两种动脉血气标本采集方法比较

将需进行动脉血气分析的1004例病人分为两组各502例.对照组用一次性注射器采集动脉血,观察组用动脉血气标本采集系统留取动脉血.结果观察组动脉血气标本的凝血率、无效腔气体率、标本稀释率及采血时病人疼痛程度均显著低于对照组(P＜0.05,P＜0.01).提示动脉血气标本采集系统优于普通一次性注射器抽取动脉血标本.     

两种动脉采血法在新生儿科应用中的比较

目的：探讨桡动脉采血和股动脉采血两种采血法在新生儿科应用中的临床效果。方法将我院儿科NICU收治200例患儿随机分为观察组和对照组（各100例）,观察组采用桡动脉采血法采集血气标本,对照组采用股动脉采血法采集血气标本。结果观察组一次穿刺成功率明显高于对照组（P＜0.05）,误入静脉率明显低于对照组（P＜0.05）,发生血肿或瘀斑的比例均较之对照组低（P＜0.05）,重度疼痛率明显低于对照组（P＜0.05）;且观察组穿刺时间明显短于对照组,两组比较差异具有统计学意义（P＜0.05）。结论桡动脉采血较之股动脉采血时对患儿的不良影响明显要小,具有操作方便、安全、简单、穿刺成功率高等优点,值得推广应用。     

应用小针头采集桡动脉血气标本

危重患者需要监测动脉血气分析，表浅动脉频繁采血，易造成穿刺部位感染、局部出血及血肿、假性动脉瘤等并发症。为了保护血管，减少并发症，减轻患者痛苦，我科对45例患者采用小针头行桡动脉采血，取得了较好的效果，报告如下。[第一段]     

应用小针头采集桡动脉血气标本

危重患者需要监测动脉血气分析,表浅动脉频繁采血,易造成穿刺部位感染、局部出血及血肿、假性动脉瘤等并发症.为了保护血管,减少并发症,减轻患者痛苦,我科对45例患者采用小针头行桡动脉采血,取得了较好的效果,报告如下.     

冠状动脉介入诊疗两种穿刺途经效果比较

对 2 90例冠心病病人经桡动脉途径行冠状动脉 (冠脉 )介入诊疗 ,并与 30 0例经股动脉途径者进行比较。结果经桡动脉途径者伤口出血、术后排便困难、术后主观不适发生率显著低于经股动脉穿刺者 (P <0 .0 5 ,P <0 .0 1) ;冠脉闭塞 ,迷走神经反射与股动脉途径比较 ,差异无显著性意义 (均P >0 .0 5 )。提示经桡动脉途径行冠脉介入诊疗术安全、不良反应发生率低 ,可减轻病人痛苦 ;但桡动脉较股动脉细 ,穿刺较困难 ,股动脉途径暂时不会被取代。     

破伤风患儿血气分析标本采集血管选择探讨

破伤风发作时喉肌和呼吸肌痉挛可引起呛咳、呼吸困难、发绀、甚至窒息 ,导致肺炎及肺不张[1] 。动脉血气分析能客观反映肺呼吸功能 ,了解肺功能损害的性质和程度 ,以及酸碱平衡失调的情况 [2 ] 。新生儿血气分析采血一般首选桡动脉 ,其次为颞动脉、足背动脉及胫后动脉 [3 ]。1 997年 9月至 2 0 0 0年 1 0月 ,笔者对 1 5例破伤风患儿首选颞动脉穿刺 ,获得较高穿刺成功率 ,现将方法报告如下。1　资料与方法1 .1　一般资料1 5例中 ,男 7例、女 8例 ,日龄 3～ 1 0 d。其中轻型破伤风 2例 ,中型 4例 ,重型 9例。首选颞动脉穿刺为观察组 ,首选桡动…     

动脉血气标本采集部位的选择

目的探讨动脉血气标本采集部位。方法将146例低氧血症患者随机分为两组,对照组73例在股动脉穿刺采血,观察组73例在足背动脉穿刺采血。结果观察组动脉血气标本一次采集成功率显著高于对照组(均P<0.01),误穿静脉发生率及患者血肿发生率显著低于对照组(均P<0.01)。结论对低氧血症患者在足背动脉进行血气标本的采集,提高了一次采集成功率,并降低了血肿发生率。     

婴幼儿颞浅动脉与桡动脉采集血气分析效果比较

婴幼儿患者根据病情经常需要取动脉血检查血气分析,以便了解患儿的酸碱平衡、呼吸功能、电解质及血氧饱和度.传统的桡动脉穿刺采血常因桡动脉易滑动,采血点不易固定,患儿体质差异,血管深浅不一,易给患儿造成痛苦,特别是单独取血或患儿烦躁时成功率低,易形成皮下血肿.2008年6月至2009年3月我科采用颞浅动脉取血检查血气分析,效果较好,报告如下.     

