不同频率踝关节运动对下肢静脉回流的影响

[目的]探讨不同频率踝关节运动对下肢静脉血液回流的情况,为临床护理工作提供实验依据。[方法]选17名健康受试者取平卧位于右侧下肢踝关节进行“环转”方式主动活动,借助彩色多普勒超声仪检测不同频率活动下的股静脉血流峰速度。[结果]不同频率组的踝关节运动均使下肢静脉血流速度走向趋势呈“峰”状波动,踝关节运动每分钟10次、20次、30次、40次分别为实验1组、实验2组、实验3组、实验4组,实验1组与实验3组股静脉血流速度增加量分别与其他组股静脉血流速度增加量比较,差异有统计学意义（P〈O．05）,实验2组与实验4组股静脉血流速度增加量差异无统计学意义（P〉O．05）。[结论]不同频率组的踝关节运动对下肢静脉血流速度有影响。     

不同频率踝关节运动对下肢静脉回流的影响

[目的]探讨不同频率踝关节运动对下肢静脉血液回流的情况,为临床护理工作提供实验依据.[方法]选17名健康受试者取平卧位于右侧下肢踝关节进行"环转"方式主动活动,借助彩色多普勒超声仪检测不同频率活动下的股静脉血流峰速度.[结果]不同频率组的踝关节运动均使下肢静脉血流速度走向趋势呈"峰"状波动,踝关节运动每分钟10次、20次、30次、40次分别为实验1组、实验2组、实验3组、实验4组,实验1组与实验3组股静脉血流速度增加量分别与其他组股静脉血流速度增加量比较,差异有统计学意义(P＜0.05),实验2组与实验4组股静脉血流速度增加量差异无统计学意义(P＞0.05).[结论]不同频率组的踝关节运动对下肢静脉血流速度有影响.     

综合护理干预对颅脑手术后昏迷病人双下肢深静脉血栓形成的影响

[目的]探讨并分析综合护理干预对颅脑手术后昏迷病人双下肢深静脉血栓形成的影响。[方法]随机选取110例颅脑手术后昏迷病人作为研究对象,将其均分为对照组和观察组各55例,对照组病人实施常规护理干预,观察组病人在对照组基础上给予综合护理干预,从临床护理、饮食指导、心理护理、锻炼指导以及健康教育指导等方面进行,比较两组病人住院期间股静脉、腘静脉血流速度以及深静脉血栓发生率。[结果]干预后观察组,股静脉、腘静脉血流速度明显高于对照组,且深静脉血栓发生率低于对照组。[结论]对颅脑手术后昏迷病人实施综合护理干预,能够有效预防双下肢深静脉血栓的发生,效果较好。     

电脑中频治疗仪对开胸术后病人下肢静脉血流动力学的影响

[目的]探求开胸术后下肢深静脉血栓形成的机械预防方法。[方法]采用随机数字表法将70例开胸术后病人分为实验组和对照组。实验组在常规护理基础上应用电脑中频治疗仪对下肢深静脉靶部位进行理疗,对照组接受常规护理。收集两组病人的下肢静脉血流动力学参数。[结果]实验组股总静脉、股浅静脉、股深静脉、腘静脉和胫前静脉的收缩期最大血流速度、舒张期最低血流速度和平均血流速度大于对照组,尤其是治疗后即时的下肢静脉血流动力学各参数变化明显（P〈0.05）。[结论]电脑中频治疗仪有加快开胸术后病人下肢静脉血流速度的作用,可以作为下肢深静脉血栓形成的机械预防方法之一。     

个体化双排扣病人裤在股静脉置管病人中的应用

<正>随着肿瘤、尿毒症、心血管疾病等发病率的逐年增高,越来越多的病人需要进行静脉营养支持、化疗、长期补液或静脉血液透析等而采取深静脉置管[1]。由于定位标志明确,股动脉搏动容易触及,股静脉穿刺比较容易成功,且股静脉血流量大,血流速度较快,较大程度地降低了刺激性药物对血管的损伤,所以股静脉置管技术常常应用于临床[2]。然而,由于股静脉置管部     

