湿热敷配合海普林软膏涂搽保护血透血管效果观察

目的 保护血液透析患者直接动静脉穿刺（直穿）血管，减轻患者痛苦。方法 将46例维持性血液透析直穿血管患者随机分为观察组与对照组备23例。对照组患者透析后24h，直穿局部进行湿热敷。观察组患者在湿热敷基础上将海普林软膏涂搽直穿局部，并辅以按摩。结果 观察组血管弹性、血流量显著优于对照组（均P＜0．05），穿刺局部并发症发生率显著低于对照组（P〈0．05）。结论 湿热敷配合海普林软膏涂搽穿刺局部对直穿血管有较强保护作用。     

应用硫酸镁与海普林软膏治愈静脉炎的效果比与护理

目的:探讨更简便有效的消除药液外渗导致静脉炎方法.方法:选择120例不同程度浅静脉炎患者,随机配对分为观察组和对照组各60例,观察组用海普林软膏外涂治疗,对照组用50％硫酸镁湿敷,观察两组肿痛消除的效果.结果:2组治愈时间进行u检验,P＜0.05,静脉炎治愈时间有显著性差异.结论:海普林软膏外涂消除静脉炎肿痛的效果优于50％硫酸镁湿敷,且操作简便.     

海普林软膏预防长春瑞宾致静脉炎疗效观察

目的探讨海普林软膏预防长春瑞宾（NVB）致静脉炎的疗效及护理方法。方法将60例使用NVB化疗患者随机分为观察组和对照组各30例，均采用NP（NVB＋DDP）方案化疗2个周期，两组在注射NVB前、后静脉输入地塞米松预防静脉炎；观察组在此基础上于化疗前、后加用海普林软膏外涂化疗局部血管。比较两组静脉炎发生率。结果观察组静脉炎发生率6．7％，对照组发生率43．3％，两组比较，差异有显著性意义（P〈0．01）。结论使用海普林软膏可明显降低NVB致静脉炎的发生率。     

喜疗妥霜涂搽保护血透内瘘血管效果观察

将 30例病人随机分成对照组和观察组 ,各 15例。对照组病人于透析后 2 4h局部用温水 (4 0～ 5 0℃ )热敷 ;观察组病人透析后 2 4h将喜疗妥霜剂 (含多磺酸基粘多糖 )涂于穿刺部位周围 ,观察且用频谱治疗仪照射。结果观察组与对照组在血管弹性、血流量、血管杂音及血管并发症发生等方面比较 ,差异有显著性意义 (均P <0 .0 5 )。提示喜疗妥霜剂对内瘘血管有较强保护功能。     

海普林软膏预防长春瑞宾致静脉炎疗效观察

目的探讨海普林软膏预防长春瑞宾(NVB)致静脉炎的疗效及护理方法。方法将60例使用NVB化疗患者随机分为观察组和对照组各30例,均采用NP(NVB+DDP)方案化疗2个周期,两组在注射NVB前、后静脉输入地塞米松预防静脉炎;观察组在此基础上于化疗前、后加用海普林软膏外涂化疗局部血管。比较两组静脉炎发生率。结果观察组静脉炎发生率6.7%,对照组发生率43.3%,两组比较,差异有显著性意义(P<0.01)。结论使用海普林软膏可明显降低NVB致静脉炎的发生率。     

海普林联合胶原贴敷料改善血管型眶周色素沉着的疗效观察

目的:探讨海普林联合胶原蛋白敷料治疗血管型眶周色素沉着的修复效果。方法:将患者随机分成两组。观察组:46例,外用海普林联合胶原贴敷料;对照组:44例,外用氢醌霜联合胶原贴敷料,两组均治疗8周。结果:观察组的总有效率明显优于对照组。结论:海普林联合胶原蛋白敷料治疗血管型眶周色素沉着的临床疗效好,安全、副反应小。     

湿热敷治疗新生儿硬肿症效果观察

将96例新生儿硬肿症患儿随机分为对照组(46 例)和观察组(50 例)。对照组置入暖箱,观察组在此基础上对患儿双下肢进行湿热敷。结果观察组复温时间(12.00±3.64) h、硬肿消失时间(3.02±1.49) d;对照组复温时间(20.26±5.63) h、硬肿消失时间(4.03±1.45) d,两组比较,差异有显著性意义(均P<0.01)。提示暖箱复温配合湿热敷是治疗新生儿硬肿症的有效方法。     

