不同封管液对静脉留置针相关静脉炎和堵管发生率的影响

目的观察不同封管液对留置针堵管率及静脉炎发生率的影响,为临床封管液的选择提供实证依据。方法选取留置静脉留置针的住院患者150例,随机分为三组:生理盐水组、50U/mL肝素盐水组、100U/mL肝素盐水组,每组各50例,分别采用生理盐水、50U/mL肝素盐水、100U/mL肝素盐水封管,观察比较三组静脉留置针堵管及静脉炎发生率。结果生理盐水组堵管率为32.0%、50U/mL肝素盐水组为14.0%、100U/mL肝素盐水组为10.0%,三组比较,差异有统计学意义(P<0.05)。三组静脉炎情况比较,差异有统计学意义(P<0.05),其中100U/mL肝素盐水组最重。结论50U/mL肝素盐水封管可在一定程度上防范留置针堵管,不增加静脉炎发生的危险,因此,效果优于生理盐水和100U/mL肝素盐水。     

SD大鼠导管相关性血栓模型的建立及血栓动态演变过程研究

目的建立中心静脉导管相关性血栓模型,动态观察血栓形成的病理形态演变过程,为临床研究及实践提供参考。方法取健康雄性SD大鼠80只,随机分为假手术组和模型组,各40只。假手术组暴露颈外静脉后立即缝合切口;模型组暴露、切开颈外静脉,置入硅胶导管。两组均于术后1 d、4 d、7 d、10 d、14 d各取8只大鼠行颈外静脉至上腔静脉段取材,观察血栓形成情况及病理形态。结果假手术组无血栓形成;模型组成栓率85.0%。模型组造模术后1 d可见血栓形成;术后4 d血栓体积增大,但尚未出现机化;术后7 d血栓开始出现机化;术后10 d血栓机化明显;术后14 d血栓完全机化,血管腔出现再通。结论用SD大鼠经颈外静脉置管构建导管相关性血栓模型切实可行,理论上是研究导管相关性血栓一种较理想的造模方法。     

预充式导管冲洗器预防PICC堵管的效果观察

目的探讨预充式导管冲洗器应用于经外周静脉置入中心静脉导管(PICC)冲管和封管的临床效果。方法将109例PICC留置患者按照随机数字表法分为观察组(55例)和对照组(54例)。每次输血、给药后观察组使用预充式导管冲洗器进行冲管和封管,对照组使用普通10 ml注射器抽取生理盐水冲管后再抽取肝素封管液进行封管。观察两组堵管发生率及导管留置时间。结果观察组堵管发生率为5.45%,导管留置时间为(55.49±3.61)d;对照组分别为25.93%、(47.32±2.68)d,两组比较,差异有统计学意义(均P<0.01)。观察组堵管等级显著轻于对照组(P<0.01)。结论使用预充式导管冲洗器对PICC进行冲管和封管,可有效减少堵管发生率,延长带管时间,且安全可靠。     

两种抗凝法对双腔静脉导管迟发性并发症的影响

目的:探讨两种抗凝方法对导管迟发性并发症的影响.方法:观察171例经锁骨下双腔静脉导管进行血液透析病人,其中置管期间每天肝素盐水抗凝(A组)84例,每次透析治疗结束时肝素盐水抗凝(B组)87例.结果:A组留置天数为1 879 d,导管相关性感染率(CAIR)为8.52例/1 000留置天,导管内血栓形成率(CTR)为4.76%;B组留置天数为1 912 d,CAIR为2.62例/1 000留置天,CTR为5.75%.两组CAIR有统计学差异(P<0.05),而CTR无统计学差异,两组病人中无1例出现深静脉血栓形成.结论:两种抗凝方法对于预防导管内血栓形成及深静脉血栓形成的作用相同,但是,每次透析治疗结束时予肝素盐水抗凝的CAIR显著降低.     

不同浓度肝素封管对颈内静脉半永久双腔导管置管的影响

目的:探讨不同浓度肝素封管对维持性血透患者颈内静脉半永久双腔导管置管术后出血、血栓形成和第一次透析时血流量的影响。方法:按半永久性颈内静脉留置导管置管术后肝素封管浓度分为三组,观察颈内静脉留置管置管前、后凝血功能;置管后伤口出血情况及透析时导管内血栓形成及透析中血流量情况。结果:三组置管前凝血功能正常,B、C组置管后PT、APTT较置管前,较A组置管后显著升高;C组置管后PT、APTT较置管前,较B组置管后显著升高。三组穿刺点及隧道口出血程度随着肝素封管浓度的增加而显著增加,A组第一次透析时11例患者导管内有不同程度的血栓形成,栓塞率达到35.5%,B组和C组栓塞率明显低于A组,血流量欠佳率明显高于A组,两组间无显著差异。结论:用比导管内容量多0.1～0.2ml的50mg肝素盐水封管,既能减少手术后伤口出血,又能防止导管内血栓形成、保证透析时血流量,不时为一种术后较好的封管方法。     

