肿瘤患者PICC导管拔除方法的研究

目的:探讨改进肿瘤患者PICC导管拔除方法的可行性和优越性。方法:选择计划性拔除PICC导管患者205例,将其随机分为试验组107例与对照组98例,试验组采用新方法拔除PICC导管,在拔除导管后,用16 cm的弯血管钳沿静脉走向逆行向穿刺点部位刮除静脉内血液及皮下淤血;对照组采用常规方法拔除PICC导管,拔除导管后用指压法压迫穿刺点至不出血为止。比较两组导管拔除后24,48,72 h静脉炎的发生率以及导管拔除后潜在并发症的发生情况。结果:试验组导管拔除后24,48,72 h静脉炎发生率以及导管拔除后潜在并发症发生率均低于对照组(P<0.05)。结论:采用新方法拔除PICC导管,有利于患者静脉通路的快速恢复,减轻了患者的痛苦。     

颈内中心静脉导管拔除规范化护理方案的制订与应用

目的 构建颈内中心静脉导管拔除护理方案,规范医护人员操作行为,降低患者相关问题发生率。方法通过文献检索、质量评价、提取并汇总证据及专家咨询,制订中心静脉导管拔除规范化护理方案,主要包括拔除时机、拔除前评估、拔除操作要点、拔除后注意事项及并发症处理。采用非同期对照研究,便利选取2021年5月—6月70例住院患者为对照组,采用常规颈内中心静脉导管拔除操作流程;2021年7月—8月的75例住院患者为试验组,实施颈内中心静脉导管拔除规范化护理方案;比较两组患者穿刺点疼痛、穿刺点渗血、拔管困难、导管断裂发生率。结果 干预后,两组患者穿刺点疼痛、穿刺点渗血发生率比较,差异有统计学意义（χ2=4.494、4.116,P<0.05）;两组患者拔管困难、导管断裂发生率比较,差异无统计学意义（P>0.05）。结论 开展中心静脉导管拔除规范化护理方案,可降低中心静脉导管拔除相关问题发生率,提高中心静脉导管拔除护理质量。     

抗菌药物封管在三向瓣膜式静脉输液港中的应用

中心静脉导管相关性感染（catheter-related sepsis，CRS）的治疗方法有两种^[1]：即导管拔除和抗菌药物封管。拔除导管虽然是常用而有效的方法，但可能拔除的并非是感染的导管。本文探讨的三向瓣膜式输液港是通过手术植入的隧道式中心静脉导管，且成本相对较大，故在没有明确是否导管感染的情况下不宜轻易拔除导管。     

双水平无创呼吸机在气管插管患者拔管前的应用及护理

探讨无创呼吸机在气管插管患者拔管前的应用及护理.对31例气管插管患者在机械通气序贯脱机过程中,采用在拔除气管导管前先给予具有双水平的自主呼吸与时间控制(ST)模式的无创呼吸机进行治疗,待患者适应后再拔除气管导管,拔管后继续给予无创呼吸机治疗.31例中有29例脱机成功,脱机成功率为93.6％.气管插管患者在有创无创呼吸机序贯治疗过程中,拔除气管导管前先给予无创呼吸机治疗后再拔管,可以提高有创呼吸机的脱机成功率.     

急诊气管插管病人非计划性拔管的预防及护理体会

在急诊科,气管内插管作为危重病人保持气道通畅的手段被广泛采用.非计划性拔管是指气管导管滑脱或未经医护人员同意病人将插管拔除,包括医护人员操作不当引起.气管导管滑脱是指气管导管从气管内脱出体外.     

夹闭综合征致PICC导管体内两处破损的原因分析与护理

对1例夹闭综合征致PICC导管在体内发生两处破损的案例进行原因分析,认为发生导管夹闭综合征时导管受损部位并非局限于肋锁三角.由多学科会诊制订切实可行的拔管方案和个性化体内导管断裂应急预案,在介入科为患者行导管拔除术.导管拔出顺利,核对导管长度与置入时相同,行冲管试验,发现导管有两处破损,无断裂,患者无不适.     

三级医院护士颈内中心静脉导管拔除知信行现状及影响因素分析

目的:了解三级医院护士颈内中心静脉导管拔除知信行现状,探讨其影响因素。方法:2021年6月—2021年11月以便利抽样法对河南省8所三级医院610名护士采用自行设计的颈内中心静脉导管拔除知信行问卷进行调查。结果:610名护士颈内中心静脉导管拔除知信行总分为(62.04±8.18)分。多元回归分析显示影响护士颈内中心静脉导管拔除知信行的因素有年龄、是否参加过相关培训(P<0.05)。结论:护士颈内中心静脉导管拔除知信行水平欠佳,存在知识掌握不均衡现象。护理管理者应根据护士的不同特征开展相关培训,鼓励护士主动学习新知识、新理念,不断更新自我知识体系,从而改变护理行为,提高临床护理质量。     

下肢经外周置入中心静脉导管破裂1例的原因分析及护理

总结1例下肢经外周置入中心静脉导管发生穿刺点处破裂的原因及护理措施。导管发生破裂原因可能与护士的维护经验不足、患者活动导致导管磨损或受压破损有关。导管破裂无法修剪,只能拔除导管。建立维护网络站点,加强导管跟踪管理,提高维护网点护士识别导管破裂能力,重视操作细节,并加强患者健康宣教,是预防导管破裂的重要措施。患者出现导管破裂后顺利拔除,未出现相关并发症。     

