It is necessary to gradually decrease blood pressure in the elderly, as they might have reduced tissue circulation and impaired auto-regulation of blood flow.     

MAP洗涤红细胞再冰冻的实验研究

目的对红细胞洗涤后冰冻保存的安全性探讨。方法选择20袋(2u/袋)悬浮红细胞,每袋分成2份(1u/份)为实验组和对照组,实验组制备成M AP洗涤红细胞后再冰冻保存;对照组直接制备成冰冻红细胞,一周后实验组和对照组用同等方法进行去甘油解冻,并计算红细胞的回收率及其相关质控指标。结果实验组和对照组冰冻红细胞回收率,甘油残余量,上清液游离血红蛋白含量及体外溶血率比较无显著性差异(P>0.05),两组成品无菌试验均阴性。结论M AP洗涤红细胞制备成冰冻红细胞,各项质量指标符合国家标准,能应用于临床,因而有效解决临床备用洗涤红细胞剩余而造成的血液浪费。