经骨髓输液在抢救创伤失血性休克中的临床研究

目的研究经骨髓输液在抢救创伤失血性休克过程中的可行性和有效性,探讨急诊抢救输液的新方法。方法选择创伤失血性休克268例,随机分为经骨髓输液和经静脉输液两组。静脉穿刺困难的立即行经骨髓穿刺输液,对照组经静脉常规穿刺置管输液。结果两组输液后在血压回升的时间和输液的速度上差异无统计学意义(P>0·05),但在建立输液通道所用的时间上,经骨髓输液组较静脉输液组明显缩短。结论在抢救创伤失血性休克中,经骨髓输液是静脉穿刺困难患者的替代方法,不但安全、迅速、有效,而且便于在院前急救和基层医院开展。     

危重患者快速建立深静脉通路的临床研究

目的探索使用改进后的浅静脉留置针快速建立深静脉通路的临床应用。方法将浅静脉留置针进行改进成为深静脉留置针,用改进后的浅静脉留置针进行深静脉穿刺置管。选取本院50例中心静脉置管患者作为对照组,深静脉留置针进行深静脉置管患者52例作为观察组,两组就操作时间进行对比研究。结果颈内静脉穿刺置管法:对照组17例,平均用时(25.7±2.5)min,观察组19例,平均用时(7.5±1.9)min;锁骨下静脉穿刺置管法:对照组21例,平均用时(24.8±3.6)min,观察组22例,平均用时(7.2±2.0)min。股静脉穿刺置管方法:对照组12例,平均用时(23.7±3.1)min,观察组11例,平均用时(6.8±1.8)min。以上指标两组对比均具有统计学意义(P0.05)。结论使用改进后的浅静脉留置针进行深静脉置管,可大大缩短操作时间,建立有效静脉通路,尽快开通生命通道,具有临床实用价值。     

快速骨髓腔穿刺输液在创伤性休克患者院前急救中的应用

目的探讨快速骨髓腔穿刺输液在创伤性休克患者院前急救中的应用。方法选取2016年1月至2017年12月院前急救中遇到的创伤性休克患者60例,并按输液方式的不同等分为常规静脉输液组和骨髓腔穿刺输液组。观察两组患者建立有效输液通道的时间、输液速度、血压回升所需时间、抢救有效率及并发症发生率。结果快速骨髓腔穿刺输液组建立有效输液通道所用时间明显短于常规静脉输液组,差异有统计学意义(P0.05);快速骨髓腔穿刺输液组并发症发生率低于常规静脉输液组,但差异无统计学意义(P0.05);快速骨髓腔穿刺输液组抢救有效率明显高于常规静脉输液组,差异有统计学意义(P0.05)。结论创伤性休克患者在院前急救中采用快速骨髓腔穿刺输液可有效缩短静脉通道建立时间,提高抢救有效率,临床应用效果较优。     

经骨髓腔输注高渗盐水治疗创伤失血性休克的临床研究

目的:探讨经骨髓腔输注3%高渗盐水在创伤失血性休克患者早期液体复苏中的应用。方法:2015-04-2016-02将47例创伤失血性休克患者分为骨髓腔通路组(IO组)和外周静脉通路组(IV组),使用3%高渗盐进行液体复苏,对比2组患者建立通道时间、液体复苏前及之后30、60min时平均动脉压、血压、心率、电解质变化,观察治疗期间不良反应、后期MODS及病死率情况。结果:IO组建立输液通路时间显著性少于IV组(P0.01),2组在液体复苏后30min升压效果达到峰值,但2组间各时间点血压回升差异无统计学意义,2组均未见明显不良反应,2组在液体复苏前后电解质改变及MODS、病死率差异无统计学意义。结论:在创伤失血性休克患者早期液体复苏中经骨髓腔通路与外周静脉通路输注3%高渗盐水均有助于提高和维持血压,但经骨髓腔通路输液更迅速、方便,是建立危重患者急救液体通道的可行方法。     

经骨髓通路输液在失血性体克矿工院前急救中的应用

目的 研究经骨髓输液对失血性休克矿工院前急救的可行性和有效性.方法 选择失血性休克矿工32例,分为经外周静脉通路输液和经骨髓通路输液两组.结果 两组在输液后在输液的速度和血压回升的时间上没有显著差别,但在建立输液通道所用的时间上,经骨髓输液组明显比经外周静脉通路组缩短.结论 对失血性休克矿工的院前急救中,经骨髓通路输液安全、迅速、有效.     

