真空静脉采血针头拔出方式对患者及操作者的影响

目的比较真空静脉采血针头拔出方式对患者及操作者的影响。方法随机选取2016年5月-2018年5月于复旦大学附属华山医院北院护理部进行真空静脉采血的患者1 000例,按照随机数表法,分为试验组和对照组,每组500例。采血完成后,试验组采用右手食指和拇指握针翼下针梗拔针,并增加左手握真空管顺延采血针中间软管螺旋状帮助复位的动作。对照组仅采用右手食指和拇指握针翼拔针的拔出方案。比较两组患者在两种拔针方案下拔针后针头滴血情况、污染操作者的手的次数、拔针时操作者手指触碰穿刺部位的次数、3 d后电话随访患者穿刺部位皮下瘀血的情况。结果试验组患者在拔针后出现的针头滴血2例、污染操作者的手3次、拔针时操作者手指触碰穿刺部位7次、3 d后电话随访穿刺部位皮下瘀血5次,均较对照组少,试验组患者出现疼痛反应26次,较对照组112次少,试验组患者血液反流7次,较对照组41次少,试验组患者使用其拔针方案拔针时护士职业暴露3次,较对照组17次少,差异均有统计学意义(P<0.05)。结论使用右手食指和拇指握针翼下针梗拔针,左手握真空管顺延采血针中间软管螺旋状复位,右手中指和拇指拔出真空管针头的拔出方案可以降低患者针头滴血情况,皮下瘀血、血液反流情况得到改善,护士职业暴露比例降低。     

批量体检采血拔针后两种按压方法的临床分析

目的探讨一种新的静脉采血拔针后的按压方法，以减少出血及皮下淤血。方法将1900例需要进行静脉采血的学生随机分2组，实验组950例：用消毒棉球大面积按压法（食指、中指、无名指3指并排横向，将针眼上下2—3cm全部压住，拔针时尽量不外加压力，拔针角度与皮肤保持平行，出针既加压，按压时间5min）。对照组。950例；常规用棉签小面积按压，只按压针眼，时间同实验。结果实验组出血，皮下淤血的发生率均明显少于对照组（P〈0．01），差异具有统计学意义。结论此方法确实有效，使被采血者的血管得到保护，减轻了疼痛，并且减小了其他学生的恐惧心理。     

Nurses failure to appreciate the risks of infection due to needle stick accidents: a hospital based survey.

One of the most important occupational risks to healthcare workers is exposure is to blood-borne viruses. This study examined nurses' perceptions of risk of contracting infection following single or multiple exposure to blood or body fluids. Two hundred and ninety nurses were surveyed using a questionnaire. One hundred and thirty-three responded; 85 worked in higher risk areas (ITU, Haematology, Haemodialysis and Neonatal Surgical Units) (Group A) and 48 worked in lower risk areas (medical wards, an orthopaedic and an ENT ward) (Group B). Forty-nine percent of subjects from group A and 60% of subjects from Group B believed that a needle stick injury with a needle contaminated with infected blood was an unlikely source of infection. Fifteen percent from group A and 20% from group B thought that infection with a blood-borne virus following a needle stick injury contaminated with Human Immunodeficiency Virus (HIV) infected blood was very unlikely. Twelve percent from group A and 10% from Group B did not know whether resheathing needles between use can provide protection against HIV. Sixty-seven percent from group A and 71% from group B disagreed with the statement that nurses are at higher risk of exposure to HIV/HBV than the other healthcare workers. Thirteen percent from group A and 5% from group B agreed with the statement, whereas 8% from group A and 5% from group B thought that nurses are at less risk. Only 22% from group A and 23% from group B would take more precautions if they knew that the patient had HIV/HBV infection, whilst 11% and 8% respectively admitted that they would take special precautions only when the patient has clinical symptoms of HIV/HBV infection. The findings suggest that these nurses would benefit from further education regarding infection from blood-borne viruses.     

