改良动脉穿刺方法在肿胀手综合征中的应用效果

肿胀手综合征是行维持性血液透析患者常见并发症之一,由于静脉回流被阻断或者动脉血流压力的影响,造成肢体远端静脉回流障碍;如果血管吻合后静脉流出道梗阻,动脉血流通过侧支循环流经手部静脉或尺侧静脉时严重影响手部静脉回流,出现肿胀手.主要临床表现为手部发生冻疮样变化,色泽暗红,皮肤发痒,严重者可致坏死[1].笔者通过在内瘘闭塞段分段定点穿刺,分段再通扩张等护理措施,较好地缓解了肿胀手的临床症状,维持了慢性透析患者动静脉内瘘的正常功能.现将护理体会介绍如下.     

月经期透析肝素不同给药路径的应用研究

目的探讨月经期安全有效的血液透析抗凝技术。方法选择30例月经期患者进行自身对照研究,将等量普通肝素采用不同的给药方法;对照组先采用静脉给首剂肝素后,再从动脉端持续追加剩余肝素。实验组不给首剂肝素,采用直接从动脉端持续给药法。分别观察记录透析当日月经量、月经持续时间。结果实验组患者透析当日月经量(19.54±3.00)g,月经持续时间(5.44±1.29)d,均小于对照组的(21.87±2.29)g,(7.24±1.66)d,有显著性差异(P0.01)。结论在肝素给药剂量相等的情况下,建议月经期透析采用直接动脉持续给药方法。     

改良透析器首次使用不同预处理方法的效果比较

透析器在首次使用时如果预冲方法不当或预冲不彻底,就会发生透析器不良反应,不仅增加了患者痛苦,而且增加了透析的治疗风险[1].本院改良了透析器预冲方法,在临床应用收到较好效果,现介绍如下.     

1例血液透析并发急性溶血患者的护理

通过对1例首次血液透析中并发不典型急性溶血反应患者的成功治疗与护理,总结其相关经验,以供同行临床参考。     

首量肝素分别由动静脉端给药在血液透析中抗凝效果的观察

目的探讨首量肝素分别由动静脉端给药在血液透析中抗凝的效果和不良反应。方法将56例采用普通肝素抗凝且均复用透析器的血液透析患者分为2组:研究组28例采用首量肝素由动脉端给药抗凝,对照组28例采用首量肝素由静脉端给药抗凝。观察2组抗凝效果及并发症发生情况。结果研究组抗凝效果明显优于对照组,肝素用量少于对照组,使用肝素后出血、过敏等并发症的发生亦少于对照组。结论血液透析中首量肝素由动脉端给药抗凝效果好。     

Observation on clinical efficacy of warm needling therapy for chronic lumbar strain

Objective

To observe the clinical efficacy of warm needling therapy for chronic lumbar strain.

Methods

A total of 60 patients with chronic lumbar strain who met the inclusion criteria were randomized into a treatment group and a control group by the random number table, with 30 cases in each group. The treatment group was treated with warm needling therapy, while the control group was treated with ordinary acupuncture treatment. The treatments were both performed once every other day, and 7 times constituted a course of treatment. Visual analog scale (VAS) score was used to assess the degree of pain and the clinical efficacy was compared between the two groups.

Results

The total effective rate of the treatment group was higher than that of the control group (P<0.05). There was no significant difference in VAS score between the two groups before treatment (P>0.05). After treatment, the VAS scores of both groups decreased significantly, and the intra-group differences were statistically significant (both P<0.05). The VAS score of the treatment group after treatment was statistically different from that in the control group (P<0.05).

Conclusion

Warm needling therapy has a better curative effect than ordinary acupuncture in the treatment of chronic lumbar strain.

     

Effect of heat-sensitive moxibustion on facial function score in patients with facial paralysis

Objective

To observe and compare the therapeutic efficacies of heat-sensitive moxibustion plus Western medication, dry Western medication, and acupuncture plus TDP in treating peripheral facial palsy (FP).

Methods

Ninety FP patients were randomized into a Western medication group, a heat-sensitive moxibustion group, and an acupuncture group by using sealed envelope, 30 cases in each group. The Western medication group was intervened by conventional Western medication; the heat-sensitive moxibustion group was by heat-sensitive moxibustion in addition to the same Western medication; the acupuncture group was by the Western medication plus acupuncture and TDP radiation. For the three groups, 6-day treatment was taken as a treatment course, with a 2-day interval between 2 courses, and totally 4 treatment courses were observed.

Results

After intervention, the modified Portmann scores were changed significantly in the three groups (P<0.05), and the improvements in the heat-sensitive moxibustion group and the acupuncture group were both superior to that in the Western medication group. The recovery plus markedly effective rate of the acupuncture group was significantly different from that of the Western medication group (P<0.05), and there was a significant difference in comparing the recovery plus markedly effective rate between the heat-sensitive moxibustion group and acupuncture group (P<0.05).

Conclusion

Heat-sensitive moxibustion is effective in treatment peripheral facial paralysis, and this method is free of pain, causing no adverse reactions, and worth promotion in clinic.

     

高迁移率族蛋白-1浓度变化与脓毒症预后的关系

目的 探讨脓毒症患者血浆高迁移率族蛋白-1(HMGB-1)质量浓度变化对预测28d生存情况的临床价值.方法 采用的瞻性设计,入选广东省人民医院ICU 2008年6月至2009年9月脓毒症非多器官功能障碍综合征患者56例,排除:年龄＜18岁;慢性疾病终末期;入选3d内2个或2个以上器官功能障碍;急性胰腺炎,但明确无感染者;因为其他医学原因,预测不可能生存超过28 d的患者.45例患者最终纳入统计.患者于发病后第0,1,3,7天采外周静脉血,离心取血浆酶联免疫吸附法检测HMGB-1浓度,前7d每天进行感染相关器官功能衰竭评分(SOFA)、急性生理与慢性健康状况评分Ⅱ( APACHEⅡ),并随访28 d临床结局.根据28 d生存情况将患者分为存活组和死亡组,采用t检验比较两组间血浆HMGB-1浓度及其变化的差异,Spearman秩相关分析血浆HMGB-1质量浓度及其变化与SOFA、APACHEⅡ评分的关系,接收者工作特征曲线(ROC曲线)下面积法检验相关指标的预测效力.结果 死亡组、存活组第0,1,3,7天血浆HMGB-1质量质量浓度质鼍浓度差异无统计学意义(P＞0.05);死亡组血浆HMGB-1第3天与第0天差值显著低于存活组;第3天与第0天m浆HMGB-1差值预测脓毒症患者28 d生存的曲线下面积为0.868 ±0.061(P=0.000,95％ CI:0.748～0.988);最佳截断点2.72 ng/mL,此时灵敏度为81.8％、特异度86.7％;血浆HMGB-I第3天与第0天差值与第1,2,3,4天SOFA评分之间呈显著负相关(P＜0.05).结论 脓毒症患者血浆HMGB-1下降可以预测28 d生存情况,早期监测其动态变化有助于预测脓毒症患者预后.