颈外静脉留置针在心血管内科病人中的应用

目的探讨一次性静脉留置针经颈外静脉穿刺置管的方法及优点。方法对心血管内科中遇到的危重病人采用一次性静脉留置针经颈外静脉穿刺进行输液治疗。结果观察78例病人,其中3例穿刺失败。结论使用一次性静脉留置针经颈外静脉穿刺输液具有操作简便,一次穿刺置管成功率高,完成时间短,并发症少及固定牢固,不易脱出等优点,是一种安全简便实用的静脉输液方法。     

PICC置管术在临床护理应用中的评价

目的比较外周静脉留置针与外周中心静脉置管(PICC)在肿瘤化疗过程中应用价值。方法将2007年1月至2008年3月60例首次化疗的肿瘤患者分为两组,30例外周静脉留置针为A组,30例PICC置管为B组,两组基本情况无明显差异。治疗中观察记录留管时间、并发症发生情况。结果A组留置针保留时间为1～5d,中位时间3.4d,B组PICC置管保留时间为14～290d,中位时间162.3d;两组比较差异有显著统计学意义(P<0.05)。两组的主要并发症有局部渗血、静脉炎、感染及管腔堵塞。A组发生局部渗血14例、静脉炎17例、感染11例及管腔堵塞8例,B组发生局部渗血6例、静脉炎2例、感染6例及管腔堵塞0例。结论PICC置管安全、保留时间长,在肿瘤病人的临床价值显著高于外周静脉留置针。     

中心静脉穿刺置管术在基层医院输液的应用

目的总结分析输液用中心静脉穿刺置管术的操作及术后护理,为经外周静脉输液困难的患者建立静脉输液通路提供一个途径。方法回顾性分析2009年10月至2010年10月西安北车医院24例经外周静脉输液困难的患者,行中心静脉穿刺置管术的穿刺部位选择、穿刺要点、术后护理方法及并发症的发生情况。结果 (1)24例患者均成功行中心静脉穿刺置管术,术后输液通畅;(2)1例患者发生血肿,发生率为4.1%,2例患者发生置管处皮肤轻微感染,发生率为8.3%。未发生其他并发症。(3)导管平均留置时间(20±9)d。结论中心静脉穿刺置管术安全可靠,是经外周静脉输液困难的患者建立静脉输液通路的一个途径,可在基层医院广泛开展。     

静脉留置针的不良反应与护理

静脉留置针又称套管针,留置静脉穿刺针代替普通的静脉穿刺,不但解决了急、危重患者快速输液、输血的问题,而且大大减轻了患者的痛苦,在应用过程中留置针也常出现一些不良反应,从而给病人增加了痛苦、导致留置的时间缩短。因此,防范留置针不良反应极为重要。     

婴儿使用静脉留置针的体会

总结500例患儿静脉留置针的护理,包括穿刺方法,血管选择,进针角度和置管期间的护理,拔针注意事项等,认为良好的护理可以提高患儿使用静脉留置针的时间,减轻患儿痛苦,减少重复穿刺,是减少护患纠纷,提高工作效率和护理质量的保证。     

静脉留置针留置时间与静脉血管的炎症反应相关性研究

目的研究静脉留置针在不同留置时间与静脉血管的炎症反应相关性。方法将种系相同,体重相近的大耳新西兰健康白兔随机分成两组,取其双耳内外侧的耳缘静脉作为实验血管,进行静脉留置针输液,以相同的速度分别输入等量的0.9%氯化钠注射液,每日1次。输毕后用肝素盐水封管,分别保留至72~96h和120~168h后,以一穿刺点为中心取长2cm,宽1cm的活体标本做病理切片,观察静脉血管的病理变化。结果血管周围组织大部均有不同程度的炎症反应。静脉留置针保留72~96h后,血管内中重度炎症发生率24%;静脉留置针保留120~168h后,血管内中重度炎症发生率60%,明显高于保留72~96h的血管。结论建议静脉留置针保留时间应在96h以内。     

带标识片弹力网应用于静脉留置针固定新方法的护理

目的探讨应用带标识片的弹力网加无菌透明膜固定静脉留置针的新方法。方法将100例需静脉输液患者随机分为观察组、对照组,观察组应用带标识片的弹力网加无菌透明膜固定静脉留置针,对照组采用无菌透明膜固定静脉留置针,观察输液状况,静脉留置针留置固定的效果。结果2组无一例发生感染,观察组导管脱出率明显低于对照组,留置时间较对照组长(P<0.01)。结论带标识片的弹力网加无菌透明膜固定方法是固定静脉留置针较好的方法。     