尿激酶与生理盐水封管预防白血病患者PICC堵管对照研究

目的探讨尿激酶预防性封管与生理盐水封管预防白血病患者经外周置入中心静脉导管（PICC）堵管发生率及尿激酶预防性封管和溶栓前后对激活的部分凝血酶原时间（APTT）及凝血酶原时间（PT）的影响。方法将50例患者随机分为对照组和观察组各25例,观察组用尿激酶预防性封管,对照组用生理盐水封管,观察两组堵管发生率;同时对尿激酶预防性封管及溶栓前后APTT及PT进行监测。结果两组患者堵管发生率比较,差异无统计学意义（P〉0．05）;尿激酶封管及溶栓前后APTT及PT变化不显著（均P〉0．05）。结论小剂量尿激酶进行PICC封管不影响患者APTT及PT值,亦不能显著降低堵管发生率。     

尿激酶与生理盐水封管预防白血病患者PICC堵管对照研究

目的 探讨尿激酶预防性封管与生理盐水封管预防白血病患者经外周置入中心静脉导管(PICC)堵管发生率及尿激酶预防性封管和溶栓前后对激活的部分凝血酶原时间(APTT)及凝血酶原时间(PT)的影响.方法 将50例患者随机分为对照组和观察组各25例,观察组用尿激酶预防性封管,对照组用生理盐水封管,观察两组堵管发生率;同时对尿激酶预防性封管及溶栓前后APTT及PT进行监测.结果 两组患者堵管发生率比较,差异无统计学意义(P>0.05);尿激酶封管及溶栓前后APTT及PT变化不显著(均P>0.05).结论 小剂量尿激酶进行PICC封管不影响患者APTT及PT值,亦不能显著降低堵管发生率.     

不同剂量肝素钠脐静脉导管封管效果比较

目的探讨肝素钠对新生儿的影响,以选择适合新生儿脐静脉导管的封管液。方法选择留置脐静脉导管的危重新生儿60例,按随机数字表法分为观察Ⅰ组和观察Ⅱ组各30例,观察Ⅰ组用25U肝素液,观察Ⅱ组用50U肝素液脉冲正压封管;封管前后分别经外周血管采血检测血小板参数(PLT、PCT、PDW)和凝血功能(PTA、PTR、PT、INR、APTT、FIB、TT);置管期间全程观察患儿有无出血倾向和导管通畅等情况。结果两组均未出现皮肤淤斑、注射穿刺处拔针后出血不止等现象,未发生堵管;封管前后PLT、PCT、PDW值和PTA、PTR、PT、INR、APTT、FIB、TT值比较,差异无统计学意义(均P0.05);观察Ⅰ组封管前后PT变化曲线与观察Ⅱ组相比,接近相交点较多,曲线较少分离。结论脐静脉导管使用小剂量(25U)肝素液脉冲式正压封管有效,安全。     

不同剂量肝素钠脐静脉导管封管效果比较

目的探讨肝素钠对新生儿的影响,以选择适合新生儿脐静脉导管的封管液。方法选择留置脐静脉导管的危重新生儿60例,按随机数字表法分为观察Ⅰ组和观察Ⅱ组各30例,观察I组用25U肝素液,观察Ⅱ组用50U肝素液脉冲正压封管;封管前后分别经外周血管采血检测血小板参数（PLT、PCT、PDw）和凝血功能（PTA、PTR、PT、INR、APTT、FIB、TT）;置管期间全程观察患儿有无出血倾向和导管通畅等情况。结果两组均未出现皮肤淤斑、注射穿刺处拔针后出血不止等现象,未发生堵管;封管前后PLT、PCT、PDW值和PTA、PTR、PT、INR、APTT、FIB、TT值比较,差异无统计学意义（均P〉0．05）;观察Ⅰ组封管前后PT变化曲线与观察Ⅱ组相比,接近相交点较多,曲线较少分离。结论脐静脉导管使用小剂量（25u）肝素液脉冲式正压封管有效,安全。     

糖尿病患者应用浅表静脉留置针不同封管方法的比较

目的 探讨对糖尿病患者静脉留置导管最有效的封管方法.方法 将210例使用静脉留置针输液的糖尿病患者随机分为三组各70人.三组使用相同材料完成静脉留置针穿刺后均使用可来福接头与静脉留置针连接,当日输液完毕,A组不使用任何液体冲管,B组使用生理盐水冲管,C组使用肝素盐水冲管.结果 C组静脉留置导管的堵管率显著低于A组(P＜0.0125),而留置时间较A组、B组显著延长(P＜0.05).结论 应用可来福正压接头,在液体输完后用肝素盐水封管是糖尿病患者静脉留置导管最为有效的封管方法.     

