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。     

高渗性药物经外周静脉输液与中心静脉输液致静脉炎的研究进展

高渗性药物在临床上被广泛使用,静脉炎是使用高渗性药物静脉治疗最普遍的并发症,静脉炎的发生既增加了病人的痛苦又延长了住院时间。文文综述了近年来高渗性药物经外周和中心静脉输液致静脉炎的研究进展,旨在为使用高渗性药物时合理选择静脉输液途径提供依据。     

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。     

化疗患者安全静脉输液治疗知情同意的规范化管理

目的：让化疗患者正确选择输液器和静脉穿刺途径。方法临床护士根据《静脉治疗护理技术操作规范》新标准的要求，对化疗患者制订实施了《安全静脉输液治疗知情同意书》，临床护士向化疗患者提供选择不同输液工具、静脉输液途径的依据、利弊信息，让患者或家属做出选择。结果首次化疗患者125例，患者知情同意选择避光、精密输液器125例（100％）；知情同意选择静脉穿刺途径中，外周静脉留置针108例（占86．4％） ，经外周中心静脉置管（PICC ）17例（占13．6％）。结论化疗患者知情同意选择输液器和静脉穿刺途径，可提高护理质量，提高患者对护士护理技术的满意率，防止护理纠纷的发生。     

医护合作预防老年患者高渗药物静脉渗漏性损伤的效果研究

目的评价医护合作在预防老年患者高渗性药物输液渗漏性损伤中的效果。方法成立医护合作小组,明确岗位职责发挥专业特点,规范高渗性药物输液流程及管理。结果高渗性药物治疗选择中心静脉置管比例、输液渗漏发生率、医护合作与对照组比较差异均有统计学意义(P0.01或P0.05)。结论医护合作能有效预防老年患者高渗性药物输液渗漏性损伤发生,提高输液护理质量。     

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.     

六神丸蜂蜜膏外敷治疗高渗性药物静脉外渗的护理

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。高渗性药物是指药物渗透压〉450mOsm／L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、静脉炎和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。     

静脉输液治疗小组模式在综合医院的应用

目的:探讨静脉输液治疗小组模式在综合医院中的应用效果。方法:抽取靖江市人民医院2016年1月至2018年12月行静脉输液治疗的患者900例,其中2016年1~12月行静脉输液治疗的患者300例接受常规护理干预,2017年1~12月和2018年1~12月行静脉输液治疗的患者600例均接受静脉输液治疗小组模式护理干预。比较静脉输液治疗小组模式实施前(2016年)、后(2017年、2018年)静脉输液工具选择比例、护士静脉输液质量考核评分以及用药错误、静脉炎等不良事件发生率。结果:2017年、2018年静脉留置针、外周静脉置入中心静脉导管使用比例均显著高于2016年,一次性钢针使用比例均显著低于2016年,差异均有统计学意义(均P<0.05);2018年静脉留置针使用比例均显著高于2017年,一次性钢针使用比例显著低于2017年,差异均有统计学意义(均P<0.05);2017年、2018年静脉输液治疗不良事件发生率分别为8.00%、3.67%,均显著低于2016年的15.00%,2018年静脉输液治疗不良事件发生率显著低于2017年,差异均有统计学意义(均P<0.05);2017年、2018年护士士静脉输液质量考核评分均显著高于2016年,2018年护士士静脉输液质量考核评分显著高于2017年,差异均有统计学意义(均P<0.05)。结论:静脉输液治疗小组模式在综合医院中应用效果显著,降低了静脉输液治疗不良事件的发生率,提高了静脉输液质量以及护士静脉输液治疗的专业水平和职业素质,值得临床重视。     

老年患者外周静脉输液对静脉损伤的观察和护理

外周静脉输液是临床治疗和急救用药及供给营养的重要途径。老年患者血管条件及心理承受能力差,尤其在应用高渗溶液时,易造成血管痉挛、渗出、静脉炎等,为减少老年患者外周静脉的损伤,减轻病痛,作者对69例老年患者的外周静脉输液进行观察,针对实际观察到的问题,采取相应的预防护理措施,减少了各种输液并发症的发生,提高了疾病治愈率和抢救成功率。     

降钙素基因相关肽中介十二指肠高渗溶液抑制胃酸的作用

目的和方法 :采用氢气清除法测定大鼠胃粘膜血流 (GMBF) ,通过近胃动脉灌注特异性CGRP受体拮抗剂hC GRP8-37,研究降钙素基因相关肽 (CGRP)在十二指肠高渗溶液抑制胃内蛋白胨引起的胃酸分泌和GMBF增加效应中的作用。结果 :①胃内灌注 6 %蛋白胨引起胃酸分泌和GMBF显著增加 ;②十二指肠灌注高渗溶液使胃内蛋白胨刺激胃酸分泌和GMBF增加的作用显著减弱 ;③hCGRP8-37能部分阻断 6 %蛋白胨引起的GMBF增加效应 ;④hCGRP8-37使十二指肠灌注高渗溶液对胃内蛋白胨引起的胃酸分泌的抑制作用显著减弱 ,但对GMBF的抑制作用无显著影响。结论 :①CGRP可能中介了十二指肠高渗溶液对蛋白胨引起的胃酸分泌的抑制作用 ;②十二指肠高渗溶液抑制胃内蛋白胨引起的GMBF增加效应可能与CGRP无关 ;③胃内蛋白胨引起的GMBF增加效应可能部分通过CGRP介导。     

The effect of hyperosmotic solutions on the hepatic blood flow,

Summary. The present study was undertaken in order to measure the effect of hyperosmotic solutions on portal and hepatic blood flow. In five anaesthetized pigs without arterial blood supply to the liver, portal blood flow rate was measured (electromagnetic flowmeter) during 5 min lasting intravenous infusions of hyperosmotic galactose (50%, 84–100 ml) and mannitol (25%, 100 ml), with physiological saline (100 ml) as control. Portal blood flow increased to a peak value of (39% [P= 0–06] galactose and 37%, [P= 0–06], mannitol) soon after stop of the hyperosmotic infusion. For galactose the change ended somewhat earlier than for mannitol. Saline induced a minor increase (15%). Similarly, increments of, on average, 144% of the hepatic blood flow rate was seen in six patients with cirrhosis, following infusion of hyperosmotic galactose, the increase being more pronounced than in the pigs. The causes for these osmotic effects are not known, but they have to be taken into consideration in studies of the portal and hepatic blood flow.     