产后痔硫酸镁湿热敷的疗效观察

目的 探讨硫酸镁湿热敷治疗产后痔的效果.方法 将分娩后发生产后痔的135例产妇随机分为观察组(80例)和对照组(55例),观察组采用50%硫酸镁湿热敷治疗,对照组采用0.5%碘伏外洗.结果 观察组治疗总有效率显著高于对照组(P＜0.01),止痛时间显著短于对照组(P＜0.01),止痛率显著高于对照组(P＜0.01).结论 50%硫酸镁湿热敷治疗产后痔效果较好.     

Risk of Vascular Access Complications with Frequent Hemodialysis

Frequent hemodialysis requires using the vascular access more often than with conventional hemodialysis, but whether this increases the risk for access-related complications is unknown. In two separate trials, we randomly assigned 245 patients to receive in-center daily hemodialysis (6 days per week) or conventional hemodialysis (3 days per week) and 87 patients to receive home nocturnal hemodialysis (6 nights per week) or conventional hemodialysis, for 12 months. The primary vascular access outcome was time to first access event (repair, loss, or access-related hospitalization). Secondary outcomes were time to all repairs and time to all losses. In the Daily Trial, 77 (31%) of 245 patients had a primary outcome event: 33 repairs and 15 losses in the daily group and 17 repairs, 11 losses, and 1 hospitalization in the conventional group. Overall, the risk for a first access event was 76% higher with daily hemodialysis than with conventional hemodialysis (hazard ratio [HR], 1.76; 95% confidence interval [CI], 1.11–2.79; P=0.017); among the 198 patients with an arteriovenous (AV) access at randomization, the risk was 90% higher with daily hemodialysis (HR, 1.90; 95% CI, 1.11–3.25; P=0.02). Daily hemodialysis patients had significantly more total AV access repairs than conventional hemodialysis patients (P=0.011), with 55% of all repairs involving thrombectomy or surgical revision. Losses of AV access did not differ between groups (P=0.58). We observed similar trends in the Nocturnal Trial, although the results were not statistically significant. In conclusion, frequent hemodialysis increases the risk of vascular access complications. The nature of the AV access repairs suggests that this risk likely results from increased hemodialysis frequency rather than heightened surveillance.Establishing and maintaining a suitable vascular access for hemodialysis has long been considered the Achilles heel of hemodialysis. Any intervention that potentially increases risk to the vascular access must be carefully evaluated.Frequent hemodialysis provides multiple physiologic and quality-of-life benefits to patients with ESRD. The Frequent Hemodialysis Network (FNH) Daily Trial showed that, compared with conventional thrice-weekly hemodialysis, in-center hemodialysis performed 6 days per week improved self-reported health-related quality of life, left ventricular mass, and several other surrogate outcomes.¹ Similar improvement trends have been seen with nocturnal hemodialysis performed 6 nights per week.^2,3 Yet despite these demonstrated benefits, frequent hemodialysis may have potential risks. Compared with conventional hemodialysis, frequent hemodialysis requires using the vascular access up to twice as often. In addition to direct trauma caused by more frequent venipuncture of arteriovenous accesses, more frequent access use could theoretically result in increased endothelial trauma due to shear forces created by returning blood, more inflammation, and greater exposure to bacterial pathogens. These factors, in turn, could cause more access stenosis, thrombosis, and infection. In the FHN Daily Trial and Nocturnal Trial, we tested the hypothesis that both types of frequent hemodialysis would increase the risk of vascular access complications.     

