PICC导管在乳腺癌化疗患者中的应用及护理

PICC是指将硅胶导管经由外周静脉（贵要静脉、肘正中静脉、头静脉）植入锁骨下静脉或上腔静脉的技术方法,导管头端一般以不超过上腔静脉中下1/3为宜。因其对血管刺激小,可留置时间较长,且不影响肢体活动,临床广泛用于需要长期静脉输液治疗（如化疗、肠外营养支持）的患者;同时也有效避免了由于药物引起的静脉炎、渗漏性损伤等给病人带来的痛苦。我科自2012年5月25日～2013年11月25日为162例乳腺癌化疗病人应用了该项技术,取得了较好的临床护理效果,现将护理体会报道如下。     

血栓性四肢浅静脉炎

<正> 上肢浅静脉主要有桡侧的头静脉及尺侧的贵要静脉,二者均起自手静脉网,头静脉入腋静脉,贵要静脉入肱静脉。二者在上行过程中互相吻合,肘正中静脉是较大的肘部吻合支。下肢浅静脉主要有大隐静脉及小隐静脉,前者起自足的内侧缘,沿下肢内侧上行至卵圆窝入股静脉,后者起自足的外侧缘,沿小腿后方上行至膕窝入膕静脉。病因及病理:病因很多,最常见的原因是静脉输液,尤其是静脉插管输注高渗液如50%葡萄糖,或刺激性较强的红霉素等抗菌素溶液。其次是感染,如静脉周围的感染性病灶;损伤,如挫伤;血流郁滞,如静脉曲张(因郁滞的血液内含氧量低,     

40例多囊卵巢综合征葡萄糖钳夹术病人的护理

我科于2002年9月～2003年6月开展了钳夹术 ,为了解多囊卵巢综合征 (PCOS)患者胰岛素抵抗水平 ,利用高胰岛素—正常血糖钳夹术来评价胰岛素敏感性 ,对40例PCOS患者进行钳夹术 ,并在同时实施针对性护理 ,取得了满意的效果。1临床资料1 1对象 :本组PCOS患者40例 ,均为女性 ,年龄16～36岁 ,体重指数23 48±3 56。1 2方法 :受试对象空腹12小时 ,于次日清晨8时测定身高、体重、腰臀围及血压并排空小便。取仰卧位 ,分别在双前臂头静脉 ,正中静脉或贵要静脉穿刺 ,并留置导管以生理盐水维持静脉通道 ,以备抽血和输注各种实验药物如胰岛素 ,取手…     

两种静脉行经外周静脉置入中心静脉导管的临床效果比较

目的 比较贵要静脉与头静脉行经外周静脉置入中心静脉导管（PICC）置管的临床效果.方法 行上腔中心静脉置管的成年患者共94例,根据所选用于置管的静脉不同分两组各47例.其中贵要静脉组行贵要静脉置管,头静脉组行头静脉置管,比较两组患者行PICC置管的一次成功率、置管总时长以及患者对置管的满意度.结果 贵要静脉组的静脉穿刺时一次成功率为95.74％,明显高于头静脉组的61.70％（x2 =51.067,P＜0.05）.两组患者采用不同静脉进行PICC置管的并发症总发生率差异无统计学意义（P＞0.05）.行贵要静脉置管的贵要静脉组患者中61.70％感满意,而行头静脉置管的头静脉组患者中仅10.64％感满意,贵要静脉组置管满意度61.70％高于头静脉组10.64％（x2 =43.062,P＜0.05）.结论 综合穿刺者过硬的临床操作技术,对出现的并发症的及时正确处理以及患者的配合这三方面才能有效延长导管的留置时间,患者方可最大程度从中获益.     

新生儿PICC置管操作常见并发症及临床护理

目的:探讨新生儿PICC置管操作常见并发症,并对其护理方法及效果进行观察。方法:将近两年某院收治的130例新生儿作为研究对象,观察不同静脉置管成功率、并发症发生率等,给予新生儿优质护理干预。结果:贵要静脉一次穿刺成功率与下肢大隐静脉比较无统计学意义(P>0.05),两种静脉穿刺成功率明显高于其他静脉穿刺率(P<0.05);贵要静脉并发症发生率低于其他静脉穿刺(P<0.05)。结论:导管堵塞、静脉炎、药液外渗等为新生儿PICC置管常见并发症,通过优质护理干预可促进患者康复。     

