Seldinger法中心静脉穿刺置管63例分析

目的:总结中心静脉穿刺置管经验.方法:回顾分析63例中心静脉穿刺置管临床资料.结果:全组穿刺成功61例(97.8%),一次试穿成功54例(85.7%),颈内静脉穿刺失败,改颈外静脉穿刺置管2例;误穿颈总动脉形成颈部血肿1例,置管成功率100%.误穿颈总动脉形成颈部血肿1例.结论:掌握中心静脉及其毗邻解剖,熟悉多种穿刺途径,可提高穿刺成功率、减少并发症.     

肝移植术中心静脉穿刺置管的解剖定位研究

目的比较解剖定位颈内静脉和锁骨下静脉两种路径行中心静脉穿刺置管的成功率和并发症,为临床选择安全有效的穿刺路径提供参考。方法限期肝移植手术患者随机交叉研究,随机确定颈内静脉和锁骨下静脉穿刺的先后顺序。全身麻醉诱导后,由同一组麻醉医师依据解剖定位标志按确定的穿刺顺序完成颈内静脉穿刺置管、锁骨下静脉穿刺置管。记录成功置管前静脉穿刺次数、引导钢丝置入次数,置管时间;同时记录误入动脉、血肿形成、气胸等并发症的发生率。结果 42例限期肝移植手术患者入选该研究。颈内静脉和锁骨下静脉穿刺置管的次数分别为(2.3±0.7)次,(2.9±1.4)次(n=42,P0.05),置管时间分别是(1.58±0.49)min,(2.24±1.01)min(n=42,P0.05)。1例患者行颈内静脉穿刺时误入颈动脉,并发血肿;1例患者行锁骨下静脉穿刺后出现血肿。结论解剖定位穿刺颈内静脉比锁骨下静脉更容易更快捷。     

锁骨下静脉穿刺置管术600例临床观察及解剖学基础

目的熟悉锁骨下静脉的局部解剖结构,熟练掌握SVC的操作方法和技能,提高穿刺成功率。方法回顾性分析我院2010年3月至2014年3月接受SVC的600例住院患者(男410例,女190例)的临床资料。结果成功穿刺582例,穿刺成功率为97%。其中1次穿刺成功546例(91%),重复穿刺或改颈内静脉或其它穿刺38例(6.3%),失败16例(2.7%)。发生并发症22例(3.7%),其中误入动脉8例(1.3%),气胸3例(0.5%),导管尖端导入颈内静脉5例(0.8%),导管相关感染2例(0.3%),导管堵塞2例(0.3%),心律失常2例(0.3%)。结论 SVC简单易学,安全可靠,成功率高,并发症少,导管保留时间较长,是一种较好的中心静脉穿刺方法,值得在临床推广使用。     

经胸锁乳突肌三角顶点入路行右颈内静脉穿刺置管160例临床分析

目的：探讨经胸锁乳突肌三角顶点入路行右颈内静脉穿刺置管的临床价值。方法：回顾性分析160例通过胸锁乳突肌胸骨头、锁骨头与锁骨形成的锁骨上三角顶点作为穿刺点行右颈内静脉穿刺置管患者的临床资料,分别统计一次穿刺成功率、穿刺时间、带管时间及并发症的发生类型。结果：本组一次穿刺成功149例,穿刺成功率93．1％;穿刺时间5—20min,平均9min;带管时间5～45d,平均21d;并发症主要有穿刺点局灶性红肿11例（6．9％）,误入动脉1例（0．6％）,感染3例（1．9％）,堵管1例（0．6％）。结论：经胸锁乳突肌三角顶点人路行右颈内静脉穿刺置管成功率高,并发症少且轻微,可应用于临床。     

高位颈内静脉置管的临床应用与体会

中心静脉穿刺置管有多条途径，唯有颈内静脉标志相对明显，操作简单方便，而且血胸、气胸等并发症较锁骨下静脉穿刺少，是目前采用最多的中心静脉置管途径。2007年1月以来，我院对18例病人实施了高位颈内静脉穿刺置管，现报告如下。     

