表阿霉素外渗后局部组织损伤处理的实验研究

目的 观察不同药物治疗表阿霉素外渗后局部组织损伤的效果,以寻找理想的处理方法.方法 制作2种表阿霉素外渗动物模型,模型Ⅰ为单纯表阿霉素外渗,模型Ⅱ为表阿霉素外渗伴局部组织淤血.对2种局部损伤模型分别用云南白药加50%乙醇湿敷(A疗法),50%的硫酸镁湿敷(B疗法)和2%利多卡因加地塞米松对局部损伤组织环形封闭(C疗法)进行治疗,未给予任何治疗者为对照组,每组各12例.对4组的疗效进行肉眼和组织学观察.结果 治疗后第2天,4组间组织损伤比较差异无统计学意义(P＞0.05).模型Ⅰ第5天,模型Ⅱ第7天局部组织充血水肿、炎性细胞浸润显著消退,模型Ⅱ以云南白药加50%乙醇湿敷组效果最为显著,50%的硫酸镁湿敷对模型Ⅰ有较好疗效,2%利多卡因加地塞米松环形封闭对局部组织淤血消退的疗效较好.模型Ⅱ的病情、组织修复难度重于或大于模型Ⅰ.结论 临床处理表阿霉素外渗应根据局部组织损伤的不同特点选择合理有效的方法进行针对性处理.     

不同疗法对表阿霉素外渗后局部组织损伤处理的相关性研究

目的 探讨不同疗法对表阿霉素外渗后局部组织损伤修复的理想方法,为临床护理提供依据.方法 制作两种表阿霉素外渗动物模型(模型Ⅰ为单纯表阿霉素外渗,模型Ⅱ为表阿霉素外渗伴局部组织淤血),分别采用临床常用的3种处理方法进行动物实验比较性研究,局部损伤组织后分别用50%葡萄糖水加维生素B12湿敷(A组),50%的硫酸镁湿敷(B组),2%利多卡因加地塞米松对局部损伤组织环形封闭(C组),未给予任何治疗者为对照组,同时对各组外渗性损伤的愈合时间、病理形态进行观察.结果 3 d后观察各组损伤组织外观形态差异无显著性意义(P＞0.05),第7天局部组织充血水肿、炎性细胞浸润显著消退,以50%葡萄糖水加维生素B12湿敷组为优,50%的硫酸镁湿敷对模型Ⅰ有较好疗效,2%利多卡因加地塞米松环形封闭对模型Ⅱ疗效较好;模型Ⅱ的病情、组织修复难度重于或大于模型Ⅰ.结论 应根据表阿霉素外渗致局部组织损伤的不同特点选择合理的方法进行针对性处理.     

三种不同疗法对表阿霉素外渗后局部组织损伤处理的效果比较

目的比较三种不同疗法对表阿霉素外渗后局部组织损伤的治疗效果。方法制作两种表阿霉素外渗动物模型(模型Ⅰ为单纯表阿霉素外渗,模型Ⅱ为表阿霉素外渗伴局部组织瘀血),分别采用临床常用的3种方法进行动物实验对照性研究,局部损伤组织分别用云南白药加50%乙醇湿敷(A疗法);50%的硫酸镁湿敷(B疗法);2%利多卡因加地塞米松对局部损伤组织环形封闭(C疗法);对照组未给任何治疗者,并进行肉眼和组织学观察。结果4组间观察第2天损伤组织差异无显著意义(P>0.05),第7天局部组织充血水肿,炎性细胞浸润显著消退,以云南白药加50%乙醇湿敷组为优,50%的硫酸镁湿敷对局部组织充血水肿(模型Ⅰ)有较好疗效,2%利多卡因加地塞米松环形封闭对表阿霉素外渗伴局部组织瘀血的疗效较好,模型Ⅱ的病情、组织修复难度重于或大于模型Ⅰ。结论临床处理表阿霉素外渗应根据局部组织损伤的不同特点,选择合理有效的方法。     