彩色多普勒超声引导PICC成功率及发生并发症原因的分析

目的分析彩色多普勒超声引导外周静脉植入中心静脉导管(PICC)成功率及其并发症形成的原因。方法 151例PICC患者,均行超声引导下经上肢浅静脉(贵要静脉)植入静脉导管,且拔管前超声常规检查置管静脉。结果 (1)151例患者贵要静脉内径2mm的148例,其中,141例贵要静脉主干明显且经腋静脉、锁骨下静脉至上腔静脉,一次性成功植入静脉导管132例(132/148,占89.19%),9例(9/148,占6.08%)因操作原因失败,另7例(7/148,占4.73%)贵要静脉主干不明显未能植入上腔静脉而入皮下浅静脉;其余3例患者贵要静脉内径1.8mm,均未能成功植入静脉导管。(2)132例成功PICC患者,临床静脉给药治疗结束,拔管前超声检查15例(15/132,占11.36%)静脉导管周和(或)静脉壁形成血栓,回顾发现该类患者静脉导管沿导丝植入前均用碘伏擦拭消毒。结论贵要静脉内径、走形及正确的操作是PICC成功的因素,碘伏消毒静脉导管可导致静脉血栓形成,超声引导对PICC具有重要作用。     

提高静脉穿刺一次成功率的几点体会

静脉注射在临床工作中是常用的一种治疗方法 ,可用以补液、治疗 ,还可以作快速给药的途径 ,因此 ,能否一针见血是静脉注射的关键 ,怎样才能使静脉穿刺一次成功呢 ?临床工作中 ,通过对不同病人实行不同的穿刺方法 ,得出以下体会。1　选择合适的静脉是穿刺成功的重要保证1 1　血管的选择　长期输液者 ,尽量保护血管 ,穿刺从末梢开始 ,避免不必要的损伤。抢救休克等危重者 ,应选择较粗大静脉以保证静脉通道通畅 ,利于大量液体快速输入。如选择肘部贵要静脉、头静脉、正中静脉 ,或胫内踝大隐静脉等。1 2　部位的选择　术前输液 ,宜选用不影响手…     

静脉留置针在脑外科的应用

静脉输液是治疗危重病人的主要手段。在脑外科护理躁动不安病人时 ,保证药物顺利输入是赢得抢救时间和达到治疗目的的关键 ,反复多次的静脉穿刺 ,既造成病人的痛苦又易使浅表静脉受到破坏 ,使得以后的静脉穿刺更困难 ,并大大增加了工作量 ,静脉留置针的使用可有效地解决这个问题。现将护理体会介绍如下。1　材料与方法选用美国 B- D公司生产的用 Vialon材料制成的静脉留置针 ,依据病人的情况分别选用 18号及 2 0号大小不同的型号。穿刺方法 :根据具体情况选择便于固定的静脉 ,如四肢浅表静脉 ,贵要静脉 ,要远离关节的部位 ,常规消毒皮肤。…     

早产儿不同部位置入中心静脉导管的比较

经外周置入中心静脉导管(PICC)在早产儿治疗中有广阔的应用前景.因为前臂的贵要静脉粗、直、静脉瓣少,且易于观察和触及,是目前PICC的首选静脉.但有些早产儿贵要静脉显露不清,或穿刺失败,必需选择其他部位的静脉作为穿刺点.     

抢救危重病人迅速建立静脉通道的体会

临床上经常遇到危重病人 ,抢救危重病人时要争分夺秒 ,迅速建立静脉通道对抢救危重病人是非常重要的。根据我们几年来的临床观察 ,总结出以下几点体会。1　对于大部分危重病人特别是休克病人 ,由于血容量不足 ,末梢循环不良 ,周围毛细血管瘪、管壁脆 ,不易穿刺。在抢救时应该首先选择比较粗的 ,又避开关节部位的大血管 ,如颈静脉丛、上肢的头静脉、贵要静脉、正中静脉等 ,必要时还可以选择乳房周围静脉丛 ,这样既保证了静脉穿刺的成功率 ,又节省了时间 ,而且避开了关节部位 ,易于固定 ,不致因肢体活动而造成失败。2　长期住院的危重病人 ,应…     

Efficacy of gut lavage,hemodialysis, and hemoperfusion in the therapy of paraquat or diquat intoxication

