不同进针长度行静脉输液时对血管壁影响的对比研究

为了解静脉输液进针长度对血管壁的影响。对８只家兔和６２例住院病人进行自身血管损伤程度的对照观察，进针长度分别为０．６ｃｍ及１．２ｃｍ。结果显示：进针１．２ｃｍ组，无论是动物还是病人其疼痛反应、血管壁损伤、管周组织瘀血、血管阻塞程度等均明显大于进针０．６ｃｍ组（Ｐ〈０．０１）。且进针１．２ｃｍ组每条静脉平均使用寿命地明显短于进针０．６ｃｍ组。提示临床护理人员行静脉输液时，在确保针头进入血管、达到牢固     

两种进针部位和长度静脉输液时药物外渗的比较

为了解静脉输液进针部位和长度对血管壁损伤而引起药物外渗的情况，对住院病人进行自身血管损伤引起药物外渗程度的对照观察。观察组：在血管右侧进针，进针长度0．6cm；对照组：从血管正上方进针，进针长度为1．2cm，经临床实践证明，观察组血管损伤而引起药物渗漏占6．14％，而对照组血管损伤占14．16％有显著的差异性，提示临床护理人员行静脉输液时，为减少药物外渗，应尽量从血管右侧进针，并尽量减少进针长度。     

1周岁内患儿头皮静脉穿刺及针头固定方法的探讨

目的为减轻患儿痛苦,提高穿刺成功率,保证输液质量和患儿的安全,降低静脉输液的并发症,探讨小儿头皮静脉穿刺的最佳手法、进针角度、固定方法.方法随机将1 000例1周岁以内的患儿分为对照组与观察组,每组500例,分别采用不同的手法、进针角度、固定方法进行前瞻性临床研究.结果对照组500例患儿疼痛反应、复针率、液体外渗、针头脱出血管、血管周围发红、血管阻塞等并发症明显大于观察组,静脉使用率、一针成功率,观察组明显大于对照组.结论针头与皮肤成5°,快速进入皮肤后变换手法,右手拇指、示指持针柄前后面,针头与血管平行,直刺进入血管,以"S"型固定.可减轻针头对血管壁的损伤,操作简单且易固定,效果好,是一种理想的固定方法.     

1周岁内患儿头皮静脉穿刺及针头固定方法的探讨

目的　为减轻患儿痛苦 ,提高穿刺成功率 ,保证输液质量和患儿的安全 ,降低静脉输液的并发症 ,探讨小儿头皮静脉穿刺的最佳手法、进针角度、固定方法。方法　随机将 10 0 0例 1周岁以内的患儿分为对照组与观察组 ,每组 5 0 0例 ,分别采用不同的手法、进针角度、固定方法进行前瞻性临床研究。结果　对照组 5 0 0例患儿疼痛反应、复针率、液体外渗、针头脱出血管、血管周围发红、血管阻塞等并发症明显大于观察组 ,静脉使用率、一针成功率 ,观察组明显大于对照组。结论　针头与皮肤成 5°,快速进入皮肤后变换手法 ,右手拇指、示指持针柄前后面 ,针头与血管平行 ,直刺进入血管 ,以”S”型固定。可减轻针头对血管壁的损伤 ,操作简单且易固定 ,效果好 ,是一种理想的固定方法。     

输液性静脉炎的局部诱发理论的探讨

目的 通过动物实验采用穿刺针头深插法输注20%甘露醇致兔耳缘静脉炎的发生和局部炎症反应情况与输液过程中从针头输出的药物是否有逆流,分析局部炎症与含药物的血液逆流的相关性.方法 新西兰白兔18只,随机分为常规穿刺、穿刺针头深插组,每组9只.两组采用兔耳静脉输注20%甘露醇(2.4 ml/kg).常规穿刺组穿刺针头进血管1 cm,穿刺针头深插法穿刺针头进血管3.5 cm,8 h注射一次,共3次.观察两组静脉炎的发生情况.结果 两组均呈急性炎症病理特点,血管周围水肿、血管内皮肿胀、炎性细胞浸润程度不同,常规组病理损伤程度重,统计学有差异(P<0.05).纤维组织增生程度变化小,无统计学意义(P>0.05).两组标本中都含有甘露醇,但是常规穿刺组的含量高于深插法穿刺组.结论 输出的药物随着血液有少许逆流.含药物的血液逆流对穿刺点的血管内膜损伤处的刺激与输液静脉局部炎症与有相关性.穿刺针头深插法能减轻局部炎症反应,为临床深静脉置管预防输液性静脉炎提供可靠理论依据.     

