等离子前列腺电切术中水温控制护理干预的效果

[目的]观察冲洗液温度对经尿道等离子前列腺电切病人体温、心率、血压的影响。[方法]96例前列腺电切病人随机分为两组，分别应用36℃～37℃（体温组）和20℃～25℃（实验组）的冲洗液冲洗膀胱，监测两种冲洗液对术前、手术结束时病人体温、血压、心率的影响，并进行统计学分析。[结果]体温组手术结束时中心体温、血压、心率变化小，寒战发生率为12．8％；而室温组体温，血压，心率变化较明显，寒战发生率为34．7％。两组体温下降和寒战的发生率、血压变化、心率差异有统计学意义。[结论]经尿道前列腺等离子电切病人手术时采用36℃～37℃的冲洗液较20℃～25℃冲洗液效果好。     

等体温冲洗液对经皮肾镜碎石术患者体温和失血量的影响

目的探讨应用等体温冲洗液对经皮肾镜碎石术(MPCNL)患者体温及失血量的影响.方法将60例MPCNL患者随机分为加温组和常温组各30例,2组患者手术均在室温相同(20~24℃)的手术间进行,加温组使用恒温箱中37℃的冲洗液,常温组用室温下放置的冲洗液.观察比较2组患者术前、术中、术后体温、心率、血压、寒战、躁动及术中失血量的变化.结果2组患者术前体温、心率、血压无差异(P>0.05).2组患者术中、术后体温、心率、血压有明显差异(P<0.05或P<0.01);加温组术中失血量、寒战、躁动均明显好于常温组(P<0.05或P<0.01).结论 MPCNL术中采用37℃的加温冲洗液可以使患者在术前及术后的体温保持恒定,心率、血压平稳,术中失血量减少,有效降低术中寒战、躁动的发生率.     

不同浓度安尔碘冲洗液术前结膜囊冲洗的效果

目的：探讨不同浓度安尔碘冲洗液术前结膜囊冲洗消毒的效果。方法选择拟行内眼手术患者150例,按照随机数字表法随机分为0．01％安尔碘组、0．025％安尔碘组、0．05％安尔碘组,每组各50例。3组患者术前均行常规的内眼手术准备,进入手术室后均用0．5％的碘伏消毒术眼皮肤和睑缘,手术开始前3组患者分别用相应浓度的安尔碘冲洗液进行结膜囊冲洗,冲洗后1 min做结膜囊细菌培养,之后使用荧光素钠进行角膜染色,裂隙灯下观察结膜充血状态和角膜上皮损伤情况,比较3组效果。结果0．025％和0．05％的安尔碘冲洗液冲洗后细菌培养阴性率分别为92．0％,94．0％,优于0．01％安尔碘冲洗液78．0％,差异有统计学意义（χ2＝7．197,P＜0．05）;0．05％安尔碘冲洗液对结膜的刺激性和对角膜上皮的损伤大于其他两组（χ2值分别为20．257,18．656;P＜0．05）。结论0．025％安尔碘冲洗液有高效的杀菌作用,且对眼部角、结膜无破坏性损伤,故更适于眼科手术术前结膜囊消毒。     

经尿道前列腺电切术中应用不同温度冲洗液对病人生命体征的影响

[目的]观察不同冲洗液温度对经尿道前列腺电切术（TURP）术中病人生命体征的影响。[方法]按冲洗液温度将TURP病人随机分为室温组（21℃～24℃，n=30）和等温组（37℃～38℃，n=50），监测不同温度冲洗液对术中45min和术毕病人中心体温、心率及血压的影响。[结果]室温组中心体温降至（35．0±0．48）℃，寒战发生率为32．0％，平均动脉压升高，心率加快；等温组术毕中心体温降至（35．7±0．41）℃，寒战发生率为6．7％。两组中心体温和寒战发生率有统计学差异（P〈0．01）。[结论]TURP术中采用室温冲洗液可导致病人术中低体温，且对生命体征有较大影响。而采用等温冲洗液能减轻围手术期低体温的发生，增加手术安全性。     

5％葡萄糖注射液用于胆道镜手术冲洗液60例分析

目的 观察5％葡萄糖注射液作为胆道镜手术冲洗液的临床效果.方法 选择拟行胆道镜下取石的肝内外胆管结石患者60例,术中均以5％葡萄糖注射液作为冲洗液,每500 ml加庆大霉素8万U.患者均子手术前及术中0.5h、1h、1.5h及术后2h抽取静脉血,检测血钾、血钠、血氯化物、血糖、血渗透压5项指标.结果 上述检验项目术前与术中各时段及术后2h的检测结果比较差异无统计学意义(P＞0.05).结论 胆道镜下取石手术以5％葡萄糖注射液加庆大霉素作为冲洗液,清晰度高,利于手术的操作,且对患者的生化检验项目无影响.     

