综合护理干预在小儿静脉留置针并发症中的应用效果

目的：探讨综合护理干预在小儿静脉留置针并发症中的应用效果。方法选取2011年4月—2014年6月于五原县妇幼保健院儿科门诊收治需进行静脉留置的患儿124例,采用随机分配原则将其分为观察组与对照组,各62例。对照组患者予以常规护理,观察组患者予以综合护理干预。观察两组患儿并发症发生情况及护理满意度。结果观察组患儿并发症发生率为9.6%,低于对照组的33.9%,差异有统计学意义（ P<0.05）;观察组患儿护理满意度高于对照组（ P<0.05）。结论综合护理干预在小儿静脉留置针并发症中的应用效果显著,可有效降低并发症发生率,提高护理满意度。     

基于微信平台追踪式健康教育在儿科门诊静脉留置针家庭护理中的应用

目的 探讨基于微信平台追踪式健康教育在儿科门诊静脉留置针家庭护理中的应用效果。方法 选取2020年1月至4月江西省儿童医院采取常规健康教育期间于门诊输液室接受输液治疗的200例患儿作为对照组,另选取2020年5月至8月江西省儿童医院采取基于微信平台追踪式健康教育期间于门诊输液室接受输液治疗的200例患儿作为观察组。比较两组患儿的留置针留置时间、家属健康行为、并发症发生率和患儿家属满意度。结果 观察组留置针留置时间长于对照组,差异有统计学意义（P<0.05）。干预前,两组患儿家属健康行为评分的比较,差异无统计学意义（P>0.05）;干预后,两组患儿家属健康行为评分高于干预前,且观察组患儿家属健康行为评分均高于对照组,差异有统计学意义（P<0.05）。观察组并发症总发生率低于对照组,差异有统计学意义（P<0.05）。观察组患儿家属总满意度高于对照组,差异有统计学意义（P<0.05）。结论 基于微信平台追踪式健康教育能够延长儿科门诊静脉留置针患儿留置针使用时间,促进患儿家属健康行为,减少并发症,从而提升家属满意度。     

预见性护理在外周静脉留置针输液患儿中的应用分析

目的探讨经外周浅静脉留置针输液患儿进行预见性护理干预的疗效及安全性。方法选取医院儿科经外周浅静脉留置针输液治疗的住院患儿160例。患儿依据病历号尾数分为两组,单数者为观察组,双数者为对照组,每组各80例。对照组采用常规儿科静脉留置针输液护理,观察组在常规静脉输液护理的基础上给予预见性护理干预。比较两组患儿的留置针留置时间以及非计划拔管(包括导管堵塞、穿刺点渗血、穿刺点液体渗漏、静脉炎、自行拔管)情况。结果观察组留置针的平均留置时间为(3.31±0.44)d,对照组的平均留置时间为(2.77±0.31)d,两组比较差异有统计学意义(χ~2=4.792,P<0.05)。观察组患儿的非计划拔管率明显低于对照组,差异有统计学意义(P<0.05)。结论预见性护理干预可显著降低静脉输液留置针非计划拔管率,延长静脉留置针留置时间,减轻患儿痛苦及护士工作量,值得临床推广。     

护理干预在静脉留置针中的应用及效果观察

目的观察护理干预在静脉留置针中的应用及效果。方法选取我科收治的需要静脉留置针的患者110例,随机分为两组,观察组(55例)和对照组(55例)。对照组采取常规的静脉输液护理,观察组采取多种措施进行护理干预,从静脉留置针的置留时间、拔针原因和患者满意度三方面比较两组患者的临床疗效。结果观察组静脉留置针的置留时间明显长于对照组(P 0.05);观察组因为输液外渗、堵管、针头脱出和静脉炎等原因拔针的患者例数明显少于对照组(P 0.05);观察组的护理满意度高于对照组(P 0.05)。结论护理干预在静脉留置针中具有较好的效果,可以在临床上推广使用。     