化疗药物外渗后局部组织损伤处理的实验研究

目的根据化疗药物外渗后局部组织损伤的特点寻找理想的处理方法。方法制作化疗药物外渗的动物坏死模型,分别采用临床常用的三种处理方法进行动物实验,进行肉眼观察及组织学观察。结果1∶5 000呋喃西林加季德胜蛇药外敷对化疗药物外渗所致的局部组织坏死疗效最佳,其次为复方利多卡因,50%硫酸镁外敷疗效甚微,对照组无效。结论临床处理化疗药物外渗应根据其局部特点选择合理有效的方法。     

马铃薯外敷与硫酸镁湿敷治疗甘露醇外渗的疗效比较

[目的 ]比较新鲜马铃薯片外敷与 5 0 %硫酸镁湿敷对 2 0 %甘露醇血管外渗所致局部组织损伤的疗效。 [方法 ] 45例静脉输注2 0 %甘露醇液体血管外渗漏至皮下组织的病人被随机分为两组 ,分别采用新鲜马铃薯片外敷及 5 0 %硫酸镁湿敷治疗 ,观察局部组织肿胀消退时间。 [结果 ]马铃薯外敷组局部组织肿胀消退时间明显短于 5 0 %硫酸镁湿敷组 (P <0 .0 1)。 [结论 ]采用新鲜马铃薯片外敷治疗 2 0 %甘露醇外渗致局部组织肿痛具有独特疗效     

长春新碱血管外渗防护的实验研究

目的　探讨长春新碱血管外渗局部组织损伤防护的理想处理方法。方法　用 2 1只新西兰大白兔 ,按临床常用 1.5倍药物浓度将每只兔制作 4个部位长春新碱 (VCR)静脉外渗模型。局部分别用云南白药加 5 0 %乙醇膏湿敷、海普林软膏涂擦、5 0 %硫酸镁湿敷和不使用任何药物 4种方法进行对比 ,不同时期行肉眼和组织病理变化观察。结果　 4组间 3d无差异 ,7d充血、水肿、炎细胞浸润消退 ,以云南白药乙醇组为优 ,海普林组次之。硫酸镁组对组织水肿有疗效 ,其他与对照组无差异。结论　云南白药乙醇、海普林外敷对VCR血管外渗有良好的防护作用。5 0 %硫酸镁外敷仅能减轻充血 ,无防护作用     

矾冰液湿敷治疗20%甘露醇静脉滴注外渗的观察

目的 探讨矾冰液湿敷治疗20%甘露醇静脉滴注外渗所致局部组织损伤的疗效.方法 48例20%甘露醇外渗漏至皮下组织的病人被随机分为2组,分别采用矾冰液及50%硫酸镁湿敷治疗,观察2组疗效.结果 矾冰液湿敷疗效优于50%硫酸镁湿敷(p＜0.05) 结论 矾冰液湿敷治疗20%甘露醇静脉滴注外渗效果明显优于传统的50%硫酸镁湿敷,值得临床推广.     

甘露醇外渗致局部组织损伤后干预的再研究

目的 探讨甘露醇外渗引起组织损伤的干预措施。方法 给兔四肢脱毛备皮,局部消毒后每个肢体(易观察处)注射20％甘露醇15ml,并对局部肿胀的范围作好标记。建立甘露醇渗漏模型。将10只兔子随机分成5组,A组用热水袋热敷,30min／次,2次／d;B组一次性注射0．5％利多卡因5ml在肿胀组织周围;C组用“六味醇”中药湿敷1h／次,2次／d;D组用未加温的50％硫酸镁湿敷,1h／次,2次／d;E组不干预。干预期间每天观察局部皮肤颜色及肿胀情况,并测量肿胀面积,第5天取局部组织进行组织学观察。结论 甘露醇外渗引起的组织损伤可首选中药湿敷和热敷法。     