全身麻醉恢复期预防拔除气管导管不良反应的研究进展

综述全身麻醉恢复期拔除气管导管引起不良反应的机制、影响因素以及采取的预防措施,为开展全身麻醉恢复期拔除气管导管引起不良反应预防的研究和提高患者全麻恢复期复苏质量提供借鉴。     

非计划性胃管拔管的原因分析及护理

非计划性拔管是指尚未达到拔管指证而将人体的治疗性、诊断性导管拔除.其中既有病人未经医护人员同意将插管拔除,也包括医护人员操作不当引起[1].范河谷等[2]认为意外脱管的几率:胃管＞气管插管＞静脉插管＞尿管＞引流管.胃肠减压作为一项基础护理操作,在各科均有广泛应用,尤其对普外科病人而言,更是临床上常用的也是重要的治疗措施,但紧随而至的导管的意外拔除也成了突出问题.     

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.     

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.     

手转胎头术失败的原因与分娩结局临床分析

目的 探讨手转胎头术失败的原因与分娩结局.方法 选择2008年1月至2010年12月于我院住院分娩的持续性枕横位、枕后位产妇198例,根据行手转胎头术后结果分为成功组126例、失败组72例.比较两组分娩结局,对比分析失败原因.结果 失败组胎儿体质量≥3500 g的发生率[76.4％(55/72)]明显高于成功组[31.7％(40/126)],差异有统计学意义(x2=30.177,P=0.001)、失败组宫缩乏力发生率[58.3％(42/72)]高于成功组[38.1％ (48/126)],差异有统计学意义(x2=7.569,P=0.006)、失败组骨盆临界或轻度狭窄发生率[38.9％ (28/72)]高于成功组[23.8％(30/126)],差异有统计学意义(x2 =5.030,P=0.002)、失败组手转胎头时机不当(宫口开大＜6 cm、胎头位于坐骨棘上及宫口开大8～10 cm、胎头位于坐骨棘下≥2 cm)发生率[61.1％(44/72)]高于成功组[38.9％(49/126)],差异有统计学意义(x2=9.084,P=0.003).失败组母儿并发症(产后出血、产褥病率、胎儿窘迫、新生儿窒息)发生率高于成功组(x2 =9.586,P=0.002、x2=9.334,P=0.002、x2=5.910,P=0.015、x2=5.240,P=0.022)、失败组剖宫产发生率[72.2％(52/72)]明显高于成功组[34.1 ％(43/126),x2=26.641,P=0.001)].结论 手转胎头术能使难产变顺产,降低剖宫产率,减少母儿并发症,但须积极预防、处理导致手转胎头术失败的原因,对矫正失败后继续矫正及试产应慎重.     

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.     

Evidence-Based Pain Management and Palliative Care in Issue Four for 2009 of The Cochrane Library

ABSTRACT

The Cochrane Library of Systematic Reviews is published quarterly. Issue 4 for 2009 contains 4027 complete reviews, 1906 protocols for reviews in production, and 11447 one-page summaries of systematic reviews published in the general medical literature. In addition, there are citations of 600,000 randomized controlled trials, and 12,200 cited papers in the Cochrane methodology register. The health technology assessment database contains over 7500 citations. This edition of the Library contains 90 new reviews, of which 19 have potential relevance for practitioners in pain and palliative medicine.     

Wie zuverlässig sind Angaben zu nichtentzündlichen ausgedehnten Schmerzen?

ZusammenfassungFragestellung Es wurde geprüft, wie sich der Differenziertheitsgrad zweier Schmerzmessmethoden auf Angaben zur Ausgedehntheit klinischer Schmerzen auswirkt. Zugleich wurde der Referenzzeitraum variiert, über den die Patienten berichten sollten.Methode Erfasst wurde der Einfluss zu Lasten der Befragungsdifferenziertheit durch den Vergleich zweier Körperschema-Bildvorlagen. Drei Referenzzeiträume (Schmerz aktuell, letzte Woche, letztes halbes Jahr) wurden vorgegeben.Ergebnisse Patienten mit ausgedehnten Schmerzen gaben bei differenzierter Befragung um so mehr Schmerzen an, je weiter die Schmerzen zurück lagen und je größer der Berichtszeitraum war. Patienten mit gelenknahen Schmerzen gaben bei hoch differenzierter Befragung weniger ausgedehnte Schmerzen in der Vergangenheit an als bei globaler Einschätzung. Patienten mit Rückenschmerzen berichteten bei differenzierter Befragung zum aktuellen Schmerz über weniger ausgedehnte Schmerzen als bei globaler Befragung.Schlussfolgerung Die Angaben zur Schmerzausdehnung variieren vor allem bei Patienten mit ausgedehnten Schmerzen in Abhängigkeit von der Differenziertheit der Befragung. In diesen Fällen ist die Wahrscheinlichkeit erhöht, dass sich die Beschwerdesymptomatik zumindest teilweise erst in der Reaktion auf die situativen Befragungsbedingungen konstituiert und daher nicht auf andere Befragungsbedingungen generalisiert werden kann.