改良手背静脉穿刺方法

改良手背静脉穿刺方法山东省兖州矿务局第７０工程处医院王瑞秀笔者自１９９２年９月至１９９３年４月，对门诊１７６例手背静脉输液方法进行改进，使一次穿刺成功率明显提高，现报告如下。１临床资料３４７例均为门诊输液病人，其中男１９３例，女１５４例，年龄２５～８...     

手背静脉穿刺致手部运动障碍1例

手背静脉为周围静脉输液的常用部位,在静脉穿刺过程中可出现静脉穿刺点的渗漏、淤血,及因无菌技术操作不严造成的静脉炎;但是手背静脉穿刺造成手部运动障碍尚属首例,也未见文献报告。现将护理体会报告如下:1 病历简介患者,女,37岁,本院护师,因咽痛、咳嗽、发热3天入院。既往身体健康。查体:体温38.9℃,脉搏87次/分,呼吸21次/分,血压17/10kPa。神志清,自主体位,鼻腔有稀薄分泌物,鼻窦无压痛;咽部稍充血,无分泌物,扁桃体不大。双肺呼吸音清,未闻干湿性罗音。四肢运动正常。诊断为:“急性上呼吸道感染”。遵医嘱给予5%葡萄糖500ml,病毒唑0.5静滴。选左手手背尺侧浅静脉为穿刺点,在穿刺针刺入皮肤尚未进入静脉血管时,患者即感左肩部放射性疼痛,     

浅静脉穿刺两种不同握拳法的对比观察

对 5 0 0例浅静脉充盈不佳需行静脉穿刺的病人采用自身对照的方法 ,即双日采取常规扎止血带后反复用力握拳运动 6次 ,单日采取常规扎止血带握拳 1次即行静脉穿刺。结果反复握拳法病人静脉充盈度及静脉穿刺成功率均优于单次握拳法 (均P <0 .0 1)。提示静脉穿刺前反复用力握拳 ,能明显改善静脉充盈度 ,提高静脉穿刺成功率     

回压静脉法在静脉穿刺困难患者中的应用

目的提高静脉血管充盈不佳患者的穿刺成功率,减轻患者痛苦。方法采用自身对照法,对112例静脉穿刺困难患者按输液单双日采用不同方法进行静脉穿刺。双日采用传统方法如握拳、拍打局部使静脉充盈后进行静脉穿刺（传统法）;单日采用从静脉远心端向近心端推压3～6次后行静脉穿刺（回压法）。比较两种方法浅静脉充盈程度及一次穿刺成功率。结果回压法浅静脉充盈良好率显著高于传统法（P〈0.01）,一次穿刺成功率回压法与传统法比较,差异有显著性意义（P〈0.05）。结论回压静脉穿刺方法可提高静脉穿刺成功率。     

外涂硝酸甘油加热敷在浅静脉穿刺困难患者中的应用

目的探讨浅静脉穿刺时解除血管痉挛更有效的方法。方法将80例血管条件差（血管痉挛、塌陷）但需静脉注射患者随机均分为对照组与观察组。对照组采用热敷法，观察组采用外涂1％硝酸甘油再加以热敷的方法。结果观察组患者一次穿刺成功率、静脉穿刺时间、血管充盈时间、血管充盈持续时间及血管充盈度与对照组比较，差异有显著性意义（P〈0．05，P〈0．01）。结论硝酸甘油加热敷对解除浅静脉穿刺时血管痉挛有显著疗效，且安全、舒适。     

人体手背掌指关节处静脉逆向穿刺技术的Meta分析

目的比较逆向穿刺与顺向穿刺的一次穿刺成功率和稳定性,评价掌指关节处静脉输液逆向穿刺的可行性。方法检索MEDLINE、COCHRANE图书馆数据库、中国期刊全文数据库(CNKI)、重庆维普资讯中文科技期刊数据库(VIP)以及万方数据库,纳入所有关于人体手背掌指关节处逆向穿刺的临床试验,采用RevMan5.1软件分析数据。结果共纳入14篇文献,与相同部位的顺向穿刺比较,逆向穿刺的成功率高于顺向穿刺(OR=4.46,95%CI:2.71～7.32,P<0.01);逆向穿刺药液渗漏发生率低于顺向穿刺(OR=0.26,95%CI:0.19～0.34,P<0.01)。结论掌指关节处静脉逆向穿刺在穿刺成功率和稳定性上优于相同部位的顺向穿刺,可作为需要长期静脉输液治疗患者的辅助方法。     

握持反射用于新生儿手背静脉穿刺固定

新生儿输液多选用头皮静脉,但有的患儿由于皮肤颜色较深或新生儿黄疸等原因,使头皮静脉暴露不佳,便会选择四肢静脉穿刺.选择新生儿手背静脉穿刺时,因患儿手较小,且存在握持反射,同定有一定的难度.     