胃左静脉血流动力学与食管静脉曲张程度的对比研究

目的　探讨食管静脉曲张时胃左静脉血流动力学特征与内镜下曲张程度的关系。方法　应用彩色多普勒血流显像仪对 170例食管和 /或胃底静脉曲张病人和 3 0例健康成人进行胃左静脉血流方向和血流速度测量。结果　所有健康对照组均呈向肝型血流 ,而食管静脉曲张病人有 85 %为离肝型 ,轻度曲张病人有约 3 2 %仍为向肝型血流。轻度静脉曲张病人血流速度为 ( 8.3± 2 .6)cm/s ,中度为 ( 11.9± 2 .1)cm/s ,重度为 ( 13 .9± 3 .5 )cm /s ,三组间比较差异有显著性 (P <0 .0 1)。且离肝血流速度大于 15cm/s( 10 /17,5 8.8% )时出血机会显著增高。结论　随着静脉曲张程度的增大 ,胃左静脉离肝血流速度平行增加 ,而且胃左静脉离肝血流速度越高 ,曲张静脉出血的可能性越大。     

彩色多普勒超声检测不同运动方式对下肢静脉血流动力学的作用

目的选择能明显提高下肢静脉血流动力的有效运动方式，为预防下肢静脉血栓形成，提供理论依据。方法健康人128例，分成4种不同的运动组。使用高频彩超分别检测运动前后下肢静脉形态与血流动力学6项指标的变化。结果踮脚运动能显著增加股总静脉、浅静脉、深静脉及腘静脉的最大血流速度(Vmax)、时间速度积分面积(VTI)、血流量/min；其次为自主伸缩下肢运动。采用中频治疗仪、康复治疗仪的运动方式仅能有效改善腘静脉各血流参数。结论采用自主收缩小腿肌群的踮脚运动能有效改善下肢静脉血流动力学，有助于预防下肢静脉血栓形成。     

不同护理方式对下肢静脉血液回流的影响

[目的]探讨不同护理方式对下肢静脉血流动力学的影响，为下肢深静脉血栓高危人群选择有效的活动方式提供理论依据。[方法]用彩色多普勒超声检测10名健康自愿受试者股静脉在平卧静息状态、下肢抬高30度、踝关节主动伸屈运动、踝关节被动屈伸运动4种状态下的股静脉血流峰速度、平均速度和单位时间血流量。[结果]在这4种常用护理方式中，以平卧静息状态股静脉血液回流速度最慢，其他3种方式在静息状态基础上都有增加。其中，足踝主动活动组增加最快，其次是足踝被动活动组，而下肢抬高组增加较少。[结论]下肢抬高及踝关节运动可有效促进下肢静脉血液回流，以踝关节主动运动效果最为理想。     

Autar和Caprini深静脉血栓形成风险评估表在ICU的应用效果比较

[目的]分析Autar和Caprini深静脉血栓形成风险评估表在ICU的应用效果。[方法]将108例病人采用随机数字表法分为A组、B组和C组,A组病人采取常规方法预防下肢深静脉血栓发生。B组和C组病人分别采用Autar和Caprini深静脉血栓形成风险评估表进行护理干预。护理工作完成后,从病人股静脉血流平均速度、血流峰速度和下肢深静脉血栓的发生率方面对护理效果进行观察比较。[结果]C组病人股静脉血流平均速度和血流峰速度均好于A组和B组病人(P0.05)。在下肢深静脉血栓的发生率方面,C组病人发生率低于A组(P0.017)。[结论]Caprini深静脉血栓形成风险评估更适宜ICU病人的使用,有效预防病人下肢深静脉血栓的发生。     

电脑中频治疗仪对开胸术后病人下肢静脉血流动力学的影响

[目的]探求开胸术后下肢深静脉血栓形成的机械预防方法.[方法]采用随机数字表法将70例开胸术后病人分为实验组和对照组.实验组在常规护理基础上应用电脑中频治疗仪对下肢深静脉靶部位进行理疗,对照组接受常规护理.收集两组病人的下肢静脉血流动力学参数.[结果]实验组股总静脉、股浅静脉、股深静脉、腘静脉和胫前静脉的收缩期最大血流速度、舒张期最低血流速度和平均血流速度大于对照组,尤其是治疗后即时的下肢静脉血流动力学各参数变化明显(P＜0.05).[结论]电脑中频治疗仪有加快开胸术后病人下肢静脉血流速度的作用,可以作为下肢深静脉血栓形成的机械预防方法之一.     

