静脉留置针封管液应用及封管技术研究

静脉留置针又称套管针,现已在临床中特别是ICU中广泛应用。但多因封管不当而致堵管,被迫终止留置。因此,为降低堵管率,延长留置时间,近年来临床各科护理人员对留置针封管技术及封管液选择进行了大量研究。现报告如下。1封管液的选择1.1传统封管液传统的静脉留置针封管液为20 U/ml肝素钠液或0.4%枸橼酸钠液。但对于不宜使用肝素钠或有出血倾向的患者,则限制了留置针的使用。梁燕等报道,可用生理盐水取代肝素钠封管,其效果也较好。由于接受静脉留置针的多为重症、术后、肿瘤等患者,输液时间长,用生理盐水取     

脑梗死患者浅静脉留置针两种封管方法的比较

目的:比较老年脑梗死患者浅静脉留置针生理盐水封管和肝素钠封管的效果。方法:将136例老年脑梗死患者随机分成生理盐水封管组及肝素钠封管组,每组68例,两组分别在浅静脉留置针输液完毕时采用生理盐水或肝素钠(50 U/mL)封管,比较两组患者浅静脉留置针阻管发生率及阻管发生时间。结果:生理盐水封管组浅静脉留置针阻管发生率为22.1%,而肝素钠封管组为7.4%,后者显著少于前者(P<0.05)。浅静脉留置针阻管发生时间生理盐水封管组为(2.96±0.913)d,而肝素钠封管组为(6.00±0.791)d,后者阻管发生时间显著长于前者(P<0.001)。结论:老年脑梗死患者浅静脉留置针肝素钠封管优于生理盐水封管。     

不同浓度肝素钠溶液在静脉留置针封管中的效果观察

静脉留置针又称套管针,作为头皮针的换代产品,以其操作简单,套管柔软,套管在静脉内留置时间长且不易穿破血管壁等优点,被广泛应用于临床,而留置成功的关键在于封管,封管就是用适量的液体注入留置针,防止套管内凝血,保持套管通畅。临床常用小剂量的肝素钠溶液封管。临床工作中,我们发现不同剂量的肝素钠溶液对其抗凝作用有一定的影响,我科从2007-01/2008-12对使用静脉留置针的患者采用不同浓度的肝素盐水进行封管,现报告如下。     

静脉留置针肝素钠封管液对预防静脉血栓形成的影响

目的 探讨静脉留置针肝素钠封管液与0.9％氯化钠注射液封管液对预防静脉血栓形成的影响.方法 将40例患者按入院的先后顺序分为2组：观察组和对照组,每组20例.观察组采用肝素钠稀释液（含肝素钠25 U·mL-1）进行脉冲式正压封管,对照组采用0.9％氯化钠注射液进行脉冲式正压封管.观察2组静脉血栓形成的情况.结果 观察组有血栓形成发生率显著低于对照组（P＜0.05）.结论 对肾病综合征患者采用肝素钠封管液封管效果较好.     

两种封管液在儿科静脉留置针封管中的效果比较

目的 探讨氯化钠溶液与肝素钠用于儿科静脉留置针封管的效果比较.方法 将100例患儿随机分为实验组和对照组,分别使用肝素钠和氯化钠溶液进行静脉留置针封管,并对其留置针保留时间、堵管率、静脉炎发生率、凝血功能、自发性出血倾向进行对比,进行统计学处理.结果 肝素钠封管堵管率明显低于氯化钠溶液,而留置针保留时间明显高于氯化钠溶液.结论 肝素钠封管不良反应与氯化钠溶液封管差异无统计学意义,且优点显著,可以在儿科1～6岁患儿中广泛应用.     

可来福无针密闭输液接头的临床应用

静脉留置针输液已广泛应用于临床,它具有减少重复穿刺率,减轻病人痛苦,提高护理效率等优点,但在临床应用中又遇到新的问题.如:留置针被回血堵塞,肝素钠封管过程繁琐,许多患者不适应肝素钠封管,护士被钢针意外扎伤等等.自2002年5月我科使用美国BD公司生产的可来福无针输液接头,用于套管针的留置,大大减轻了护士的工作量,避免了血液回流堵塞静脉留置针,延长了留置针的留置时间,减少了肝素钠的用量.现将我科应用可来福无针密闭输液接头的情况介绍如下.     

两种封管液在留置针封管中的临床比较

静脉留置针又称套管针,已于30年代在欧美国家普及使用,10 a前在亚洲一些较发达的国家和地区也广泛使用[1]。留置针避免了反复穿刺、保护静脉、减少患者痛苦、为抢救和治疗赢得了时间,提高了护士的工作效率等,已被广泛应用于临床。选择合适的封管液,掌握正确的封管技术是保持浅静脉留置针通畅的关键,为了减少静脉炎等其他并发症的发生和节省患者的费用,减少再穿刺的痛苦,我科在使用静脉留置针的同时,注重了封管液的选择,延长了留置针的使用时间,现报告如下。1对象和方法1.1对象2007-01/2008-03选择我院使用留置针住院患者600例,随机分为两组A组、B组,每组300例,A组采用0.9%生理盐水注射液+肝素钠封管,B组采用甲硝唑注射液+肝素钠封管。1.2方法1.2.1材料苏州碧迪医疗器械有限公司生产的Y型留置针,3M透明敷贴,一次性5 m l注射器,0.9%生理盐水注射液(100 m l)+肝素钠稀释液,甲硝唑注射液(100 m l,500 m g)+肝素钠稀释液。1.2.2穿刺部位粗、直、弹性良好的四肢静脉。1.2.3封管液配置A组是将6 250 U肝素原液加入100 m l生理盐水中,B组是将6 250 U肝素原液...     

静脉留置针3种封管液的效果观察

目的　探讨浅静脉留置套管针封管液的临床应用 ,以提高护士工作效率 ,减轻患者痛苦。方法　将 15 0例患者随机分为 3组 ,每组 5 0例 ,分别采用肝素钠、保养液、生理盐水封管 ,比较 3种封管液封管效果。结果　 3种封管液成功率无统计学差异 (P >0 .0 5 )。结论　生理盐水用于静脉留置针封管安全可靠 ,值得临床推广应用     

生理盐水和肝素钠用于静脉留置针封管效果的比较

目的：比较生理盐水和肝素钠用于静脉留置针封管的效果。方法：将120例采用常规静脉留置针输液的患者,随机分为观察组和对照组各60例,观察组用生理盐水封管,对照组用肝素钠稀释液封管,对静脉留置针留置时间、堵管及静脉炎发生率进行比较。结果：两组患者静脉留置针的留置时间、堵管及静脉炎发生率比较差异无显著意义（P〉0.05）。结论：生理盐水用于静脉留置针封管安全有效,值得临床推广。     

2种封管液对应用止血药物患者静脉留置针留置效果探讨

目的探讨口腔术后应用止血药的患者采用不同肝素封管液封管对静脉留置针留置时间的影响.方法将200例术后留置周围静脉留置针的患者随机分为实验组与对照组,实验组输液结束时以20AxaIU/ml低分子肝素钠稀释液0.5ml封管1次,对照组输液结束时以62.5U/ml肝素钠稀释液2～3ml封管1次.观察留置时间与堵管率.结果实验组留置针留置时间明显长于对照组,p=0.000;堵管率明显低于对照组,p＜0.05,差异均具有显著性意义.结论低分子肝素钠封管液封管可有效延长术后留置针的留置时间.     

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.