前列腺电切术中甘露醇冲洗致过敏反应1例报告

1病例介绍患者，男性，对岁。1998年6月3日因前列腺增生收入我科，既往有青霉素及磺胶类药物过敏史。6月5日9：00在硬膜外麻醉下经尿道行前列腺电切术，术中以4％甘技醇为冲洗液高压冲洗膀航，同时静脉输入平衡盐500ml及5％葡萄糖500ml，未用抗生素类药物。10：30患者逐渐出现直径约2．Ocm圆环形红色皮疹，高出正常皮肤，除颜面部外遍布全身其他部位，血压降低为10／6kPa，心律加快，128次／分，面色发组。考虑为药物过敏，给予地塞米松Icmg，异丙学25mg，葡萄糖酸钙ig静脉注射，病情有好转，继续手术。术毕，13：cod回病房，房人嗜睡，红…     

等离子前列腺电切术中水温控制护理干预的效果

[目的]观察冲洗液温度对经尿道等离子前列腺电切病人体温、心率、血压的影响。[方法]96例前列腺电切病人随机分为两组,分别应用36℃~37℃(体温组)和20℃~25℃(实验组)的冲洗液冲洗膀胱,监测两种冲洗液对术前、手术结束时病人体温、血压、心率的影响,并进行统计学分析。[结果]体温组手术结束时中心体温、血压、心率变化小,寒战发生率为12.8%;而室温组体温,血压,心率变化较明显,寒战发生率为34.7%。两组体温下降和寒战的发生率、血压变化、心率差异有统计学意义。[结论]经尿道前列腺等离子电切病人手术时采用36℃~37℃的冲洗液较20℃~25℃冲洗液效果好。     

冲洗液温度对经尿道前列腺电切病人中心体温的影响

目的　观察冲洗液温度对经尿道前列腺电切病人体温、心率、血压的影响。方法　6 2例前列腺电切病人随机分为 2组 ,分别应用体温 (37～ 38)℃和室温 (2 1～ 2 4 )℃冲洗液冲洗膀胱 ,监测 2种冲洗液对术中 30、6 0min和术终病人体温、血压、心率的影响 ,并进行统计学分析。结果　体温冲洗液组手术结束时中心体温下降到 (35 .7± 0 .4 1)℃ ,寒战发生率为 5 .7% ;室温组下降到 (35 .0± 0 .4 8)℃ ,寒战发生率为 33.3% ,平均动脉压升高 ,心率加快。经统计学分析发现 2组体温下降和寒战的发生率差异有显著性 (P <0 .0 0 1和P <0 .0 1)。结论　室温冲洗液较体温冲洗液对经尿道前列腺电切病人的中心体温影响大 ,手术时应当采用体温冲洗液     

两种不同温度冲洗液对TVP术后膀胱痉挛的影响

目的探讨两种不同温度膀胱冲洗液用于前列腺电气化（TVP）患者持续膀胱冲洗,与患者术后膀胱痉挛等并发症的关系。方法采用两种不同温度的冲洗液对两组患者行持续膀胱冲洗,观察膀胱痉挛发生率,并留取冲洗液计算出血量,监测冲洗前后血压和心率变化。结果观察组膀胱痉挛发生率较对照组低,两组出血量无明显变化。且观察组冲洗前后患者血压和心率变化小。结论36～37℃加温液是用于TVP术后持续膀胱冲洗液的最适宜温度,能明显减少膀胱痉挛的发生,减少心脑血管并发症的发生。     

复跳早期冲洗液温度对心脏手术患者血压和心率的影响

探讨心脏冲洗液温度对复跳早期心功能的影响。选择2014年2月~2015年5月在我院接受心脏手术的患者66名,按照随机数表法分为A、B、C三组,各22例患者,由台上护士配制不同温度的冲洗液,其中A组为复跳早期使用25℃冲洗液冲洗,B组患者用37℃冲洗液冲洗,C组使用40℃冲洗液冲洗,对三组患者冲洗后血压、心率变化进行比较。两组患者术前男女比例、平均年龄、收缩压、舒张压、心率比较不具有统计学差异(P0.05);A、C两组收缩压、舒张压、心率变化比较差异具有统计学意义(P0.05)。37摄氏度的心脏冲洗液温度对复跳早期血液、心率影响最小,温度过高或过低都将对心脏手术患者产生不良影响,有效的护理措施能改善患者预后。     

微孔多聚糖止血材料在消化性溃疡出血内镜治疗中的疗效及安全性观察

目的 探讨微孔多聚糖止血材料在消化性溃疡出血内镜治疗中的疗效及安全性。方法 收集内镜下诊断为消化性溃疡伴出血患者25例（观察组）,内镜下止血治疗方法为常规止血方法（机械止血、电凝止血）联合微孔多聚糖止血材料进行电动正压喷洒止血治疗,对比同期采用常规止血方法治疗的消化性溃疡伴出血患者25例（对照组）,比较2组患者5min...     

