无偿献血200ml与400ml的比较

实施无偿献血以来，石家庄市无偿献血者的一次采血量一般为200ml，随着无偿献血工作的深入开展，本中心自2001年下半年起加大了采400ml血的宣传力度,首先在再次献血者中采集400ml，逐渐发展到在健康公民知情自愿情况下采集400ml，400ml采集率稳步提高。现将本中心200ml与400ml采血情况做一比较分析，报告如下。     

Evaluation of left atrial functions by color tissue Doppler imaging in adults with body mass indexes ≥30 kg/m<Superscript>2</Superscript> versus those <30 kg/m<Superscript>2</Superscript>

Evaluation of atrial function has received less attention than that of the ventricle although normal atrial function is required for optimal overall cardiac function. Obesity is associated with increased cardiovascular morbidity and mortality. In this study, we compared left atrial functions in obese adults (body mass index = BMI ≥30 kg/m²) with those in non-obese adults (BMI <30 kg/m²) by color tissue Doppler parameters. There were 37 adults with BMI ≥30 kg/m² (mean age 36 ± 11 years) and 26 adults with BMI <30 kg/m² (mean age 35 ± 5 years). Mean BMI was 38 ± 6 kg/m² in the obese group whereas that was 24 ± 2 kg/m² in the non-obese group. For color tissue Doppler imaging, sample volumes were placed on the mid left atrium at the septum, lateral, inferior, and anterior walls. The peak systolic strain (S _s), peak systolic strain rate (SR_s), peak early diastolic SR (SR_e), peak late diastolic SR (SR_a), peak systolic tissue velocity (TV_s), peak early diastolic TV (TV_e) and peak late diastolic TV (TV_a) values were measured. For each measurement, values in three consecutive cardiac cycles were measured and then averaged. To simplify the analysis, the values at each wall were combined and averaged to obtain mean values. All left atrial systolic function parameters (S _s, SR_s, TV_s) were similar between the groups. In addition, there was no statistically significant difference at left atrial diastolic function parameters (SR_e, SR_a, TV_e, TV_a). We could not find any significant difference between obese and non-obese adults at left atrial functions assessed by color tissue Doppler parameters.     

国产Gd-DTPA大剂量(0.3mmol/kg)静脉注射的初步研究

目的研究国产ＧｄＤＴＰＡ大剂量（０３ｍｍｏｌ／ｋｇ）静脉注射的安全性、耐受性和效果。方法共研究了４１例患者。分两次注射,第一次注射０１ｍｍｏｌ／ｋｇ,３０分钟后再注射０２ｍｍｏｌ／ｋｇ,从而达到累积０３ｍｍｏｌ／ｋｇ。每次注射后即刻和延时２０分钟时分别行Ｔ１ＷＩ扫描。观察患者检查前后的生命体征,询问患者的主观感觉,２４小时后随访。对于３１例颅内病变患者的６７个病灶还进行了增强效果的分析,计算病灶的相对信噪比：Ｃ／Ｎ＝（病灶信号强度－正常脑白质信号强度）／背景信号强度。结果检查前后患者的生命体征未见明显差异。４例患者报告有副作用,均未经治疗而自行缓解。副作用发生的概率是９７６％。三倍量国产ＧｄＤＴＰＡ的使用可以普遍地提高颅内病灶的相对信噪比。结论使用大剂量（０３ｍｍｏｌ／ｋｇ）国产ＧｄＤＴＰＡ可认为是安全的。对于颅内病变,三倍量增强ＭＲ可提高相对信噪比和病灶的检出率,对于颅内小病变和脑转移瘤尤其有意义。     

甘南州无偿献血从200ml向400ml转变的调查

<正>甘南藏族自治州从2004年开始推行无偿献血工作,并实施《中华人民共和国献血法》,使无偿献血工作走入规范化、法制化,自此甘南州临床用血发生了历史性转变,全州七县一市18个临床医疗用血单位和急救用血100%来源于自愿     

Beneficial hemodynamic response of transthoracic cardiac pacing in a 2 kg preterm neonate