颈内中心静脉穿刺置管术并发症的临床分析

目的分析、探讨颈内中心静脉穿刺置管术并发症和改进技术。方法对2003年8月至2006年12月158例应用颈内中心静脉穿刺置管术患者进行回顾性分析,了解颈内中心静脉穿刺和置管过程中并发症发生情况,研究相关的并发症和技术问题。结果颈内中心静脉穿刺置管术并发症发生率为7.59%,其中局部出血、血肿5例（3.16%）,误穿动脉3例（1.90%）,局部红肿感染2例（1.27%）,心律失常1例（0.63%）、气胸1例（0.63%）。结论颈内中心静脉穿刺置管术具有一定的危险性,需注意预防并发症的发生。     

锁骨下静脉穿刺输液港植入的并发症分析

目的 探讨锁骨下静脉穿刺输液港植入并发症发生的危险因素,总结减少并发症的策略。方法 回顾性分析2010年6月~2018年6月我院605例经锁骨下静脉穿刺植入输液港患者的临床资料,选取性别、年龄、身高、BMI、入路（右侧、左侧）及输液港导管尖端位置等6种可能影响锁骨下静脉穿刺输液港植入并发症发生的相关因素进行分析。结果 本组患者总体并发症发生率为3.64%,其中术中并发症发生率为1.98%,包括穿刺失败改对侧锁骨下静脉穿刺后植入、气胸、误入颈内静脉;远期并发症发生率为1.65%,包括1例锁骨下静脉血栓,1例输液港外露,1例导管破损,2例导管堵塞,1例导管脱落,4例导管感染。术中并发症患者均顺利完成化疗,远期并发症导致非正常取港10例。左、右侧植入患者的并发症发生率比较,差异无统计学意义（P＞0.05）;异常BMI（BMI＞24 kg/m2和BMI＜19 kg/m2）是并发症发生的危险因素。结论 锁骨下静脉穿刺植入输液港并发症发生率低,异常BMI指数患者是锁骨下静脉穿刺输液港植入并发症发生的高危人群。     

两侧锁骨下静脉置管误入颈内静脉发生率的比较

危重病患者由于治疗需要常常放置深静脉导管.其中锁骨下静脉置管,因其感染率低、固定方便及患者感觉舒适而成为保留较长时间静脉通路的重要途径.而误入颈内静脉为穿刺置管的并发症之一,易引起中心静脉压读数错误和血栓性静脉炎.笔者观察了两侧锁骨下静脉置管误入同侧颈内静脉的发生率,报道如下.     

在B超引导下行经外周静脉穿刺中心静脉置入术临床效果分析

目的分析并总结在B超引导下行经外周静脉穿刺中心静脉置入术(PICC)的临床效果,探讨B超引导下行PICC的置管技巧。方法回顾性分析2016年1月至2017年5月重庆市急救医疗中心神经外科102例患者在B超引导下行PICC置入术的临床资料,统计一次性穿刺成功率、一次性送管成功率及并发症例数,分析并发症发生的原因及处理方法。结果 102例病例中有94例穿刺1次,6例穿刺2次,2例穿刺次数大于2次;一次性穿刺成功率为92.16%。5例患者在置管术中发生导管异位,2例发生术后并发症。结论掌握PICC相关血管解剖知识和影像学知识,熟练运用B超导引系统进行穿刺置管,可以提高置管成功率,减少术后并发症的发生。     

颈内静脉穿刺置管211例体会

我院自1990年11月至1995年5月以来施行颈内静脉穿刺置管211例,现报告如下: 1 器械与方法 1.1 穿刺针与留置导管 选择进口或国产静脉穿刺套管留置针。型号分别是1.7×133mm,1.6×100mm,1.6×170mm。 小心静脉留置管(西德贝朗公司BRAUN生产)套装内包括金属穿刺针,(φ1.3×70mm)弹簧金属导丝,(φ0.89×5mmm血管扩张器,输血饥输液测压留置管(φ1.1×2(×)mm)等。     

Secular change in menarche in women in Madrid

The age at menarche was estimated by recollection in 1617 women between the ages of 18 and 60 in Madrid and a nearby suburb, Pinto. The population of Pinto is working-class and the Madrid group, taken from residential neighbourhoods , belongs to the upper middle class. In both groups we found a diminution in average age at menarche, from 14.04 to 13.02 years in Madrid and from 14.55 to 13.16 years from about 1935 to about 1965 in Pinto. These changes have been more intense in the group which is less well-off economically, where living conditions have varied much more drastically.     

