股静脉置管不同固定方法比较

目的探讨股静脉不同置管固定方法的效果。方法将232例股静脉置管患者随机均分为观察组和对照组各116例。观察组用3M透明敷贴联合无痛保护膜固定导管,对照组只用3M透明敷贴固定。结果两组导管留置时间及局部皮肤不良反应发生率比较,差异有统计学意义(均P0.01)。结论3M透明敷贴联合无痛保护膜固定股静脉置管效果好,并发症少,有利于患者完成全程治疗。     

股静脉置管不同固定方法比较

目的探讨股静脉不同置管固定方法的效果。方法将232例股静脉置管患者随机均分为观察组和对照组各116例。观察组用3M透明敷贴联合无痛保护膜固定导管,对照组只用3M透明敷贴固定。结果两组导管留置时间及局部皮肤不良反应发生率比较,差异有统计学意义（均P〈0.01）。结论3M透明敷贴联合无痛保护膜固定股静脉置管效果好,并发症少,有利于患者完成全程治疗。     

应用银离子喷剂预防经外周置入中心静脉导管感染

目的:探讨银离子敷料对经外周置人中心静脉导管穿刺点护理预防中心静脉导管感染的效果.方法:特84例行中心静脉置管的患者随机分为透明敷料组和银离子敷料组各42例.透明敷料组用3M透明敷贴联合银离子喷剂敷料贴于PICC固定处皮肤,银离子敷料组单用3M透明敷贴.结果:透明敷料组感染发生率及局部皮肤阳性反应率显著高于银离子敷料组(均P＜0.05).结论:应用银离子喷剂行中心静脉导管穿刺点护理可降低导管感染率.     

皮炎平联合银离子敷贴治疗PICC致局部湿疹

目的 探讨PICC置管所致局部湿疹的有效治疗方法.方法 将58例PICC置管后发生湿疹患者随机分为对照组和观察组各29例.对照组使用庆大霉素湿敷加3M透明敷贴固定PICC;观察组采用加庆大霉素湿敷后,局部涂抹皮炎平,最后用银离子敷贴固定PICC.结果 观察组治疗效果显著优于对照组(P＜0.01).结论 皮炎平加庆大霉素湿敷联合银离子敷贴治疗PICC置管所致局部湿疹疗效确切,方法简单.     

新换药方法对预防PICC置管后透明膜过敏的效果观察

目的:探讨新换药方法对预防经外用静脉穿刺中心静脉置管后局部皮肤过敏的效果观察.方法:将86例接受PICC穿刺的病人随机分成常规组(n=43)和改良组(n=43).常规组使用3L透明贴膜固定PICC导管；改良组使用康乐宝皮肤保护膜涂在穿刺局部周围皮肤上,再使用3L透明贴膜固定导管.观察并比较两组皮肤不良反应的发生情况.结果:常规组出现18例皮肤不良反应,改良组出现2例皮肤不良反应,两组比较差异显著,有统计学意义(P＜0.05).结论:新换药方法中应用的康乐宝皮肤保护膜能在皮肤表面形成一层膜状保护层,它可以提高皮肤对透明贴膜的耐受程度,减少皮肤损伤.     

自我粘缠绷带用于PICC穿刺点局部固定

目的 探讨自我粘缠绷带用于PICC穿刺点的固定效果.方法 将98例PICC置管患者按置管奇偶数顺序分为观察组和对照组各49例.PICC穿刺后,在常规固定的基础上,对照组采用普通医用绷带加压固定,观察组采用自我粘缠绷带固定.结果 观察组渗血时间(17.00±1.46)h,48 h更换敷贴(1.42±0.18)次,对照组分别为(20.00±1.21)h、(1.98±0.31)次,两组比较,差异有显著性意义(均P＜0.01);观察组患者肢体舒适度显著优于对照组(P＜0.01).结论 自我粘缠绷带用于PICC穿刺点局部止血效果好,且不影响患者肢体舒适.     

3M HP型透明敷料应用于PICC置管后的效果观察

目的:调查分析3M加强型(HP型)透明敷料对PICC固定处皮肤的保护作用.方法:选择2011年5月～2012年5月98例PICC置管患者,随机分为实验组50例和对照组48例,固定敷料实验组选用3M加强型透明敷料(HP型).对照组选用选用3M普通透明敷料,敷料实验组患者更换频率一般均为每周1次,对照组每周更换2次,观察两组患者穿刺点周围的皮肤反应情况,并调查患者自感舒适情况以及有无导管脱出现象.结果:实验组皮肤反应和导管脱出明显低于对照组,自我舒适感明显高于对照组.结论:PICC置管后应用3M加强型透明敷料固定,能够有效避免或减少患者不同程度的皮肤反应和预防导管脱落,较大提高患者的自觉舒适度.     