Analysis of a new technique to stabilize the chronic peritoneal dialysis catheter

A significant cause of morbidity for peritoneal dialysis patients is catheter dysfunction. In our experience, the most common cause of catheter dysfunction was cephalad migration of the catheter tip out of the true pelvis. A new technique for catheter placement that reduces catheter migration from 35% to 6% (P less than .01 chi 2) is described. Our results demonstrate that peritoneal catheters which dysfunction because of catheter flip generally do so in the first 3 months.     

An indwelling urinary catheter for the 21st century

What's known on the subject? and What does the study add? A vast literature has been published on the prevalence, morbidity and microbiology of catheter‐associated urinary tract infections. Research and development in recent years has focused on producing antibacterial coatings for the indwelling Foley catheter with insufficient attention to its design. This article provides a critical examination of the design of the indwelling Foley catheter. Design specifications are outlined for a urine collection device that should reduce the vulnerability of catheterised urinary tract to infection. The indwelling urinary catheter is the most common cause of infections in hospitals and other healthcare facilities 1 . As long ago as 1958, Paul Beeson 2 warned ‘… the decision to use this instrument should be made with the knowledge that it involves the risk of producing a serious disease which is often difficult to treat’. Since then, scientific studies have progressed revealing a greater understanding of the bladder's defence mechanisms against infection and how they are undermined by the Foley catheter 3 - 5 . In addition, the complications caused by the development of bacterial biofilms on catheters have been recognised and the ways in which these bacterial communities develop on catheters have become clear 5 , 6 . It is now obvious that fundamental problems with the basic design of the catheter, which has changed little since it was introduced into urological practice by Dr Fredricc Foley in 1937 7 , induce susceptibility to infection. These issues need to be addressed urgently if we are to produce a device suitable for use in the 21st century.     

THE EVOLUTION AND DEVELOPMENT OF THE URINARY CATHETER

The urinary catheter is one of the most frequently used medical devices and has a long and intriguing history of development. This paper describes the catheter from its simple beginnings through the subtle but important changes it has undergone paralleling the advances in plastics technology witnessed this century. The changes have not been without controversy and the recent association of catheters with tissue toxicity, which has forced the implementation of strict guidelines for their manufacture and use, is described.     

Directional differences in urethral pressure recordings: Contributions from the stiffness and weight of the recording catheter

The difference between urethral pressures measured along the anterior wall and those measured along the posterior wall was found to increase markedly as the stiffness of the catheter was increased and to increase by a greater amount if the weight of the catheter was increased. A method of grading the stiffness of catheters is proposed and the use of stiff catheters in past reports of urethral measurements is discussed.     

Surgical implantation of CAPD catheters: presentation of midline incision-lateral placement method and a review of 110 procedures

One hundred-and-ten consecutive surgically implanted one-cuffstraight peritoneal dialysis catheters in 103 adult patientsover a 7 year period have been reviewed. All catheters wereplaced for chronic dialysis (CAPD). There were no early failures.Early complications consisted of one leak, 14 migrations, andtwo wound infections. In the long term 15 patients requiredtransfer to haemodialysis (5 recurrent peritonitis, 7 unableto cope, 3 inadequacy of dialysis). Overall probability of cathetersurvival was 92.4% at 1 year and 82.4% at 2 years. The surgicalimplantation technique described provides a safe, reliable accessfor peritoneal dialysis with a low complication rate.     

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目的：探讨腹腔镜胆总管球囊导管扩张术和扩张导管扩张术在处理胆管狭窄中的临床应用。方法：采用腹腔镜胆总管探查，根据扩张情况对炎性狭窄或膜状狭窄结石取净者，胆管切口即时缝合。段状狭窄结石取净者，塑料支架内引流。恶性狭窄晚期者，自膨式金属支架或塑料支架内引流。结石未取净者，T管外引流。结果：炎性狭窄或膜状狭窄扩张61例，良性段状狭窄扩张37例，恶性太狭窄扩张12例，胆漏6例，残石3例，中转开腹1例，死亡1例。结论：选择合适病人，经腹腔镜胆总管探查术中采用球囊导管或扩张导管扩张胆管狭窄有效、可行。