Intestinal helminthiasis in school children in Haiti in 2002

A survey on intestinal helminths in school children was conducted in Haiti in 2002. This first nationwide study involving the entire country was stratified by department according to urban and rural zones using the cluster method. Focusing on elementary school children (n=5792; age range 3 to 20 years), it involved 26 urban and 49 rural schools randomly selected. Stools were preserved in formalin and examined by the Ritchie technique. Thirty-four per cent of stools (1981/5792) tested positive for intestinal helminths with the following parasites identified: Ascaris lumbricoides (27.3%), Trichuris trichiura (7.3%), Necator americanus (3.8%), Hymenolepsis nana (2%), Taenia sp. (0.3%) and Strongyloides stercoralis (0.2%). The helminth prevalence was higher in rural (38.4%) compared to urban areas (30%). There was no significant difference in prevalence by sex and age. The importance of geohelminths changed from one department to another with the highest prevalence found in the Southern department of Grande Anse (73.7%) and the lowest prevalence in the Center department (20.6%). Five out of the country's nine departments had a similar prevalence varying from 25.5% to 28.2%. Intestinal helminthic polyparasitism was observed in a percentage of infested school children comprise between 3.4% and 28.6% according in relation to the geographical area. A program to fight against geohelminths in school children should be initiated as a public health priority. Albendazole is the drug of choice. Frequency of drug distribution should be based on the prevalence of geohelminths in each department.     

Experience in adult population in dengue outbreak in Delhi

A dengue outbreak has recently hit the Indian capital. We studied the clinical profile of adult patients. Five hundred and sixty patients of dengue infection were admitted in a specially created ward according to the criteria laid down by WHO. Haematemesis (28.28%), epistaxis (26.78%) and malena (14.28%) were some of the common presentations. Similarly lymphadenopathy, especially cervical (30.89%), palatal rashes (26.96%) and hepatomegaly (23.75%) were the most commonly encountered findings on physical examination. Most of the cases were of dengue fever with haemorrhage and only 2.5% cases were classified under dengue haemorrhagic fever or dengue shock syndrome. The average hospital stay was 3.4 days but only 9.8 hours in the eleven patients who died, suggesting their late arrival in preterminal situation giving little time for resuscitation. Thrombocytopenia was not a feature and only 12.85% patients had platelet count less than 70,000/cmm. Most of the patients who were admitted with thrombocytopenia, showed normalization in their platelet counts in next few days. Serological examination demonstrated evidence of recent dengue infection in 41.17% patients. Few patients required blood or platelet concentrate transfusion. Eleven patients died, three due to DIC, one of intracranial haemorrhage and seven due to massive gastric haemorrhage. Rest of the patients recovered completely. Thus we can conclude that recent outbreak in Delhi was of dengue fever with haemorrhage and mortality was very low in patients who came early to the hospital.     

Changes in the hypothalamic nuclei in in experimental allergy

Summary In rabbits subjected to prolonged sensitization and in which the Arthus phenomenon was induced there was a marked reaction of the hypothalamic nuclei. Staining by Gomori's method indicated a cellular swelling, loss of granules, and protoplasmic vacuolization in the supraoptic nucleus. There was a considerable increase in the size of the cross-sectional area of the cells. The same effects were much less well shown in the paraventricular nucleus. These results show that marked signs of increased neurosecretion developed in the animals at the height of the Arthus phenomenon.(Presented by Active Member AMN SSSR V. V. Parin) Translated from Byulleten Éksperimental'noi biologii i Meditsiny, Vol. 55, No. 4, pp. 110–113, April, 1963.     

Development in in vitro toxicology

There are three principal pressures driving the development of in vitro toxicology: (1) the need for more efficient testing systems to cope with the large number of xenobiotics currently being developed; (2) public pressure to reduce animal experimentation; and (3) a need for a better understanding of the mechanisms of toxicity. Within this, in vitro toxicology is focused on local, systemic, and target-organ toxicity. It is becoming increasingly apparent that a step or decision-tree approach using input of a variety of experimental data (physicochemical properties, biokinetics, cytotoxicity) provides the most efficient system for predicting toxicity. Examples of the use of in vitro toxicity systems for prediction of systemic toxicity and target-organ (liver) toxicity are presented.Originally presented at ECCP 93.