临床护理路径在心血管患者静脉留置针中的研究分析

目的:提高静脉留置针使用有效期,保证心血管患者得到及时用药,有效开放静脉抢救通道。方法:建立了心血管患者静脉留置针的临床护理路径(Clinical Nursing Pathway,CNP)。选择我院2018年1-12月期间接诊的静脉留置针心血管患者为研究对象,共100例,随机分组,即对照组(50例,常规护理)与实验组(50例,在常规护理基础上辅以临床护理路径),比较两组护理效果,包括留置时间、不良反应情况、患者满意度等。结果:护理后,两组患者留置时间无明显差异,但实验组不良反应发生率、静脉炎发生率低于对照组,差异有统计学意义(P<0.05);实验组满意度、一次性置管成功率高于对照组,而非计划性拔管率则低于对照组,差异有统计学意义(P<0.05)。结论:心血管患者静脉留置针护理中辅以临床护理路径,可减少不良反应,预防静脉炎,延长置管时间,提高护理满意度,值得优选。     

带手套穿刺对留置套管针一次成功率的影响

为探讨戴手套与不戴手套穿刺对留置静脉套管针一次成功率的影响 ,为护理人员的自身防护提供科学依据 ,选取冠状动脉搭桥术病人 12 0例 ,随机分为实验组和对照组 ,实验组采用戴手套穿刺法 ,对照组采用常规洗手后不戴手套穿刺法。结果两组一次穿刺成功率经χ2 检验 ,无统计学意义( χ2 =0 .5 6 3,P >0 .0 5 )。说明戴手套留置套管针并不影响一次穿刺成功率。     

Flow dynamics through spinal needles

We examined the flow pattern produced when liquid dye was actively injected into a fluid medium at various flows through five different commonly used spinal needles. At all flows, the Whitacre-type needles produced a directional stream exiting at an angle from the longitudinal axis. At intermediate rates the stream developed tracks which disappeared at faster rates. The Quincke needle always produced an undeviated stream of dye and did not form tracks at any flow rate. When a perspex plate (representing the spinal cord) was interposed in front of the needle, the dispersion of dye was always unidirectional from the Whitacre needle and bidirectional from the Quincke needle. The dye adhered to the surface of the plate as a concentrated film at slow rates and at faster rates it dispersed turbulently for both types of needle.     

<Emphasis Type="Italic">Susuks</Emphasis> (charm needles) in the craniofacial region

Objectives  We conducted a study to determine the numbers of susuks (charm needles) and their distribution in the craniofacial region of susuk wearers, and the sex, racial affiliation, and age of the wearers. In addition, we sought to determine whether the presence of susuks posed any potential hazard to patients undergoing magnetic resonance imaging (MRI). Methods  We studied various radiographs of 33 susuk wearers (age range, 33–69 years) and investigated the most common sites of insertion in the craniofacial region. A susuk was also suspended inside a 1.5-T MRI machine to determined whether it was attracted by the machine’s magnet. Results  The largest number of susuks that we observed in the craniofacial region was 39 pins, and susuks were particularly numerous in Malay Muslim women. Other sites with susuks were the maxillofacial region (except the temporomandibular region) and the forehead. The susuks showed no ferromagnetic characteristics. Conclusions  As susuks are made from gold, they are generally biocompatible with human tissue and do not cause problems to their wearers. Gold and the other minor metal constituents found in susuks have no ferromagnetic characteristics and therefore pose no hazard to patients undergoing MRI.     