三种静脉插管行血液透析的临床比较

目的;比较股静脉,锁骨下静脉和颈内静脉插管留置双腔导管在血液透析中的应用。方法：１０６例尿毒症患者,４０例行股静脉插管,３６例行锁骨下静脉插管,３０例行颈内静脉插管进行血液透析（血透）。观察三种不同插管途径的血流速度,评估透析的充分程度,血尿素氮重复循环率,导管留置时间以及与导管相关的并发症。     

Comparison of different methods for measuring intra-abdominal pressure

OBJECTIVE: Intra-abdominal pressure (IAP) can be measured in different ways but is usually measured indirectly via the urinary bladder. The aim of the study was to: 1) compare urinary bladder pressure, femoral vein pressure, and inferior caval vein pressure with IAP at different levels of IAP; and 2) try to find an optimal amount of fluid to be instilled into the urinary bladder before measurement of the bladder pressure, and to compare changes in blood flow in the femoral vein with that in the caval vein at different pressure levels. DESIGN: Experimental study. SETTING: Animal research laboratory. SUBJECTS: Eight domestic swine of both sexes, weighing 30.6+/-2.9 kg (mean+/-SD). INTERVENTIONS: Catheters connected to pressure transducers were placed into the urinary bladder, the inferior caval vein, the femoral vein, and the superior caval vein. Transit time flow probes were placed around the inferior caval vein and the femoral vein. After a stabilizing period, the abdominal pressure was increased stepwise by instillation of Ringer's solution into the abdomen and then decreased. Thereafter, we instilled fluid into the bladder at an IAP of 8 mmHg and at 20 mmHg and measured the amount of fluid needed to elevate the intra-vesical pressure by 2 mmHg. RESULTS: The pressures recorded in the urinary bladder, the inferior caval vein, and the femoral vein reflected the pressure in the abdominal cavity very well. The fluid volume needed to increase the bladder pressure by 2 mmHg was significantly lower at 20 mmHg IAP than at 8 mmHg. Blood flow in the femoral vein and the inferior caval vein showed a similar pattern and decreased when the intra-abdominal pressure increased. CONCLUSIONS: In our porcine model, and increasing the IAP by means of instillation of Ringer's solution, a reliable estimation of the IAP was obtained by measuring the pressure in the urinary bladder, the femoral vein or the inferior caval vein. The IAP estimated indirectly as the urinary bladder pressure is affected by the amount of fluid in the bladder, which should not exceed 10-15 ml. The decrease in femoral vein blood flow reflects the changes in inferior caval vein flow during increased IAP.     

Simple external rotation of the leg increases the size and accessibility of the femoral vein

Objective: To determine if external rotation of the leg increases the size and accessibility of the femoral vein compared with a neutral position. Methods: One hundred patients presenting to a tertiary teaching hospital were prospectively recruited. The right common femoral vein of each subject was scanned with a linear probe (5–10 MHz) inferior to the inguinal ligament, with the leg in a neutral position and then in the externally rotated position. The transverse diameter of the femoral vein, the accessible diameter of the vein (lying medial to the femoral artery) and the depth of the vein were measured. Results: The mean diameter of the femoral vein in the externally rotated leg was greater than with the leg in the neutral position (15.4 mm vs 13.8 mm); the mean difference was 1.6 mm (95% CI 1.3–1.9). The mean accessible diameter of the femoral vein was larger with the leg externally rotated (13.8 mm vs 11.7 mm, mean difference 2.1 mm, 95% CI 1.8–2.5). The depth from the skin to the femoral vein was less with the leg in external rotation (20.9 mm vs 22.6 mm, mean difference 1.7 mm, 95% CI 1.2–2.2). The mean diameter and depth were greater in patients with overweight or obese body mass index (BMI) measurements in both leg positions. The increase in femoral vein diameter and accessibility with external rotation was observed in all BMI groups. Conclusion: The total and accessible femoral vein diameter is increased and the surface depth of the vein is decreased by placing the leg in external rotation compared with the neutral position.     