不同药物治疗长春新碱血管外渗的组织学变化

[目的 ]观察长春新碱血管外渗后用不同药物治疗组织损伤的疗效。 [方法 ]选 2 1只新西兰大白兔 ,按临床常用 1.5倍药物浓度将每只兔制作 4个部位长春新碱 (VCR)静脉外渗模型。局部分别用云南白药加 5 0 %乙醇膏湿敷、海普林软膏涂擦、5 0 %硫酸镁湿敷 ,1处为空白对照 ,观察不同时期组织病理变化。 [结果 ] 4组间 3d无差异。 7d充血、水肿、炎细胞浸润消退 ,以云南白药乙醇组为优 ,海普林组次之。硫酸镁组对组织充血有疗效 ,其他与对照组无统计学意义。 [结论 ]云南白药乙醇、海普林外敷对VCR血管外渗组织损伤可起到一定保护作用。 5 0 %硫酸镁外敷仅能减轻组织充血     

不同药物用于治疗重酒石酸长春瑞滨外渗后疗效的实验观察

[目的]探讨重酒石酸长春瑞滨(盖诺)外渗后理想的处理方法。[方法]制作盖诺外渗的动物坏死模型,分别采用临床上常用的3种处理方法进行动物实验,并进行肉眼及组织学观察。[结果]1∶5000呋喃西林加季德胜蛇药外涂对盖诺外渗的局部组织坏死疗效最佳,复方利多卡因次之,50%硫酸镁湿敷疗效甚微,对照组无效。[结论]1∶5000呋喃西林加季德胜蛇药外涂治疗盖诺外渗是一种行之有效的处理方法。     

对马铃薯外敷治疗液体外渗的临床探讨

目的探讨不同方法处理静脉输液造成的液体外渗的效果。方法分别采用马铃薯切片外敷和温热水湿热敷对60例静脉输液导致的液体外渗患者进行处理。按液体外渗先后顺序随机分组,各3O例．对其更换次数、显效时间及痊愈时间等指标进行比较。结果两组间在各指标间均有显著性差异（P＜0．01）。结论提示用马铃薯切片外敷液体外渗处,其消除水肿效果明显优于温热水湿热敷,且操作简便,无任何副作用,具有临床推广价值。     

甘露醇治疗脑水肿出现高钠血症的机理探讨与防治

目的 探讨甘露醇在治疗脑水肿时出现血钠增高的机理并治疗方法。方法 分析56倒脑水肿患者应用甘露醇后血钠增高的情况及治疗的结果。结果 56例中经治疗53例在不同时间使血钠恢复正常，3例在纠正高钠血症之前死亡。结论 甘露醇是治疗脑卒中及外伤性脑水肿最有效的药物，但在治疗中因其本身药物作用，可能出现血钠增高而影响患者预后，对于特殊人群要尤其注意。     

Impact of two different models on influenza and pneumococcal vaccination in hospitalized patients

OBJECTIVE: The Centers for Disease Control (CDC) recommends trivalent influenza (TIV) and pneumococcal (PPV) vaccination for eligible hospitalized patients. We conducted a retrospective study comparing two different methods of assessment and its impact on TIV and PPV vaccination in hospitalized patients. DESIGN: Two sequential models were compared in a community hospital for assessing patients' vaccination status and eligibility for TIV and PPV in an inpatient setting. In the first model (Model I), physicians were responsible for assessing eligibility and ordering TIV and/or PPV. In the second model (Model II), nurses were responsible for assessment and vaccination of eligible patients. Charts of hospitalized patients were randomly analyzed for completion rates of the assessment form, rate of vaccination, and documentation of the reason for not vaccinating eligible patients. RESULTS: A total of 138 charts were analyzed for Model I and 168 charts were analyzed for Model II. A significantly higher completion rate for assessment was noted for Model II compared with Model I (79.16% versus 34.78%, P < 0.001 for TIV; 72.02% versus 33.33%, P < 0.001 for PPV). Hospital vaccination rates were not significantly different between the two models for TIV (P = 0.625) and PPV (P = 0.689). A significant percentage of patients refused PPV in Model II [8.03% versus Model I at 3.2% (P = 0.04)]. CONCLUSION: A standing order protocol for assessing hospitalized patients' vaccination status by nursing staff and allowing them to vaccinate eligible patients without depending upon a physician order significantly improved the assessment compliance rate, but not the vaccination rates. Our findings suggest that a system-based method with nursing assessing the need for vaccination and a physician ordering the vaccination would probably have a higher potential for success.     

