大角度冲击式浅静脉穿刺术的临床研究

目的在手背浅静脉穿刺术中,对采用60°~70°角冲击式进针方法和常规进针方法进行比较研究,探讨大角度冲击式浅静脉穿刺术的临床效果。方法选择住院接受静脉输液治疗的患者100例,分别采用两种不同进针方法对患者左右手进行静脉穿刺,研究患者在接受静脉穿刺时的回血时间、疼痛程度、穿刺成功率、输液过程液体外渗率,血管可重复利用率、拔针后皮下淤血率、患者对穿刺进针方法的满意度7项指标。将结果进行比较分析。结果实验组回血时间快于对照组(P0.05);疼痛程度轻于对照组(P0.05);患者满意度、穿刺成功率及血管可重复利用率高于对照组(P0.05);液体外渗率、皮下淤血率低于对照组(P0.05)。结论结果显示,60°~70°角冲击式浅静脉穿刺法可缩短进针时间,减轻患者疼痛感,降低液体外渗率、皮下瘀血率,提高血管的可重复利用率及患者满意度,明显优于传统静脉穿刺方法。     

小角度进针静脉采血对体检对象疼痛程度的影响

目的探讨健康体检人群静脉采血时合适的进针角度，以减轻疼痛。方法在体检人群中，选取393例为实验组，选取387例为对照组，实验组采用改良进针角度，对照组采用传统进针角度，比较2组不同进针角度与疼痛的感受程度。结果实验组静脉采血比对照组静脉采血能明显减轻疼痛；2组进针角度与疼痛程度比较差异有显著统计学意义（P〈0．01）。结论采用改良进针角度在健康体检人群中进行静脉采血，可以达到有效减轻疼痛甚至无痛的效果。     

小角度进针静脉采血对体检对象疼痛程度的影响

目的 探讨健康体检人群静脉采血时合适的进针角度,以减轻疼痛.方法 在体检人群中,选取393例为实验组,选取387例为对照组,实验组采用改良进针角度,对照组采用传统进针角度,比较2组不同进针角度与疼痛的感受程度.结果 实验组静脉采血比对照组静脉采血能明显减轻疼痛;2组进针角度与疼痛程度比较差异有显著统计学意义(P＜0.01).结论 采用改良进针角度在健康体检人群中进行静脉采血,可以达到有效减轻疼痛甚至无痛的效果.     

采用不同进针角度进行静脉穿刺的效果比较

[目的 ]探讨采用两种进针角度进行静脉穿刺对病人痛感的影响及一次性穿刺成功率。 [方法 ]对 2 3 0例门诊输液病人采取自身对比法进行常规静脉穿刺和 45度角静脉穿刺各 690例次 ,观察病人的疼痛反应及一次穿刺成功率。 [结果 ]两组疼痛反应、一次穿刺成功率比较均有统计学意义 (P <0 .0 1)。 [结论 ]静脉穿刺以 45度角或接近 45度角进针较传统 2 0度角进针具有进针后回血速度快、穿刺成功率高、疼痛轻的特点     

快速垂直静脉穿刺对患者疼痛的影响

目的观察快速垂直静脉穿刺对患者疼痛的影响。方法选择清醒的住院静脉输液病人440例,分为实验组和对照组。实验组护士右手持针柄在血管上方或右侧0.1~0.2 cm处将针尖快速垂直刺入皮内,然后迅速以20°角度沿血管方向潜行穿入血管;对照组针头与皮肤之间以20°角度在血管上方或右侧0.1~0.2 cm处穿入皮下,再沿血管方向潜行穿入血管。观察两组病人疼痛情况。结果实验组疼痛明显轻于对照组,两组比较差异具有显著性(P<0.05)。结论快速垂直静脉穿刺疼痛轻,效果好。     

小角度进针静脉采血对体检对象疼痛程度的影响

目的探讨健康体检人群静脉采血时合适的进针角度,以减轻疼痛。方法在体检人群中,选取393例为实验组,选取387例为对照组,实验组采用改良进针角度,对照组采用传统进针角度,比较2组不同进针角度与疼痛的感受程度。结果实验组静脉采血比对照组静脉采血能明显减轻疼痛;2组进针角度与疼痛程度比较差异有显著统计学意义(P<0.01)。结论采用改良进针角度在健康体检人群中进行静脉采血,可以达到有效减轻疼痛甚至无痛的效果。     

