3M加强固定胶带在重症婴幼儿鼻胃管固定中的应用

目的：分析并讨论3M加强固定胶带在重症婴幼儿鼻胃管固定中的临床效果。方法100例重症婴幼儿,将其分至采用3M加强固定胶带的试验组50例,普通胶布固定的对照组50例。观察两组患儿的非计划性拔管（UEX）情况以及鼻胃管留置时间等。结果试验组留置时间明显长于对照组,且仅发生2例UEX,发生率为4%,而对照组UEX发生12例,发生率为24%。两组比较,χ2=8.306, P=0.004〈0.05,差异有统计学意义。结论3M加强固定胶带在重症婴幼儿鼻胃管固定中不仅UEX发生率低,留置时间长,而且不良反应少,值得在儿科室中推广应用。     

3M弹力胶带在留置尿管中的运用

目的:评价3M弹力胶带在固定留置尿管中降低导尿管滑脱及减轻牵拉疼痛的作用。方法:将200例留有导尿管的患者随机分成两组,观察组101例,对照组99例。观察组采用3M弹力胶带固定,对照组采用常规方法固定。比较两组患者在留置尿管期间的导管滑脱率及疼痛发生率。结果:观察组发生导管滑脱2例,滑脱率为1.98%,对照组发生导管滑脱8例,滑脱率为8.08%,两组比较差异有统计学意义(P<0.05);观察组发生牵拉疼痛6例,发生率为5.9%,对照组发生牵拉疼痛17例,发生率为17.2%,两组比较差异有统计学意义(P<0.05)。结论:应用3M弹力胶带固定导尿管,可以减轻尿管的牵拉疼痛,有利于留置导尿管的固定。     

透气易撕胶带固定胃管新方法的应用与观察

目的观察透气易撕胶带固定胃管新方法的效果。方法将实验组28例留置胃管病人使用透气易撕胶带按新方法固定,对照组28例用普通胶布按传统方法固定。结果两组胃管固定方法成功率比较,实验组明显高于对照组,差异有统计学意义,P<0.05;两组胃管固定方法病人舒适度及有无过敏现象比较,实验组也优于对照组,差异有统计学意义,P<0.01。结论透气易撕胶带固定胃管新方法明显优于普通胶布传统固定法,值得在临床推广应用。     

新生儿胃管固定方法的改进效果分析

目的观察留置胃管固定方法的改进效果。方法随机将新生儿科100例留置胃管患者分为两组各50例,分别采用常规法和改进法,对2种胃管固定方法进行分析比较。结果改进留置胃管固定方法后,发生重新固定,脱落从插的概率明显降低,两组固定方法有显著差异（P〈0．05）。结论改进固定留置胃管方法比常规方法优越。     

三种胃管固定方法的比较分析

目的观察三种胃管固定方法的效果。方法将观察对象分为三组,第一组为对照组用传统的方法固定。第二组为实验组用蝶形胶布固定。第三组为实验组在蝶形胶布的基础上,脸颊处用3m透明敷帖固定。观察三种方法固定的效果及皮肤刺激的情况。结果实验组的固定方法滑脱率明显低于对照组,P〈0.05,差异有统计学意义。在皮肤刺激方面实验组发生例数也比对照组明显减少,P〈0.05,差异有统计学意义。结果在蝶形胶布的基础上,脸颊处用3m透明敷帖固定胃管的方法可有效减少胃管的滑出,减轻护士的工作量,增加安全性。并且能减少胶布对患者皮肤的刺激,增加舒适度。     

危重新生儿留置胃管固定方法的改进方法探讨

留置胃管可保证危重新生儿获得良好的营养支持,以及需行胃肠减压、药物治疗患儿的有效进行。过去新生儿使用的传统留置胃管固定方法易脱管和滑管,现我科对传统固定方法进行改进[1],采用3M高弹力胶布固定胃管效果显著,现报道如下。1资料与方法1.1一般资料我科于2011年1-11月收治危重新生儿260例,胎龄27～41周;出生体质量650～4200g;其中经口留置胃管100例,经鼻留置胃管160例。     

3M弹力固定带在临床固定鼻胃管中的应用

胃管留置是临床上常见的治疗方法,如何使胃管固定通畅是基本护理常规,而最佳固定方法也是临床上探讨的问题。在工作中,传统胶布固定简单易行,由于胶布的长时间使用存在种种缺陷,致使胃     