造口袋及无痛保护膜在肠外瘘患者皮肤护理中的应用

目的 探讨造口袋及无痛保护膜在肠外瘘患者皮肤护理中的应用效果.方法 将35例肠外瘘患者按入院时间分为两组,观察组20例采用造口袋及无痛保护膜对瘘周皮肤进行护理,对照组15例采用传统的持续负压吸引和氧化锌实施痿周皮肤护理.结果 观察组瘘口周围皮炎发生率及换药次数显著低于和少于对照组(P＜0.05,P＜0.01).结论 造口袋结合无痛保护膜的护理方法可有效预防瘘口周围皮炎的发生,减少患者的医疗费用.     

彩色多普勒血流显像技术引导下行PICC 30例

目的 探讨彩色多普勒血流显像技术(CDFI)引导下行PICC置管的临床价值.方法 选择经临床诊断需要行PICC且血管条件符合盲穿的肿瘤患者60例,分为观察组和对照组各30例.对照组采用传统的盲穿法,观察组在CDFI的引导下穿刺置管,比较两组穿刺置管成功率、局部组织损伤率、置管操作所需时间.结果 观察组穿刺置管成功率显著高于对照组(P＜0.05),局部组织损伤率及操作时间显著低于和短于对照组(均P＜0.01).结论 CDFI引导下行PICC可提高局部血管状况较差患者的置管成功率、缩短操作时间及降低局部损伤发生率.     

置管前备皮对早产儿PICC维护效果的影响

目的探讨置管前备皮对早产儿PICC维护效果的影响。方法将需行PICC置管的住院早产儿按编号排序,奇数分为备皮组267例,偶数分为非备皮组268例。两组PICC穿刺操作及导管维护均由3名取得PICC专科护士培训合格证书的高年资护师完成,非备皮组按常规行PICC置管,备皮组在PICC置管前剃除胎毛。结果备皮组皮肤破损发生率显著低于非备皮组,更换敷贴所用时间较非备皮组显著缩短,疼痛评分显著低于非备皮组(均P0.01);两组穿刺处皮肤感染率比较,差异无统计学意义(P0.05)。结论 PICC置管前备皮能显著降低更换敷贴时对患儿皮肤造成的撕脱损伤,减轻患儿疼痛,并缩短更换敷贴时间。     

3M Capital hip arthroplasty

We reveiwed 267 Capital hip replacements. Patients were recalled in 1998 after reports of failure of this prosthesis. 208 hips (200 patients) were followed-up (average 6 years). 9 hips (4%) had been revised for aseptic loosening and 10 stems (5%) were radiographically loose. Males and both varus and valgus stems showed a higher incidence of loosening. The failure rate, however, was considerably lower than the published figures. The reason for this is not clear, but obviously design is not the only factor contributing to loosening. Therefore, a continuous routine registration of clinical data and relevant outcome parameters on a large scale seems desirable.     

Interaction of edrophonium with muscarinic acetylcholine M2 and M3 receptors

BACKGROUND: It has been reported that edrophonium can antagonize the negative chronotropic effect of carbachol. This study was undertaken to evaluate in detail the interaction of edrophonium with muscarinic Mz and M3 receptors. METHODS: A functional study was conducted to evaluate the effects of edrophonium on the concentration-response curves for the negative chronotropic effect and the bronchoconstricting effect of carbachol in spontaneously beating right atria and tracheas of guinea pigs. An electrophysiologic study was conducted to compare the effects of edrophonium on carbachol-, guanosine triphosphate (GTP)gama S-, and adenosine-induced outward K+ currents in guinea pig atrial cells by whole cell voltage clamp technique. A radioligand binding study was conducted to examine the effects of edrophonium on specific [3HIN-methylscopolamine (NMS) binding to guinea pig atrial (M2) and submandibular gland (M3) membrane preparations, and on atropine-induced dissociation of [3H]NMS. RESULTS: Edrophonium shifted rightward the concentration-response curves for the negative chronotropic and bronchoconstricting effects of carbachol in a competitive manner. The pA2 values for cardiac and tracheal muscarinic receptors were 4.61 and 4.03, respectively. Edrophonium abolished the carbachol-induced outward current without affecting the GTPgamma S- and adenosine-induced currents in the atrial cells. Edrophonium inhibited [3H]NMS binding to M2 and M3 receptors in a concentration-dependent manner. The pseudo-Hill coefficient values and apparent dissociation constants of edrophonium for M2 and M3 receptors were 1.02 and 1.07 and 21 and 34 microM, respectively. Edrophonium also changed dissociation constant values of [3H]NMS without affecting its maximum binding capacities. CONCLUSION: Edrophonium binds to muscarinic M2 and M3 receptors nonselectively, and acts as a competitive antagonist.     