静脉穿刺的改进及护理

静脉输液是临床用药的重要途径之一。为提高静脉穿刺的成功率,我们从穿刺过程中各方面进行改进,取得了良好的效果。现将总结的经验介绍如下。1静脉选择长期输液者应有计划地保护和合理使用静脉。一般从远端小静脉开始,选用弹性好、回流通畅、外横径较粗、便于穿刺和观察的部位,并采用交替注射法。有研究表明老年患者留置浅静脉套管时静脉炎的出现与血管管径有明显关系。管径越小。置管反应率越高,出现反应的时间也越早。特别是管径<3 mm血管置套管针时,69.9%的患者置管时间不超过3 d,有的只能留置1 d,4 d内静脉炎的发生率100%。因此,应选择血管径>3mm的静脉[1]。2握拳和进针方法大部分患者握拳松紧度不受操作者控制。过松,血管充盈不佳且不宜固定;过紧,皮肤肌肉过度紧张,挤压血管壁,血管充盈受损。改进后我们采用非握拳法操作。让穿刺者手自然放置不需握拳,常规消毒后,操作者左手紧握患者的四指或五指,使之向手心方向弯曲成弧形,然后采用直接进针,进针角度45°角,这样针头进入皮肤同时直接进入血管,减少了对皮下组织的切割和撕拉现象,能快速进入皮下,患者只感觉轻微疼痛。3进针长度以往我们总是将针头进入血管内较长(2/3或以上),对血管...     

静脉穿刺直入血管法的临床研究

目的通过对静脉穿刺进针方法的研究 ,采取直接刺入血管的进针方法 ,使静脉穿刺达到无痛、微创、快速、准确无误的质量标准。方法操作者分别用传统的“三段式”进针法和直接刺入血管法为 70名住院患者行静脉输液 ,了解两种不同穿刺方法进针速度、病人对疼痛的感觉 ,穿刺对病人局部组织的损伤程度及一针见血率。结果两组病人对穿刺疼痛的感觉经秩和检验Uc =4 .2 2 ,P <0 .0 0 0 5 ,有显著性差异。两种不同进针方法 ,进针速度经U检验 ,U =15 .70 ,P <0 .0 0 1,差异有显著意义。直接刺入血管法对局部组织的损伤范围只是对皮肤、皮下组织及血管壁穿刺点的损伤 ,而“三段式”进针法 ,除对皮肤、血管壁穿刺点的损伤外 ,对皮下组织的损伤为遂道式损伤和撕裂伤。按进针深度 1/ 2计算 ,其损伤体积为 2 .2 4mm3 。两种方法穿刺一针见血率分别为 95 .71%、92 .88%。经 χ2检验 ,χ2 =0 .5 3,P >0 .2 5 ,无显著性差异。结论直接进针法可减少病人的局部损伤 ,减轻病人疼痛 ,且进针速度快 ,准确无误 ,明显优于传统的“三段式”进针法     

静脉输液插管时避免橡皮塞堵塞针头的方法探讨

目的 :探讨静脉输液插管时避免橡皮塞碎屑堵塞针头的方法。方法 :将 6 0 0例静脉输液患者随机分为 3组 :1组 :2 0 0例。采用传统垂直进针方法即针头与瓶塞角度成 90°进针 ;2组 :2 0 0例。采用斜角进针方法即针头斜面向上与瓶塞角度成 70°～ 75°进针 ;3组 :2 0 0例。采用改进的进针方法即采用斜角进针。针头斜面向上与瓶塞角度成70°～ 75°进针 ,进针同时辅以将针头斜面推向背面。结果 :1组的阻塞率明显高于 3组 (P <0 .0 0 5 ) ;2组的阻塞率明显高于 3组 (P <0 .0 5 )。结论 :改进的进针方法明显优于传统进针方法及斜角进针方法 ,值得临床推广应用     