Effect of mannitol on phosphate transport in intact and acutely thyroparathyroidectomized rats.

Clearance experiments were performed in male Sprague-Dawley rats to determine the effect of mannitol on phosphate (Pi) transport. Solutions of 10 per cent mannitol or normal saline were infused at progressively increasing flow rates with or without parathyroid extract (PTE) infusion into the following animals: Group I: Intact Rats-Mannitol Infusion: A--Intact, hypocalcemic; B--Intact, normocalcemic, normomagnesemic; Group II: TPTX Rats: A--Mannitol infusion; B--Mannitol + PTE infusion; C--Hydropenia + PTE infusion; and D--Saline + PTE infusion. In contrast to previous reports, mannitol increased Pi excretion in intact rats. When Ca + Mg were maintained constant in intact rats or after TPTX, mannitol failed to increase Pi excretion. In TPTX rats receiving mannitol + PTE, increased Pi excretion was again noted. Comparison of Pi excretion during PTE infusion during hydropenia and volume expansion with mannitol or saline in TPTX rats revealed significantly higher Pi excretion with volume expansion. Pi excretion paralleled Na excretion in intact mannitol-loaded and PTE-infused TPTX animals undergoing a mannitol or saline diuresis. Pi and Na excretions, however, were dissociated in mannitol-loaded TPTX rats, intact animals receiving simultaneous Ca and Mg infusion, and TPTX hydropenic animals receiving PTE. These studies indicate that (1) mannitol increases Pi excretion in intact rat, (2) the phosphaturia is PTH-mediated, (3) Pi and Na excretions can be dissociated, and (4) volume expansion with either mannitol or saline enhances the effect of PTH on Pi transport in the renal tubule.     

康惠尔增强型透明贴防治静脉炎的作用机制实验研究

[目的]探讨康惠尔增强型透明贴防治兔静脉炎的作用机制。[方法]将24只健康日本大耳白兔随机分成模型组、硫酸镁组和康惠尔组。采用20%甘露醇溶液静脉输注制造实验性静脉炎模型。硫酸镁组和康惠尔组于每次输液结束后5min之内分别给予25%硫酸镁涂抹和贴敷康惠尔增强型透明贴。分别于末次输液后24h、48h、72h取兔耳缘静脉组织标本,观察细胞间黏附分子-1(ICAM-1)和血管内皮生长因子(VEGF)的表达。[结果]模型组ICAM-1和VEGF表达高于康惠尔组和硫酸镁组,差异有统计学意义(P<0.05)。[结论]采用康惠尔增强型透明贴贴敷,可防治甘露醇引起的静脉炎,其防治静脉炎的作用机制可能与其抑制ICAM-1和VEGF的升高有关。     

Forearm Compartment Syndrome After Intravenous Mannitol Extravasation in a Carbosulfan Poisoning Patient

We report a case of forearm compartment syndrome caused by extravasation of mannitol in an intoxicated patient. The pathophysiology and management of a forearm compartment syndrome from extravasation of mannitol are discussed in this case.     