三种静脉输液排气法的应用比较

目的探寻排气一次成功率最高、用时最短、平均损失液量最少的静脉输液排气法。方法对护理专业本科、大专、中专《护理学基础》教材介绍的三种静脉输液排气方法各选取50例输液患者从一次性排气成功率、平均排气时间、平均损失液量三方面进行实验与比较。结果中专护理教科书介绍的静脉输液排气法成功率达94%,平均排气时间10.10±0.82s,平均损失液量0.33ml。结论中专教科书中介绍的排气法可明显提高护理工作效率,节省操作时间,降低损失药液量,确保输入药物的有效剂量和浓度。     

骨髓腔内输液技术在急危重症患者抢救中的应用进展

在急危重症患者抢救时,当外周静脉系统塌陷、外周静脉通路难以建立或中心静脉置管时间太长时,可以通过骨髓腔内输液通路迅速建立补液途径,骨髓腔内输液技术已渐渐应用于多种急危重症的抢救。在抢救急危患者尤其心搏骤停的患者,骨髓腔输液建立抢救输液通路速度快操作简单,在急诊抢救中骨髓输液渐渐成为一种替代静脉通路的紧急输液通路。本文对骨髓腔输液的种类、骨髓腔输液和其余输液装置的比较以及骨髓腔输液在急危重症中的应用进行综述。     

介绍一种快速静脉输液简易加压方法

快速静脉输液是临床应用很广的治疗、抢救方法之一,如颅内高压要静脉输入甘露醇,抢救失血性休克病人时,需要快速静脉输入液体补充血容量等。而快速静脉输入通常需要加压,一般的加压方法是选用20ml或30ml的一次性注射器和一次性的针头,反复穿刺瓶塞打入气体而达到加压作用,但往往会因为注气压力大或反复穿刺瓶塞致使液体从瓶塞穿刺处或加压所用的针头处漏出,造成药物浪费或加压失败,而使用简易加压方法后,可克服以上的缺陷及不足。现将制作方法介绍如下。     

硝酸甘油联合山莨菪碱涂擦对急诊静脉穿刺成功率的影响

目的:探讨硝酸甘油联合山莨菪碱涂擦在提高急诊患者静脉穿刺成功率中的应用及临床效果。方法:将119例急诊静脉输液患者随机分为观察组65例和对照组54例,对照组按常规穿刺,观察组穿刺前局部涂擦硝酸甘油加山莨菪碱混合药液,反复涂擦1 min,见血管扩张后再按常规穿刺。比较两组患者浅静脉充盈程度、一次穿刺成功率、静脉穿刺所需时间;比较观察组患者涂药前后1 min心率变化情况。结果:两组患者浅静脉充盈程度、一次穿刺成功率、静脉穿刺所需时间比较差异有统计学意义(P<0.01);观察组患者涂药前后1 min心率变化比较差异无统计学意义(P>0.05)。结论:硝酸甘油联合山莨菪碱涂擦局部能提高急诊静脉穿刺成功率,为抢救患者赢得时间,且操作简便、安全,值得推广应用。     

休克性肺炎加压输液的体会

休克性肺炎是内科急症之一.我们根据休克指数将液体总量的2/3经加压输液及其他合理治疗,使病人转危为安。在加压输液过程中我们注意以下几点:①迅速建立两条静脉通路.②尽快补充血容量,在前2小时内应达1000～2000ml.应用密闭式输液,开始     