Objective: To describe the beneficial hemodynamic effect of transthoracic external pacing compared with epicardial pacing in a 2 kg premature neonate with congenital complete heart block, hydrops and complex congenital heart disease. Methods: Transthoracic epicardial pacing was instituted at a rate of 120 beats/min to treat life-threatening bradycardia (HR 50–60 beats/min), hypotension (BP 45/20 mmHg) and severe lactic acidosis (pH 7.18, lactate 7.5 mmol/l) despite significant catecholamine support. Due to the size of the patient, the external pacing electrodes were placed on the back and front of the patients chest. To achieve ventricular capture, the electric output had to be increased to 140 mA, resulting in symmetric chest movements. Result: Transthoracic pacing resulted in an immediate improvement of the cardiovascular status, with an adequate blood pressure (BP 60/25 mmHg) and normalization of acid-base-balance. After the insertion of an epicardial pacemaker (paced rate at 140 beats/min), a significantly lower blood pressure was achieved (BP 50/25 mmHg), indicating an additive effect of the rhythmic chest movements to the blood pressure. Unfortunately, third-degree burns were detected on the patients back 1 day after pacemaker insertion. Conclusion: Transthoracic pacing is a life-saving option in an emergency situation, when maximal pharmacological support fails to maintain adequate cardiac output. It may have some additional beneficial effect on blood pressure generation in these patients. To prevent skin injury, the output used needs to be as low as feasible, and the period of pacing as brief as practicable.     

无偿献血300ml与200ml献血反应的比较分析

ELISA检测室内质控与临床化学测定的质控方法相比有其特殊性 ,由于 ELISA试剂盒的有效期短 ,批号更换频繁 ,短时间内难以积累最佳条件下 2 0次质控物的检测结果。而采用“即刻法”质控统计方法 ,只需连续测 3次 ,即可对第 3次检验结果进行质控。笔者在免疫实验室 ELISA检测室内质控中采用了即刻法取得了良好的效果 ,现以检测HBs Ag室内质控为例 ,简述如下。材料与方法1　材料　 1 ng HBs Ag质控血清 (由卫生部临床检验中心提供 ) ;酶标仪 (美国伯乐 5 5 0 ) ;洗板机 (美国伯乐 1 5 75 ) ;40～ 2 0 0 μl加样枪 (芬兰产 ) ;检测HBs…     

无偿献血300 ml与200 ml献血反应的比较分析

为了解法定献血量内献血反应与献血量是否有明确的关系 ,对无偿献血量为 3 0 0 ml和 2 0 0 ml献血者献血反应的发生情况进行了比较分析。现报告如下 :材料与方法1　对象　 2 0 0 0年 7月～ 2 0 0 1年 6月 ,在驻耒部队无偿献血官兵中 ,按本人自愿原则 ,随机抽取 1 2 42人 ,全部为初次献血 ,体质及训练强度相似。其中5 3 8例采血 3 0 0 ml,70 4例采血 2 0 0 ml。2　方法　由采血护士和巡回医师观察并记录献血反应。结果采用两标本率差异显著性检验。结　　果　　见表 1、表 2。表 1　献血 3 0 0 ml与献血 2 0 0 ml献血反应发生率比较献血量例…     

磁共振弥散加权成像联合磁共振波谱技术对4ng/ml≤PSA≤20ng/ml前列腺癌诊断的价值

目的:探讨磁共振扩散加权成像(DWI)联合磁共振波谱技术(MRS)在4ng/ml≤PSA≤20ng/ml前列腺癌诊断中的应用价值。材料与方法:选择血清PSA在4ng/ml-20ng/ml之间的患者47例,均行DWI及MRS扫描,并与穿刺活检或手术切除病理结果对照,分析DWI、MRS诊断前列腺癌的准确率。结果:病理结果显示前列腺癌31例、前列腺增生14例、前列腺炎2例,前列腺癌组和非前列腺癌组的年龄间比较没有差异(P0.05)。DWI诊断前列腺准确率为93.54%,MRS诊断前列腺癌准确率为74.19%,DWI联合MRS诊断前列腺癌准确率为96.77%。结论:功能磁共振成像技术DWI及MRS安全便捷,两者联合有助于提高前列腺癌检出率。     

巧用1ml注射器

临床在转运危重患者时,常常会用到氧气袋,而氧气袋导管与一次性鼻导管之间一般采用玻璃接头将其连接.但在临床使用中,玻璃接头存在着安全隐患,它易摔碎且伤及患者和医护人员,医护人员常为此而烦恼.鉴此,我科2012年以来,采用1 ml一次性注射器代替玻璃接头将其连接,效果很好.现介绍如下. 1 方法 将1 ml一次性注射器的活塞抽出,去掉针头,剪掉注射器针筒尾端,将注射器空筒连接在一次性鼻导管与氧气袋导管之间即可.     

