血液透析中股静脉单针与双腔针的应用

目的 :比较股静脉单针与留置双腔针的优缺点 ,以选择更佳的血液透析通路。方法 :回顾对照研究 ,79例用股静脉单针 ,4 3例用股静脉双腔针的血流量、KT/V值和相关并发症等。结果 :最大血流量股静脉单针为 2 4 0± 32ml,双腔留置针为 2 0 0± 4 8ml;KT/V值分别是 0 8± 0 5 ,1 0± 0 5 ,股静脉双腔留置针出现血流量不足、感染、导管堵塞等并发症的发生率明显高于股静脉单针 ,各指标差异均有显著性 (P <0 0 5 )。结论 :股静脉单针是一种更理想的临时性血液透析通路     

Predictors of outcomes in managing breast abscesses—A large retrospective single‐center analysis

We have retrospectively examined a wide range of clinical characteristics, sonographic features, microbiology, and antibiotic regimens in patients with breast abscesses to seek predictive features related to outcome. Because consensus for optimal treatment of breast abscesses has moved toward minimally invasive management using single or repeated needle aspiration (ASP) coupled with adjuvant antibiotics, we assessed whether any factors correlate with the need for repeat procedures by analyzing the number of ASPs and/or surgical incision and drainage (I&D) per abscess. We examined 127 abscesses in 114 patients from a single urban public hospital, and among clinical characteristics, we found that only smoking history (P = .021) and the presence of nipple rings (P = .005) were associated with greater likelihood of necessitating repeat for abscess resolution procedures. Neither diabetes, lactational status, and HIV nor ultrasound features imaging of an abscess including size >3 cm, multiloculation, rind thickness, or central vs peripheral location were correlated with the need for a repeat procedure. Likewise, no specific micro‐organisms predicted a greater likelihood of requiring repeat procedures, and no specific initial antibiotic regimen (gram‐positive and/or gram‐negative or multiresistance coverage) impacted clinical outcomes. Our data indicate that no specific imaging abscess characteristics, type of micro‐organism, or initial choice of antibiotics affect outcomes, and therefore, these features should not preclude attempts at conventional therapy by repeated aspiration and antibiotic treatment. While a smoking history and presence of a nipple ring may increase the risk of a prolonged course, the decision to change antibiotics or repeat aspiration should rely instead on clinical evaluation and judgment by experienced physicians.     

肾自动活检术在老年肾脏病中的应用价值与风险评估

目的评估超声引导肾自动活检术在老年肾脏病患者中的临床应用价值。方法回顾性分析我院肾内科6年间对老年肾脏病患者进行肾自动活检术的成功率和并发症并探讨其临床价值。结果106例患者活检手术总成功率100%,其中取材不良2例(1.9%),取材合格12例(11.3%),取材良好92例(86.8%);共5例出现轻度并发症(4.7%),其中肉眼血尿2例(1.9%),肾周血肿3例(2.8%),无严重出血并发症;肾活检结果对诊断与治疗的影响:临床诊断修正率为35.8%,治疗方案修正率为41.5%。结论肾自动活检术在老年性肾脏疾病患者中应用的成功率高而并发症少且大多较轻,其病理结果对明确诊断和决定治疗方案具有重要意义,值得进一步推广应用。     

护理工作中针刺伤的防护

近年来,针刺伤已经成为护理人员面临的主要职业危害之一。它不仅会造成多种血源性疾病的传播,还给护士的心理带来很大的影响,因此针刺伤的防护已经引起了广泛关注。本文综述了护士发生针刺伤的原因以及防护措施,以期对护理人员针刺伤的防护起到一定的指导作用。     

心肌再血管化机制的对比实验研究

目的观察研究钬激光和True-cut活检针心肌再血管化近、远期的机制和效果。方法利用经静脉注射造影剂对犬缺血心肌模型进行心肌超声微泡造影。结果部分结扎犬的冠状动脉前降支,建立缺血模型后,缺血区超声微泡密度明显降低,分别用2种方法再血管化后,2组犬缺血区超声微泡密度较缺血时均明显增加,接近其缺血前的微泡密度;再血管化区超声微泡较其他部位提前显影。远期超声微泡检查显示心肌灌注较急性缺血时也有一定改善。结合组织学方法发现,远期心肌灌注的改善得益于隧道周围新生循环结构如心肌窦和新生血管的增加。结论钬激光和True-cut活检针隧道均可即刻使缺血心肌灌注改善,并逐渐闭塞,新生循环结构使缺血区得到有限的灌注。应用新一代经静脉注射造影剂超声心肌微泡造影结合组织学方法可作为研究心肌再血管化机制的可靠手段。     