Endotracheal epinephrine is unreliable

When intravenous access cannot be obtained in an emergency, the endotracheal route of emergency drug administration can be used for epinephrine, atropine, and lidocaine. Optimal drug dosages for endotracheal administration as well as the amount and type of diluent are presently unknown. We compared central intravenous, peripheral intravenous, intraosseous, and intratracheal administration of epinephrine 1:10,000 in both normotensive and hemorrhagic shock dogs. The shock model consisted of 50% blood volume depletion over 15 min. Epinephrine was administered in a dose of 0.01 mg/kg (0.1 cc/kg) by the intraosseous route, central, and peripheral intravenous routes followed by a 5 cc normal saline flush. Intratracheal administration consisted of epinephrine 0.01 and 0.02 mg/kg diluted 1:1 and 1:2 with normal saline or sterile water and administered deep into the tracheo-bronchial tree using a 30-cm catheter. The effect of epinephrine was assessed by the response of the arterial blood pressure. Epinephrine was equally effective by the intraosseous, central intravenous, and peripheral intravenous routes in terms of time to onset of action, time to peak effect, and magnitude of effect on systolic, diastolic, and mean arterial pressures in both the shock and non-shock animals. The duration of effect was significantly longer (P less than 0.02) for the intraosseous route of administration. The endotracheal route of administration was unreliable and not reproducible in either the normotensive or shock animals. In 8/12 episodes in normotensive animals, including 5 trials with double doses of 0.02 mg/kg and dilutions of 1:1 and 1:2, and in 4/9 studies with shock animals including three with double doses, there was no discernable response of systolic or diastolic blood pressure.     

骨髓腔输液在心搏骤停患者急救中的应用效果

目的探讨骨髓腔输液在心搏骤停患者急救中的应用方法及效果。方法采用便利抽样法选取2017年1月至2019年1月某院急诊科收治的96例心搏骤停患者为研究对象,按治疗先后分为观察组和对照组各48例,分别行骨髓腔输液和常规静脉输液,评价并比较两组患者建立有效通道的时间、首次给药时间及输液速度等。结果全部患者均成功建立有效的输液通道;观察组患者建立有效通道所花的时间、首次给药时间等均短于对照组,差异均有统计学意义(均P<0.05);两组患者的输液速度经比较,差异无统计学意义(P>0.05)。结论与常规外周静脉输液相比,骨髓腔输液能缩短心搏骤停患者穿刺所用的时间,实现快速给药,且输液速度未见明显降低,是一种安全可靠的快速输液通道,值得临床推广应用。     

Intima在肾综合征出血热患者输液中的应用

目的 研究Ｉｎｔｉｍａ在肾综合征出血热（ＨＦＲＳ）患者输液治疗中应用效果。方法 将ＨＦＲＳ患者随机分为两组,分另用Ｉｎｔｉｍａ和头皮针进行输液治疗。检测低血压休克期两组患者建立第二组静脉通道所需时间,检测两组患者 扫热期、少尿期、多尿期输液器乳头细菌污染数,统计两组病人液体渗漏例数,并将三组观察指标分别进行差异比较。结果 Ｉｎｔｉｍａ组较头皮针组可减少低血压休克抢救建立委塥和通道所需时间,消除输液     

Intravascular access in pediatric cardiac arrest

All cases of patients aged less than 48 months who presented in cardiac arrest to the Hennepin County Medical Center's emergency department (ED) during the years 1984 to 1986 were reviewed retrospectively. The ED record, initial and subsequent chest radiographs, hospital charts, and autopsy reports were analyzed. A total of 33 cases were reviewed. The average patient age was 5 months. The average time needed to establish intravascular access was 7.9 +/- 4.2 minutes. Success rates were 77% for central venous catheterization, 81% for surgical vein cutdown, 83% for intraosseous infusion, and 17% for percutaneous peripheral catheterization. Percutaneous peripheral catheterization, when successful, and bone marrow needle placement were the fastest methods of obtaining intravascular access. There were no major immediate complications, and delayed complications were minimal. Attempts at peripheral intravenous catheter placement should be brief, with rapid progression to intraosseous infusion if peripheral attempts are not successful.     

