Seldinger穿刺法用于老年肿瘤患者PICC置管

目的 探讨Seldinger穿刺法应用于老年肿瘤患者PICC置管的效果.方法 将66例需要置管化疗的老年患者随机分为观察组和对照组各33例,对照组采用常规PICC置管法,观察组采用Seldinger穿刺法置管.结果 两组一次穿刺、一次置管成功率以及穿刺点出血发生率比较,差异有统计学意义(P＜0.05,P＜0.01).结论 Seldinger穿刺法可显著提高老年肿瘤患者PICC穿刺及置管成功率,减少穿刺点出血,保证置管效果.     

中心静脉导管感染的前瞻性调查及护理对策

目的 探讨中心静脉置管的感染特点与防治措施.方法 时461例中心静脉置管患者进行监测,包括置管时间、地点、导管留置时间、置管医生、置管部位皮肤、导管的细菌培养结果等.结果 461例置管患者中发生导管相关性感染30例(6.5%),感染与患者年龄、置管医生操作技术、置管地点、导管留置时间、惠者疾病类型相关(P＜0.05,P＜0.01);感染的病原菌中革兰阴性菌9株,革兰阳性菌6株,真菌6株.结论 对患者进行中心静脉置管时,需保持置管环境的洁净,提高操作人员的操作技能,缩短置管留置时间,以预防中心静脉导管感染.     

中心静脉导管感染的前瞻性调查及护理对策

目的探讨中心静脉置管的感染特点与防治措施。方法对461例中心静脉置管患者进行监测,包括置管时间、地点、导管留置时间、置管医生、置管部位皮肤、导管的细菌培养结果等。结果461例置管患者中发生导管相关性感染30例（6.5%）,感染与患者年龄、置管医生操作技术、置管地点、导管留置时间、患者疾病类型相关（P〈0.05,P〈0.01）;感染的病原菌中革兰阴性菌9株,革兰阳性菌6株,真菌6株。结论对患者进行中心静脉置管时,需保持置管环境的洁净,提高操作人员的操作技能,缩短置管留置时间,以预防中心静脉导管感染。     

PICC与锁骨下静脉置管在肿瘤患者化疗中的应用效果比较

目的 探讨PICC与锁骨下静脉置管在肿瘤化疗患者中的应用效果,为临床护理工作提供依据.方法 将80例肿瘤化疗患者根据所选择导管类型分成PICC组和锁骨下静脉置管组各40例,比较两组置管成功率、导管留置时间、并发症发生率.结果 两组一次穿刺置管成功率、导管留置时间比较,PICC组显著优于锁骨下静脉置管组(均P＜0.01);两组并发症发生率比较,差异无显著性意义(P＞0.05),但锁骨下静脉置管组发生严重感染2例、血气胸1例、动脉损伤2例,PICC组无严重并发症发生.结论 PICC一次穿刺置管成功率高、留置时间长,无严重并发症发生,可作为肿瘤患者长期化疗的首选.     

Seldinger穿刺法用于老年肿瘤患者PICC置管

目的探讨Seldinger穿刺法应用于老年肿瘤患者PICC置管的效果。方法将66例需要置管化疗的老年患者随机分为观察组和对照组各33例,对照组采用常规PICC置管法,观察组采用Seldinger穿刺法置管。结果两组一次穿刺、一次置管成功率以及穿刺点出血发生率比较,差异有统计学意义（P〈O．05。P〈O．01）。结论Seldinger穿刺法可显著提高老年肿瘤患者PICC穿刺及置管成功率,减少穿刺点出血,保证置管效果。     

食管癌患者经外周置入中心静脉导管置管术后静脉血栓的影响因素分析

目的探讨食管癌患者经外周置入中心静脉导管(PICC)置管术后静脉血栓形成的影响因素。方法收集2017年1月至2021年1月保定市第二医院收治的126例行PICC置管术食管癌患者临床资料,根据血栓发生情况将其分为血栓组(n=34)和无血栓组(n=92)。比较两组患者性别、年龄、手术史、病理类型、TNM分期、静脉血栓史、化疗次数、PICC导管类型、穿刺肢体位置、持续置管时间、活动频率和强度等对PICC相关性静脉血栓形成的影响。结果单因素分析结果显示,两组患者TNM分期、静脉血栓史、化疗次数、持续置管时间、活动频率和强度比较,差异均有统计学意义(P<0.05);两组患者性别、年龄、病理类型、手术史、导管类型、穿刺肢体位置比较,差异均无统计学意义(P>0.05)。多因素分析结果显示,TNM分期、静脉血栓史、化疗次数、持续置管时间、活动频率和强度均是食管癌患者PICC置管术后静脉血栓形成的影响因素(P<0.05)。结论TNM分期、静脉血栓史、化疗次数、持续置管时间、活动频率和强度均是食管癌患者PICC相关性静脉血栓形成的重要影响因素,针对上述影响因素积极采用有效的预防措施,能够在一定程度上降低患者静脉血栓的发生率。     