胶原/壳聚糖止血敷料在外科伤口中的应用

背景:壳聚糖与胶原联合可更有效地止血。目的:评价胶原/壳聚糖止血敷料的材料学性能及应用于外科伤口的生物相容性。方法:以"生物材料,止血敷料,纱布,胶原/壳聚糖,生物相容性"为中文关键词,以"biomaterial;hemostatic material;bioresorbable material;hemostasis effect;hemostatic mechanism"为英文关键词,采用计算机检索2000-01/2010-06与生物敷料、胶原/壳聚糖止血材料在伤口或创面止血过程中应用相关的文献。结果与结论:壳聚糖独特的生物学特性,具有广谱抑菌、促进上皮细胞生长及止血,促进创面愈合的作用,在体内具有良好的生物降解性与组织相容性,可用于指端损伤和肉芽创面的治疗,如制成伤口敷料、可吸收缝线、止血材料、防粘连剂、药物缓释及组织工程支架,用于平战时伤口的处理。     

Topical hemostasis: a valuable adjunct to control bleeding in the operating room,with a special focus on thrombin and fibrin sealants

Background: Achieving surgical hemostasis plays a major role in the operating room. Occasionally, classical surgical techniques are ill suited or fail to achieve the desired control at the site of bleeding. Topical hemostasis may be seen as a useful addition to assist the surgeon in controlling surgical bleeding. Objective: To provide a brief overview of available topical hemostatic agents with a focus on the different formulations of thrombin. Methods: The scope of the review was limited to a keyword search on PubMed and Ovid (surgical hemostasis, thrombin, tissue adhesives). Conclusion: Proven as adjuncts to surgical hemostasis, topical hemostatic agents have become quite valuable to bridge or to achieve permanent hemostasis.     

Role of cardiac myocyte tissue factor in heart hemostasis

BACKGROUND: The tissue-specific pattern of tissue factor (TF) expression suggests that it plays a major role in the hemostatic protection of specific organs, such as the heart and lung. In support of this notion, we found that mice expressing very low levels of TF exhibit hemostatic defects in the heart and lung. Hemosiderosis and fibrosis are observed in the hearts of all low TF mice as early as 3 months of age. In contrast, TF(+/-) mice expressing approximately 50% of wild-type levels of TF had no detectable hemostatic defects. OBJECTIVE AND METHODS: The objective of this study was to determine the threshold of TF that is required to maintain hemostasis under normal and pathologic conditions, and to investigate the specific role of cardiac myocyte TF in heart hemostasis using mice with altered levels of TF expression in cardiac myocytes. RESULTS: First, we found that mice with 20% of wild-type levels of TF activity in their hearts had hemosiderosis and fibrosis by 6 months of age. Secondly, mice with a selective deletion of the TF gene in cardiac myocytes had a mild hemostatic defect under normal conditions but exhibited a significant increase in hemosiderosis and fibrosis after challenge with isoproterenol. Finally, we showed that cardiac myocyte-specific overexpression of TF abolished hemosiderin deposition and fibrosis in the hearts of low TF mice. CONCLUSIONS: Taken together, our results indicate that TF expression by cardiac myocytes is important to maintain heart hemostasis under normal and pathologic conditions.     

ARFI ultrasound monitoring of hemorrhage and hemostasis in vivo in canine von Willebrand disease and hemophilia