3M高强度外科胶带固定浅静脉留置针的应用

目的:探讨浅静脉留置针留置引起接触性皮炎的有关因素.方法:对在儿科住院使用留置针留置输液的426例患儿中发生接触性皮炎37例的有关因素进行回顾性分析.结果:接触性皮炎的发生以留置头皮静脉高于下肢大隐静脉;留置针留置4～5天者比3天以内者高;使用3M透明通气型(低过敏)比医用3M高强度外科胶带高(P＜0.01或0.05).结论:留置时间3天以内,使用3M高强度外科胶带,可降低周围接触性皮炎的发生.     

护理干预对脑卒中留置胃管患者非计划性拔管的影响

目的观察护理干预对脑卒中留置胃管患者非计划性拔管的影响。方法选择脑卒中长期留置胃管患者96例,随机分对照组及护理干预组,对照组予留置胃管常规护理,干预组对留置胃管患者加强护患沟通,落实非计划性拔管预防措施,采取预见性护理,制定非计划性拔管应急预案,关注高危人群,规范管道管理,改善患者的舒适度等。结果护理干预组没有非计划性拔管发生,对照组拔管率明显高于干预组（P〈0．05）,差异具有显著性,两组患者满意度比较P〈0．01,差异具有显著性。结论有效的护理干预能最大限度减少脑卒中留置胃管患者的非计划性拔管的发生率,提高患者住院满意度,减少患者因反复插管引起的不适,帮助患者早日康复。     

气管切开术后缝合固定套管的临床观察

目的探讨气管切开术后缝合固定气管套管的临床疗效。方法将658例行气管切开术患者随机分为试验组和对照组各329例。对照组术后予以常规气管套管固定;试验组术后予以缝合固定气管套管。对2组术后置管并发症情况进行比较。结果试验组皮肤挫伤、套管脱管、切口出血发生率分别为7.3%、0、0.6%,低于对照组的36.5%、10.3%、14.6%,差异均有显著统计学意义(P<0.01)。结论气管切开套管缝线固定能有效地保护颈部皮肤、减轻患者不适和痛苦、减少出血、避免套管脱出,提高了手术安全性,值得临床推广应用。     

右美托咪啶在胃管置入术中的临床应用

目的探讨右美托咪啶应用在胃管置入术中的可行性和安全性。方法选择60例拟行消化系统择期手术的全麻患者,年龄40~65岁,体重45~65 kg,ASAⅠ~Ⅱ级。采用随机数字表法将患者分成两组（n=30）。A组术前静脉泵注右美托咪啶1μg·kg-1（10 mL,10 min泵完）。B组术前静脉泵注生理盐水10 mL（10 min泵完）。泵注结束后,留置胃管。记录患者泵药前（T0）、胃管置入前（T1）、胃管置入口腔时（T2）、胃管置入成功时（T3）的收缩压（SBP）、舒张压（DBP）、心率（HR）。记录胃管置入操作用时、胃管置入一次成功的例数。观察相关不良反应。评价患者舒适程度。结果 B组T2、T3时SBP、DBP、HR显著高于B组T0时SBP、DBP、HR（P〈0.05）。A组T2、T3时SBP、DBP、HR均显著低于B组T2、T3时SBP、DBP、HR（P〈0.05）。A组胃管置入操作用时显著少于B组（P〈0.05）。A组胃管置入一次成功例数显著多于B组（P〈0.05）。A组相关不良反应显著少于B组（P〈0.05）。A组患者舒适程度显著优于B组（P〈0.05）。结论右美托咪啶可安全有效地应用于胃管置入术。     

胃管改良置入法用于上消化道出血胃肠引流的效果

目的 评价经改良后的胃管置人法对上消化道出血患者胃肠引流情况的效果,探讨其临床适用性.方法 选择2011年3月～2013年3月于本院就诊的150例上消化道出血患者,随机分为实验组80例和对照组70例,对照组患者使用普通胃管,实验组患者使用经改良的胃管,且较普通胃管插入位置靠下,观察两组患者的胃管引流情况和患者的引流效果.结果 实验组患者的引流通畅率为86.25％,明显优于对照组的引流通畅率72.86％,差异有统计学意义（x2=4.19,P＜0.05）.结论 改良胃管置入法对上消化道出血患者有很好的胃肠引流效果,适合临床长期推广应用.     