Management of gastrointestinal mucosal damage in patients with cerebrovascular disease

Cerebro-vascular disorders are often accompanied by gastrointestinal mucosal damages which possibly result in life-threatening massive hemorrhage. Such gastrointestinal complications in acute phase of stroke are usually regarded as one of stress-induced lesions. The pathophysiologic investigation of stress-related gastroduodenal mucosal damages has suggested that increased activity of the autonomic nervous system, in particular sympathetic nervous system, plays an important role in the development of gastric mucosal lesions. The suppression of gastric acid secretion by using H2-receptor antagonists or proton-pump inhibitors is useful for the prevention and management of stroke-induced gastric mucosal damages. In the chronic phase, the drug-induced gastrointestinal mucosal lesions may increase because steroids, non-steroidal anti-inflammatory drugs, anticoagulant and antiplatelet drugs are frequently applied to patients with stroke. The endoscopic interventions such as clipping, infusion of ethanol or epinephrine-contained hyperosmotic saline, and coagulation are effective against gastroduodenal hemorrhage.     

Blood components, preparations and blood substitutes in the emergency therapy of patients with liver cirrhosis

Therapeutic action of blood components, preparations and substitutes was studied in liver cirrhosis patients with deep anemia, marked hemorrhagic complications, endogenous toxicosis, protein insufficiency and rheological disorders. A high efficacy of different media was shown in urgent therapy of liver cirrhosis patients. A choice of drugs was determined by the patients' initial status and specificities of purpose-oriented action of modern transfusion and infusion media.     

家庭肠内营养支持应用现状

介绍了家庭肠内营养的应用现状,详细阐述了家庭肠内营养的可行性、适应证与禁忌证、家庭卫生要求及人员培训、营养液的选择和配制、输注途径和方法、营养监测、并发症及处理.     

家庭肠内营养支持应用现状

介绍了家庭肠内营养的应用现状，详细阐述了家庭肠内营养的可行性、适应证与禁忌证、家庭卫生要求及人员培训、营养液的选择和配制、输注途径和方法、营养监测、并发症及处理。     

Dose-related increases in cerebrospinal fluid concentrations of methotrexate in a postoperative patient with glioblastoma.

OBJECTIVE: To investigate the postoperative pharmacokinetics of methotrexate in the plasma and cerebrospinal fluid (CSF) in the space created by tumor removal of a patient with glioblastoma during hyperosmotic disruption of the blood-brain barrier (BBB) and intraarterial chemotherapy with a stepwise increase in the methotrexate dosage. CASE SUMMARY: A 30-year-old Japanese woman with glioblastoma received four courses of hyperosmotic disruption of the BBB and intraarterial chemotherapy with a combination of peplomycin, vindesine, nimustine, pirarubicin, and methotrexate. The patient was initially administered mannitol; anticancer drugs were then infused into the left internal carotid artery. Following the first, second, third, and fourth courses of treatment, methotrexate 350, 700, 1000, and 1500 mg, respectively, were administered for 30 minutes. Samples of blood and CSF from the space created by tumor removal were obtained. Methotrexate concentrations were measured by fluorescence polarization immunoassay and the pharmacokinetic parameters of methotrexate in plasma and CSF were estimated. RESULTS: The plasma concentration of methotrexate peaked at the end of drug infusion, then decreased in a biexponential decay manner during the remainder of the treatment period. The CSF concentration of methotrexate in the space created by tumor removal peaked two hours after drug administration, then monoexponentially decreased. Although the maximal CSF concentration of methotrexate in the space created by tumor removal was lower than that in the plasma, the CSF concentration of methotrexate in the space created by tumor removal exceeded that in the plasma six hours after drug infusion. The half-life of methotrexate in the CSF exceeded that in the plasma. The AUC for the plasma and CSF methotrexate concentration increased parallel with the methotrexate dosage. The mean CSF AUC of methotrexate was 59.4% of that found in plasma. CONCLUSIONS: The CSF AUC of methotrexate in the space created by tumor removal increased parallel with the methotrexate dosage during hyperosmotic disruption of the BBB and intraarterial chemotherapy.     

Failed Back Surgery Syndrome and intrathecal drugs infusion

Even if there is no study evaluating how often Failed Back Surgery Syndrome is the cause of pain in patients who need spinal drugs infusion to control their symptoms, it seems that in most centres, Failed Back Surgery Syndrome was the most frequent indication for spinal cord stimulation and for intrathecal analgesic delivery pumps implantation. In our experience of spinal drug delivery for pain, about one third of the patients (35.7%) had undergone one or more spinal surgeries.A literature search was performed looking for intrathecal drugs infusion and Failed Back Surgery Syndrome or chronic back and leg pain without specification of previous surgery. The data in which we were interested were trialling methods, drugs used, outcomes and side effects. A comparison was made with the 14 years experience in intrathecal drugs infusion in our centre.We evaluated the side effects reported with chronic spinal drugs infusion even if not specific for patients with Failed Back Surgery Syndrome.