Clinical and in vitro investigations were carried out to test the efficacy of gut lavage, hemodialysis, and hemoperfusion in the treatment of poisoning with paraquat or diquat. In a patient suffering from diquat intoxication 130 times more diquat was removed by gut lavage 30 h after ingestion than was removed by complete aspiration of the gastric contents.Determination of in vitro clearances for paraquat and diquat by hemodialysis showed that, at serum concentrations of 1–2 ppm, such as are frequently encountered in poisoning in man, toxicologically relevant quantities of herbicide cannot be removed from the body. At a concentration of 20 ppm, on the other hand, hemodialysis proved to be effective, the clearance being 70 ml/min at a blood flow rate of 100 ml/min. The efficacy of hemoperfusion with coated activated charcoal was on the whole better. Especially at concentrations around 1–2 ppm, the clearance values for hemoperfusion were some 5–7 times higher than those for hemodialysis.In a patient suffering from paraquat poisoning, both hemodialysis as well as hemoperfusion were carried out. The in vitro results could be confirmed: At serum concentrations of paraquat less than 1 ppm no clearance could be obtained by hemodialysis while by hemoperfusion with activated charcoal quite high clearance values were measured and the serum level dropped down to zero.

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Zusammenfassung Klinische Untersuchungen und Laboratoriumsversuche wurden durchgeführt, um die Wirksamkeit von Darmspülung, Hämodialyse und Hämoperfusion bei Paraquat- und Deiquat-Vergiftungen zu prüfen.Bei einem Patienten wurde 30 Std nach Deiquat-Aufnahme durch Darmspülung 130mal mehr Deiquat entfernt als durch vollständige Aspiration des Mageninhaltes. In vitro-Versuche ergaben, daß bei Blutserumkonzentrationen von 1–2 ppm, die bei Vergiftungen oft gemessen werden, durch Hämodialyse keine toxikologisch relevanten Paraquat- oder Deiquat-Mengen entfernt werden können. Dagegen erwies sich die Hämodialyse bei 20 ppm und einer Blutumlaufgeschwindigkeit von 100 ml/min mit einer Clearance von 70 ml/min als wirksam. Die Hämoperfusion mit beschicheter Aktivkohle war in diesen Versuchen aber eindeutig überlegen, denn insbesondere bei Konzentrationen um 1–2 ppm waren die Clearance-Werte 5–7mal höher als bei der Hämodialyse.Die in vitro-Ergebnisse wurden bei einem Patienten mit einer Paraquat-Vergiftung bestätigt: Bei Konzentrationen unter 1 ppm war die Hämodialyse wirkungslos, während durch Hämoperfusion relativ hohe Clearance-Werte erreicht wurden, so daß der Serumspiegel rasch unter die Nachweisgrenze abfiel.

     

Aquatic Insects and Trace Metals: Bioavailability,Bioaccumulation, and Toxicity

Abstract

The uptake of metals from food and water sources by insects is thought to be additive. For a given metal, the proportions taken up from water and food will depend both on the bioavailable concentration of the metal associated with each source and the mechanism and rate by which the metal enters the insect. Attempts to correlate insect trace metal concentrations with the trophic level of insects should be made with a knowledge of the feeding relationships of the individual taxa concerned. Pathways for the uptake of essential metals, such as copper and zinc, exist at the cellular level, and other nonessential metals, such as cadmium, also appear to enter via these routes. Within cells, trace metals can be bound to proteins or stored in granules. The internal distribution of metals among body tissues is very heterogeneous, and distribution patterns tend to be both metal and taxon specific. Trace metals associated with insects can be both bound on the surface of their chitinous exoskeleton and incorporated into body tissues. The quantities of trace meals accumulated by an individual reflect the net balance between the rate of metal influx from both dissolved and particulate sources and the rate of metal efflux from the organism. The toxicity of metals has been demonstrated at all levels of biological organization: cell, tissue, individual, population, and community. Much of the literature pertaining to the toxic effects of metals on aquatic insects is based on laboratory observations and, as such, it is difficult to extrapolate the data to insects in nature. The few experimental studies in nature suggest that trace metal contaminants can affect both the distribution and the abundance of aquatic insects. Insects have a largely unexploited potential as biomonitors of metal contamination in nature. A better understanding of the physico-chemical and biological mechanisms mediating trace metal bioavailability and exchange will facilitate the development of general predictive models relating trace metal concentrations in insects to those in their environment. Such models will facilitate the use of insects as contaminant biomonitors.     