不同采血针对新生儿足跟采血成功率的影响

目的：探讨不同采血针在新生儿疾病筛查采血中的采血效果。方法：采用三种采血针分别对2126例（A组）、1786例（B组）、1471例（C组）新生儿进行足跟采血，比较其采血成功率。结果：A、B、C三组之间差异有统计学意义（P〈0．01）。结论：采用7号一次性注射针头采血（C组）可明显提高采血成功率。     

静脉留置针持续骶麻复合丙泊酚镇静在婴幼儿脐以下手术中的应用

目的探讨婴幼儿脐以下手术使用骶管持续阻滞并丙泊酚持续镇静的效果及安全性。方法选5个月～3岁、行脐以下手术的婴幼儿40例,随机分两组:持续骶麻复合丙泊酚辅助组(A组,n=20)和氯胺酮丙泊酚复合静脉全麻组(B组,n=20)。在基础麻醉后:A组用静脉留置针行骶管穿刺胶布固定留置,0.8%～1.2%的利多卡因持续阻滞,丙泊酚4～6 mg/(kg.h)静脉辅助镇静;B组用氯胺酮丙泊酚混合液(1∶1)按氯胺酮30～50μg/(kg.min)微泵持续注射。记录并比较两组患儿麻醉诱导前、麻醉诱导后、切皮时、术中、术毕血压(BP)、心率(HR)、呼吸(R)和血氧饱和度(SpO2),苏醒时间及不良反应。结果两组患儿生命基础值间无显著性差异(p>0.05),B组的MBP在诱导至术毕间各时段及HR、R在切皮、术中术毕均有显著性升高(p<0.05),而A组则相对较为平稳;A组的苏醒时间和不良反应明显少于B组(p<0.01)。结论静脉留置针行持续骶麻复合丙泊酚镇静在婴幼儿脐以下手术中效果确切,麻药用量少,苏醒时间短,并发症少,安全可靠,值得推介。     

妊娠期糖尿病不同血糖水平孕妇的临床特点与妊娠结局分析

目的探讨妊娠期糖尿病(gestational diabetes mellitus,GDM)不同血糖水平孕妇的临床特点与妊娠结局。方法选择2013年1月至2015年3月在山东省单县东大医院行产前检查并住院分娩的GDM孕妇150例,依据75g葡萄糖耐量试验(75g oral glucose tolerance test,75 g OGTT)各时点血糖结果,以其中1项血糖水平异常为GDM A组,2项血糖水平异常为GDM B组,3项血糖水平均异常为GDM C组。对3组孕妇的临床特点和妊娠结局进行分析。结果 GDM C组孕前体质量指数(body mass index,BMI)和肥胖率(26.2±4.8、36.0%)均明显高于GDM B组(24.3±3.8、17.6%)和GDM A组(24.3±3.8、2.7%)(P0.05)。GDM C组胰岛素使用率(24.0%)明显高于GDM B组(3.9%)和GDM A组(1.3%)(P0.05)。GDM C组空腹胰岛素、胰岛素抵抗指数(21.2±4.9、6.1±2.0)明显高于GDM B组(18.6±5.1、4.2±1.1)和GDM A组(13.2±3.3、2.8±0.8)(P0.05)。GDM C组巨大儿发生率(44.0%)明显高于GDM B组(15.6%)和GDM A组(13.5%)(P0.05)。结论 OGTT血糖多点异常的GDM患者与多项危险因素呈显著相关性,临床上应根据OGTT异常情况进行分层管理,积极干预。     

Relationship between cord blood atherogenic index and birth weight in preeclampsia

The present study was designed to analyze cord blood atherogenic index (AI) in newborns of normal pregnant and preeclamptic subjects and to correlate them with birth weight and maternal AI. The study consisted of 50 healthy pregnant women (Group I: controls) and 50 women with preeclampsia. Ten milliliter cord blood was collected from placental end of umbilical cord and 5 ml of maternal venous sample was drawn from antecubital vein at the time of delivery. Serum was separated by centrifugation and Apo A-I and Apo B levels were analyzed by immunoturbidimetric Immunoassay kits. AI was calculated as ratio of Apo B to Apo A-I. Apo B levels were significantly elevated in Group II in both cord blood and maternal blood as compared to Group I (p < 0.001). Apo A-I levels were lower in maternal blood and higher in cord blood of group II. In maternal blood, AI was higher in Group II as compared to Group I (p < 0.001). In group I, a significant positive correlation was observed between cord blood AI and birth weight and values being higher in males. In group II, a significant negative correlation observed between cord blood AI and birth weight was higher in females.     