Can emergency physicians perform extended compression ultrasound for the diagnosis of lower extremity deep vein thrombosis?

BACKGROUND: Current point-of-care ultrasound protocols in the evaluation of lower extremity deep vein thrombosis (DVT) can miss isolated femoral vein clots. Extended compression ultrasound (ECUS) includes evaluation of the femoral vein from the femoral vein/deep femoral vein bifurcation to the adductor canal. Our objective is to determine if emergency physicians (EPs) can learn ECUS for lower extremity DVT evaluation after a focused training session.METHODS: Prospective study at an urban academic center. Participants with varied ultrasound experience received instruction in ECUS prior to evaluation. Two live models with varied levels of difficult sonographic anatomy were intentionally chosen for the evaluation. Each participant scanned both models. Pre- and post-study surveys were completed.RESULTS: A total of 96 ultrasound examinations were performed by 48 participants (11 attendings and 37 residents). Participants’ assessment scores averaged 95.8% (95% CI 93.3%-98.3%) on the easier anatomy live model and averaged 92.3% (95% CI 88.4%-96.2%) on the difficult anatomy model. There were no statistically significant differences between attendings and residents. On the model with easier anatomy, all but 1 participant identified and compressed the proximal femoral vein successfully, and all participants identified and compressed the mid and distal femoral vein. With the difficult anatomy, 97.9% (95% CI 93.8%-102%) identified and compressed the proximal femoral vein, whereas 93.8% (95% CI 86.9%-100.6%) identified and compressed the mid femoral vein, and 91.7% (95% CI 83.9%-99.5%) identified and compressed the distal femoral vein.CONCLUSION: EPs at our institution were able to perform ECUS with good reproducibility after a focused training session.     

Ultrasonographic Investigation of the Effect of Inguinal Compression on the Cross-sectional Area of the Femoral Vein

Objectives:  The reverse Trendelenburg position increases the cross-sectional area (CSA) of the femoral vein, making it easier to cannulate, although this position is potentially harmful in hypovolemic patients. The authors hypothesized that compression above the femoral vein increases the CSA of the femoral vein during emergency cannulation.
Methods:  Ultrasound was used to measure the CSA of the femoral vein of 20 healthy volunteers. The following five measurements were made inferior to the inguinal crease: 1) in the horizontal supine position (control), 2) with inguinal compression 2 cm above the inguinal crease (at the point of arterial pulsation and its medial side), 3) in the Trendelenburg position 15°, 4) in the Trendelenburg position 15° plus inguinal compression, and 5) in the reverse Trendelenburg position 15°.
Results:  Femoral vein CSA was increased by 35% by inguinal compression in the horizontal supine position (p < 0.001) and was decreased by the Trendelenburg position (p < 0.001). However, inguinal compression increased the CSA by 66% in the Trendelenburg position (p < 0.001). The reverse Trendelenburg position also increased the CSA of the femoral vein by 50% (p < 0.001).
Conclusions:  Inguinal compression presents an alternative method for increasing the CSA of the femoral vein for venous catheterization in normal patients.     

模拟失重后家兔股静脉壁超微结构的变化

背景目前对模拟失重的研究大多数只局限于对动脉系统的影响,对静脉系统的影响有待研究.目的观察模拟失重对家兔股静脉壁超微结构及血管重塑的影响.设计以实验动物为研究对像完全随机对照研究.单位解放军第四军医大学航空航天医学系.材料实验于2000-12/2001-12在解放军第四军医大学航空航天医学系完成.24只雄性健康新西兰兔,体质量2.0～2.5kg.干预建立头低位(-20°)倾斜的模拟失重家兔模型.24只雄性健康新西兰兔,随机分为对照组、模拟失重10 d组、模拟失重21 d组,每组8只.用透射电镜观察兔股静脉壁的超微结构.主要观察指标电镜下观察静脉血管壁内皮细胞、线粒体、内弹力板、平滑肌层的变化及变性情况.结果实验组家兔股静脉内皮细胞细胞器减少,线粒体溶解、消失;空泡变性增多并可见吞噬体;内弹力板变薄且有断裂;平滑肌层变薄,部分平滑肌细胞有变性,间质增多.模拟失重21 d组较模拟失重10 d组变化更明显.结论在模拟失重影响下,家兔股静脉壁结构发生血管重塑性变化,呈萎缩性改变,模拟失重时间越长,改变越明显.     