乳癌化疗患者静脉置管异位原因分析及处理

目的对乳癌化疗患者3种静脉置管后发生异位的原因进行分析,为选择合适的置管方式提供指导。方法根据239例乳癌化疗患者意愿,分别选择PICC、颈内静脉、锁骨下静脉置管,按标准的操作规程,置管后即刻作X射线定位。对3种置管方法的导管异位情况进行比较分析。结果3种静脉置管异位的发生率有显著差异（P＜O．01）;其中PICC置管异位的发生率最高。不同肢体和血管PICC置管异位率比较,差异无统计学意义（均P＞O．05）。结论静脉置管异位与导管性质及导管在体内行走的长度有关。一旦发生导管异位,需谨慎处理后方可化疗。     

经股静脉置入PICC堵管现状及影响因素分析

目的 了解经股静脉置入PICC堵管现状及其影响因素,为开展相关护理措施提供参考。 方法 回顾性分析241例经股静脉置入PICC患者临床资料,经单因素和logistic回归分析发生导管堵管的影响因素。 结果 24.07%患者发生了导管堵管,回归分析结果显示,导管堵管的独立危险因素为伴有导管脱出、首次置管、经常行走以及导管类型为耐高压材质（均P＜0.05）。 结论 经股静脉置入PICC堵管发生率较高,临床实践中应加强关注导管堵管的独立风险因素,并开展针对性干预或相关健康教育,降低堵管发生率。     

困难置管血液肿瘤婴幼儿2种静脉通路应用效果比较

目的比较经股静脉中段置入PICC与经股静脉置入CVC在置管困难血液肿瘤婴幼儿中的应用效果。方法回顾性分析2014年1月至2019年6月置管困难肿瘤婴幼儿140例的临床资料,其中67例采用经股静脉中段置入PICC,73例采用经股静脉置入CVC。比较两组导管成本费用、置管时间、导管留置时间和导管并发症发生率的差异。结果 PICC组费用总支出、平均每日维护费用、置管时间低于/短于CVC组,导管留置时间长于CVC组(均P0.01);两组出口部位感染、堵管和总并发症发生率差异有统计学意义(P0.05,P0.01),而导管相关性血流感染、滑脱和静脉炎等发生率差异无统计学意义(均P0.05)。结论经股静脉中段置入PICC在成本支出、置管时间、留置时间和导管并发症方面均优于股静脉CVC,是置管困难血液肿瘤婴幼儿安全、可行的静脉通路。     

上肢运动方案在肿瘤患者PICC置管护理中的应用

目的探讨上肢运动方案在肿瘤患者PICC置管护理中的应用效果。方法将367例肿瘤PICC置管患者按照住院时间分为对照组184例和观察组183例。对照组给予常规护理,观察组在此基础上实施上肢运动。结果腋静脉最大血流速度和平均血流速度的组间效应、时间效应及交互效应具有显著性,置管后28 d内观察组静脉血栓发生率及导管异位发生率显著低于对照组(P0.05,P0.01)。结论上肢运动有利于提高肿瘤PICC置管患者腋静脉血流速度和平均血流速度,降低静脉血栓和导管异位发生率。     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

A comparison of the inhibitory effects of four volatile anaesthetics on the metabolism of chlorzoxazone, a substrate for CYP2E1, in rabbits

Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.     

Systemic analgesia adapted to the children's condition

A concept of balanced analgesia using nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol (acetaminophen), opioids, and corticosteroids can also be used in patients with pre-existing illnesses. NSAIDs are the most effective treatment for acute pain of moderate intensity in children; however, these drugs should be avoided in patients at increased risk for serious side effects, e.g. patients with renal impairment, bleeding tendency, or extreme prematurity. NSAIDs can be given with minimal risks to the younger child with mild to moderate asthma, and, in these patients, the use of steroids can be encouraged; in addition to their antiemetic and analgesic action, a beneficial effect on asthma symptoms can be expected. In the non-intubated child with cerebral trauma, exaggerated sedation caused by opioids and increased bleeding tendency caused by NSAIDs must be avoided. In neonates and small infants, the oral administration of sucrose or glucose is helpful to minimize pain reaction during short uncomfortable interventions.