Neuromuscular Relaxants as Antagonists for M sub 2 and M sub 3 Muscarinic Receptors

Background: Neuromuscular relaxants such as pancuronium bind to M sub 2 and M3 muscarinic receptors as antagonists. Blockade of muscarinic receptors in atria of the M2 subtype mediates tachycardia. In the lung, blockade of M2 receptors on parasympathetic nerves potentiates vagally induced whereas blockade of M sub 3 receptors on bronchial smooth muscle inhibits bronchospasm. The current study was designed to quantify the affinity of a series of neuromuscular relaxants for the M2 and M3 muscarinic receptors, which were individually stably transfected in Chinese hamster ovary cell lines.

Methods: Competitive radioligand binding assays determined the relative binding affinities of the neuromuscular relaxants pancuronium, succinylcholine, mivacurium, doxacurium, atracurium, rocuronium, gallamine, and pipecuronium for the muscarinic receptor in the presence of a muscarinic receptor antagonist (sup 3 H-QNB) in membranes prepared from cells individually expressing either the M2 or M3 muscarinic receptor.

Results: All muscle relaxants evaluated displaced3 H-QNB from muscarinic receptors. The relative order of potency for the M2 muscarinic receptor (highest to lowest) was pancuronium, gallamine, rocuronium, atracurium, pipecuronium, doxacurium, mivacurium, and succinylcholine. The relative order of potency for the M3 muscarinic receptor (highest to lowest) was pancuronium, atracurium, pipecuronium, rocuronium, mivacurium, gallamine, succinylcholine, and doxacurium.     

Potential Benefits of Muscarinic M3 Receptor Selectivity

Detrusor smooth muscle contains muscarinic receptors of the M₂ (≈2/3) and M₃ (≈1/3) subtypes. M₃ receptors are mainly responsible for normal micturition contraction, whereas, the role of M₂ receptors has not yet been clarified. In certain disease states, M₂ receptors may also contribute to bladder contraction. Different muscarinic receptor subtypes can contribute to processes of cellular activation or inhibition. For example, in salivary glands, both M₁ and M₃ receptor subtypes may control secretion. In the cardiovascular system, the M₂ receptor subtype can mediate parasympathetically-driven bradycardia and a decrease in cardiac output. In the brain, where the role of cortical M₁ receptors in cognition is well documented, M₁ receptor blockade would be expected to compromise central nervous system function. Muscarinic receptors that mediate contraction of human ciliary muscle are most probably M₃ and M₅. Drugs selective for the M₃ receptor might be expected to have clinical efficacy in detrusor overactivity with a reduction in adverse events related to the blockade of other receptor subtypes. However, the clinical effectiveness of a drug depends not only on its receptor affinity, but also on its pharmacokinetics and the importance of specific muscarinic receptors for a given organ function.     

Akin osteotomy using the 3M Shapiro Staplizer

Internal fixation of the Akin osteotomy has taken many forms. With the advent of the 3M Power Metaphyseal Staplizer, fixation of this osteotomy has been improved. This staple provides ease of use, light compression, maintenance of position, and speed.     

The M3 from the international point of view

Deciding to cease treatment in intensive care unit patients whose prognosis is hopeless allows programming the moment of death, and hence, post mortem transplantable organ donation. Such organ donations are more frequent in Anglo-Saxon countries. In the context of growing organ needs, they have significantly increased the number of organs that are available for transplant. Progressive experience has shown that crystal-clear procedures must be set up in order to avoid lack of understanding, opposition, or even conflict between involved medical teams and immediate relatives of potential donors. The decision of organ transplantation must totally be separated from the decision of treatment cessation. Supportive treatment cessation must be done according to previously established procedures. Medications that are compatible with organ transplantation must be listed. Finally, the needs of patient relatives must be met.     

