基于医护一体化的预见性护理干预对心血管内科高渗性药物所致渗漏性损伤及静脉炎的预防作用

目的探讨基于医护一体化的预见性护理干预对心血管内科高渗性药物所致渗漏性损伤及静脉炎的预防作用。方法选取2018年5月至2020年5月心血管内科收治的使用高渗性药物的110例患者为研究对象,随机将其分为对照组和观察组,各55例。对照组采用常规护理干预,观察组在对照组基础上采用基于医护一体化的预见性护理干预。比较两组的干预效果。结果观察组的渗漏性损伤总发生率低于对照组(P<0.05)。观察组的静脉炎总发生率低于对照组(P<0.05)。干预后,观察组的医护合作、护理质量评分均高于对照组(P<0.05)。结论基于医护一体化的预见性护理干预有助于提高心血管内科使用高渗性药物患者的渗漏性损伤和静脉炎的预防效果,改善医护合作情况,提高护理质量,值得推广。     

品管圈活动降低高渗性药物输液外渗与静脉炎的作用

目的探讨品管圈活动在降低高渗性药物输液外渗与静脉炎中的应用效果。方法采取方便抽样法,选取上海交通大学附属第六人民医院神经外科和老年科2012年1—3月接受高渗性药物输液的患者3 623例为对照组(活动前);2012年10—12月接受高渗性药物输液的患者3 772例为观察组(活动后)。2012年4—9月以"降低高渗性药物输液外渗和静脉炎的发生率"为主题开展品管圈活动。结果品管圈活动前后,高渗性药物输液外渗发生率由18.41%降为8.85%,静脉炎发生率由6.73%降为3.58%,差异有统计学意义(P0.05)。护士对高渗性药物的认知显著提高(P0.05)。活动后圈组成员在品管圈应用、团队精神、专业知识、沟通协调、活动信心与责任荣誉6个方面均有显著提高,差异有统计学意义(P0.05)。结论品管圈活动能降低高渗性药物输液外渗与静脉炎的发生,规范临床高渗性药物的输注,提高输液护理质量与安全。     

品管圈管理在降低高渗性药物输液外渗及静脉炎中的应用

目的 探讨品管圈管理在降低高渗性药物输液外渗和静脉炎中的应用效果。方法：采取方便抽样方法,选取2012年1-3月在某三级甲等综合医院老年科和神经外科病区接受高渗性药物输液的3623人次为对照组（活动前）;2012年10-12月在老年科和神经外科病区接受高渗性药物输液的3772人次为观察组（活动后）,成立品管圈管理活动小组,对开展品管圈管理活动前后的高渗性药物发生输液外渗及静脉炎情况进行比较分析。结果 品管圈活动后,高渗性药物中心静脉使用率由28.82%上升为55%,高渗性药物输液外渗发生率由18.41%降为8.85%,静脉炎发生率由6.73%降为3.58%,差异有统计学意义（P﹤0.01）。活动前后通过自制“圈员自我评估表”测评,圈组成员在品管圈应用、团队精神、专业知识、沟通协调、活动信心及责任荣誉6个方面均有显著提高,差异有统计学意义（P﹤0.01）。结论 品管圈活动能进一步规范高渗性药物的输液途径,降低高渗性药物输液外渗及静脉炎的发生,提高团队成员的个人能力。     

高渗性药物临床输液途径的现况调查及影响因素分析

目的通过对临床高渗性药物输液途径现况的调查,分析影响患者输液途径选择的因素。方法采用方便抽样的方法选择在我院老年科和神经内科需输注高渗性药物的住院患者600例,采用自行设计的问卷,调查目前临床高渗性药物的输液途径现状,并分析相关影响因素。结果在调查的600例需输注高渗性药物的住院患者中,使用中心静脉途径的只有32．5％,使用外周静脉途径的占67．5％;患者输液途径的选择虽受年龄、文化程度、所在科室、输液途径教育指导及自费等因素影响较大;然而护士的认知及技能和医生的支持度也是不容忽视的。结论针对目前临床高渗性药物的输液途径现状,加强对患者输液知识的健康教育,提倡个体化选择,同时护理管理者应加大管理力度,重视输液知识的培训及掌握经外周插管的中心静脉导管（PICC）技术,降低医疗成本,最大限度提高患者治疗的安全性和舒适性,真正提高输液的品质。     

