增大静脉穿刺角度对进针疼痛的效果分析

目的探讨减轻患者穿刺疼痛和减轻血管损伤的静脉穿刺方法。方法对200例不同疾病患者采用自身对照法,分别采用增大静脉穿刺角度法与传统穿刺法。前者是在血管上方采取针尖斜面与血管纵轴平行方向直刺血管,见回血或感觉有突破感后,迅速将针柄放平,再沿血管进针少许。传统的穿刺方法,针尖斜面朝上,针头与皮肤成20°~30°,由静脉上方或侧方刺入皮下,再沿静脉方向潜行刺入,见回血后可再顺静脉进针少许。结果观察日患者穿刺的疼痛反应程度明显轻于对照日(p<0.01),穿刺成功率2组无差异。结论采取针尖斜面与血管纵轴平行方向直刺血管,既能减轻患者痛苦,又能减少血管损伤,优于传统的进针方法。     

静脉穿刺进针角度的探讨

通过对200例患者静脉穿刺进行针角度的观察和调查,得出静脉穿刺时增大针头与皮肤间的进针角度(约60°)可减轻进针疼痛或达到无痛注射。现简介如下:1 临床资料 选择1999年2月至2002年2月接受静脉注射输液的清醒患者。共计200例,其中男90例,女110例,年龄20～65岁之间。分实验组及对照组进行观察和比较。2 操作方法 实验组和对照组均由本人操作,两组均选一次性使用输液器7号针头。选择的穿刺对象全都是接受静脉输液的清醒患者,均选用患者上肢前臂或手背静脉为穿刺点,原则上从远心端至近心端依次选择血管。2.1 实验组:选择好患者穿刺血管后,常规消毒皮肤,操作者右手持穿刺针头在血管上方的皮肤约成60°角快速进针穿过皮肤,再呈约20°沿血管方向行走,见回     

轻快冲击式大角度静脉穿刺术的临床研究

为观察轻快冲击式大角度静脉穿刺术的临床效果 ,选择清醒的住院静脉输液病人 41 6例 ,并分为实验组和对照组 ,实验组在血管上方皮肤处 ,以2 5度～ 40度角以轻快冲击式动作进针 ;对照组采用在血管上方或侧方 2 0度角进针潜行进针法。检测两组进针时间和病人疼痛程度。结果 :实验组针尖到达血管腔时间明显短于对照组 (P <0 .0 1 ) ,疼痛程度也明显轻于对照组(P <0 .0 0 5)。说明轻快冲击式大角度静脉穿刺术较常规静脉穿刺术进针时间短 ,无痛率高     

输液中两种不同静脉穿刺操作方法效果比较

目的:比较在输液中两种不同静脉穿刺方法的临床效果。方法:500例静脉输液患者同体左、右侧手背同部位静脉血管不同方法进行静脉穿刺,专人操作。均选用7号头皮针,血管选择均为同一人左、右手背血管各1次,分2d进行。第1天左手(对照组)采用传统静脉穿刺方法(针尖斜面向上,与皮肤呈15～30°,由静脉上方或侧方刺入皮下,再沿静脉方向潜行刺入静脉,见回血后再顺静脉推进少许),第2天右手(观察组)采用改进的静脉穿刺方法(针尖斜面向上,与皮肤呈10～14°,直刺血管见回血后再沿静脉方向进针0.5～1cm)。并观察两种不同静脉穿刺操作方法的疼痛发生率及穿刺成功率情况。结果:对照组疼痛发生率明显高于观察组(P<0.005),观察组穿刺成功率明显高于对照组(P<0.005)。结论:改进的静脉穿刺方法明显减轻患者的疼痛,提高了穿刺成功率。     

两种静脉采血法的比较

2005年8月~2005年12月,我院对100例患者应用不同方法行静脉采血,探讨提高穿刺成功率的方法。现报告如下。1资料与方法1.1临床资料本组男58例,女42例,21~60岁。随机分为实验组和对照组各50例,两组性别、年龄、病情等一般资料比较无显著性差异(P>0.05),具有可比性。1.2方法实验组:采用BD针行静脉采血,在血管上方与皮肤成30°~40°快速刺入0.1~0.3cm,见回血后改为15°沿静脉走向刺入0.6~1.2cm,接采血管留取血标本。对照组:采用常规静脉采血法,穿刺时针头与皮肤成20°,由静脉侧方或上方刺入皮下,见回血后再顺静脉进针少许,接采血管留取血标本…     