M3 muscarinic receptor expression on suburothelial interstitial cells

OBJECTIVE

To identify the cells expressing the M₃ muscarinic receptor subtype in the lamina propria of the bladder.

MATERIALS AND METHODS

The bladders from five normal guinea pigs were isolated and fixed in 4% paraformaldehyde. Tissues sections (10 µm) were then cut and stained with antibodies to the type 3 muscarinic receptor (M₃), the interstitial cell marker vimentin and the nonspecific nerve marker PGP 9.5. The specificity of the antibody to the M₃ receptor was established using the complementary blocking peptide and Western blot analysis of human embryonic kidney (HEK) cells transfected to express the M₃ receptor protein.

RESULTS

The M₃ antibody pre‐incubated with its blocking peptide showed no immunohistochemical staining. Investigating this antibody using HEK cells transfected to express the M₃ receptor protein and control HEK cells showed a single band in the transfected cells and no band in the control cells. M₃ receptor immunoreactivity (M₃‐IR) was detected primarily on a dense network of vimentin‐positive (vim⁺) cells lying immediately below the urothelium, i.e. the suburothelial interstitial cells (Su‐ICs). The M₃‐IR was punctate and appeared to be located on the cell surface. The diffuse network of cells in the remaining regions of the lamina propria showed no M₃‐IR. Few nerve fibres were associated with the M₃‐IR Su‐ICs. The M₃‐IR Su‐ICs were most numerous and prominent in the lateral wall. The number of M₃‐IR/vim⁺ cells diminished towards the bladder base and were absent in the bladder urethral junction. In the base and urethral junction there were vim⁺ cells that were not M₃‐IR. A population of umbrella cells in the lateral wall also showed weak punctate M₃‐IR.

CONCLUSIONS

Using a well‐characterized M₃ antibody, these results show for the first time that the M₃ muscarinic receptor in the lamina propria is located specifically on the Su‐ICs. The physiological role of these cells is unknown and consequently the significance of what appears to be a cholinergic signalling system is unclear. Previously published data showed that these cells respond to nitric oxide and atrial natriuretic peptide with an increase in cGMP and possibly prostaglandin. All of these observations, taken together, suggest that the Su‐ICs receive multiple inputs and that they must be part of a complex signalling system in this region of the bladder wall.     

毒蕈碱受体亚型介导逼尿肌细胞收缩与IP3关系的实验研究

目的　探讨信使分子IP3 在毒蕈碱受体亚型M3 R介导逼尿肌细胞收缩中的作用。　方法　MR非选择性激动剂 (carbachol)、拮抗剂 (atropine)及M2 R拮抗剂 (methoctramine)、M3 R拮抗剂 (4 DAMP)刺激原代培养人逼尿肌细胞 ,通过 [3 H]掺入法 ,检测磷脂酰肌醇 (PI)代谢产物 [3 H] IP含量。　结果　 [3 H] IP含量随carbachol刺激浓度增加而增加 ;10 -9、10 -8、10 -7、10 -6、10 -5、10 -4mmol/L的 4 DAMP抑制carbachol后 ,[3 H] IP含量分别为 392 6 .5 7± 2 73.2 9、2 780 .5 2± 2 11.0 9、2 4 36 .84± 15 3.6 2、1973.2 2± 16 4 .71、1372 .38± 14 1.35及 110 7.98± 92 0 .4 5cpm ,相同浓度的at ropine作用后 ,[3 H] IP含量分别为 36 0 2 .6 9± 2 80 .17、2 891.31± 2 0 7.4 5、1983.97± 14 5 .74、12 6 9.5 7± 10 5 .31、110 6 .37± 75 .2 3、92 7.5 0± 77.36cpm ;而相同浓度的methoctramine作用后 ,[3 H] IP含量分别为 4 4 6 2 .74± 36 0 .6 9、3938.6 1± 32 7.13、3315 .4 5± 2 70 .36、30 6 3.19± 2 4 6 .79、2 92 7.37± 2 2 6 .4 5及 2 836 .5 5± 2 4 1.6 3cpm ,两者之间差异有非常显著性意义 (P <0 .0 1) ,表明 4 DAMP和atropine能显著抑制carbachol诱导的代谢反应 ,而methoctram