婴幼儿颞浅动脉与桡动脉采集血气分析效果比较

婴幼儿患者根据病情经常需要取动脉血检查血气分析,以便了解患儿的酸碱平衡、呼吸功能、电解质及血氧饱和度。传统的桡动脉穿刺采血常因桡动脉易滑动,采血点不易固定,患儿体质差异,血管深浅不一,易给患儿造成痛苦,特别是单独取血或患儿烦躁时成功率低,易形成皮下血肿。2008年6月至2009年3月我科采用颞浅动脉取血检查血气分析,效果较好,报告如下。     

采集动脉血气标本的质控探讨

动脉血气分析对于临床的诊断、治疗、预后具有重要作用,是一项不可缺少的辅助诊疗手段。但往往由于采集血气标本时质量控制(以下简称质控)做得不严密,而产生系统性偏差,直接影响到测定结果的准确性,影响了诊断和治疗。因此加强采集动脉血气标本的质控甚为重要。我科自1991年3月～1992年3月共采集动脉血气标本82例,不合格标本9例,占10.98%。其中因抗凝剂浓度、体积与血液比例失调4例,占4.88%;外源性离子导致结果假性增高1例,占1.22%;误抽股静脉血2例,占2.44%;血液标本溶血2例,占2.44%。本文就标本质控及影响标本质量的原因加以探讨。一、影响标本质量的原因     

Lactate, pH, and blood gas analysis in critically ill patients

To obtain information about the relationship between different types of circulatory insufficiency, a series of oxygen parameters and plasma lactate, we have performed a pilot study comprising five patients with circulatory insufficiency.
Plasma lactate was measured on a Stat Profile 7 (NOVA Biomedical, USA) and pH/blood gases on an ABL™ 520 (Radiometer Medical A/S, Denmark).
Plasma lactate seems to be inversely related to base excess (BE), whereas no relationship to venous oxygen tension p O₂(v) of the vein draining the inadequately perfused region seemed to exist. In one patient we made simultaneous measurements from v. cava inferior., v. cava superior., a. pulmonalis and a. radialis. Simultaneously sampled plasma lactate from different sites differed up to 0. 6 mmol/L with the highest value obtained from v. cava inferior.
This pilot study indicates that the increase of plasma lactate may vary with the type of circulatory disturbance and the sampling site.     

鼻饲方式对ICU危重症患者免疫功能及病情的影响

目的进一步研究不同鼻饲方式对ICU危重症患者免疫功能及病情的影响,为选择恰当的鼻饲方式提供依据。方法将180例ICU危重症患者根据随机数字表分为三组各60例。持续24h组用输液泵持续泵注;持续16h组泵入16h,休息8h;间断24h组用输液泵分8个时间单元泵入,每个时间单元为3h,即持续泵入2h,间隔1h。结果三组淋巴细胞计数及APACHEⅡ评分比较,差异无统计学意义(均P0.05);住院第1天与第9天APACHEⅡ评分比较,差异有统计学意义(P0.01)。结论 3种鼻饲方式维持ICU危重症患者免疫功能及改善病情方面未体现显著差别。结合前期研究,间断泵注24h可减少胃潴留,更适于ICU危重症患者的营养支持。     

Endocrine effects of vasopressin in critically ill patients

Vasopressin, also called antidiuretic hormone, is a 9 amino-acid peptide, synthesized from a precursor containing neurophysin II, by neurones from the supra-optic and peri-ventricular nuclei, and then stored in the posterior hypophysis. Vasopressin regulates plasmatic osmolality and volaemia via V2 receptors at the levels of the kidney, and vascular smooth muscle tone via V1a arterial receptors. Both its synthesis and release from hypophysis vesicles depend on variations in plasma osmolality, volaemia, and arterial blood pressure. In addition, vasopressin interacts with the main hormonal systems involved in the response to stress, including the hypothalamic-pituitary adrenal axis, other anterior pituitary hormones, mainly prolactin and growth hormone, the renin-angiotensin system, and regulates insulin synthesis and glucose metabolism. Interestingly, during critical illness, exogenous administration of vasopressin showed little effects on the circulating levels of these various hormones, except an increase in prolactin. The absence of endocrine effects of vasopressin during critical illness is unclear and may relate to an already maximal hormonal stimulation or to down-regulation of vasopressin receptors.     