超薄型美皮康预防PICC术后机械性静脉炎的效果观察

[目的]探讨超薄型美皮康预防经外周静脉置入中心静脉导管(PICC)机械性静脉炎的临床效果。[方法]选择留置PICC病人120例,随机分为对照组和实验组各60例。实验组在PICC置管后沿穿刺静脉方向,在穿刺点上方5cm～10cm处平行覆盖10cm×10cm超薄型美皮康;对照组置管后在穿刺局部透明贴膜固定,进行常规护理。两组病例均连续观察2周,采用美国静脉输液护理学会静脉炎分级标准评估。[结果]实验组病人静脉炎的发生率低于对照组(P<0.05)。[结论]机械性静脉炎是PICC置管后常见的并发症,超薄型美皮康可减少其发生率,使病人易于接受PICC,同时可以减轻病人的痛苦。     

新生儿应用静脉留置针送软管的方法

静脉留置针广泛应用于新生儿,可以减轻患儿的痛苦,减少护理工作量。现将几种送软管的方法介绍如下。直接送管法:选择好血管,常规消毒皮肤,穿刺者手持静脉留置针,另一手绷紧皮肤,以15~30°进针,见回血后降低穿刺角度,再沿血管方向进针0.2cm左右,右手固定针芯,左手将套管全部推入静脉,再用左手食指压迫套管尖端处静脉,右手拔除针芯。渐进送管法:选择好血管,按上法进针后,见回血后降低穿刺角度,沿血管方向进0.1~0.2cm,左手食指与拇指固定套管,右手拔出针芯少许,再沿血管方向进针0.1~0.2cm,如此反复进行,至套管全部送入后拔出针芯,应用此法软管…     

不同进针角度对减轻人工血管动静脉内瘘血栓形成病人溶栓疼痛效果的影响

[目的]探讨以最佳的角度行血管穿刺为人工血管动静脉内瘘(AVG)血栓形成病人行溶栓治疗,以减轻疼痛刺激。[方法]将48例病人随机分为两组,分别采用20°和40°从静脉上方对人工血管穿刺行溶栓护理,帮助再通。比较两种穿刺方法的疼痛程度、穿刺成功率、输液外渗、溶栓效果等。[结果]两组病人溶栓成功率差异无统计学意义(P0.05),以40°从静脉上方穿刺病人感受的疼痛程度较轻,两组比较差异有统计学意义(P0.05),穿刺成功率较高。[结论]行人工血管溶栓时进针角度的不同影响病人的疼痛程度感受及穿刺成功率,宜40°从静脉上方穿刺,以减轻病人疼痛,提高穿刺成功率。     

不同角度静脉穿刺患者疼痛及穿刺成功率的比较研究

目的 探求一种既能减轻患者疼痛又能提高穿刺成功率且能减少血管损伤的静脉穿刺角度与方法.方法 对200例患者采用自身对照法,在血管上方以20～30°、31～40°、41～50°、51～60°、>60°的角度,分别采取针尖斜面与血管纵轴平行方向(即针尖斜面向左或向右)直刺血管与传统的针尖斜面向上的穿刺方法,分为观察组和对照组进行疼痛程度和穿刺成功率比较.结果 2组比较存在差异性,观察组优于对照组(除外>60°穿刺成功率2组无差异).结论 采用针尖斜面与血管纵轴平行方向直刺血管,既能显著减轻患者疼痛又能提高穿刺成功率且能减少血管损伤,各方面均优于传统的针尖斜面向上的进针方法,且无论采用哪种进针方法,51～60°为最佳进针角度.     

两种不同静脉穿刺角度对病人疼痛的影响

[目的]观察两种不同静脉穿刺角度对病人疼痛的影响。[方法]将200例住院静脉输液病人左右手随机分为观察组和对照组,每组100例,对照组采用与皮肤呈15°～20°进行静脉穿刺,观察组采用与皮肤呈30°～35°进行静脉穿刺。观察并比较两组病人的疼痛程度。[结果]观察组病人疼痛程度明显低于对照组(P<0.05)。[结论]采用与皮肤呈30°～35°进行静脉穿刺可减轻病人的疼痛感。     

Determination of creatine kinase isoenzyme MB activity in serum using immunological inhibition of creatine kinase M subunit activity. Activity kinetics and diagnostic significance in myocardial infarction.