大角度静脉穿刺采血法的临床应用

目的探讨改变静脉穿刺的角度,应用于静脉采血,减轻患者静脉采血时引起的疼痛,提高静脉采血工作质量。方法选取门诊静脉采血患者600人,随机分成观察组和对照组,每组300人。观察组采用改变穿刺角度,穿刺点直接选在被穿刺血管的上方;对照组用常规操作方法静脉采血。观察两组患者疼痛的程度。结果大角度静脉穿刺采血法进行采血,患者疼痛感明显减轻（P〈0.05）。结论大角度静脉穿刺采血法,具有对皮肤损伤小,进针速度快,明显减轻了患者静脉采血时疼痛感。     

静脉穿刺直入血管法的临床研究

目的通过对静脉穿刺进针方法的研究 ,采取直接刺入血管的进针方法 ,使静脉穿刺达到无痛、微创、快速、准确无误的质量标准。方法操作者分别用传统的“三段式”进针法和直接刺入血管法为 70名住院患者行静脉输液 ,了解两种不同穿刺方法进针速度、病人对疼痛的感觉 ,穿刺对病人局部组织的损伤程度及一针见血率。结果两组病人对穿刺疼痛的感觉经秩和检验Uc =4 .2 2 ,P <0 .0 0 0 5 ,有显著性差异。两种不同进针方法 ,进针速度经U检验 ,U =15 .70 ,P <0 .0 0 1,差异有显著意义。直接刺入血管法对局部组织的损伤范围只是对皮肤、皮下组织及血管壁穿刺点的损伤 ,而“三段式”进针法 ,除对皮肤、血管壁穿刺点的损伤外 ,对皮下组织的损伤为遂道式损伤和撕裂伤。按进针深度 1/ 2计算 ,其损伤体积为 2 .2 4mm3 。两种方法穿刺一针见血率分别为 95 .71%、92 .88%。经 χ2检验 ,χ2 =0 .5 3,P >0 .2 5 ,无显著性差异。结论直接进针法可减少病人的局部损伤 ,减轻病人疼痛 ,且进针速度快 ,准确无误 ,明显优于传统的“三段式”进针法     

两种静脉穿刺方法对患者的影响

目的改进静脉穿刺方法,提高成功率,减少患者痛苦。方法将60例需要静脉输液的患者随机分为对照组和实验组各30例,对照组采用传统“三段式”进针法,实验组采用进针角度35—45°直接刺入血管法。观察两种不同穿刺方法所用时间、患者对疼痛的感觉及穿刺成功率。结果直接刺入血管法患者疼痛感觉轻于“三段式”进针法（P〈0．01）,穿刺所用时间短于“三段式”进针法（P〈0．01）,穿刺成功率（95．0％）高于“三段式”进针法（87．7％）（P〈0．05）。结论直接刺入血管法可减轻患者疼痛,缩短穿刺时间,提高穿刺成功率,值得在临床推广应用。     

无痛注射治疗化疗药物引起渗漏的对比观察

目的 :比较冰敷、利多卡因、氟美松、维生素B12 与氟美松、维生素B12 治疗化疗药物引起渗漏的疗效 ,观察 2种治疗的进针方法、退针方法、病变皮肤完全恢复正常的时间、患者疼痛的程度。方法 :用冰敷、利多卡因、氟美松、维生素B12 治疗化疗药物引起的渗漏 13例为实验组 ,用氟美松、维生素B12 治疗化疗药物引起渗漏的 13例为对照组。记录病变皮肤完全恢复正常的时间 ,进针及退针所用时间 ,比较治疗过程及化疗药物刺激造成 0～ 3级疼痛患者的百分数。结果 :实验组皮肤无明显改变 ,静脉闭锁病例少 ,局部无疤痕形成。对照组病变皮肤完全恢复正常最长约需 10d ,个别病例局部形成疤痕。实验组注射利多卡因的进针、退针、注药时间短 ,最长为 4s ,患者 0、1级疼痛病例多 ,疼痛程度轻。对照组因进针、退针、注药疼痛最长达 2 4 0s ,患者 2、 3级疼痛病例多 ,致患者疼痛程度重 (P <0 0 1)。实验组因冰敷及应用利多卡因 ,化疗药物刺激未造成患者疼痛 ,对照组因化疗药物刺激造成患者疼痛 ,最长为 330 h ,疼痛程度重 (P <0 0 1)。结论 :冰敷、利多卡因、氟美松、维生素B12 治疗化疗药物引起渗漏进针方法及退针方法科学 ,患者疼痛时间短 ,痛苦程度轻 ,病变皮肤完全恢复正常的时间短 ,系无痛注射治疗     

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.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

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.     

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.