高渗性药物临床输液途径的调查与分析

目的通过对临床高渗性药物输液途径的现况调查,分析发生相关并发症的原因。方法选择2009年8月—2010年8月在上海交通大学附属第六人民医院老年科和神经内科接受输注高渗性药物的住院患者600例,采用自行设计的问卷调查,内容包括临床高渗性药物的输液途径现状和护士对高渗性药物的认知情况。结果 600例患者中,使用中心静脉途径的占32.5%,使用外周静脉途径的占67.5%;外周静脉输液并发症的发生率为37.1%,中心静脉输液并发症的发生率为6.6%,两组比较差异有统计学意义(P<0.001);护士对高渗性药物的认知处于中等水平。结论高渗性药物经中心静脉输液可显著减少输液相关并发症的发生和重复静脉穿刺的次数,最大限度提高患者治疗的安全和舒适,同时,需重视输液知识的培训,提高护士的认知状态,有利于临床输液的质量与安全。     

1例小儿室间隔缺损封堵术后强刺激性药物渗漏的护理体会

正静脉输液是临床上常用的一种给药途径,若药物外渗于血管周围组织,将可造成不同程度的组织损伤,若渗液属于强刺激性药物,则可能造成严重的组织坏死,给患者带来极大的痛苦~([1])。因此,在临床护理工作中,提高病情观察和判断能力的同时,预防和减少输液渗漏的发生尤为重要。一旦发生渗漏,特别是强刺激性药物的渗漏,积极有效的处理可有效降低对患者     

老年肝硬化患者静脉输液并发症82例原因分析及护理

目的:探讨老年肝硬化患者在静脉输液时如何避免并发症发生.方法:回顾性地分析2 a内82例老年肝硬化患者在静脉输液治疗中出现并发症的原因.结果:82例老年肝硬化患者静脉输液时有51例(62.19%)出现渗漏性损伤,20例(24.39%)发生静脉炎,7例(8.53%)出现输液反应.结论:由于老年患者血管壁薄,静脉输液后易出现渗漏性损伤,护理人员在为老年患者输液操作时应谨慎,勤于观察,拔针后延长局部按压的时间,减少渗漏性损伤的发生.     

六神丸蜂蜜膏外敷治疗高渗性药物静脉外渗的临床观察和护理

当前,静脉输液领域不断发展,但输液前对药物渗透压、pH值等因素进行综合评估尚未成为规范,静脉输液相关并发症的发生多见[1]。高渗性药物是指药物渗透压＞450 mOsm/L的的药物。输液外渗是指输液过程中输入的药液漏出或渗浸在静脉以外的皮下组织中。静脉输注高渗性药物时药液外渗易刺激静脉和皮下组织,造成局部血管损伤、静脉炎、膜间室综合征等不良反应,甚至导致肢体功能障碍,同时也增加了患者心理压力和经济负担[2,3]。我们采用六神丸蜂蜜膏外敷治疗高渗性药物静脉外渗,取得良好的疗效.     

老年患者77例静脉输液及并发症的护理

回顾性地分析2005年11月～2008年12月收治的77例老年患者在输液治疗中出现输液并发症的原因及护理措施。结果77例老年患者静脉输液时有43例（55.8%）出现渗漏性损伤,18例（23.4%）发生静脉炎,11例（14.3%）发生输液反应。认为老年患者血管壁薄,静脉输液后易出现渗漏性损伤,护理人员在为老年患者输液时应谨慎操作。合适的护理可有效减少老年患者输液并发症,提高输液安全性,增加老年住院患者的满意度。     

老年患者77例静脉输液及并发症的护理

回顾性地分析2005年11月～2008年12月收治的77例老年患者在输液治疗中出现输液并发症的原因及护理措施.结果77例老年患者静脉输液时有43例(55.8%)出现渗漏性损伤,18例(23.4%)发生静脉炎,11例(14.3%)发生输液反应.认为老年患者血管壁薄,静脉输液后易出现渗漏性损伤,护理人员在为老年患者输液时应谨慎操作.合适的护理可有效减少老年患者输液并发症,提高输液安全性,增加老年住院患者的满意度.     

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.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.