This is a new method for the determination of creatine kinase isoenzyme MB activity in serum. The method uses direct activity measurement of creatine kinase B subunit activity after blocking of CK-M subunit activity by inhibiting antibodies. The test takes no longer than 15 min. The method yields an intra-serial C.V. of 2.0-12.9%, and a C.V. from day to day of 5.5%. The detection limit is 3.4 U/l creatine kinase MB. In the 95 cases with proven myocardial infarction several types of creatine kinase MB activity kinetics could be determined. The percentage of creatine kinase MB of peak CK-total is 6-25%, with a mean of 11.1%. The amount of creatine kinase MB with respect to total CK activity after reinfarction is higher than the amount after initial infarction.     

Dissociable correlates of two classes of retrieval processing in prefrontal cortex

Although substantial evidence suggests that the prefrontal cortex (PFC) implements processes that are critical for accurate episodic memory judgments, the specific roles of different PFC subregions remain unclear. Here, we used event-related functional magnetic resonance imaging to distinguish between prefrontal activity related to operations that (1) influence processing of retrieval cues based on current task demands, or (2) are involved in monitoring the outputs of retrieval. Fourteen participants studied auditory words spoken by a male or female speaker and completed memory tests in which the stimuli were unstudied foil words and studied words spoken by either the same speaker at study, or the alternate speaker. On "general" test trials, participants were to determine whether each word was studied, regardless of the voice of the speaker, whereas on "specific" test trials, participants were to additionally distinguish between studied words that were spoken in the same voice or a different voice at study. Thus, on specific test trials, participants were explicitly required to attend to voice information in order to evaluate each test item. Anterior (right BA 10), dorsolateral prefrontal (right BA 46), and inferior frontal (bilateral BA 47/12) regions were more active during specific than during general trials. Activation in anterior and dorsolateral PFC was enhanced during specific test trials even in response to unstudied items, suggesting that activation in these regions was related to the differential processing of retrieval cues in the two tasks. In contrast, differences between specific and general test trials in inferior frontal regions (bilateral BA 47/12) were seen only for studied items, suggesting a role for these regions in post-retrieval monitoring processes. Results from this study are consistent with the idea that different PFC subregions implement distinct, but complementary processes that collectively support accurate episodic memory judgments.     

俯卧位通气对高海拔地区肺复张治疗无效急性呼吸窘迫综合征患者氧合的影响

目的 探讨俯卧位通气对高海拔地区肺复张术(RM)治疗无效急性呼吸窘迫综合征(ARDS)患者的治疗作用.方法 从海拔2260m的地区医院筛选RM治疗无效的41例ARDS患者[平均氧合指数( PaO2/FiO2)较RM前升高＜20％视为RM无效],依不同病因分为肺内源性ARDS组(ARDSp组)和肺外源性ARDS组(ARDSexp组),每组再按信封法随机分为俯卧位组和仰卧位组,即ARDSp俯卧位组(11例)、ARDSp仰卧位组(9例)、ARDSexp俯卧位组(10例)、ARDSexp仰卧位组(11例).在通气前及通气1、2、3、4h监测动脉血氧分压( PaO2)、PaO2/FiO2、静态顺应性(Cst)、气道阻力(Raw)的变化.结果 通气lh时,ARDSexp俯卧位组PaO2/FiO2( mm Hg,l mm Hg=0.133 kPa)即较通气前显著升高(157.4±40.6比129.3±48.7,P＜0.05),并随通气时间延长呈持续增高趋势,4h达峰值(219.1 ±41.1);且ARDSexp俯卧位组通气3h内PaO2/FiO2较其他3组显著增高,另3组间则差异无统计学意义.ARDSp俯卧位组、ARDSexp俯卧位组通气4h时PaO2/FiO2均较相应仰卧位组显著增高(208.8±39.7比127.4±47.1,219.1±41.1比124.9±50.8,均P＜0.05).4组通气前后Cst无显著改变,各组间差异也无统计学意义.ARDSp俯卧位组通气4h时Raw(cmH2O·L-1·s-1)较通气前显著降低(6.8±1.7比10.7±1.8,P＜0.05),且明显低于其他3组;其他3组各时间点Raw组内及组间比较差异均无统计学意义.结论 俯卧位通气作为ARDS机械通气重要策略之一,可以改善RM无效高原ARDS患者的氧合,为抢救患者赢得宝贵的时间.     