应用微量泵输液时滴/min与ml/h的换算

临床上某些药物作静脉滴注时 ,经常以滴 /ｍｉｎ为单位 ,近年来随着微量泵的广泛应用 ,为精确计算药量带来了不少便利。微量泵的计量单位是ｍｌ/ｈ ,在实际应用时需与滴 /ｍｉｎ进行换算 ,根据临床经验 ,输液器每毫升输出 17.5滴 ,用带 7号头皮针的输液器作 10 0次计量 ,由此推导出以滴数为单位滴注时 ,只要将所需滴 /ｍｉｎ数乘以常数 3.5 ,便是微量泵所要设置的ｍｌ/ｈ数。应用微量泵输液时滴/min与ml/h的换算$青岛市第8人民医院!266100@薄其果 $青岛市第8人民医院!266100@刘文启…     

Predictors of insufficient amikacin peak concentration in critically ill patients receiving a 25 mg/kg total body weight regimen

Purpose

Amikacin requires pharmacodynamic targets of peak serum concentration (C _max) of 8–10 times the minimal inhibitory concentration, corresponding to a target C _max of 60–80 mg/L for the less susceptible bacteria. Even with new dosing regimens of 25 mg/kg, 30 % of patients do not meet the pharmacodynamic target. We aimed to identify predictive factors for insufficient C _max in a population of critically ill patients.

Methods

Prospective observational monocentric study of patients admitted to a general ICU and requiring a loading dose of amikacin. Amikacin was administered intravenously at the dose of 25 mg/kg of total body weight. Independent determinants of C _max < 60 mg/L were identified by mixed model multivariate analysis.

Results

Over a 1-year period, 181 episodes in 146 patients (SAPS 2 = 51 [41–68]) were included. At inclusion, the SOFA score was 8 [6–12], 119 (66 %) episodes required vasopressors, 150 (83 %) mechanical ventilation, and 81 (45 %) renal replacement therapy. The amikacin C _max was 69 [54.9–84.4] mg/L. Overall, 60 (33 %) episodes had a C _max < 60 mg/L. The risk of C _max < 60 mg/L associated with BMI < 25 kg/m² varied across quarters of inclusion. Independent risk factors for C _max < 60 mg/L were a BMI < 25 kg/m² over the first quarter (odds ratio (OR) 15.95, 95 % confidence interval (CI) [3.68–69.20], p < 0.001) and positive 24-h fluid balance (OR per 250-mL increment 1.06, 95 % [CI 1.01–1.11], p = 0.018).

Conclusions

Despite an amikacin dose of 25 mg/kg of total body weight, 33 % of patients still had an amikacin C _max < 60 mg/L. Positive 24-h fluid balance was identified as a predictive factor of C _max < 60 mg/L. When total body weight is used, low BMI tended to be associated with amikacin underdosing. These results suggest the need for higher doses in patients with a positive 24-h fluid balance in order to reach adequate therapeutic targets.     

Impact of Withdrawal of 450 ml of Blood on Respiration-Induced Oscillations of the Ear Plethysmographic Waveform

