压力传感器在乳腺癌改良根治术后皮下积液预防中的应用效果观察

[目的]探讨压力传感器在乳腺癌改良根治术后皮下积液预防中的应用效果。[方法]将106例乳腺癌改良根治术后病人随机分为对照组和观察组各53例,两组均应用弹性胸带加压包扎伤口,对照组护士根据临床经验调整胸带的松紧,以病人呼吸运动不受限为宜;观察组在病人胸带下胸骨旁位置放置压力传感器,护士根据显示器上的数值,调整胸带松紧。比较两组病人皮下积液发生率、积液时间、皮瓣坏死发生率、平均日引流量、拔管时间、住院时间及病人满意度。[结果]两组病人皮下积液发生率、皮瓣坏死发生率、积液时间、住院时间及病人满意度比较差异均有统计学意义(P0.05或P0.001)。[结论]应用压力传感器有效控制胸带压力,有助于预防乳腺癌改良根治术后皮下积液的发生。     

自制胸带用于乳腺癌改良根治术后皮下积液的效果观察

目的 探讨自制胸带在乳腺癌改良根治术后加压包扎,防止术后皮下积液的应用效果.方法 选择2006年3月-2008年2月收治的乳腺癌患者70例,随机分为对照组和观察组各35例.观察组使用自制胸带加压包扎;对照组使用传统绷带加压包扎.观察2组患者引流管引流量、皮下积液和皮瓣坏死情况等.采用X2检验和t检验.结果 观察组皮下积液和皮瓣坏死的发生率较对照组显著降低,切口Ⅰ期愈合率显著高于对照组.结论 自制胸带在乳腺癌改良根治术后加压包扎可以降低皮下积液和皮瓣坏死的发生率.     

自制胸带用于乳腺癌改良根治术后皮下积液的效果观察

目的探讨自制胸带在乳腺癌改良根治术后加压包扎,防止术后皮下积液的应用效果。方法选择2006年3月-2008年2月收治的乳腺癌患者70例,随机分为对照组和观察组各35例。观察组使用自制胸带加压包扎;对照组使用传统绷带加压包扎,观察2组患者引流管引流量、皮下积液和皮瓣坏死情况等。采用χ^2检验和t检验。结果观察组皮下积液和皮瓣坏死的发生率较对照组显著降低,切口Ⅰ期愈合率显著高于对照组。结论自制胸带在乳腺癌改良根治术后加压包扎可以降低皮下积液和皮瓣坏死的发生率。     

智能可控气囊胸带在乳腺癌改良根治术后患者中的应用

目的:探讨智能可控气囊胸带在乳腺癌改良根治术后伤口包扎中的应用效果。方法:将100例乳腺癌改良根治术患者随机分为实验组和对照组各50例,实验组采用智能可控气囊胸带包扎,对照组采用弹力绷带包扎,比较两组效果。结果:实验组皮下积液、皮瓣坏死发生率、拔管时间、引流量与对照组比较均有统计学意义(P0.05)。结论:采用智能可控气囊胸带加压包扎在减少术后引流量、缩短置管时间及降低并发症发生率方面优于弹性绷带,值得推广应用。     

改良结构性胸带加压包扎法在乳腺癌根治术后的应用

目的:探讨改良结构性胸带加压包扎法在乳腺癌根治术后的应用效果.方法:将94例乳腺癌患者随机分为两组,观察组52例采用改良结构性胸带加压包扎,压力值设定在4.0kPa;对照组42例采用传统胸带加压包扎,压力为3.0～6.7kPa,观察两组的临床效果并比较.结果:观察组皮下积液、皮瓣坏死的发生率、拔管时间、引流量与对照组比较均有显著性差异(P<0.05),切口一期愈合率与对照组比较有极显著性差异(P<0.01).结论:对乳腺癌根治术后患者采用改良结构性胸带加压包扎法,可减少并发症的发生,促进切口愈合,缩短住院时间.     

肩肘约束带用于乳癌术后预防皮下积液的效果观察及护理

目的探讨肩肘部约束带用于乳腺癌改良根治术后防止皮下积液的效果。方法选择2010年3～10月乳腺癌改良根治术后162例患者,随机分为对照组和实验组,对照组采用传统单纯胸带加压包扎,观察组除胸带加压包扎外另加肩肘部约束带,观察两组创腔引流量,拔管时间及患肢功能恢复情况。结果实验组创腔引流量明显少,引流管置管时间短,患肢恢复良好,两组比较差异有显著意义（P〈0.05）。结论乳腺癌改良根治术后患者加用肩肘部约束带可有效防止皮下积液的发生,利于切口愈合,促进康复。     