两种小儿头皮静脉输液针头固定方法的比较

目的:探讨小儿头皮静脉输液针头固定的最佳方法.方法:选择2007年7月～8月在我院门诊输液室进行头皮静脉输液的787例患儿为研究对象,其中单日输液的396例患儿为实验组,双日输液的391例患儿为对照组,两组一般资料比较无显著性差异(P>0.05).对照组采用常规方法固定针头,实验组采用改良方法固定针头.比较两组针头固定的效果.结果:对照组液体外渗、针头脱出、胶布松脱的次数明显多于实验组,两组比较有极显著性差异(P<0.01).结论:采用改良方法固定针头可减轻针头对血管壁的损伤,防止头皮针脱出或胶布松脱,固定效果好,操作简单易行,值得推广应用.     

静脉输液操作方法研究

传统的静脉输液操作过程中 ,在静脉穿刺见回血后 ,将针头再平行进入少许 ,放松止血带和调节器 ,嘱病人松拳 ,见液体输入通畅 ,再用胶布固定[1] 。而在临床操作实践中发现 ,看到回血后 ,将针头送入多少适宜难以掌握 ,且往往由于在针头送入血管的过程中针头刺穿血管壁而造成穿刺失败。通过对静脉输液操作方法的研究和临床实践 ,采用见回血停止进针的方法 ,提高了静脉穿刺成功率 ,现介绍如下。1　临床资料1.1　资料与方法　选择哈那好输液器 ,连接 7号头皮针 ,按常规静脉输液操作进行准备及操作。随机抽取 2 0 0 1年 6月—2 0 0 1年 10月我院家…     

冷热敷时间对硫酸镁治疗兔耳缘静脉炎影响的实验研究

[目的]探讨硫酸镁冷热敷交替治疗静脉炎的最佳时机。[方法]静脉注射20%甘露醇建立兔耳缘静脉硬结型静脉炎模型,将24只建模成功的新西兰大白兔随机分为4组,均予50%硫酸镁湿敷。对照组为常温湿敷,实验1组、实验2组、实验3组分别冷敷12 h2、4 h4、8 h后换为热敷治疗。湿敷72 h后,大体观察及病理切片观察血管壁损伤程度、血管周围出血程度、血管淤血程度、炎细胞浸润程度、纤维组织增生程度、血栓形成程度、水肿程度。[结果]实验1组、实验2组较对照组、实验3组静脉总体损伤程度显著降低;血管壁损伤程度、血管周围出血程度、血管淤血程度、纤维组织增生程度、水肿程度各组比较差异均有统计学意义。[结论]硫酸镁治疗静脉炎冷热敷交替的最佳时机为12 h~24 h。     

不同氧疗方式对兔海水淹溺肺水肿的治疗作用

目的　观察不同氧疗方式对海水淹溺肺水肿 (PE -SWD)的治疗作用。方法　实验动物随机分为正常对照组、海水淹溺组、高压氧 (HBO)治疗组、机械通气 (MV)组。在不同时间点观察动脉血气分析、生命体征、肺损伤指标 ,并进行病理学检查和观察存活时间。结果　两种氧疗方式治疗后PaO2 、SaO2 较海水淹溺组有明显改善 (P <0 0 1) ,异常的生命体征得到一定程度纠正 ,肺损伤程度减轻。治疗组动物存活时间明显延长 ,且机械通气组优于高压氧组。结论　高压氧和机械通气治疗可明显控制PE -SWD时的低氧血症 ,并减轻肺损伤程度     

剖宫产孕妇留置导尿管长度的探讨

为降低剖宫产孕妇留置导尿管的重插率，对尿管插入长度进行了观察。将８５例剖宫产孕妇随机分为实验组与对照组。实验组尿管插入长度为８ｃｍ～１０ｃｍ，对照组为４ｃｍ～６ｃｍ。结果显示：实验组重插率明显低于对照组（Ｐ＜０．０１）。     