彩色多普勒超声诊断下肢深浅静脉血栓形成中的价值

目的探讨彩色多普勒超声诊断下肢深浅静脉血栓形成中的价值。方法对下肢深静脉血栓形成的患者37例，进行彩色多普勒超声检查。结果37例中，股静脉完全栓塞5例，股浅静脉完全栓塞4例，大隐静脉入口处完全栓塞1例，胭静脉完全栓塞3例，股静脉不全栓塞15例，股浅静脉不全栓塞3例，大隐静脉入口处不全栓塞2例，胭静脉不全栓塞4例。结论彩色多普勒超声可区分各种下肢静脉血栓并评价其严重程度，是一种无创伤、实时而又敏感的诊断方法。     

超声引导下犬自体血栓栓塞性急性肺动脉高压模型的建立及意义

目的 探讨超声引导下建立肺动脉血栓栓塞所致犬急性肺动脉高压模型的可行性.方法 模拟人体急性肺动脉血栓栓塞的病理生理过程,建立肺动脉血栓栓塞所致的犬急性肺动脉高压模型.超声引导下经股静脉穿刺,放置右心导管监测肺动脉压力,同时对侧股静脉推注自体血栓,以肺动脉收缩压超过30 mmHg为模型建立成功的标准.结果 超声可以准确引导右心导管的放置.实验用犬27只,成功建立急性肺动脉高压模型24只,成功率88.9%.结论 超声引导下建立肺动脉血栓栓塞所致犬急性肺动脉高压模型的方法具有良好的可行性和可重复性.     

股浅静脉与股深静脉血栓形成差异的超声研究

目的 探讨股浅静脉与股深静脉在血栓形成上存在差异的血流动力学机制.方法 选择144例下肢深静脉血栓患者为研究对象,共观察下肢深静脉148条,统计分析股浅静脉血栓与股深静脉血栓在发病率及闭塞程度上是否存在差异.结果 148条下肢深静脉血栓中,股浅静脉完全闭塞及部分闭塞分别为139条及9条,股深静脉完全闭塞及部分闭塞分别为92条及47条,股浅静脉较股深静脉血栓发病率高(P<0.01),股浅静脉血栓形成导致血管闭塞程度较股深静脉重(P<0.01).结论 股浅静脉较股深静脉易患血栓且闭塞程度重与其距小腿较远,小腿肌肉收缩形成具有一定速度的血流在股浅静脉血流速度明显减低有关.     

The utility of point-of-care ultrasound in the assessment of volume status in acute and critically ill patients

BACKGROUND: Volume resuscitation has only been demonstrated to be effective in approximately fifty percent of patients. The remaining patients do not respond to volume resuscitation and may even develop adverse outcomes (such as acute pulmonary edema necessitating endotracheal intubation). We believe that point-of-care ultrasound is an excellent modality by which to adequately predict which patients may benefit from volume resuscitation.DATA RESOURCES: We performed a search using PubMed, Scopus, and MEDLINE. The following search terms were used: fluid responsiveness, ultrasound, non-invasive, hemodynamic, fluid challenge, and passive leg raise. Preference was given to clinical trials and review articles that were most relevant to the topic of assessing a patient’s cardiovascular ability to respond to intravenous fluid administration using ultrasound.RESULTS: Point-of-care ultrasound can be easily employed to measure the diameter and collapsibility of various large vessels including the inferior vena cava, common carotid artery, subclavian vein, internal jugular vein, and femoral vein. Such parameters are closely related to dynamic measures of fluid responsiveness and can be used by providers to help guide fluid resuscitation in critically ill patients.CONCLUSION: Ultrasound in combination with passive leg raise is a non-invasive, cost- and time-effective modality that can be employed to assess volume status and response to fluid resuscitation. Traditionally sonographic studies have focused on the evaluation of large veins such as the inferior vena cava, and internal jugular vein. A number of recently published studies also demonstrate the usefulness of evaluating large arteries to predict volume status.