A validated method for assessing hemostasis in vivo is critical for testing the hemostatic efficacy of therapeutic agents designed for patients with bleeding disorders such as von Willebrand disease (VWD) and hemophilia A. We hypothesize that rate of bleeding and time to hemostasis can be monitored in vivo by acoustic radiation force impulse (ARFI) ultrasound. We performed ARFI imaging following 12-gauge needle puncture of hind limb muscle encompassing an ∼2 mm vein in six normal, eight naïve hemophilia A before and after infusing canine factor VIII, three hemophilia A expressing canine factor VIIa following gene transfer, and two naïve VWD dogs. Serial data sets were processed with custom software to (1) estimate the rate of hemorrhage and (2) estimate the time of hemostasis onset. The rate of hemorrhage during the first 30 min following puncture was markedly increased in the VWD dogs relative to normal but was not significantly different between normal, naïve hemophilia A or hemophilia A expressing cFVIIa. ARFI-derived times to hemostasis were significantly longer in naïve hemophilia A dogs than in normal dogs and were shortened by canine coagulation factors VIII and VIIa. These data support our hypothesis that rate of hemorrhage and time to hemostasis in vivo in response to a standardized hemostatic challenge can be detected by ARFI ultrasound in canine models of VWD and hemophilia. These data also suggest that the ARFI-monitored hemostatic challenge is relevant for in vivo testing of the hemostatic efficacy of therapeutic clotting factor replacement products used to treat inherited bleeding disorders.     

关节镜下射频消融系统治疗急性膝关节损伤

目的探讨关节镜下射频消融系统治疗急性膝关节损伤的效果。方法利用美国Serfsa-Stryker射频消融系统对13例急性膝关节损伤的病人行关节镜下软骨修整、滑膜、绒毛切削、半月板部分切除、镜下止血等治疗并与既往镜下常规器械的同类手术比较，观察手术时间、镜下出血、术后关节积液及关节功能恢复情况。结果射频消融系统运用于镜下手术，手术时间明显缩短，镜下手术不出血还可止血，术后关节积液少，功能恢复快。结论关节镜下射频消融系统治疗急性膝关节损伤疗效满意，是镜下治疗急性膝关节损伤的最佳选择。     

关节镜下缝合修复半月板损伤

目的探讨膝关节镜下半月板缝合修复的临床效果。方法对2010年1月至2012年12月诊断为半月板撕裂损伤的29例患者行关节镜下半月板缝合修复,并进行随访及回顾性分析。结果 29例患者均顺利完成半月板缝合修复手术,平均缝合手术时间40 min,随访6～18个月进行评估,所有患者绞锁症状消失,疼痛缓解,按照Lysholm评分,术前（49.4±8.7）分,术后（92.6±5.3）分,两者比较差异有统计学意义（P〈0.05）。结论关节镜下缝合修复半月板损伤可获得满意的疗效,是一种较为理想的治疗方法。     

内镜下止血夹联合肾上腺素治疗上消化道出血的护理配合

目的探讨内镜下止血夹联合肾上腺素治疗上消化道出血的最佳护理配合方法,提高诊疗成功率。方法对184例上消化道出血患者行内镜下止血夹联合肾上腺素注射止血治疗,其中105例病变局限者单用止血夹止血,75例病灶显示不清者均先以8%去甲肾上腺素盐水局部喷洒,然后用1∶10 000肾上腺素生理盐水局部黏膜下注射,再用止血夹止血;4例转外科治疗。结果内镜下一次性止血180例,成功率97.83%;4例（2.17%）转外科手术治疗,无并发症发生。结论止血夹联合肾上腺素治疗消化道出血具有操作简单、安全、效果确切等优点。而有效的护理配合有助于医生顺利完成内镜下止血治疗,从而提高了治疗的成功率。     

内镜下治疗十二指肠乳头括约肌切缘出血的护理配合技巧

目的 探讨内镜逆行胰胆管造影(endoscopic retrograde cholangiopancreatography,ERCP)术后十二指肠乳头括约肌切缘出血内镜下止血治疗的操作护理配合与技巧.方法 纳入2011年3月至2020年2月在我院内镜中心行ERCP治疗后出现十二指肠乳头括约肌切缘或周围出血并行内镜下止血...     

Endoscopic diagnosis and treatment of Dieulafoy's ulcer

Dieulafoy's ulcer often develops unmanageable severe gastrointestinal hemorrhage and sometimes takes a fatal course. In the past surgical operations were considered to be the only life-saving measure for this lesion. Since 1979, 46 lesions of Dieulafoy's ulcer in 45 cases with active bleeding from exposed blood vessels were treated during emergency endoscopy by the hemostatic method of pure ethanol injection. Transient hemostasis was obtained in all cases. Rebleeding occurred in 5 cases (11%) and pure ethanol injection was performed again. Hemostasis was obtained in all cases, but one case again had rebleeding due to an overlooked Dieulafoy's ulcer located in the gastric fundus. Emergent surgical operation was performed in this case. No case required elective surgery and no deaths were attributed to bleeding. Our method achieved complete hemostasis at a rate of 98% (44 cases) for Dieulafoy's ulcer. The pure ethanol injection method is one of the most effective hemostatic methods for the Dieulafoy's ulcer.