静脉注射多柔比星对血管内膜损伤的病理学研究

[目的]观察两种浓度的多柔比星静脉推注对免血管内膜的损伤程度。[方法]选择24只大白兔,分为对照组和实验组,对照组多柔比星浓度为1．0mg／mL;实验组多柔比星浓度为0．5mg／mL。分别在兔左右耳缘静脉推注,且在推注后48h、2周分别取左右耳缘静脉血管组织标本进行病理学分析。[结果]推注48h后两组兔血管内膜损伤程度比较,差异有统计学意义（P〈0．01）;推注2周后两组免血管内膜损伤程度亦存在差异（P〈0．01）。E结论]静脉推注低浓度（0．5mg／m1．）多柔比星,能明显减轻对血管内膜的损伤,从而有效保护血管,降低静脉炎发生率。     

Age effects susceptibility to pulmonary barotrauma in rabbits

OBJECTIVE: We studied the effect of age on the development of pulmonary barotrauma after mechanical ventilation with high peak inspiratory pressures (PIP). DESIGN: Young (4 to 6 wk old) and adult rabbits were ventilated for 1 hr at PIPs of 15, 30, and either 45 cm H2O (young group) or 55 cm H2O (adult group). MEASUREMENTS AND MAIN RESULTS: The pulmonary capillary filtration coefficient (Kf,c) was measured in an isolated lung perfusion system after the animals were killed. In young rabbits, Kf,c increased significantly from the 15 cm H2O PIP value in both the 30 cm H2O (55%) and 45 cm H2O (507%) PIP groups, whereas Kf,c was increased in adult rabbits only in the 55 cm H2O (113%) PIP group. Kf,c was significantly (p less than .01) higher in young rabbits than in adult rabbits after ventilation, with every level of PIP being 91% higher at 15 cm H2O PIP and 440% higher at 45 to 55 cm H2O PIP. Also, a greater incidence of pneumothorax and airleaks was observed in the young rabbits. Pressure-volume loops demonstrated that the young rabbits had more compliant lungs and chest wall than adult rabbits. CONCLUSIONS: These data indicate that the lungs of young rabbits had a higher baseline microvascular permeability and were more susceptible to the development of ventilator-induced increased microvascular permeability. More compliant lungs and chest wall and the larger distending volumes attained at each peak airway pressure appear to be the mechanisms.     

头穴透刺对急性脑缺血大鼠海马齿状回nestin影响的研究

目的：通过观察头穴透刺对急性脑缺血大鼠海马齿状回Nestin表达的变化,探讨头穴透刺抗脑缺血损伤的作用机理。方法：雄性SD大鼠32只,随机分为正常组、脑缺血组、假手术组、头穴透刺组各8只。采用改良线栓法制作大鼠大脑中动脉栓塞局灶性脑缺血模型,头穴透刺组大鼠待清醒后1h,取百会透前顶、率谷透悬厘进行针刺治疗。治疗后对各组大鼠进行神经功能缺损评分,采用免疫组化法检测海马齿状回神经巢蛋白（nestin）的表达。结果：治疗7d后,头穴透刺组大鼠神经缺损评分明显低于较脑缺血组（P〈0．01）;脑缺血组与正常组及假手术组比较,nestin表达明显增加（P〈0．01）;与脑缺血组比较,头穴透刺组nestin阳性表达明显增加（P〈0．01）。结论：头穴透刺可以使急性脑缺血大鼠受损神经功能明显恢复,能使脑缺血大鼠海马齿状回nestin的表达明显增加,提示头穴透刺有显著抗脑缺血损伤的作用。     

Adipose-derived stem cells enhance bone regeneration in vascular necrosis of the femoral head in the rabbit

Osteonecrosis of the femoral head was induced in rabbits by intramuscular injection of methylprednisolone and vascular occlusion of the capital femoral epiphysis by electrocoagulation. Eight weeks later the animals received no treatment (group A), core decompression by drilling a hole (diameter 1.2 mm) from the outer cortex 2.5 cm distal to the proximal end of the greater trochanter (group B), or injection of 10(7) autologous adipose-derived stem cells (ADSCs) directly into the femoral head (group C). Eight weeks later, microcomputed tomography scans indicated that bone and trabecular volume and density were significantly higher in group C than in other groups. Histology indicated more new bone formation in group C than in other groups. Group C showed strong osteocalcin immunoreactivity in subchondral bone osteoblasts in the necrotic femoral head, whereas few osteocalcin-positive cells were found among osteoblasts in other groups. Thus, autologous ADSC transplantation improved osteogenesis and the microstructure of vascular deprivation-induced osteonecrotic tissue.     