Effect of Secondary Interventions on Patency of Vascular Access Sites for Hemodialysis

PURPOSE: To determine the impact of secondary procedures performed to maintain arteriovenous fistula (AVF) and arteriovenous graft (AVG) patency. METHODS: There hundred and eighty six vascular access procedures were retrospectively evaluated. 156 (40.4%) patients required radiological interventions to treat acute thrombosis, swelling of the extremity with the access site, insufficient hemodialysis, or stenosis at an anastomotic site. RESULTS: The 386 cases comprised 106 AVGs and 280 AVFs. In 138 of the 156 cases, which required a radiological intervention, the treatment was successful and saved the vascular access site. The unassisted post-intervention patency time for these 138 successful cases was 13.1 +/- 12 months (range, 1-65 months). Twenty-nine (63%) of the 46 access sites treated with surgical thrombectomy were saved. CONCLUSIONS: Frequent, regular follow-up of hemodialysis patients with vascular access sites is the best way to diagnose problems early and allow the best chance of long-term function.     

Steal in Hemodialysis Patients Depends on Type of Vascular Access

OBJECTIVES: To study incidence and severity of steal phenomena in hemodialysis patients and to investigate possible methods for its detection. METHODS: A questionnaire was composed based on a literature search. A subgroup of patients having steal as identified by the questionnaire was studied using physical examination, arterial blood pressure, skin temperature, digital oxygenation, grip strength and plethysmography. Contralateral arms served as controls. RESULTS: A cold hand was present in 50% of the patients with a brachiocephalic (BC) arteriovenous fistula (AVF, n = 28) compared to 25% of prosthetic forearm loops (loop, n = 27) and 12% of the radiocephalic (RC, n = 65, p < 0.05) fistulas. Diabetics were at risk for steal (p < 0.001). Intensity of steal was not related to magnitude of access flow. Digital skin temperatures and grip strength were lower in steal hands (p < 0.02). Manual compression of the AVF normalised low digital pressures in steal hands (106 +/- 33 vs 154 +/- 25 mmHg, p < 0.001, contralateral side 155 +/- 21 mmHg). CONCLUSIONS: Mild to moderate steal symptoms are common in a hemodialysis patient. Individuals with a BC are at a higher risk for developing complaints associated with reduced hand circulation compared to patients with a RC or loop. Low finger pressures in the presence of steal symptoms are usually reversible.     

The Impact of Transvenous Cardiac Devices on Vascular Access Patency in Hemodialysis Patients

Creating a vascular access in the presence of a cardiovascular implantable electronic device (CIED) in a patient with or approaching end‐stage renal disease can be challenging. In this study, we aimed to evaluate the impact of a CIED on the outcomes of vascular access creation in hemodialysis patients and determine their effects on vascular access patency. This is a single‐center retrospective review of hemodialysis patients who underwent vascular access creation after CIED placement. Outcomes of vascular access creation and need for endovascular interventions were compared between patients with vascular access created ipsilateral and contralateral to the site of CIED. Comparing patients with arteriovenous (AV) access created ipsilateral to CIED placement (n = 19) versus the contralateral side (n = 17), the primary failure rate was 78.9% versus 35.3% (p = 0.02). For AV accesses that were matured, the median primary patency durations for AV accesses created ipsilateral to the CIED was 11.2 months compared to 7.8 months for AV accesses created contralateral to the CIED (p = 1.00). AV accesses created ipsilateral to a CIED have a higher primary failure rate compared with the contralateral arm and should be avoided as much as possible.     

Pneumatic Tourniquet for Surgical Procedures of Hemodialysis Vascular Access

Pneumatic tourniquet has been frequently utilized in various surgical specialties to facilitate surgical procedures on the extremities. However, its use for surgical procedures of hemodialysis access has been limited to some surgeons in the United States and often confined to the hospital settings under general anesthesia or regional nerve block. We have successfully employed a pneumatic tourniquet system for surgical procedures of hemodialysis access under conscious sedation and local anesthesia in an outpatient setting. Because prolonged tourniquet inflation is associated with ischemic pain and other potential complications, we have limited the continuous inflation time to <30 minutes. Our recent data from 550 surgical procedures of hemodialysis access have emphasized that pneumatic tourniquet use is well tolerated under conscious sedation and not associated with significant adverse events. These and other reported data suggest that pneumatic tourniquet can reduce procedure time, minimize required dissection, reduce vascular trauma by eliminating vascular clamps and potentially improve the outcomes of surgical procedures of hemodialysis access. These advantages may be translated into cost savings for hemodialysis access care. This review discusses practical issues of pneumatic tourniquet use and its applications in surgical procedures of hemodialysis access.