Pitfalls in acid/base experiments with conscious dogs

Arterial pH and blood gases were measured at intervals in conscious dogs after their first human contact of the day. Blood was sampled through an indwelling catheter in the aorta without disturbing the animals. It appeared that in the first 90 min arterial PO₂, oxygen saturation and haemoglobin concentration significantly declined. PCO₂ and pH changed less consistently when the acid/base status of the dogs was normal, but when a non-respiratory acidosis was present there was a significant decrease in pH and a significant increase in PCO₂. Arterial pH and blood gases were also measured before and after feeding the animals. It appeared that an appreciable metabolic alkalosis developed within 2 h after a meal. The alkaline tide was accompanied by a trend to higher values for PCO₂. It is concluded that, after a period of seclusion, renewed human contact causes behavioural changes in a dog, which may result in appreciable transitory changes in arterial pH and blood gas values. Blood sampling from conscious dogs should therefore take place after a proper period of habituation; preferably, a few samples should be taken at intervals to check that a steady state has been reached. If possible, blood should be collected before feeding; in any case the relationship in time of blood sampling to feeding should be constant throughout.     

马尾松松针中木脂素类化学成分的研究

目的研究松科(Pinaceae)植物马尾松(P.massoniana Lamb.)松针(pine needles)水煎液中的化学成分。方法利用Diaion HP-20,Toyopearl HW-40和硅胶等柱色谱技术进行分离纯化,根据化合物的理化性质和光谱数据进行结构鉴定。结果从马尾松针水煎液镇痛作用较强的正丁醇萃取部位分离得到3个木脂素类化合物,其化学结构分别确定为化合物7(massonianoside D): (7S,8r)-4,9′-二羟基-3,3′-二甲氧基-7,8-二氢苯骈呋喃-1′-丙醇基新木脂素-9-O-α-L-鼠李糖苷;化合物8(异落叶松脂素):4,4′,9,9′-四羟基-3,3′-二甲氧基-7-苯基四氢萘木脂素;化合物9(异落叶松脂素-9-O-木糖苷):4,4′,9′-三羟基-3,3′-二甲氧基-7-苯基四氢萘木脂素-9-O-β-D-木糖苷。结论化合物7为新化合物,化合物8,9为首次从本植物中分离得到。     

靳三针配合康复训练治疗缺血性中风偏瘫疗效观察

目的观察靳三针疗法配合康复训练治疗缺血性中风偏瘫的临床疗效。方法选取94例缺血性中风偏瘫患者,随机分为靳三针配合康复治疗组和康复对照组,在治疗前、治疗14 d后、治疗28 d后分别采用神经功能缺损评分（NDS）和运动功能（四肢简化Fugl-Meyer）评分量表等进行疗效评价。结果两组的NDS评分及FMA评分在治疗14 d与治疗前、治疗28 d与治疗14 d比较均有改善（P〈0.05）;治疗28 d后,治疗组疗效更为显著,与对照组比较差异有统计学意义（P〈0.05）。结论靳三针配合康复治疗与单纯康复治疗均能促进中风偏瘫患者神经功能恢复,改善患者的运动功能;靳三针配合康复治疗更全面,疗效更显著,优于单纯康复治疗。     

A sewing needle in the liver in children: A case report and literature review

Rationale:In clinical practice, foreign bodies (FBs) in the digestive tract are more common in children, but intrahepatic FBs are rare, especially those that can cause infection, bleeding, bile leakage, and other complications. However, there is no consensus on its diagnosis and treatment due to the lack of large-scale cohort studies.Patient concerns:Case 1 is a 4-years 8-months-old girl, who at the age of 10 months, showed an X-ray finding of a striped FB in her liver, with no symptoms. However, the patient’s parents refused surgery. After nearly 4 years of active surveillance, the patient visited our hospital for surgery. Case 2, a 2-year-old male, reported a sewing needle that completely pierced into the right upper abdomen due to an accidental fall that took place half-a-day before admission. He only had right upper abdominal pain. CT showed a striped FB in the liver.Diagnosis:FB in the liver (sewing needle).Interventions:Both the patients were injected with human tetanus immunoglobulin and underwent surgical removal.Outcomes:Both patients recovered smoothly and had no complications during follow-up.Lessons:Active surveillance might be considered for cases with no symptoms or complications and no displacement of the FB, but surgery should be the first choice. If the patient’s condition is complicated, it is recommended to use ultrasound or X-ray to help decision-making during the operation. Additionally, tetanus, child safety, and family education are important supportive measures.     

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。