一般留置针与正压留置针在患儿中的应用及护理体会

目的:研究一般留置针与正压留置针在患儿中的应用及护理体会。方法:对医院在2016年7月到2018年7月收治的4000例输液穿刺患儿,分为对照组(n=1300例)和观察组(n=2700例)两组,对照组采取一般留置针护理,观察组则应用正压留置针护理,对两组患儿护理满意度进行对比。结果:对比两组患儿护理满意度,观察组患儿护理满意度96.7%,对照组患儿护理满意度84.1%,两组对比有统计学意义(P0.05);对比两组中观察组留置针留置时间(4.8±1.0)d、堵塞率3.7%,对照组留置针留置时间(2.2±1.3)d、堵塞率20.3%,观察组与对照组对比存在统计学意义(P0.05)。结论:在临床患儿穿刺中应用正压留置针,有利于延长留置时间,充分发挥正压式留置针的优势,对提升护理满意度发挥积极作用,可在实践中推广应用。     

改良小儿静脉留置针穿刺技术的临床应用效果评价

目的:评价改良小儿静脉留置针穿刺技术在小儿科中的临床应用效果。方法:选择某院小儿科收治的100例行静脉留置针穿刺治疗患儿作为研究对象,根据穿刺方法的不同将患儿分为观察组与对照组,每组各50例,对照组患儿采用传统静脉留置针穿刺技术,观察组患儿采用改良小儿静脉留置针穿刺技术,观察两种穿刺技术的临床应用效果及患儿家长满意度。结果:观察组患儿一次穿刺成功率为98.0%,明显高于对照组患儿的84.0%;观察组患儿留置针保留时间明显长于对照组患儿,观察组患儿穿刺后不良反应发生率为4.0%,明显低于对照组患儿的18.0%;此外观察组患儿家长满意度明显高于对照组,以上指标组间差异均可见统计学意义(P<0.05)。结论:改良小儿静脉留置针穿刺技术能够保证静脉输液及抢救危重患儿的及时性和有效性,不良反应较少,患儿家长满意度高,可在临床护理工作中进一步推广应用。     

腋静脉留置针在新生儿重症监护病房（NICU）输液中的效果观察

目的探讨对新生儿重症监护病房（NICU）患儿采用腋静脉留置针进行输液的效果。方法将我院2008年1月至2010年1月收治的新生儿160例随机分为两组,观测组80例采用双腋静脉交替穿刺留置针输液,对照组80例采用头皮及四肢浅静脉留置针输液。比较两组留置针穿刺成功率,平均使用时间以及并发症发生率。结果观察组留置针穿刺成功率高,保留时间长,发生并发症明显减少。结论腋静脉管径粗大,行走直,腋静脉穿刺成功率高,保留时间长,发生并发症明显减少,避免反复穿刺,减轻患儿痛苦,为抢救赢得时间并提高护理工作效率。     

综合护理干预对静脉留置针并发症的影响

目的探讨综合护理干预对静脉留置针并发症的影响。方法选取2016年1月~2017年1月我院收治的静脉留置针穿刺患者400例,随机分为观察组和对照组,每组200例,观察组患者采用综合护理干预方式,对照组患者采用常规护理方式,对比分析两组患者静脉留置针并发症的发生率。结果两组患者在并发症发生率的对比、静脉留置针时间及满意度评分比较中,其观察组数据优于对照组数据,两组患者差具有统计学意义(P<0.05)。结论通过综合护理干预对静脉留置针,能够有效地降低留置针并发症的出现率;并且还能不断的提升责任护士的护理水平,建立良好的护患关系,促进医院整体护理水平的提升。     