危重患者两种血糖控制方法效果比较

目的探讨危重患者血糖控制的适宜方法 ,以提高血糖控制治疗效果、降低相关并发症。方法将126例ICU危重患者随机分为胰岛素强化治疗组(强化组)和常规治疗组(常规组)各63例,常规组将目标空腹血糖控制在11.9mmol/L以下,强化组12～24h使血糖控制在4.4～6.1mmol/L;均严格动态监测血糖变化。结果入ICU第2、3、5天强化组空腹血糖显著低于常规组(均P0.01);低血糖、病死、医院感染发生率,机械通气时间,ICU入住时间低于或短于常规组,但差异无统计学意义(均P0.05)。结论胰岛素强化治疗对危重患者有益,但较常规治疗并不能显著改善危重患者状况和预后。在护理过程中坚持严格动态观察血糖变化,避免低血糖的发生,可保证危重患者各项治疗顺利进行。     

The effects of secondary transport on critically ill patients

This study examined the effect of secondary transport on critically ill patients and the effectiveness of a regionally based intensive care service. Four hundred and ninety-five patients were studied retrospectively over a 2-year period. Eighty-two were transferred from peripheral hospitals in a mobile intensive care unit while the remaining 413 were admitted directly to the intensive therapy unit at the Western Infirmary, Glasgow. The severity of illness in both groups was assessed using the APACHE II scoring system. The transferred group were scored before and after the journey, while the directly admitted group were scored only on admission. The results show that the transferred patients exhibited a consistent cardiorespiratory response to transport irrespective of their severity of illness, and that the mortality in both groups of patients in the intensive therapy unit was not significantly different. The results also suggest that in the transferred group, the outcome is not only dependent on the severity of illness but also on other factors, such as the hospital from which the patient was referred and the duration of the pretransfer admission.     

不同通气方式用于腹腔镜胆囊切除术的血气分析比较

目的：观察口咽通气道联合面罩给氧通气、喉罩通气及气管插管通气三种方式对腹腔镜胆囊切除患者血气分析的影响。方法选择本院收治需行腹腔镜胆囊切除患者300例作为研究对象,随机分为三组,每组100例,A 组采取口咽通气道联合面罩通气,B 组给予喉罩通气,C 组给予气管插管通气,比较三组患者血气分析相关指标差异及并发症发生率差异。结果A 组、B 组、C 组气腹后5 min PaCO2分别为（5．79±0．57）kPa、（5．73±0．56）kPa、（5．69±0．46）kPa,均高于气腹前 PaCO2, tA ＝16．231;tB ＝16．127;tC ＝16．387,P ＜0．05,三组比较无明显差异;A 组采取口咽通气道联合面罩给氧通气后术后并发症18例（18．0％）,低于 B 组术后并发症25例（25．0％）、C 组38例（38．0％）,χ2AC ＝32．262;χ2AB ＝15．687,均 P ＜0．05。三组胃膨胀情况比较无显著统计学差异;且三组均未出现返流。结论口咽通气道联合面罩通气、喉罩通气及气管插管通气均可应用于腹腔镜胆囊切除术,操作简便、安全,具有重要临床价值。     

Closed-loop control of blood glucose levels in critically ill patients

A closed-loop control system was constructed for automatic intravenous infusion of insulin to control blood sugar levels (BSL) in critically ill patients. We describe the development of the system. A total of nine subjects were recruited to clinically test the control system. In the patients who underwent closed-loop control of BSL, the controller managed to control only one patient's glycaemia without any manual intervention. The average BSL attained during closed-loop control approached the target range of 6-10 mmol/l, and had less deviation than when BSL had been maintained manually. We conclude that closed-loop BSL control using a sliding scale algorithm is feasible. The main deficiency in the current system is unreliability of the subcutaneous glucose sensor when used in this setting. This deficiency mandates high vigilance during use of the system as it is being developed.     

The effects of hydroxyethyl starch solution in critically ill patients

AIM: In the treatment of the critically ill patients an adequate fluid therapy appears to be essential to optimize hemodynamics and to get a suitable tissue perfusion. In this study we have evaluated the effects of volume replacement, carried out with 2 different solutions: hydroxyethyl starch 6% (HAES) and albumin 20% (HA). METHODS: Twenty patients suffering from sepsis were recruited and randomized into 2 groups. The first group was treated with hydroxyethyl starch 6% ( HAES treated group), and the second with albumin 20% (HA treated group). The volume of colloids was given to maintain pulmonary capillary wedge pressure (PCWP) between 15 and 18 mmHg. Daily, both hemodynamic parameters and blood gas analyses were monitored. RESULTS: Groups were homogeneous for age, sex and pathology. During the treatment we observed that cardiac index (CI), right ventricular ejection fraction (RVEF), oxygen consumption index (VO(2)I), oxygen delivery index (DO(2)I), and rate between arterial oxygen pressure and fraction of inspired oxygen (PaO(2)/FiO(2)) were increased significantly only in HAES treated group (P<0.05). APACHE II score decreased significantly only in HAES treated group (P<0.05), contrarily to the HA treated group, in which we observed a non significant increase. CONCLUSIONS: Since hydroxyethyl starch induced a hemodynamic and clinical improvement, these effects translated into an improvement of sensorium and a reduction of APACHE II score, without causing pulmonary edema, we can conclude that hydroxyethyl starch 6% ws 130,000 dalton ms 0.4 (Voluven) is an effective fluid for resuscitation of hypovolemic patients and represent an attractive alternative to albumin.