静脉留置针在头皮静脉穿刺中的应用体会

目的观察静脉留置针在小儿头皮静脉中的应用。方法我科2010年2月至2011年6月应用静脉留置针穿刺小儿头皮静脉效果观察。结果留置针易于固定,留置时间长。结论该穿刺方法方便、实用。     

静脉留置针致静脉炎原因及护理

目的探讨静脉留置针致静脉炎原因及护理方法。方法对我院急诊科2010年1月至2011年5月200例行留置针患者,进行临床观察护理,对发生静脉炎患者进行统计分析。结果 200例患者中发生静脉炎78例,静脉炎发生率为22.5%,静脉留置针置留时间越长,发生静脉炎几率越高,5d以上置留时间静脉炎发生率与5d以下相比,具有统计学意义,P<0.05;静脉炎发生率与药物刺激性、液体输入量以及穿刺部位多种因素有关,差异比较均具有显著性。结论留置时间长短、药液输注、静脉选择与静脉炎发生密切相关,正确操作护理,早期发现有助于减少、减轻静脉炎发生。     

PICC在胃肠癌化疗中的应用研究

目的观察胃肠癌患者经外周穿刺中心静脉置管(PICC)在胃肠癌化疗中的应用研究并分析原因。方法分析2007年1月至2010年1月60例晚期胃肠癌患者实施PICC置管术的临床资料,胃肠癌患者采用PICC配合便携式化疗泵持续给药及常规输液给药2种方法进行分析比较。结果观察组与对照组2组给药方法治疗比较,有效率有显著性差异(P<0.05)。结论 PICC置管在提高近期疗效、提高生活质量,减轻抗癌药毒性反应方面取得满意效果,能有效减轻患者的痛苦,延长置管时间,保证静脉治疗的顺利完成。     

重症脑室出血的救治体会

目的回顾分析重症脑室出血病人的抢救治疗结果,进一步加深认识并总结经验。方法对24例重症脑室出血病人及早诊断,尽快行双侧侧脑室穿刺外引流,尿激酶灌注冲洗,联合间断脑脊液置换,积极防治各种并发症,观察疗效。结果本组24例病人恢复情况满意,获得良好治疗效果。结论对重症脑室出血病人应及早诊断,尽早行脑室外引流术,尿激酶灌注冲洗,联合间断脑脊液置换,药物缓解脑血管痉挛,积极防治各种并发症,可得到较好的治疗效果。     

Magnetic Resonance Imaging Correlates of White Matter Gliosis and Injury in Preterm Fetal Sheep Exposed to Progressive Systemic Inflammation

Progressive fetal infection/inflammation is strongly associated with neural injury after preterm birth. We aimed to test the hypotheses that progressively developing fetal inflammation leads to neuroinflammation and impaired white matter development and that the histopathological changes can be detected using high-field diffusion tensor magnetic resonance imaging (MRI). Chronically instrumented preterm fetal sheep at 0.7 of gestation were randomly assigned to receive intravenous saline (control; n = 6) or a progressive infusion of lipopolysaccharide (LPS, 200 ng intravenous over 24 h then doubled every 24 h for 5 days to induce fetal inflammation, n = 7). Sheep were killed 10 days after starting the infusions, for histology and high-field diffusion tensor MRI. Progressive LPS infusion was associated with increased circulating interleukin (IL)-6 concentrations and moderate increases in carotid artery perfusion and the frequency of electroencephalogram (EEG) activity (p < 0.05 vs. control). In the periventricular white matter, fractional anisotropy (FA) was increased, and orientation dispersion index (ODI) was reduced (p < 0.05 vs. control for both). Histologically, in the same brain region, LPS infusion increased microglial activation and astrocyte numbers and reduced the total number of oligodendrocytes with no change in myelination or numbers of immature/mature oligodendrocytes. Numbers of astrocytes in the periventricular white matter were correlated with increased FA and reduced ODI signal intensities. Astrocyte coherence was associated with increased FA. Moderate astrogliosis, but not loss of total oligodendrocytes, after progressive fetal inflammation can be detected with high-field diffusion tensor MRI.     

PICC在静脉化疗中的应用及护理体会

目的为肿瘤化疗病人建立良好的静脉通道,保证药物准确输入,避免化疗药物产生的局部不良反应及病人的痛苦。方法对226例肿瘤化疗病人采用PICC置管输入化疗药物。结果 PICC置管化疗全过程顺利进行,机械性静脉炎22例,4例出现局部红肿,无渗漏性损伤的发生。结论给化疗特别是时辰化疗病人施行PICC置管,能很好地保护血管,有效防止化学性静脉炎及药物渗漏的发生,减少病人痛苦;提高生活质量,而正确选择血管是穿刺成功的关键,严格无菌操作及脉冲式正压封管是预防感染和导管阻塞的保证。     