两种负压引流装置用于乳腺癌术后引流效果的比较

目的:比较两种负压引流装置用于乳腺癌术后引流的效果。方法:96例行乳腺癌根治术或乳腺癌改良根治术患者分为两组:实验组和对照组,每组48例。实验组采用自制的负压引流装置行负压引流;对照组采用一次性负压引流器行负压引流。并观察两组患者皮下积液和伤口愈合时间情况。结果:实验组的皮下积液发生率为8.3%,明显低于对照组的25.0%(P<0.05),实验组和对照组伤口愈合时间分别为(14.9±2.5)d和(16.8±4.4)d,两组比较,差异有统计学意义(P<0.05)。结论:自制的负压引流装置对乳腺癌术后患者伤口进行负压引流,能使手术创面充分引流,明显降低并发症的发生,缩短伤口愈合时间。     

乳腺癌改良根治术后伤口皮下积液45例护理体会

目的:探讨乳腺癌根治术后伤口皮下积液的护理方法。方法:将90例行乳腺癌根治术的患者随机分为实验组与对照组各45例。对照组按乳腺癌一般护理常规护理;实验组除按乳腺癌一般护理常规护理外,增加针对性护理干预。结果:实验组术后伤口皮下积液发生率明显低于对照组,两组比较有显著性差异(P<0.05),引流管拔管时间明显早于对照组,两组比较有显著性差异(P<0.01)。结论:针对性护理可降低乳腺癌根治术后伤口皮下积液发生率,缩短伤口引流管留置时间,减轻患者痛苦,提高患者生活质量。     

胶原蛋白海绵在乳腺癌改良根治术中的应用效果观察

目的探讨胶原蛋白海绵在乳腺癌改良根治术中应用的价值。方法将156例乳腺癌患者随机分成两组,对照组术后常规采取加压包扎持续负压引流,实验组则联合使用胶原蛋白海绵,分别观察两组置管时间、皮下积液和皮瓣坏死的发生率。结果实验组的置管时间(4.8±1.3)d明显短于对照组(6.3±2.7)d,有显著性差异(P<0.01),实验组皮下积液和皮瓣坏死的发生率分别为1.3%和2.6%,明显少于对照组的10.3%和11.5%,有显著性差异(P<0.05)。结论在乳腺癌改良根治术后引流管持续负压引流联合应用胶原蛋白海绵可缩短置管时间,减少皮下积液和皮瓣坏死的发生率。     

Drainobag真空高负压引流瓶在老年乳腺癌术后引流中的应用研究

目的对老年人乳腺癌术后Drainobag真空高负压引流技术的治疗效果进行研究。方法将2009年3月至2013年12月收治乳腺癌改良根治术120例,随机分为实验组和对照组。实验组65例,应用Drainobag真空高负压引流技术进行引流。对照组55例,使用传统负压引流瓶引流。分析两组术后皮下积液、皮瓣缺血坏死和并发症情况。结果实验组皮下积液与皮瓣坏死发生率均显著低于对照组,差异有统计学意义(P0.05)。实验组轻度皮肤损伤的发生率低于对照组,差异有统计学意义(P0.05)。结论改良乳腺癌根治术后应用Drainobag真空高负压引流技术可减少皮下积液和皮瓣缺血坏死的发生。     

Intracranial pressure. Intracranial pressure monitoring

Based on the data on the current literature, the authors present the basic physiological and pathophysiological aspects of measurement of intracranial pressure and discuss indications for its monitoring and clinical value.     

Plasma osmotic pressure and oncotic pressure

Water distribution in the body fluid is controlled by osmotic pressure and oncotic pressure of plasma. Lower plasma osmotic pressure induces intracellular edema, while lower plasma oncotic pressure induces extracellular edema. The increase in osmo-active substance in plasma induces increase in plasma volume (or extracellular fluid), and then results in extracellular edema.     

Systolic pressure variation and pulse pressure variation during modifications of arterial pressure

OBJECTIVE: This study was performed to investigate the effect of vasopressor therapy on systolic pressure variation (SPV) and pulse pressure variation (PPV) compared to experimentally measured left ventricular stroke volume variation (SVV). DESIGN AND SETTING: Prospective study in a university laboratory. SUBJECTS: Twelve anesthetized and mechanically ventilated pigs. INTERVENTIONS: Increase in mean arterial pressure (by 100%) using phenylephrine and decrease (by 38%) using adenosine. MEASUREMENTS AND RESULTS: SPV and PPV were calculated and compared to SVV derived from aortic blood flow measurements. SPV was significantly affected by changes in arterial pressure [4.6% (1.5) vs. 6.3% (2.1), p[Symbol: see text]<[Symbol: see text]0.05, increased vs. decreased arterial pressure], whereas PPV did not change during modifications of arterial pressure. During baseline conditions and decreased afterload, correlation with SVV was good both for SPV (r[Symbol: see text]=[Symbol: see text]0.892 and r[Symbol: see text]=[Symbol: see text]0.859, respectively) and for PPV (r[Symbol: see text]=[Symbol: see text]0.870 and r[Symbol: see text]=[Symbol: see text]0.871, respectively) (all p[Symbol: see text]<[Symbol: see text]0.001). Correlation with SVV was only moderate during increased arterial pressure (r[Symbol: see text]=[Symbol: see text]0.683 for SPV and r[Symbol: see text]=[Symbol: see text]0.732 for PPV, p[Symbol: see text]<[Symbol: see text]0.05). CONCLUSION: For guiding fluid therapy in patients under vasopressor support, PPV seems superior to SPV.     