真空静脉采血针的临床应用研究进展

当前,最常使用的采血技术为真空采血技术,这也是目前医疗领域中最先进的采血技术。一次性真空静脉采血针也可以称之为双向无菌针,主要由三个部分组成,分别是穿刺针、软管还有集血针。真空采血技术的操作极为便捷,不会给患者带来过多的痛苦,且因工作效率高和污染小等特征广泛应用于医疗领域。另外,利用真空静脉采血针进行采血时,不会对采血量进行过多的限制,保护了操作者的安全。基于此,文章主要就真空静脉采血针的临床研究进行了分析与探讨。     

强化健康教育对冠心病合并高血压患者血压的影响

目的探讨强化健康教育对冠心病合并高血压患者血压的影响。方法选择经冠状动脉造影术确诊为冠心病或已住院确诊为急性心肌梗死(AMI)且合并高血压的患者177例,分为A、B两组,分别给予强化健康教育(98例)和一般健康教育(79例),在出院后3、6、12月随访血压水平。结果6个月和12个月时,A组患者的收缩压和舒张压均显著低于B组(P<0.05);A组服用降血压药物的比例、血压控制正常比例以及合理饮食的比例均高于B组(P<0.01),坚持锻炼的时间长于B组(P<0.01)。结论经过强化教育能够提高患者对降血压药物的依从性,并能促进患者坚持锻炼和合理的饮食,从而促进患者有效地控制血压。     

三种终止早期妊娠方法的临床分析比较

目的：通过对药流、负压吸引术和药物联合负压吸引术3种终止早期妊娠的方法进行临床分析比较,探讨门诊安全有效、副作用小的终止早期妊娠方法。方法：对妊娠7~12周健康孕妇共309例采取药物流产、负压吸引术及药物联合负压吸引术,对患者流产成功率、阴道出血时间、疼痛感进行观察比较。结果：药流、负压吸引术与药物联合负压吸引术三组比较,差异有显著性意义。结论：药物联合负压吸引术更安全有效,痛苦小且副作用相对少,值得推广。     

Teaching medical history-taking: a comparison between the use of audio- and videotapes

The efficacy of audiotape was compared with that of videotape as a way of teaching students the essentials of the medical interview. Two consultants--a general physician and a neurologist--were videotaped as they took histories from two patients. The neurologist described his methods and summarized his findings, but his interview was conducted conventionally without interruptions (continuous interview). In a contrasting style, the general physician frequently explained his methods and findings in steps, interrupting his interview to do this (discontinuous interview). Fifty students starting their main medical term were divided into two groups (A and B). Group A was shown the videotape of the discontinuous interview while group B was played an audiotape of that interview. Groups A and B were then crossed over, but this time group A was allowed only to hear the audiotape of the continuous interview, while the videotape of it was played to group B. After each tape the students were tested on its content. There was no significant difference between the mean scores of Group A and Group B when tested on the discontinuous interview and both groups scored well. For the continuous interview the group who saw the videotape scored significantly better than the group who only heard this tape. Both groups scored significantly better in the test based on the discontinuous interview than they did in the test based on the continuous interview. The results indicate that videotapes are a good medium for teaching history-taking, but also suggest that audiotape recordings of medical history-taking can be effective teaching aids if the interview is explained in stages.     

一次性真空采血与一次性空针采血的临床比较

目的对一次性真空采血方法进行探讨,以指导临床工作。方法在学校的新生体检中,采取分组的形式,就一次性真空采血与一次性空针采血进行临床比较。结果一次穿刺成功率两者比较差异无统计学意义(u=1.59,p>0.05),但比较抽血时间、工作人员污染机率、血量合格人数,一次性真空采血优于一次性空针采血,差异均有统计学意义(p<0.05)。结论真空采血缩短了采血时间,提高检验效率,减少患者的痛苦,使护士在操作过程中减少与血样的过多接触,保证采血的安全,避免了交叉感染,值得大力推广。