脑出血患者急性期使用静脉留置针的方法探讨

静脉留置针既能保持静脉输液持续通畅，便于用药和抢救，又能减少普通静脉穿刺给患者带来的痛苦及对浅静脉的损伤；同时减少了护士的工作量，降低了护理工作难度。静脉留置针留置时间通常最长27d，最短2d，平均8～9d，常规留置时间是5d。然而，在临床中脑出血患者急性期使用静脉留置针的留置时间最长3d，短则几小时。     

静脉留置针在脑外科的应用及护理体会

静脉留置针用于脑外伤患者，在护理上确实有一定的难度，但在临床应用中，如果掌握了正确的穿刺方法，严格无菌操作，固定好患者及留置针，注意穿刺血管的护理，加强输液观察，掌握封管方法等，可大大减少患者因反复进行静脉穿刺的痛苦，减轻护士的工作量，又提高了护士的工作效率，也为抢救患者赢得了时间。     

浅静脉留置针临床应用及护理进展

早在60年代，静脉留置针就被欧美国家作为头皮针的替代物而普及使用，成为临床输液的主要工具。近年代，国内一些医院已相继在临床治疗中应用静脉留置针技术。随着静脉留置针在临床的广泛应用，人们越来越多地认识到留置针的优势，可减少静脉穿刺次数，减轻患者的痛苦，保护了穿刺的静脉，提高护士工作效率，有利于临床用药和紧急抢救。随着静脉留置针用于静脉输液在临床的普及应用，对于这项技术操作程序的规范、有效的穿刺置入技巧以及封管药物及时间等也尚在实践中，不断摸索和提高，现将其护理综述如下。     

静脉留置针留置时间的影响因素及护理对策

静脉留置针又称套管针,作为头皮针的换代产品,是一种先进的新型输液材料。近年来,静脉留置针技术是临床输血、输液、静脉给药、测定中心静脉压等的重要手段,尤其在抢救危重患者、输注化学药物和静脉营养等方面发挥了重要作用,应用范围日趋广泛。在我国,静脉留置针的临床应用不断扩大,涉及到家庭及社区。应用静脉留置针技术还具有提高护士工作效率、减少静脉穿刺次数、保护穿刺的静脉、安全迅速、减轻患者痛苦等优点。其留置时间目前尚无严格规定,护士凭经验决定留置时间。留置时间过长,患者发生局部并发症的危险性增加;留置时间过短,丧失了本身的作用,从而增加了护理工作量和患者的痛苦。     

留置静脉针并发症护理

静脉留置针又称套管针，作为头皮针的换代产品以其操作简单、套管柔软、在静脉内留置时间长且不易穿破血管等特点被广泛应用于临床。目前静脉留置针在临床的应用已越来越广泛，使用静脉留置针能减轻反复穿刺而造成的血管损伤和疼痛感，减少患者的痛苦，并且能较长时间的维持静脉通路，尤其在抢救危重患者和静脉营养方面发挥了重要作用。同时又能够减少护士穿刺操作次数，提高工作效率。然而在长期置管的患者常导致某些并发症的发生。因此在静脉针置管期间做好并发症的预防和护理非常重要。2007年2月至21308年2月本科对206例住院患者进行留置针静脉输液。将现情况总结如下。     

影响浅静脉留置针留置时间的因素分析及对策

目的 分析影响留置针留置时间的相关因素,探讨相应的护理对策.方法 对本科2006年3月至2007年11月使用静脉留置针的2 050例患者进行临床分析.结果 留置针的型号、穿刺部位血管选择不合理,未严格遵守原则,穿刺部位及角度不当,固定不当,药物因素等因素为影响留置针留置时间的因素.结论 正确选择留置针的型号、穿刺部位的血管,严格无菌技术,正确的穿刺方法,固定方法,封管方法及选择正确的封管液,正确输入药物和对病人行健康教育,是保证留置针留置时间延长的重要措施.     

癌症患者颈外静脉留置针的临床应用和护理体会

静脉留置针叉称套管针，由先进的生物材料制成，作为头皮针的替代品，因其穿刺成功率高、留置时间长、方便患者起床活动，还能减轻患者因反复穿刺带来的痛苦而广泛应用于临床肿瘤患者。我科自2001-2002年间采用静脉留置针行颈外静脉化疗、颈外静脉输液治疗，取得了良好效果。现将护理体会总结如下。     

静脉留置针的临床应用及护理对策

目的探讨静脉留置针的临床应用效果及护理对策。方法通过对926例静脉留置针患者的护理,对不同穿刺部位、留置时间、输入药物性质等进行临床观察。结果发现静脉留置针引起的问题与穿刺部位、输入药物性质、留置时间有关,有统计学意义(p<0.01),与体位及活动无关,无统计学意义(p>0.05)。结论静脉留置针不受体位及活动影响,只要治疗及病情需要,可随时选择使用静脉留置针。     

静脉留置针常见并发症的护理与预防

目的探讨老年患者行静脉留置针穿刺的常见并发症及其临床护理措施。方法对2008年1～12月收治于我院行静脉留置针穿刺的168例老年患者的并发症发生情况以及护理措施进行回顾性分析。结果 168例患者中,发生皮下血肿13例;发生液体渗漏8例;发生套管堵塞5例;发生局部静脉炎6例。另外有9例患者发生穿刺部位轻微感染。结论静脉留置针的常见并发症有套管堵塞、皮下血肿、液体渗漏、局部静脉炎等,留置针时间以6d以内为佳,延长留置时间则会增加发生并发症的风险。     

静脉留置针封管夹不同位置对留置效果的影响

一次性使用静脉留置针近几年来已在临床静脉输液治疗中广泛应用，具有操作方法简便，可以保护血管避免反复穿刺，留置导管也较柔软．静脉内留置时间长，且不易穿破血管等优点。尤其在抢救危急患者以及应用于长期输液、血管条件较差的患者中发挥了普通静脉穿刺针无法替代的作用，深受护理人员的偏爱。但是在静脉留置针的护理过程中，经常出现这样的现象.     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.