Pulmonary artery pressure versus pulmonary capillary wedge pressure and central venous pressure in shock

Evidence is presented from 43 dogs and 30 patients that under conditions of severe hemorrhagic, traumatic or septic shock, there may be partial obstruction of the pulmonary microcirculation due to disseminated intravascular coagulation (DIC) particularly in the pulmonary venules. This may cause the left atrial pressure to fall and the pulmonary artery pressure to rise, in some cases drastically. Pulmonary edema may result. This dangerous rise in pulmonary artery pressure is not reflected by the wedged pulmonary artery catheter which will monitor only the status of the left heart. Central venous pressure (CVP) may remain within normal limits even after pulmonary artery pressure has risen to dangerous levels with the development of pulmonary edema. It is only with right ventricle failure against the high pulmonary pressure that CVP rises. It is concluded that pulmonary artery pressure measurements are very important in monitoring intravenous fluid administration in severe shock. Wedged pulmonary artery pressures monitor the left heart but may be misleading if taken alone. Central venous pressure gives a delayed response to fluid overload.     

Intracranial pressure and cerebral perfusion pressure in near-drowning

Intracranial pressure (ICP) and cerebral perfusion pressure (CPP) were strictly controlled in 11 pediatric victims of near-drowning. Three outcome groups were defined: complete recovery, persistent vegetative state, and death. In the early postimmersion phase (first 72 h), CPP was consistently above 50 mm Hg in all patients. There were occasional, nonrepetitive, and easily controllable ICP spikes above 15 mm Hg in three patients from each group. Repeated ICP spikes above 15 mm Hg were observed in some patients with adverse outcome only after 72 h. Successful control of ICP and CPP did not ensure intact survival, and sustained late intracranial hypertension is more likely a sign of profound neurologic insult rather than its cause.     

Heel pressure ulcers and ankle brachial pressure index

There is a substantial body of literature that emphasises the importance of measuring ankle brachial pressure index (ABPI) as part of an holistic assessment for leg ulcers (Scottish Intercollegiate Guideline Network, 1998). However, there is a paucity of research-based evidence to indicate the importance of measuring ABPI as part of an holistic assessment for patients who develop pressure ulcers on their heels. (ABPI is a simple, non-invasive method of identifying arterial insufficiency within a limb.) The importance of identifying the presence of peripheral vascular disease (PVD) in patients who develop pressure ulcers on their heels is discussed, as is the argument for measuring ABPI as part of an holistic assessment for heel ulceration before planning the wound management.     

Effect of positive end-expiratory pressure on intra-abdominal pressure

Massive elevation of intra-abdominal pressure (IAP) causes renal, cardiovascular, and respiratory dysfunction. Positive end-expiratory pressure (PEEP) markedly increases the detrimental effect of IAP on the cardiovascular system. The purpose of this study was to determine the effect of PEEP on IAP. In 15 patients requiring mechanical ventilation, IAP was measured, after 15-minute equilibration intervals, at PEEP levels of 0, 5, 10, and 15 cm H2O. Parametric analysis with multiple paired t tests and nonparametric analysis with Spearman's rho and Kendall's tau tests were used to determine correlation between PEEP and IAP. All patients were male. The mean age was 39 years (range, 18-77). Ten patients had just had laparotomy. No correlation was found between PEEP and IAP. We conclude that PEEP of 15 cm H2O or less has no effect on IAP, and we discuss the clinical implications.     

Positive end-expiratory pressure increases intraocular pressure in cats

BACKGROUND AND METHODS: The purpose of the present study was to examine the effect of various levels of positive end-expiratory pressure on intraocular pressure in cats. Fourteen healthy adult cats (2.6 to 3.7 kg) without evidence of ocular disease were anesthetized with pentobarbital, paralyzed, and placed on mechanical ventilation. Direct continuous measurements of heart rate (HR), mean arterial pressure (MAP), CVP, CSF pressure, and intraocular pressure were recorded at zero end-expiratory pressure, and at 5, 10, and 15 cm H2O positive end-expiratory pressure, applied in random order. MAIN RESULTS: There were no significant changes in pHa, Paco2, HR, MAP, hematocrit, and temperature. Intraocular pressure increased significantly from 17 (during zero end-expiratory pressure) to 20 mm Hg at 10 cm H2O positive end-expiratory pressure; at 15 cm H2O positive end-expiratory pressure, intraocular pressure increased significantly to 21 mm Hg. CVP and CSF pressure increased significantly in parallel with intraocular pressure at 5, 10, and 15 cm H2O positive end-expiratory pressure. CONCLUSIONS: We speculate that similar responses occur in man, and may be undesirable in patients with already increased intraocular pressure, when higher levels of positive end-expiratory pressure are used.