A comparative study of peripheral to central circulation delivery times between intraosseous and intravenous injection using a radionuclide technique in normovolemic and hypovolemic canines

Intraosseous infusion is considered a useful technique for administration of medications and fluids in emergency situations when peripheral intravascular access is unobtainable. This study examined the effectiveness of intraosseous infusion for delivery of substances to the central circulation. Central deliveries of a radionuclide tracer administered by the intraosseous and intravenous routes were evaluated during normovolemic and hypovolemic states. Intraosseous infusion achieved peripheral to central circulation transit times comparable to those achieved by the intravenous route. Analysis of variance revealed no statistically significant differences between the peripheral to central delivery times comparing intraosseous and intravenous administration. The results demonstrate that intraosseous infusion is a rapid and effective method of delivery to the central circulation and is an alternative method for intravascular access. This study also suggests that a radionuclide tracer is useful for the evaluation of transit times following intraosseous injection.     

Successful intraosseous infusion in the critically ill patient does not require a medullary cavity

OBJECTIVES: To demonstrate that successful intraosseous infusion in critically ill patients does not require bone that contains a medullary cavity. DESIGN: Infusion of methyl green dye via standard intraosseous needles into bones without medullary cavity-in this case calcaneus and radial styloid-in cadaveric specimens. SETTING: University department of anatomy. PARTICIPANTS: Two adult cadaveric specimens. MAIN OUTCOME MEASURES: Observation of methyl green dye in peripheral veins of the limb in which the intraosseous infusion was performed. RESULTS: Methyl green dye was observed in peripheral veins of the chosen limb in five out of eight intraosseous infusions into bones without medullary cavity-calcaneus and radial styloid. CONCLUSIONS: Successful intraosseous infusion does not always require injection into a bone with a medullary cavity. Practitioners attempting intraosseous access on critically ill patients in the emergency department or prehospital setting need not restrict themselves to such bones. Calcaneus and radial styloid are both an acceptable alternative to traditional recommended sites.     

责任包干工作制在静脉输液护理质量管理中的应用

目的:探讨责任包干工作制在静脉输液护理质量管理中的应用效果.方法:选取2010年10～12月神经内科住院需要静脉输液治疗患者50例为对照组,采用常规静脉输液护理;选取2011年1～3月同类患者50例为实验组,实施责任包干工作制静脉输液,观察、比较两组平均每日案例静脉输液完成时间、一针穿刺成功率及患者满意度情况.结果:实验组平均每日案例静脉输液完成时间、一针穿刺成功率及患者满意度均优于对照组(P＜0.01).结论:静脉输液实施责任包干工作制应用效果显著,可有效提高工作效率和护理质量,从而提高患者满意度.     

The Role of Intraosseous Vascular Access in the Out-of-Hospital Environment (Resource Document to NAEMSP Position Statement)

Thousands of critically ill emergency patients are treated in the out-of-hospital setting in the United States every year. In many patients intravenous (IV) therapy cannot be initiated because of inadequate access to peripheral veins. In some cases, this lack of vascular access may limit benefit of medications because of late administration.[[]] Both speed andoverall success of vascular access are important when evaluating potential methodologies for their use in the out-of-hospital environment. Insertion of an IV cannula has been reported to require substantial time in the prehospital environment, with a recent study reporting an average successful intravenous line placement time of 4.4 ± 2.8 minutes.[[]] In critically ill pediatric patients, vascular access may present substantial difficulties to the provide.[[]] Intraosseous access may provide a significant time saving which may benefit many critically ill patients, both by decreasing the time to achieve access andby decreasing the time to administration of indicated medications.[[]] Achieving rapid administration of medications may facilitate the care of critically ill patients.[[]] Devices are now available that permit rapid, accurate access to the intraosseous space. Recent changes in the American Heart Association's resuscitation guidelines state that the intraosseous route should be the first alternative to difficult or delayed intravenous access.[[]] With these considerations, the role of intraosseous vascular access in the out-of-hospital environment should be reemphasized.