早产低出生体重儿输液中应用腋静脉穿刺留置针技术的探讨

目的：探讨在早产低出生体重儿输液中使用腋静脉穿刺留置针技术的临床效果。方法选取2013年1月～2014年1月收治需进行临床输液的早产低出生体重儿58例,随机分为观察组与对照组,观察组患儿在输液中选用腋静脉留置针,对照组患儿输液中选用头皮静脉留置针,对比观察两组患儿临床情况。结果观察组患儿一次穿刺成功率、留置针保留时间、体重增加水平均明显高于对照组,穿刺次数、并发症均明显低于对照组,恢复出生体重所需时间、住院时间明显较短,相比对照组,差异有统计学意义（P＜0.05）。结论在早产低出生体重儿输液中使用腋静脉留置针,能够有效减少穿刺次数,明显减少患儿痛苦并延长其输液时间,提高输液效率,促进患儿吸收营养,快速生长发育,具有更为理想的临床应用效果及价值。     

网状弹力绷带固定小儿留置针的应用效果

目的 探讨医用网状弹力绷带固定小儿静脉留置针在临床应用的效果.方法 将100例住院需要静脉输液的患儿纳入观察对象,随机分为观察组和对照组,对照组采用3M透明贴膜常规固定留置针,观察组采用3M透明贴膜加医用弹力绷带固定留置针.观察两组患儿家属的满意度,留置针留置≥3天的比例及平均留置时间,穿刺处红、肿、热、痛、液体渗出、导管脱出的发生率.结果 两种方法中,应用医用弹力网状绷带固定四肢和头部留置针患儿家属的满意度高.观察组中留置针保留天数≥3天较对照组的比例高,观察组留置针平均留置时间较对照组长,两组差异有统计学意义（P＜0.05）.观察组的脱管率较对照组低.结论 使用医用弹力绷带固定静脉留置针,能妥善固定留置针,延长留置针留置时间,其效果明显优于传统的胶布固定方法.该方法不仅可以减轻患儿痛苦,也减少了医护人员的工作量,提高护理质量,有效提高了患者的满意度,减少护患间纠纷.     

Role of glutathione in reduction of arsenate and of gamma-glutamyltranspeptidase in disposition of arsenite in rats

Arsenate (AsV), the environmentally prevalent form of arsenic, is converted sequentially in the body to arsenite (AsIII), monomethylarsonic acid (MMAsV), monomethylarsonous acid (MMAsIII), and dimethylarsinic acid (DMAsV) and some trimethylated metabolites. Although the biliary excretion of arsenic in rats is known to be glutathione (GSH)-dependent, involving transport of arsenic-GSH conjugates, the role of GSH in the reduction of AsV to the more toxic AsIII in vivo has not been defined. Therefore, we studied how the fate of AsV is influenced by buthionine sulfoximine (BSO), which depletes GSH in tissues. Control and BSO-treated rats were given AsV (50 micromol/kg, i.v.) and arsenic metabolites in bile, urine, blood and tissues were analysed by HPLC-HG-AFS. BSO increased retention of AsV in blood and tissues and decreased appearance of AsIII in blood, bile (by 96%) and urine (by 63%). The biliary excretion of MMAsIII was also nearly abolished, the appearance of MMAsIII and MMAsV in the blood was delayed and the renal concentrations of these monomethylated arsenicals were decreased by BSO. Interestingly, appearance of DMAsV in blood and urine remained unchanged and the concentrations of this metabolite in the kidneys and muscle were even increased in response to BSO. To test the role of gamma-glutamyltranspeptidase (GGT) in arsenic disposition, the effect of the of the GGT inhibitor acivicin was investigated in rats injected with AsIII (50 micromol/kg, i.v.). Acivicin lowered the hepatic and renal GGT activities and increased the biliary as well as urinary excretion of GSH, but failed to alter the disposition (i.e. blood and tissue concentrations, biliary and urinary excretion) of AsIII and its metabolites. In conclusion, shortage of GSH decreases not only the hepatobiliary transport of arsenic, but also reduction of AsV and the formation of monomethylated arsenic, while not hindering the production of dimethylated arsenic. While GSH plays an important role in the disposition and toxicity of arsenic, GGT, which hydrolyses GSH and GSH conjugates, apparently does not influence the fate of the GSH-reactive trivalent arsenicals in rats.     