3M聚酯泡沫敷料应用于胆道外引流管固定效果的临床观察

目的 探讨3M聚酯泡沫敷料联合其Tegaderm系列透明敷料在胆道外引流管固定的临床观察效果.方法 选取2015年1月至2017年1月期间,本科带胆道外引流管的患者100例,随机分为实验组和对照组,每组50例;对照组采用传统的缝线外加引流管固定装置(SKATER(R) FIX)进行外固定,实验组采用3M泡聚酯泡沫敷料联合Tegaderm系列透明敷料进行外固定;比较两组患者置管期间发生脱管高危倾向(固定欠稳妥)的例数,以及引流管皮肤出口周围及敷料下方的皮肤红肿、皮疹等不良反应的发生情况.结果 两组患者在置管期间发生脱管高危倾向的例数(对照组8例,实验组2例)、引流管皮肤出口周围及敷料下方的皮肤出现红肿(对照组8例,实验组1例)、皮疹(对照组6例,实验组1例)等不良反应比较,差异有统计学意义(P＜0.01).结论 3M聚酯泡沫敷料联合Tegaderm系列透明敷料应用于肿瘤患者胆道外引流管固定可降低非计划性拔管的发生,减少导管相关并发症,提高患者的舒适度,并且可以减少相关费用的支出.     

改良胃管固定法在脑卒中患者中的应用观察

目的探讨改良后的胃管固定法在留置胃管的脑卒中患者中的应用效果观察。方法将2009年1月-2011年6月本科室收治的587例留置胃管的脑卒中患者,随机分为对照组293例与实验组294例,对照组患者采用传统的胶布或胶管寸带固定法,实验组采用一次性输液管打结环绕固定法。观察两组患者的舒适清洁度、管道脱落率、成本消耗、操作时间及皮肤受损发生率。结果两组各项指标比较,均P〈0．05,差异具有统计学意义,实验组患者舒适清洁度高于对照组,管道脱落率、成本消耗、操作时间及皮肤受损发生率均低于对照组。结论新的固定方法固定更为牢固、取材方便、美观、简单易行、舒适清洁、管道脱落少、节省操作时间用成本,值得临床推广。     

Reactivity of enprostil stereoisomers in soft elastic gelatin capsules

Enprostil (methyl 7-[(1R*,2R*,3R*)-3-hydroxy-2-[(E)-(3R*)-3-hydroxy-4-phenoxy-1-butenyl]- 5-oxocyclopentyl]-4,5-heptadienoate), a gastric acid secretion inhibitor and potent anti-ulcer drug, is formulated as a propylene carbonate solution which is filled into soft elastic gelatin capsules. The drug molecule features two unresolved asymmetric carbon atoms, and synthesis yields an equimolar mixture of four different optical isomers (two diastereomeric pairs of enantiomers). The objective of this study was to establish the degree to which enprostil does or does not degrade stereoselectively in the soft elastic gelatin capsule formulation. Accordingly, we developed an HPLC method capable of resolving enprostil diastereoisomers and applied the method to determining reaction rates of enprostil in soft elastic gelatin capsules maintained at 40 degrees C. The study included three soft elastic gelatin capsule lots: the first two contained an equimolar mixture of all four enprostil enantiomers; and the third contained an equimolar mixture of two individual diastereoisomers of known optical purity. Comparing enprostil degradation rates in the three capsule lots showed that reactivity ratios in all cases were (within the limits of experimental uncertainty) equal to unity. This observation conclusively excludes the possibility of significant enantioselectivity for enprostil degradation in the soft elastic gelatin capsule formulation. We also report kinetic equations for the general case of relating stereospecific reactivity ratios to drug product shelf life when drug concentrations are monitored with nonstereoselective analytical techniques.     

