带隐神经交腿随意皮瓣修复足底皮肤缺损

目的 报道用带隐神经的小腿内侧带蒂随意皮瓣修复对侧足底皮肤缺损的临床效果。方法 在健侧小腿内侧隐神经走行区设计皮瓣，将隐神经保留在皮瓣中央，根据患足创面大小切取皮瓣，带深筋膜，蒂保留在胫前侧，将皮瓣缝合于患足的创面，皮瓣中的隐神经与患足足底内侧皮神经吻合，双下肢固定3周后断蒂。1997～2001年，临床应用13例。结果 用该皮瓣修复13例足底皮肤缺损均获得成功，皮瓣外形良好，术后6～12个月恢复感觉，无再破溃发生。结论 带隐神经交腿随意皮瓣切取简单，厚薄适度，不损伤知名血管，术后带感觉神经可恢复皮瓣的感觉，有效防止皮瓣再破溃。是修复足底皮肤缺损的较好方法。     

避免静脉配药差错的两点改进

静脉配药是护理工作中比较普遍的一项操作。以往是将输液单按床号横向排列 ,按输液顺序将输液瓶排列在输液单后面 ,准备配置的药物分别放在对应的输液瓶旁边。一些禁饮食及外科术后需要大量补液的病人 ,往往是多瓶液体、多种药物罗列在桌面上。这样不但容易与邻近病人的药物混淆 ,而且要占用护士大部分交接班时间来进行药物核对。另外 ,一张张输液单摆放在治疗台上 ,常容易被风吹散 ,被水、药物打湿而字迹模糊。我科在临床工作中将以上两种情况进行了改进 ,并在全院各科进行推广。自 1998年 7月实施至今 ,普遍反映良好 ,无 1例发生药物混乱 …     

带蒂真皮下血管网皮瓣在大面积皮肤撕脱伤中的应用

肢体大面积皮肤撕脱伤是近年随交通事故增加而伴发的严重创伤之一 ,也是急诊外科医师所面临的较为棘手问题。传统的做法是将撕脱的大张皮肤切下制成断层皮片再植 ,不仅费时费力 ,功能较差 ,而且又人为地牺牲了蒂部残存的唯一血供。近几年来我院尝试了保留真皮下血管网皮瓣治疗此种创伤 ,明显缩短平均住院日 ,疗效优于其它植皮法[1] 。本文选自 1990年 12月～ 2 0 0 1年12月收治 5 1例撕脱伤中的 2 1例皮损相对完整、采用带蒂真皮下血管网皮瓣治疗的病例 ,随访疗效满意 ,报告如下。一、资料与方法1　临床资料 :本组男 13例 ,女 9例 ,年龄 5～…     

不同液体术前急性高容量血液稀释对深静脉血栓病人血液流变学的影响

Objective To investigate the effects of acute hypervolemic hemodilution (AHH) with different fluids on blood rheology in patients with deep vein (femoral and iliac) thrombosis. Methods Thirty ASA I or II patients aged 40-64 yr who had developed deep vein thrombosis in 48 h and were scheduled for embolectomy were randomly divided into 3 groups ( n = 10 each) ; group I normal saline (NS) ; group II 6 % HES 200/0.5 ( HES) ; group IE gelofusine (GEL). AHH was performed with normal saline, 6% HES or gelofusine infusion at 20 ml·kg-1 ·h-1 for 40 min. MAP, HR and SpO2 were monitored. Blood loss, volume of blood transfusion and fluid infused and urine output during operation were recorded. Anesthesia was induced with fentanyl 3-5 fig/kg, etomidate 0.15-0.30 mg/kg, propofol 1-2 mg/kg and succinylcholine 1-2 mg/kg and maintained with 2% isoflurane and propofol infusion at 5-8 mg·kg-1·h-1 and intermittent iv boluses of vecuronium. The patients were mechanically ventilated (VT 8 ml/kg, RR 12 bpm). PaO2 and PaCO2 were maintained within normal range. Venous blood samples were obtained before and after AHH for measurement of hematocrit (Hct), whole blood viscocity (WBV) at low or high shear rates, plasma viscosity, RBC aggregation and RBC deformation. RBC aggregation index and RBC deformation index were calculated. Results MAP and HR were stable in all patients. The amount of blood transfusion and fluid infused was significantly less in group HES and GEL than in group NS. The WBV at low or high shear rates in group HES and GEL, Hct in all 3 groups and RBC aggregation index in group HES were significantly decreased after AHH, but the RBC deformation index was significantly increased in group HES. Conclusion Colloid is better than crystalloid and HES is better than gelofusine in improving intraoperative hypercoagulability and sluggish blood flow.     

下肢深静脉完全胃肠外营养的护理探讨

目的：完全胃肠外营养为不能从胃肠道摄入的各类重病人补充营养物质和治疗。方法：从股静脉或大隐静脉将硅胶送至下腔静脉，利用此管道输注高能营养液。特点：下肢深静脉ＴＰＮ既方便了护理操作，且减轻了患者的恐惧心理。     

热水手浴用于静脉保护50例疗效观察

目的：探讨长期输液病人手部浅静脉的保护。方法：比较对照组热水手浴50例与常规组42例静脉硬化情况。结果：对照组出现静脉硬化例数及程度明显低于常规组，（P＜0．01）。结论：热水手浴在静脉保护方面有一定的作用。