握持反射用于新生儿手背静脉穿刺固定

新生儿输液多选用头皮静脉．但有的患儿由于皮肤颜色较深或新生儿黄疸等原因，使头皮静脉暴露不佳，便会选择四肢静脉穿刺。选择新生儿手背静脉穿刺时，因患儿手较小，且存在握持反射，固定有一定的难度。鉴此，我科在新生儿手背静脉穿刺固定时巧妙利用握持反射，效果良好，介绍如下。     

手背静脉的分区使用

目的 合理使用手背静脉,减少静脉穿刺损伤.方法 将100例接受静脉穿刺的患者随机分为观察组和对照组各50例.对照组采用常规方法选择手背静脉穿刺;观察组将手背分为外、中、内三区.按左手外区→右手外区→左手中区→右手中区→左手内区→右手内区的顺序进行穿刺.比较两组静脉炎程度.结果 观察组静脉炎程度显著轻于对照组(P<0.01).结论 分区使用静脉在一定程度上规范了手背浅静脉穿刺操作,有利于保护静脉.     

温生姜水浸泡联合甩手垂扎法快速充盈手背高难穿刺静脉

目的探讨温生姜水浸泡联合甩手垂扎法快速充盈手背高难穿刺静脉的效果。方法将手背高难穿刺静脉患者165例随机分为观察1组、观察2组和对照组各55例。观察1组静脉穿刺前采用热水浸手并甩手垂扎压脉带,观察2组静脉穿刺前采用生姜水浸手并甩手垂扎压脉带,对照组采用热水袋热敷手背部后在输液台扎压脉带。比较三组患者静脉充盈程度、一次静脉穿刺成功率。结果三组手背静脉充盈效果和一次穿刺成功率比较,差异有统计学意义(均P<0.01),其中观察2组效果最好。结论手背高难穿刺静脉患者采用温生姜水浸泡联合甩手垂扎法有助于静脉快速充盈,提高一次穿刺成功率。     

Dissection of the Sylvian Fissure in the Trans-sylvian Approach Based on the Morphological Classification of the Superficial Middle Cerebral Vein

The superficial middle cerebral vein (SMCV) is one of the main factors that can impede a wide opening of the sylvian fissure. To reveal the most efficient SMCV dissection for a wide operative field while preserving the veins in the trans-sylvian approach, we retrospectively investigated the SMCVs through intraoperative video images. We characterized the SMCV as composed of the frontosylvian trunk (FST; receiving frontosylvian veins [FSVs] or parietosylvian veins [PSVs]), the temporosylvian trunk (TST; receiving temporosylvian veins [TSVs]), and the superficial middle cerebral common trunk (SMCCT; receiving both FSV/PSV and TSV), and classified the SMCVs of the 116 patients into 5 types based on the morphological classification of the SMCV. Type A SMCV (60.4%) with the SMCCT anastomosed to the frontal side had few bridging veins (BVs) between the SMCCT and the temporal side during dissection. Type B (7.8%) had the SMCCT with no anastomoses to the frontal side. In Type C (17.2%) consisting of the FST and TST and Type D (12.9%) with a merging of the vein of Trolard and Labbé posteriorly and the SMCVs dividing into the FST and the TST again proximally, there were few BVs between the FST and the TST during dissection. Finally, in Type E (1.7%) showing an undeveloped SMCV, there were no BVs between the frontal and the temporal lobes. Postoperative venous infarction occurred in 2.6%. Morphological classification of the SMCV can inform appropriate dissection line to create a wide operative field while preserving the veins in the trans-sylvian approach.     