Functional roles of muscarinic M2 and M3 receptors in mouse stomach motility: studies with muscarinic receptor knockout mice

Functional roles of muscarinic acetylcholine receptors in the regulation of mouse stomach motility were examined using mice genetically lacking muscarinic M(2) receptor and/or M(3) receptor and their corresponding wild-type (WT) mice. Single application of carbachol (1 nM-30 microM) produced concentration-dependent contraction in antral and fundus strips from muscarinic M(2) receptor knockout (M(2)R-KO) and M(3) receptor knockout (M(3)R-KO) mice but not in those from M(2) and M(3) receptors double knockout (M(2)/M(3)R-KO) mice. A comparison of the concentration-response curves with those for WT mice showed a significant decrease in the negative logarithm of EC(50) (pEC(50)) value (M(2)R-KO) or amplitude of maximum contraction (M(3)R-KO) in the muscarinic receptor-deficient mice. The tonic phase of carbachol-induced contraction was decreased in gastric strips from M(3)R-KO mice. Antagonistic affinity for 4-diphenylacetoxy-N-methyl-piperidine (4-DAMP) or 11-([2-[(diethylamino)methyl]-1-piperdinyl]acetyl)-5,11-dihydro-6H-pyrido[2,3-b][1,4]benzodiazepine-6-one (AF-DX116) indicated that the contractile responses in M(2)R-KO and M(3)R-KO mice were mediated by muscarinic M(3) and M(2) receptors, respectively. Electrical field stimulation (EFS, 0.5-32 Hz) elicited frequency-dependent contraction in physostigmine- and N(omega)-nitro-L-arginine methylester (l-NAME)-treated fundic and antral strips from M(2)R-KO and M(3)R-KO mice, but the cholinergic contractile components decreased significantly compared with those in WT mice. In gastric strips from M(2)/M(3)R-KO mice, cholinergic contractions elicited by EFS were not observed but atropine-resistant contractions were more conspicuous than those in gastric strips from WT mice. Gastric emptying in WT mice and that in M(2)/M(3)R-KO mice were comparable, suggesting that motor function of the stomach in the KO mice did not differ from that in the WT mice. The results indicate that both muscarinic M(2) and M(3) receptors but not other subtypes mediate carbachol- or EFS-induced contraction in the mouse stomach but that the contribution of each receptor to concentration-response relationships is distinguishable. Although there was impairment of nerve-mediated cholinergic responses in the stomach of KO mice, gastric emptying in KO mice was the same as that in WT mice probably due to the compensatory enhancement of the non-cholinergic contraction pathway.     

Multidimensional column-switching liquid chromatographic method for dissolution testing of enprostil soft elastic gelatin capsules

Enprostil (methyl 7-[(1 R,2R,3R)-3-hydroxy-2-[(E)-(3R)-3-hydroxy-4- phenoxy-1-butenyl]-5-oxocyclopentyl]-4,5-heptadienoate), an E-type prostaglandin exhibiting anti-ulcer activity, is formulated as a propylene carbonate solution filled into soft elastic gelatin (SEG) capsules. Enprostil SEG capsules were maintained for timed intervals at 50 degrees C, 30 degrees C, and room temperature, and the quantity of drug released upon complete capsule dissolution was determined as a function of storage condition. The dissolution test adhered to USP XXI guidelines (paddle method) and used a multidimensional HPLC technique to provide a sensitive and selective enprostil assay. Parallel HPLC assays determined the enprostil concentration in the propylene carbonate fill that was physically expressed from initially manufactured and from aged capsules. This corrected for any enprostil loss via chemical degradation on storage. The study included six different aged samples (six replicates each), and for all six samples, the enprostil recovered from dissolved capsules averaged 104 +/- 1.4% of the enprostil physically expressed from the capsules. Similarly, the enprostil recovered from dissolved, aged capsules averaged 103 +/- 5% of the enprostil physically expressed from capsules at the initial time point. These findings exclude the possibility that interactions with the SEG capsule wall reduce drug availability during storage under normal conditions. The multidimensional HPLC technique should generally extend to analysis of other noncationic drugs formulated into soft gelatin capsules.     

1例尼达尼布软胶囊经喂食管给药的病例分析

目的:探讨临床药师参与危重症患者口服药物治疗的作用。方法:通过临床药师参与1例尼达尼布经喂食管给药病例,探讨充液软胶囊药物经喂食管给药方案。结果:尼达尼布软胶囊给药方法建议用注射器吸取药液后注入喂食管,用至少15 mL无菌水冲洗管路。若患者同时使用肠内营养制剂,建议将肠内营养持续给予方式改为间断给药。结论:临床药师在ICU药物治疗中通过个体化药物治疗的实施,协助医护人员制订安全合理的口服药物给药方案,提高药物应用的安全性。