Objective It has been widely appreciated that ventilation-induced variations in systolic blood pressure during mechanical ventilation correlate with changes in intravascular volume. The present study assessed whether alterations in volume status likewise can be detected with noninvasive monitoring (ear plethysmograph) in non-intubated subjects (awake volunteers). Methods Eight healthy adults were monitored with EKG, noninvasive blood pressure, an unfiltered ear plethysmograph, and a respiratory force transduction belt before (PRE) and after (POST) withdrawal of 450 ml of blood from an antecubital vein. Spectral-domain analysis was used to determine the peak ventilatory frequency and the power of the associated variation in the ear plethysmographic tracing; Interphase differences in the respiration-induced plethysmographic variations were assessed by Wilcoxon signed rank test. In addition, the changes in the ear plethysmographic tracing were compared to changes in heart rate and blood pressure. Results There was a significant increase in respiratory-associated oscillations at the respiratory frequency between the PRE and POST phases (p = 0.012). These changes were detected despite lack of changes in heart rate or blood pressure. Conclusions Respiration-induced changes of the ear plethysmographic waveform during spontaneous ventilation increase significantly as a consequence of withdrawal of approximately one unit of blood in healthy volunteers. Funded only with departmental funds. Presented, in part, at the annual meeting of the American Society of Anesthesiologists, October, 2004. Implications Statement: Quantification of respiration-induced changes of an ear plethysmographic signal provided an indication of volume loss after withdrawal of 450 ml of blood in healthy, non-intubated volunteers. Gesquiere MJ, Awad AA, Silverman DG, Stout RG, Jablonka DH, Silverman TJ, Shelley KH. Impact of Withdrawal of 450 ml of Blood on Respiration-Induced Oscillations of the Ear Plethysmographic Waveform.     

巧用一次性1 ml注射器

1 一次性1 ml注射器应用于吸引器吸痰及痰标本的留取 在临床工作中,我们常规使用玻璃接头连接吸引器的橡胶管和吸痰管,但玻璃接头易破碎,且需要反复消毒,给工作带来许多不便,为解决此问题,我们选用1 ml注射器针筒代替玻璃接头取得满意效果,并由此解决了痰标本不易留取的难题.     

整形外科巧用2ml注射器

小耳畸形整形手术分两次进行,二期手术应用自体肋软骨支架,耳再造术后常会使用墙壁负压引流装置,目的首先利于伤口引流液的引出,其次为了塑形,一般此患者引流装置需要10d左右.此引流装置需要一个负压引流瓶,分别接上两个一次性吸引器连接管,一端接墙壁负压,一端接患者耳部的引流管,因为吸引器连接管比较粗,患者耳部的引流管较细,所以需要一个接头连接,以前笔者用一次性吸痰管做接头,连接后不但密闭效果不好,而且操作过程中不能保证无菌,近期笔者用一次性2ml注射器做街头,能够弥补上述不足.     

200ml和400ml血液的采集不足量率比较

2000～2002年政府下达计划献血指标,2003～2004年逐步取消献血计划指标.街头自愿无偿献血,献血量由200ml向400ml转变.实践证明采血不足量多由献血不良反应、血管等因素所致,笔者比较了采集200ml和400ml血液不足量是否有差异,报告如下.     

巧用一次性1ml注射器

1一次性1ml注射器应用于吸引器吸痰及痰标本的留取在临床工作中,我们常规使用玻璃接头连接吸引器的橡胶管和吸痰管,但玻璃接头易破碎,且需要反复消毒,给工作带来许多不便,为解决此问题,我们选用1 ml注射器针筒代替玻璃接头取得满意效果,并由此解决了痰标本不易留取的难题。1.1用物及方法取1 ml注射器,弃活塞,留针筒,用剪刀去除针筒上端突出的针翼,使针筒呈柱形,将注射器针筒接在吸痰器硅胶管与吸痰管之间,接通电源,即可进行吸痰。留取痰标本方法,取无菌1 ml注射器,取下活塞放于无菌容器中,用无菌剪刀去除针筒上端针翼,将针筒连接于吸痰器硅…     

巧用一次性2ml注射器

胸腹腔引流在中晚期肿瘤患者的治疗中被广泛应用，传统的引流管与引流袋之间的连接管在使用中存在一些弊端。临床应用中发现一次性2ml注射器巧做连接管使用效果更好。现介绍如下。     

50ml注射器之新用

正一般50 ml注射器都用于抽药,但在神经外科手术中有了新的用途。为减少对脑组织的灼伤,神经外科手术常规应用一次性滴水镊子,但是滴水镊子在不用时水会流到护士的器械台上,造成无菌区域的污染,为了避免类似的情况发生,我们采用50 ml注射器自制成节水器,取得显著效果。制作过程如下:(1)     

1ml注射器的妙用

在临床护理中,1ml注射器做为加药、打针外,还有多种用途,现将使用方法作一总结如下。