高强度聚焦超声与射频治疗子宫肌瘤术中超声监控

目的 探讨高强度聚焦超声与射频治疗子宫肌瘤术中超声监控评价的意义。方法 高强度聚焦超声与射频治疗子宫肌瘤病人17例，其中高强度聚焦超声治疗6例，射频治疗11例，术中均用超声诊断仪进行监控。结果 17例病人术中出现明显肌瘤回声增强，通过随访17例病人肌瘤逐渐缩小，肌瘤内血流信号消失。结论 高强度聚焦超声与射频治疗子宫肌瘤术中超声监控效果可靠。     

Color Doppler sonographically guided transthoracic needle aspiration of lung and mediastinal masses.

OBJECTIVE: This study investigated the diagnostic value of color Doppler sonographically guided transthoracic needle aspiration in lung and mediastinal masses. METHODS: B-mode and colorDoppler sonographic images were obtained in 48 patients with mediastinal or peripheral pulmonary tumors. Color Doppler sonography was used to show the vascular structures before the transthoracic needle aspiration procedure. It was also used to locate the needle tip during the procedure by showing the twinkling sign. This maneuver was performed with motion of the inner stylet. Pathologic and microbiological examination of the aspirates was made. RESULTS: Vascular structures were detected in 37 cases on color Doppler images and in 10 cases on B-mode images. Similarly, the needle tip was observed in 39 cases on color Doppler images but in only 9 cases on B-mode images. No complications were observed except partial pneumothorax in 2 cases. The method had sensitivity of 90.0%, specificity of 87.5%, a positive predictive value of 97.2%, a negative predictive value of 63.6%, and diagnostic accuracy of 89.6%. CONCLUSIONS: Color Doppler sonographically guided transthoracic needle aspiration is a safe diagnostic method in malignant lung tumors, especially peripheral tumors, because of its ability to differentiate vascular structures within a tumor before the transthoracic needle aspiration procedure. It provides additional information about the location of the needle tip.     

静脉留置针致静脉炎相关因素分析及对策

目的了解静脉留置针病人发生静脉炎的因素,以便制订针对性的对策。方法对165例病人使用静脉留置针所致静脉炎的相关因素进行分析。结果静脉炎的发生与远端静脉穿刺、输入刺激性药物、液量大及封管药物技术等有关。结论通过合理选择静脉、正确输入药液、选择恰当的封管液、提高护理操作技术及健康教育可以降低病人静脉炎的发生率,保证静脉留置针的安全使用。     

胰腺占位术中细针穿刺的应用

目的　探讨胰腺占位性病变术中细针穿刺细胞学检查 (IFNA)的应用价值。方法　对 36例胰腺占位性病变术中细针穿刺、活组织检查和影像诊断结果进行回顾性总结。结果　三组的诊断符合率分别为75 %、77 3%、80 6 % ,差异无显著意义 ,且三种检查的结果是互相交叉的。IFNA存在一定的假阴性 (4 / 36 ) ,但可取得细胞病理学诊断 ,未发生出血、胰瘘等严重并发症。结论　IFNA与影像检查结合应用 ,对胰腺占位性病变的定性诊断具有较大的实用价值     

锁骨下静脉置管化疗病人局部毒性反应临床观察

[目的]预防和减少化疗药物致局部毒性反应的发生。[方法]对320例肿瘤化疗病人随机分为观察组和对照组各160例。观察组采用锁骨下静脉置管化疗，对照组采用外周静脉留置针化疗，观察两组沿静脉走向区域局部毒性反应情况。[结果]对照组出现局部毒性反应发生率为75％，观察组局部毒性反应发生率为0。两组比较，x^2=192，P〈0．01。[结论]锁骨下静脉穿刺置管化疗优于外周静脉化疗，但掌握好局部解剖位置和操作要领是锁骨下静脉置管成功的关键。