骨髓间充质干细胞移植对烟雾吸入性损伤兔早期肺组织的影响

目的 探讨骨髓间充质干细胞(MSCs)移植对烟雾吸入性损伤兔早期肺组织损伤的影响.方法 采用直接贴壁法体外培养兔MSCs,用流式细胞术鉴定MSCs.将48只兔制备烟雾吸入性损伤模型后按随机数字表法均分成致伤组和MSCs组.MSCs组伤后立即静脉给予含1×107个/ml MSCs的磷酸盐缓冲液(PBS)10 ml;致伤组则给予10 ml PBS.分别于干预后2、6和24 h活杀8只兔,取肺组织行组织病理学观察,同时进行肺损伤评分.结果 流式细胞术检测显示所培养细胞为MSCs.肺大体标本和光镜下均观察到MSCs组肺损伤程度较致伤组明显减轻.虽然MSCs组和致伤组伤后2 h肺损伤评分(分)比较差异无统计学意义(4.0±0.7比4.5±0.6,P＞0.05),但MSCs组伤后6 h和24 h肺损伤评分(分)明显低于致伤组(6 h:6.1±0.9比8.2±0.9,24 h:4.6±0.9比10.4±0.8,均P＜0.01).结论 MSCs移植能明显减轻烟雾吸入性损伤兔肺组织损伤,改善肺损伤评分.

Abstract：

Objective To explore the effect of bone marrow mesenchymal stem cells (MSCs)engraftment on lung tissue at early stage of smoke inhalation injury in rabbits. Methods MSCs were proliferated by the method of whole marrow culture and identified by flow cytometry. Forty-eight rabbits were randomly divided into smoke inhalation group (S group) and MSCs group (M group) after reproduction of rabbit smoke inhalation injury model. 10 ml of phosphate buffer saline (PBS) containing 1 × 107/ml MSCs was intravenously injected in M group, meanwhile 10 ml PBS was injected intravenously in S group. Eight rabbits were sacrificed at 2, 6 and 24 hours after intervention, and the lung tissue was harvested for morphological and pathological observation, and lung injury score was used to evaluate smoke inhalation injury.Results Cultured cells were confirmed to be MSCs with flow cytometry. Lung injury in rabbits of M group was less serious in morphology and histopathology than that in S group. Though there was no significance in lung injury score between M group and S group at 2 hours after injury (4.0±0.7 vs. 4.5±0.6, P＞0.05),the lung injury scores in M group at 6 hours and 24 hours after injury were significantly lower than those in S group (6 hours: 6.1±0.9 vs. 8.2±0.9, 24 hours: 4. 6±0.9 vs. 10.4±0. 8, both P＜0. 01). Conclusion Intravenous engraftment of MSCs could ameliorate lung injury induced by smoke inhalation, and improve lung injury score significantly.     