微透析取样技术在中药体内分析中的应用研究进展

本文综述了微透析取样技术在中药体内分析中的应用,介绍微透析取样技术的原理、组成、探针类型、特点,重点阐述了微透析取样技术在测定脑、血液、皮肤等组织器官中中药有效成分浓度的应用实例。表明微透析取样技术在中药药效研究中具有广阔的前景。     

应用PASS系统分析我院2010年住院医嘱

目的:了解我院2010年住院患者的合理用药情况,探讨如何利用合理用药监测系统( PASS)提高合理用药水平.方法:利用PASS对我院2010年15 966例住院患者的1 184 997条用药医嘱进行监测,以黑色警示医嘱为依据,收集不合理用药信息,并对监测结果进行统计、分析.结果:不合理用药医嘱50 261条,发生率为4.24％.绝对禁止黑色医嘱5441条,主要为药物相互作用(66.54％)、注射液体外配伍(17.86％)、用法用量(15.46％)、儿童警告(1.14％).结论:应用PASS系统能有效监测医嘱中的不合理用药情况,有利于提高临床合理用药水平,但PASS系统尚存在局限性,有待进一步完善.     

Changes in levels of dependency and predictors of mortality in elderly people in institutional care in Dunedin

The 1983 study of dependency of subjects in institutional care in Dunedin was repeated two years later. A significant increase in levels of dependency in residential homes, particularly in the Religious and Welfare sector was found. In 1983 there were 29 high dependency residents and 73 medium dependency residents in residential homes. In 1985 these numbers had increased to 55 and 86 respectively. There was no change in the number of low dependency residents. In 1983, 6 high dependency residents had been admitted to residential home care in the year prior to the study. In 1985 the number of high dependency residents recently admitted had increased to 23. There had also been a significant increase in the dependency of patients in Religious and Welfare continuing care hospitals. Of the 933 subjects in institutional care in 1983 who were able to be followed, 354 (37.9%) died in the following 2 years. Mortality rate was higher for those in hospital care (48.1%) than for those in residential home care (29.6%). Mortality rates were higher in more dependent subjects and this was evident for each measure of dependency.     

应用PASS系统对我院2008年住院医嘱的分析

目的监测分析2008年我院住院患者用药情况。方法将PASS系统嵌入医生工作站、临床药学工作站等子系统,构建合理用药计算机网络系统,对住院医嘱进行及时监测,将监测结果向医生反馈,并对其进行统计、分析。结果2008年共监测医嘱3 620 241条,不合理医嘱908条,占0.02%。不合理医嘱中,配伍禁忌(381条)占41.96%,用法用量(381条)占41.96%,药物相互作用(108条)占11.89%,儿童用药(38条)占4.19%。经与医生沟通后,更改不合理医嘱856条,占94.27%。结论PASS系统可有效监测医嘱中的不合理用药,通过与医生交流,大大减少药物不良事件的发生,值得临床推广应用,也为临床药师开展工作带来了极大的便利。但PASS系统尚存在局限性,有待进一步完善。     

Role of desacetylation in the detoxification of cephalothin in renal cells in culture