Alzheimer’s disease – current trends in basic and clinical research. Highlights from the 16th ECNP

Advances in the molecular biological knowledge of neuronal nicotinic acetylcholine receptors (nAChRs) have led to a growing interest by the pharmaceutical industry in the development of novel compounds that selectively modulate nAChR function. The ability of (-)-nicotine, an activator of nAChRs, to enhance attentional aspects of cognition in animals and humans, to exert neuroprotective and anxiolytic-like effects, and presumably to mediate the negative correlation between smoking and Alzheimer's (and Parkinson's) Disease, has focused interest on the potential therapeutic utility of modulators of nAChR function for treatment of some of the deficits associated with these progressive, neurodegenerative conditions. Numerous compounds are known which activate nAChRs and which might serve as lead compounds toward the development of such agents. The pharmacologic diversity of neuronal nAChR subtypes suggests the possibility of developing selective compounds which would have more favourable side-effect profiles than existing agents. This broader class of agents, collectively called cholinergic channel modulators (ChCMs), is anticipated to encompass compounds which would have more favourable side-effect profiles than existing agents, which generally exhibit low selectivity. This selectivity may be achieved by preferentially activating some subtypes of nAChRs (i.e., Cholinergic Channel Activators, ChCAs) or inhibiting the function of other subtypes (Cholinergic Channel Inhibitors, ChCIs). An overview of the biology of nAChRs and the rationale for the use of ChCMs for the treatment of dementia related to neurodegenerative diseases are presented, followed by a discussion of lead compounds and compounds under consideration for clinical evaluation.     

2-(Acetoxyphenyl)-(Z)-styryl sulfides as cyclooxygenase inhibitors

2-(Acetoxyphenyl)-(Z)-styryl sulfides are described as selective cyclooxygenase-2 (COX-2) inhibitors, useful for treating inflammation and COX-2-mediated disorders including neoplasia. 2-(Acetoxyphenyl)-(Z)-styryl sulfide is claimed to be the most potent COX inhibitor in the series with a COX-2 selectivity ratio of 33. This compound is also claimed to be superior to celecoxib (Celebrex^®, Pfizer) in inhibiting cell growth of colorectal carcinoma cells. In this evaluation, the COX inhibitory activity of this compound is compared to that previously disclosed for diarylheterocycles and 2-(acetoxyphenyl)alkyl sulfides. The validity of the DLD-1 cell line in the growth inhibition studies is questioned based on recent literature reports indicating the lack of COX-2 expression in this cell line.     

Sleep-disordered breathing with chronic opioid use

Chronic opioid use for pain relief or as substitution therapy for illicit drug abuse is prevalent in our societies. In the US, retail distribution of methadone and oxycodone has increased by 824 and 660%, respectively, between 1997 and 2003. μ-Opioids depress respiration and deaths related to illicit and non illicit chronic opioid use are not uncommon. Since 2001 there has been an emerging literature that suggests that chronic opioid use is related to central sleep apnoea of both periodic and non-periodic breathing types, and occurs in ～ 30% of these subjects. The clinical significance of these sleep-related abnormalities are unknown. This review addresses the present knowledge of control of ventilation mechanisms during wakefulness and sleep, the effects of opioids on ventilatory control mechanisms, the sleep-disordered breathing found with chronic opioid use and a discussion regarding the future research directions in this area.     

Drug targets for cognitive enhancement in neuropsychiatric disorders

The investigation of novel drug targets for treating cognitive impairments associated with neurological and psychiatric disorders remains a primary focus of study in central nervous system (CNS) research. Many promising new therapies are progressing through preclinical and clinical development, and offer the potential of improved treatment options for neurodegenerative diseases such as Alzheimer's disease (AD) as well as other disorders that have not been particularly well treated to date like the cognitive impairments associated with schizophrenia (CIAS). Among targets under investigation, cholinergic receptors have received much attention with several nicotinic agonists (α7 and α4β2) actively in clinical trials for the treatment of AD, CIAS and attention deficit hyperactivity disorder (ADHD). Both glutamatergic and serotonergic (5-HT) agonists and antagonists have profound effects on neurotransmission and improve cognitive function in preclinical experiments with animals; some of these compounds are now in proof-of-concept studies in humans. Several histamine H3 receptor antagonists are in clinical development not only for cognitive enhancement, but also for the treatment of narcolepsy and cognitive deficits due to sleep deprivation because of their expression in brain sleep centers. Compounds that dampen inhibitory tone (e.g., GABA_A α5 inverse agonists) or elevate excitatory tone (e.g., glycine transporter inhibitors) offer novel approaches for treating diseases such as schizophrenia, AD and Down syndrome. In addition to cell surface receptors, intracellular drug targets such as the phosphodiesterases (PDEs) are known to impact signaling pathways that affect long-term memory formation and working memory. Overall, there is a genuine need to treat cognitive deficits associated with many neuropsychiatric conditions as well as an increasingly aging population.