胸部爆震伤致兔急性呼吸窘迫综合征模型的建立及相关因素分析

目的 构建室内胸部爆震伤致兔急性呼吸窘迫综合征(ARDS)模型并分析其发生机制及早期死亡原因,为研究肺爆震伤早期预警体系和治疗方法提供依据.方法 按照不同炸药量和致伤距离所产生的压强,将60只新西兰大白兔按随机数字表法分为5个致伤组和1个无致伤对照组.伤后观察存活率和组织病理学,并监测病理生理学指标、肺含水量.结果 冲击波压强低于1 210.5 mm Hg(1 mm Hg=0.133 kPa,A、B组)时,肺损伤较轻,表现为点状肺挫伤,肺简明损伤评定分级法(ALS)均在2级内,动物伤后24 h内全部恢复,长期存活无并发症.冲击波压强高于2 036.1 mm Hg(D、E组)时,肺损伤过重,表现为广泛的肺挫伤、肺门撕裂伤和肺内大血肿,AIS均大于5级,动物于伤后1 h内全部死亡.冲击波压强为1 917.3 mm Hg(C组)时,肺表现为广泛而恒定的挫伤,累及4个肺叶以上,AIS 4～5级,伤后6 h内出现动脉氧分压下降;肺组织可见肺泡壁水肿,部分肺泡壁断裂,肺泡融合;肺泡内充满大量炎性细胞,偶见透明膜形成.与对照组比较,C组兔致伤6 h肺湿/干重比值即显著升高(6.46±0.24比3.98±0.19,P＜0.01),血浆及支气管肺泡灌洗液(BALF)中肿瘤坏死因子-α(TNF-α)和白细胞介素-6(IL-6)即明显升高[血浆TNF-α(ng/L):328.89±6.26比62.12±2.98,BALF TNF-α(ng/L):164.87±4.59比29.51±1.12;血浆IL-6(ng/L):128.51±4.13比19.32±1.53,BALF IL-6(ng/L):94.97±1.14比22.72±0.19,均P＜0.05].结论 在1 917.3 mm Hg爆炸压强的密闭环境下,冲击伤可诱导兔发生ARDS;TNF-α及IL-6参与爆震伤致ARDS的形成与发展;特定环境下,肺脏破裂致气胸为早期死亡原因,而冲击波致循环系统功能紊乱也是引起早期死亡的重要原因.

Abstract：

Objective To reproduce acute respiratory distress syndrome (ARDS) model in rabbit induced by chest blast injury and to analyze the pathogenesis and causes of early death in order to provide the basis for the early diagnosis of lung blast injury and its early-warning system to facilitate an early treatment.Methods Sixty healthy New Zealand white rabbits were divided into six groups according to the different explosion distance with the random number table method. The survival rate and its resulting pathological changes were observed and patho-physiological indexes and lung fluid content were determined at sequential time points post-explosion. Results Shock wave pressure less than 1 210. 5 mm Hg (1 mm Hg=0. 133 kPa,group A, B) resulted in limited injury to the lung within grade-2 as assessed with the abbreviated injury scale (AIS). The rabbits in these groups recovered soon and survived without any complication. Shock pressure higher than 2 036. 1 mm Hg (group D, E) caused severe injuries to the lung, including deep laceration, disruption of lung hilus and large hematoma in the lung, and the injury severity of lungs was assessed above grade-5 as assessed with AIS. All rabbits died within 1 hour post-explosion. The groups described above failed to meet the demand of an ARDS model for the present study. Shock wave pressure at 1 917. 3 mm Hg (group C) produced extensive contusion from grade-4 to grade-5 as assessed with AIS. The rabbits survived in poor general condition, and arterial partial pressure of oxygen (PaO2) lowered within 6 hours. Pathological examination showed extensive and constant multi-focal bleeding involving more than four lobes. The alveolar wall was edematous, with partial rupture and alveolar fusion in lung tissues was observed in the group C. Alveoli were filled with inflammatory cells, and hyaline membrane was formed occasionally. Compared with control group, the wet to dry weight ratio (W/D) in lungs increased obviously (6.46±0. 24 vs. 3. 98±0. 19, P＜ 0. 01) in group C within 6 hours postinjury. The contents of tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) in plasma and bronchoalveolar lavage fluid (BALF) were also increased distinctly compared with the control group [TNF-α (ng/L) in plasma: 328. 89± 6.26 vs.62.12±2. 98, TNF-α (ng/L) in BALF: 164.87±4.59 vs. 29. 51±1.12; IL-6 (ng/L) in plasma: 128. 51±4.13 vs. 19.32±1.53: IL-6 (ng/L) in BALF: 94.97±1.14 vs. 22.72±0. 19, all P＜0. 05]. Conclusion In an airtight environment, rabbit ARDS model can be reproduced successfully by blast injury with 1 917.3 mm Hg explosion pressure; TNF-α and IL-6 are involved in the pathogenesis and development of ARDS in blast injury. Pneumothorax as a result of lung rupture is the chief reason for early death and dysfunction of circulatory system is also an important reason in producing early death.