548例中心静脉营养导管留置与维护

目的　研究长期中心静脉营养导管的放置与维护。方法　５４８ 例需长期静脉营养治疗的病人，选左锁骨下穿刺锁骨下静脉成功后，导管经皮下隧道由胸前壁引出，并在皮下作导管固定。结果　５４８ 例共静脉穿刺５９７ 次，成功率８９２％ 。并发症有局部血肿、气胸和少量空气引起气栓。导管保留时间平均（６９±１４）ｄ，明确感染５例。当营养液沉积阻塞导管可用氢氧化钠封管而使导管再通。结论　中心静脉营养导管经左锁骨下穿刺最合适，皮下隧道可预防感染，氢氧化钠溶液冲洗可使阻塞的营养导管再通

Deep blood dilution in infants undergoing cardiopulmonary bypass

Objective To evaluate the siginificance of deep blood dilution in infants undergoing cadiopulmonary bypass on the reduction of homogeneous blood product and observe its effect on the postoperative outcome.Methods Thirty six infants whose weights were less than 20kg, undergoing cardiopulmonary bypass,were divided randomly into group T and group C.Cases in group T were treated with deep blood dilution(Hb 70 75g/L)whereas those in group C were treated with mild blood dilution (Hb 85 90g/L)during bypass.Results The amount of homogeneous blood used in group T(200ml)was significantly less than that used in group C(400ml).The concentration of hemoglobin (Hb)in group T was less than that in group C(P<0 05)during bypass,after bypass,immediately after operation,and 6 hours after operation respectively,and arrived a similar level to that in group C 18 hours after operation.The dose of furosemide and the uric amount in group T were more than those in group C(P<0 05) No obvious difference in the operative outcome was detected after operation between both groups.Conclusion Deep blood dilution in infants undergoing cardiopulmonary bypass can save the perioperative amount of homogeneous blood effectively compared with mild blood dilution,and has no infaust postoperative influence.