腕掌侧浅静脉的解剖学观察及临床意义

目的探讨总结腕掌侧浅静脉的解剖学特征和在断指再植中移植的疗效。方法对腕掌侧浅静脉进行系统地解剖学观察,并应用此段浅静脉移植,修复复杂断指的血管缺损19例。结果通过解剖学观察,腕掌侧存在1～2条较为恒定的浅静脉,其直径与手指固有动脉、指背静脉相近。对14例伴有血管缺损的复杂断指和5例再植术后血管危象病例进行浅静脉移植(共25指),优良率达82．6％。结论腕掌侧浅静脉移植具有位置恒定,直径适宜,取材方便等优点,适合在复杂断指再植中血管移植。     

Hepatic Venous Outflow Reconstruction in Right Lobe Living-Donor Liver Graft Using Recipient''s Superficial Femoral Vein

Venous congestion of a liver graft from a life donor is a disastrous complication with a high risk of graft failure. For safety reasons, the middle hepatic vein (MHV) is currently unanimously left with the donor. As this vessel provides major venous draining of the right anterior sector, reconstruction of significant MHV tributaries is controversial. We describe here successful venous outflow reconstruction in adult-to-adult right lobe living-donor liver transplantation (RL-LDLT) using the recipient's superficial femoral vein (SFV). Six months after transplantation, graft function and perfusion are excellent, and the patient is free of venous morbidity related to the harvest of the SFV.     

Resurfacing the Dorsum of the Hand in a Patient With Xeroderma Pigmentosum

BACKGROUND: One of the most effective treatment methods of Xeroderma pigmentosum (XP) is full resurfacing of the exposed areas with skin grafts. OBJECTIVE: Introduction of a different surgical technique in order to minimize the undamaged skin removal in XP patients in whom multiple surgical procedures will often be necessary. METHOD: A special undulant incision of the graft margins around the metacarpal heads was performed. RESULTS: Both aesthetic and functional results were obtained. CONCLUSION: Although conservative surgical resection is primarily preferred in XP patients, in cases in whom radical surgical intervention is necessary, in order to minimize undamaged skin, surgical technique of choice should be individualized.     

Arm Vein as a Last Autogenous Option for Infrainguinal Bypass Surgery: It is Worth the Effort

OBJECTIVES: Considerable evidence exists for the use of arm vein conduit in lower limb bypass surgery. The use of arm vein in preference to synthetic conduit as a last autogenous option was assessed for patency and limb salvage outcomes. MATERIALS AND METHODS: A prospective database was interrogated and checked against TQEH operating theatre database to detect all infrainguinal arm vein bypasses performed between 1997 and 2005. Patency, limb salvage and survival data for 37 arm vein bypasses was calculated using the Kaplan-Meier survival estimate method. RESULTS: There were no perioperative deaths. 30 day patency rates were 89% primary, 95% secondary and 95% limb salvage. 12 month patency rates were 56% primary, 79% secondary and 91% limb salvage. 5 year patency rates were 37% primary, 76% secondary and 91% limb salvage. There was no significant patency advantage for primary vs. "redo" grafts (p=0.54), single vessel vs. spliced conduits (p=0.33) or popliteal vs tibial outflow (p=0.80). Patient survival rate was 92% and 65% at 1 and 5 years respectively. CONCLUSION: Lower limb bypasses using arm vein can be performed with favourable patency and limb salvage compared to synthetic conduits. However, secondary interventions are frequently required to maintain patency. We recommend a vigilant surveillance program for early identification of patency threatening disease.     

上臂皮管法修复鼻再造失败病例

目的 探讨针对鼻再造失败或效果不佳,且额部组织已完全破坏的病例,再次行全鼻再造的方法 。方法 自2008年1月至2010年1月,对3例鼻再造失败病例以上臂皮管法行全鼻再造。手术分四期进行。Ⅰ期:于左上臂内侧形成皮管(18 cm×8 cm);Ⅱ期:3周后切断皮管上端并转移至鼻根;Ⅲ期:3周后将皮管从上臂离断,形成皮瓣修剪成三叶状并向内折叠,以塑形成鼻翼、鼻尖和鼻小柱。同期取第7、8肋软骨,制成“L”形支架并固定;Ⅳ期:3周后进行断蒂修整。结果 3例患者均获成功,随访1~2年,再造鼻颜色、质地与周围皮肤较为匹配,外形及通气功能均达到满意效果。结论 对于额部组织已被破坏的鼻再造失败患者和坚决反对在额部留下任何痕迹的患者,采用上臂皮管行全鼻再造是行之有效的方法。     

Isolated Superficial Sylvian Vein Thrombosis with Long Cord Sign: Case Report and Review of the Literature