The toxicity of three cephalosporin antibiotics to rabbit kidney cells in culture was compared to their known nephrotoxic potential in vivo (cephaloridine greater than cefazolin greater than cephalothin). While cephalothin is considered to be a relatively nonnephrotoxic cephalosporin when administered to many species including humans and rabbits, in several in vitro systems involving rabbit renal tissue, cephalothin was comparatively more toxic than anticipated based on in vivo data. Cephalothin is extensively desacetylated in rabbits to a less microbiologically active metabolite, desacetylcephalothin. When a microsomal S9 fraction from rabbit kidney was added to the in vitro assay in cultured rabbit renal cells, cephalothin was desacetylated and its toxicity to kidney cells was reduced. The addition of S9 in vitro provided a toxicity ranking of the cephalosporins that correlated with their known in vivo nephrotoxic potentials (cephaloridine greater than cefazolin greater than cephalothin). The in vitro detoxification of cephalothin by S9 was blocked by the coadministration of the esterase inhibitor, aminocarb. Desacetylcephalothin was relatively nontoxic to rabbit renal tissue in vitro. These results suggest that the desacetylation of cephalothin in vivo represents a previously unrecognized mechanism of detoxification of this cephalosporin antibiotic. Furthermore, this mechanism of detoxification may be applicable to other acetylated cephalosporins.     

2009年某院住院患者抗真菌药用药调查

目的:分析讨论某院抗真菌药使用的合理性,为临床安全有效地使用抗真菌药提供参考。方法:回顾性统计分析某院2009年住院患者抗真菌药用药信息。结果:2009年某院住院患者抗真菌药DDDs排名前3名分别为:氟康唑、制霉菌素和伊曲康唑;使用金额排名前3名分别为:氟康唑、米卡芬净及卡泊芬净;更换一种抗真菌药进行治疗的患者数为176人,在全部患者中占13.4%。结论:应进一步强化用药指征的意识,提高标本送检率,同时改善某些抗真菌用药不合理更换的现象,以避免耐药性发生,从而更好更长远地体现抗真菌药的治疗价值。     

Kinetics of in vitro metabolism of methoxyphenamine in rats

1. Methoxyphenamine (MP) was metabolized in vitro by rat liver preparations to O-desmethylmethoxyphenamine (O-desmethyl-MP), N-desmethylmethoxyphenamine (N-desmethyl-MP) and 5-hydroxymethoxyphenamine (5-hydroxy-MP). These metabolic pathways were inhibited by SKF 525-A and carbon monoxide, which indicates that these reactions were mediated at least partly by an NADPH-dependent cytochrome P-450 system. 2. Strain differences in the metabolism of this drug in vitro were observed in female Lewis and Dark Agouti (DA) rats, which are proposed models for human debrisoquine phenotypes. Methoxyphenamine O-demethylase and 5-hydroxylase activity in DA rats were lower than those in Lewis rats. 3. The metabolic transformation of methoxyphenamine in vitro to O-desmethyl-MP was inhibited competitively by debrisoquine and sparteine. This indicates that the cytochrome P-450 isoenzyme mediating the metabolism of MP to O-desmethyl-MP is similar to that mediating metabolism of debrisoquine and sparteine. However, no inhibition was observed with methenytoin.     

Comparison of in vitro cell models in predicting in vivo brain entry of drugs

Although several in vitro models have been reported to predict the ability of drug candidates to cross the blood-brain barrier, their real in vivo relevance has rarely been evaluated. The present study demonstrates the in vivo relevance of simple unidirectional permeability coefficient (P(app)) determined in three in vitro cell models (BBMEC, Caco-2 and MDCKII-MDR1) for nine model drugs (alprenolol, atenolol, metoprolol, pindolol, entacapone, tolcapone, baclofen, midazolam and ondansetron) by using dual probe microdialysis in the rat brain and blood as an in vivo measure. There was a clear correlation between the P(app) and the unbound brain/blood ratios determined by in vivo microdialysis (BBMEC r=0.99, Caco-2 r=0.91 and MDCKII-MDR1 r=0.85). Despite of the substantial differences in the absolute in vitro P(app) values and regardless of the method used (side-by-side vs. filter insert system), the capability of the in vitro models to rank order drugs was similar. By this approach, thus, the additional value offered by the true endothelial cell model (BBMEC) remains obscure. The present results also highlight the need of both in vitro as well as in vivo methods in characterization of blood-brain barrier passage of new drug candidates.