Digital imaging among medical facilities

The Department of Veterans Affairs (VA) in the USA operates a network of 172 medical centres which all utilize a hospital information system (HIS) which has been developed and is currently maintained by the VA. During the past several years, an image management and communication module has been developed, installed and clinically utilized at the Washington DC and Maryland VA Medical Centres. This image management and communication system, referred to as the decentralized hospital computer program (DHCP) imaging system, is fully integrated with a commercial picture archiving and communication system (PACS). The system is utilized to capture, archive, and display all images generated within the hospital including radiology, nuclear medicine, pathology, endoscopy, bronchoscopy, and dermatology, intraoperative photographs, ECG data, and a limited number of paper documents. The ultimate goal of the project is to have all patient text and image data available at any clinical workstation to any authorized user anywhere within the network of medical centres. Clinical requirements for an imaging workstation include ease of use, rapid and reliable access to the complete set of patient information, and images which are of acceptable quality to meet the requirements of the user and the subspecialty. Patient confidentiality and data security must be safeguarded at all times. Integration of the images with the remainder of the patient's database was found to be critical to the success of the project. The experience at the Washington and Maryland facilities suggests that an imaging system that is successfully integrated with a hospital information system can provide substantial clinical and economic benefits both within and among medical centres. Clinical acceptance and utilization of the system has been excellent, particularly in diagnostic radiology where DHCP Imaging has been interfaced to a commercial PAC system. Based upon this initial experience, the VA has begun to deploy the system throughout its large network of medical centres.     

Myocardial elastography at both high temporal and spatial resolution for the detection of infarcts

Myocardial elastography is a novel method for noninvasively assessing regional myocardial function, with the advantages of high spatial and temporal resolution and high signal-to-noise ratio (SNR). In this paper, in-vivo experiments were performed in anesthetized normal and infarcted mice (one day after left anterior descending coronary artery [LAD] ligation) using a high-resolution (30 MHz) ultrasound system (Vevo 770, VisualSonics Inc., Toronto, ON, Canada). Radiofrequency (RF) signals of the left ventricle (LV) in longitudinal (long-axis) view and the associated electrocardiogram (ECG) were simultaneously acquired. Using a retrospective ECG gating technique, 2-D full field-of-view RF frames were acquired at an extremely high frame rate (8 kHz) that resulted in high-quality incremental displacement and strain estimation of the myocardium. The incremental results were further accumulated to obtain the cumulative displacements and strains. Two-dimensional and M-mode displacement images and strain images (elastograms), as well as displacement and strain profiles as a function of time, were compared between normal and infarcted mice. Incremental results clearly depicted cardiac events including LV contraction, LV relaxation and isovolumetric phases in both normal and infarcted mice, and also evidently indicated reduced motion and deformation in the infarcted myocardium. The elastograms indicated that the infarcted regions underwent thinning during systole rather than thickening, as in the normal case. The cumulative elastograms were found to have higher elastographic SNR (SNR(e)) than the incremental elastograms (e.g., 10.6 vs. 4.7 in a normal myocardium, and 6.0 vs. 2.4 in an infarcted myocardium). Finally, preliminary statistical results from nine normal (m = 9) and seven infarcted (n = 7) mice indicated the capability of the cumulative strain in differentiating infracted from normal myocardia. In conclusion, myocardial elastography could provide regional strain information at simultaneously high temporal (>/=0.125 ms) and spatial ( approximately 55 microm) resolution as well as high precision ( approximately 0.05 microm displacement). This technique was thus capable of accurately characterizing normal myocardial function throughout an entire cardiac cycle, at the same high resolution, and detecting and localizing myocardial infarction in vivo.     

Clinical Pharmacokinetics of Morphine

Morphine, the most widely used mu-opioid analgesic for acute and chronic pain, is the standard against which new analgesics are measured. A thorough understanding of the pharmacokinetics of morphine is required in order to safely and effectively use this analgesic in a wide variety of patients with different levels of organ function. A MEDLINE search was conducted to identify literature published between 1966 and January 2002 relevant to the pharmacokinetics of morphine. These publications were reviewed and the literature summarized regarding unique and clinically important elements of morphine disposition relative to its parenteral administration (including intravenous, intramuscular, subcutaneous, epidural and intrathecal administration), absorption profile (immediate release, controlled release, and sublingual/buccal, and rectal administration), distribution, and its metabolism/ excretion. Special populations, including infants, elderly, and those with renal/liver failure, have a unique morphine pharmacokinetic profile that must be taken into account in order to maximize analgesic efficacy and reduce the risk of adverse events.