Isolated cortical vein thrombosis (ICVT) is extremely rare. Only single case or small series of ICVT have been reported; clinical details are still uncertain. We report a case of isolated superficial sylvian vein thrombosis with exceedingly long cord sign. A 14-year-old female with severe sudden onset headache visited our hospital. Fluid attenuated inversion recovery and echo-planar T₂* susceptibility-weighted imaging (T₂*SW) showed a long cord sign on the surface of the sylvian fissure. The patency of dural sinuses and deep cerebral veins were confirmed by magnetic resonance venography (MRV), and diagnosis of ICVT was made. She recovered completely without anticoagulant agents. To clarify the clinical characteristics of ICVT, we reviewed 51 ICVT cases in the literature. In many cases, T₂*SW was the most useful examination to diagnose ICVT. In contrast with general cerebral venous thrombosis, MRV and conventional angiography were either supporting or useless. Anastomotic cortical veins were involved frequently; symptoms of gyri around the veins were common. It also suggested that ICVTs of the silent area might have been overlooked because of nonspecific symptoms, and more patients with ICVT may exist. In cases involving patients with nonspecific symptoms, the possibility of ICVT should be considered.     

Anatomical Assessment of Cephalic Vein and Superficial Branch of Radial Nerve Using High-Resolution Ultrasound Imaging

Introduction  The superficial branch of the radial nerve (SBRN) has a risk of nerve injury during cephalic vein (CV) cannulation. Due to the lack of imaging study regarding SBRN and CV relationship, we analyzed the anatomical relationship between the SBRN and the CV using ultrasound (US) imaging. Materials and Methods  In total, 82 upper limbs of 41 healthy volunteers were analyzed. The SBRN and CV were identified at the following three points in the elbow extension and pronation position: at the radial styloid process (point 1), 5 cm proximal to point 1 (point 2), and 10 cm proximal to point 1 (point 3). Results  The distance between the SBRN and CV was 1.1 ± 1.0 mm at point 1, 1.3 ± 1.3 mm at point 2, and 2.1 ± 1.6 mm at point 3. The depth of the SBRN from the surface of the skin was 2.7 ± 0.9 mm at point 1, 3.5 ± 1.1 mm at point 2, and 5.5 ± 1.9 mm at point 3. The percentage of the SBRN that ran beneath the CV was 17.5%, 53.5%, and 92.4% at points 1, 2, and 3, respectively. Conclusion  Ultrasonography can reveal the anatomical relationship between the SBRN and CV.     

浅静脉穿刺留置套管针在FOLFOX4方案化疗中的应用和护理

为观察浅静脉穿刺留置套管针在FOLFOX4方案化疗中的应用效果,回顾分析于我科接受FOLFOX4方案化疗的180例结直肠癌患者病例资料,根据持续静脉滴注的方式,分为浅静脉留置针组（试验组,128例）、颈内静脉置管组（对照I组,32例）和经外周静脉穿刺中心静脉置管（PICC）组（对照Ⅱ组,20例）。对各组穿刺时间、一次穿刺成功率及不良反应发生率进行统计比较。结果显示,180例患者中,试验组穿刺明显快于对照组,且一次穿刺成功率明显高于对照组,各组间不良反应发生率无明显差异。结果表明,浅静脉穿刺留置套管针安全、有效,操作简单、快捷,穿刺点选取方便,对静脉损伤小,避免了颈内静脉置管和PICC的不足,降低了静脉感染的发生率,是一种经济、简单易行的方法。     

联合门静脉／肠系膜上静脉切除的胰头癌根治术

目的探讨胰头癌侵犯门静脉（portalvein，PV）和（／或）肠系膜上静脉（superior mesentericvein，SMV）时根治切除的可行性。方法回顾分析11例PV／SMV受侵的胰头癌患者临床资料，均行扩大胰十二指肠切除术。其中7例行血管壁部分切除，3例行血管节段性切除及对端吻合，1例行受侵血管切除＋人工血管移植。脾静脉与SMV端侧吻合4例，脾静脉结扎3例。消化道重建采用Child术式。结果本组PV阻断时间平均为18．1（9～32）min。全组患者术后均未发生血管栓塞、肠坏死、肝衰竭等并发症，均康复出院。11例均获随访，时间6～20个月，3例术后1年内死亡，4例术后1—2年死亡，患者平均生存时间15（7～20）个月。结论对单纯侵犯PV／SMV的胰头癌施行联合PV／SMV切除的胰头癌扩大根治术是安全可行的。