水胶体敷料防治静脉炎与细胞黏附分子1和血管内皮生长因子的表达

背景:关于水胶体敷料防治由甘露醇引起静脉炎的方法报道较多,但大多均为临床疗效观察,缺乏微观证据支持.目的:拟以水胶体敷料防治兔静脉炎的实验,揭示与认识水胶体敷料防治静脉炎的作用机制.设计、时间及地点:前瞻性随机对照实验,于2005-01/2006-01在四川大学华西医院动物实验中心完成.材料:水胶体敷料选择康惠尔增强型透明贴,严格按照纳入、排除标准将16只基线资料一致的健康日本大耳白兔随机分成模型组和康惠尔组,每组8只.方法:采用20%甘露醇溶液静脉滴注,诱导实验性静脉炎.模型组每次输入甘露醇后不给予任何治疗措施;康惠尔组每次输液结束后5 min之内给予康惠尔增强型透明贴贴敷至下次输液时取下.主要观察指标:于末次输液后24 h取标本对各组兔耳缘静脉进行病理组织检查,检测模型组和康惠尔组兔耳缘静脉损伤时细胞内黏附分子1和血管内皮生长因子的表达量.结果:模型组和康惠尔组细胞内黏附分子1和血管内皮生长因子表达均有不同程度的增高,而康惠尔组细胞内黏附分子1、血管内皮生长因子表达低于模型组,差异有显著性意义(P<0.05).结论:康惠尔增强型透明贴防治兔浅静脉炎的作用与其抑制血管损伤时细胞内黏附分子1和血管内皮生长因子的升高有关.     

Many‐models medicine: diversity as the best medicine

Many medicines have been proposed to cure various ills of biomedicine including evidence‐based medicine, evolutionary medicine, narrative medicine, and complexity medicine, among others. To the extent that all models are idealizations or abstractions, all of these model medicines are imperfect in some respects. In the absence of a single unified model, if indeed unification is possible or even desirable, and despite the relative advantages of one model or another, in practice many models and methods are necessary in medicine. In this article, I consider the value of such diversity in models and methods. I briefly describe several models. Then I discuss simulations of agents who use diverse models. Advocates of models such as those discussed here typically claim that we should use their preferred model because it is the best. Evidence‐based medicine, for instance, has been promoted as the single best model of medicine while other models have been cast as lesser models or in opposition to it and each other. But isolated models and methods may never be as good as groups of models and methods. Debates about various individual models may result in better outcomes, but explicitly choosing to use many models is likely to produce even better outcomes.     

Employment after spinal cord injury: an analysis of cases from the Model Spinal Cord Injury Systems

OBJECTIVE: To describe the relationship of multiple biographic, injury-related, and educational factors with employment outcomes after spinal cord injury (SCI). DESIGN: Cross-sectional. SETTING: Data were collected through 18 model SCI systems, a nationwide network of hospitals that treat approximately 14% of all SCIs in the United States. PARTICIPANTS: A total of 3,756 persons with traumatic SCI who completed the Form II data collection during their annual follow-up at years 1, 2, 5, 10, 15, 20, or 25 years (the most recent Form II was accepted). MAIN OUTCOME MEASURES: The Model Systems Forms I and II were used to identify biographic, injury-related status, employment at injury, and productivity status upon follow-up (Form I is used to elicit basic demographic and discharge information, whereas Form II is used to track multiple outcomes during annual follow-ups). The Craig Handicap Assessment Reporting Technique (CHART) was used to assess hours spent in gainful employment and other productive activities. RESULTS: CHART data revealed only a modestly higher Employment rate (24.8%) than that of the traditional single Form II item (22%). Being Caucasian, younger at injury, having lived more years with SCI, having a less severe injury, and having more years of education were all predictive of being employed. Violence at injury was associated with lower employment rates (only 12.9% employed), especially among Caucasians (only 24% employed). Being employed at injury was associated with a greater probability of postinjury employment, but only in the first few years after injury. Among employed participants, women and those who had been injured fewer years averaged fewer hours spent at work. CONCLUSIONS: Findings were consistent with those in previous studies. Interventions to improve employability should focus on education and the needs of individuals from minority backgrounds.