静脉滴注丙种球蛋白治疗病毒性脑炎的临床研究

应用静注丙种球蛋白（IVIg）治疗病毒性脑炎（病脑），同时应用血浆治疗作为对照，观察结果表明症状、体征和实验室检测结果，观察组疗效均明显优于对照组。提示IVIg治疗病脑好转快，疗效好，病死率低，后遗症少。     

探讨老年病员药物性静脉炎的预防及护理

目的观察多源频谱仪照射预防老年病员药物性静脉炎的疗效。方法选择78例长期住院、反复外周静脉输液的老年病员,输注药物为血管刺激性较强的药物(前列地尔、奎诺酮类抗生素),随机平均分为A、B2组,A组采用传统的局部硫酸镁湿敷;B组采用MF-多源频谱治疗仪局部照射。结果B组病员药物性静脉炎发生率低,局部皮肤反应轻微,疗效明显优于A组(P<0.05),差异有显著性。结论反复外周静脉输入血管刺激性较强的药物,采用MF-多源频谱治疗仪局部照射可以预防老年病员药物性静脉炎,保护外周静脉血管,减轻病员痛苦,增强病员的治疗依从性,提高生活质量。     

Reduced Placental CD24 in Preterm Preeclampsia Is an Indicator for a Failure of Immune Tolerance

Introduction: CD24 is a mucin-like glycoprotein expressed at the surface of hematopoietic and tumor cells and was recently shown to be expressed in the first trimester placenta. As it was postulated as an immune suppressor, CD24 may contribute to maternal immune tolerance to the growing fetus. Preeclampsia (PE), a major pregnancy complication, is linked to reduced immune tolerance. Here, we explored the expression of CD24 in PE placenta in preterm and term cases. Methods: Placentas were derived from first and early second trimester social terminations (N = 43), and third trimester normal term delivery (N = 67), preterm PE (N = 18), and preterm delivery (PTD) (N = 6). CD24 expression was determined by quantitative polymerase chain reaction (qPCR) and Western blotting. A smaller cohort included 3–5 subjects each of term and early PE, and term and preterm delivery controls analyzed by immunohistochemistry. Results: A higher expression (2.27-fold) of CD24 mRNA was determined in the normal term delivery compared to first and early second trimester cases. The mRNA of preterm PE cases was only higher by 1.31-fold compared to first and early second trimester, while in the age-matched PTD group had a fold increase of 5.72, four times higher compared to preterm PE. The delta cycle threshold (ΔCt) of CD24 mRNA expression in the preterm PE group was inversely correlated with gestational age (r = 0.737) and fetal size (r = 0.623), while correlation of any other group with these parameters was negligible. Western blot analysis revealed that the presence of CD24 protein in placental lysate of preterm PE was significantly reduced compared to term delivery controls (p = 0.026). In immunohistochemistry, there was a reduction of CD24 staining in villous trophoblast in preterm PE cases compared to gestational age-matched PTD cases (p = 0.042). Staining of PE cases at term was approximately twice higher compared to preterm PE cases (p = 0.025) but not different from normal term delivery controls. Conclusion: While higher CD24 mRNA expression levels were determined for normal term delivery compared to earlier pregnancy stages, this expression level was found to be lower in preterm PE cases, and could be said to be linked to reduced immune tolerance in preeclampsia.     

输液容器用PP组合盖内盖材料制备及性能研究

采用聚乙烯、弹性体及其他助剂增韧改性聚丙烯（PP）,熔融共混挤出造粒制备输液容器用PP组合盖内盖材料。通过正交试验优化了各组分之间的配比,考察了聚乙烯、弹性体对PP组合盖内盖材料机械性能及内盖穿刺力的影响,并测试了内盖材料的溶出物性能。结果表明弹性体用量对内盖材料的机械性能影响最显著,当弹性体用量从15份增加到30份,材料的冲击强度先增大后减小,最高达40 kJ/m2,拉伸强度减小,内盖穿刺力减小,最小达45 N。溶出物测试显示内盖材料溶出物紫外吸收最高为0.011,易氧化物含量为0.4 mL,均低于国标限定值。     

Human Anti-Oxidation Protein A1M—A Potential Kidney Protection Agent in Peptide Receptor Radionuclide Therapy

Peptide receptor radionuclide therapy (PRRT) has been in clinical use for 15 years to treat metastatic neuroendocrine tumors. PRRT is limited by reabsorption and retention of the administered radiolabeled somatostatin analogues in the proximal tubule. Consequently, it is essential to develop and employ methods to protect the kidneys during PRRT. Today, infusion of positively charged amino acids is the standard method of kidney protection. Other methods, such as administration of amifostine, are still under evaluation and show promising results. α₁-microglobulin (A1M) is a reductase and radical scavenging protein ubiquitously present in plasma and extravascular tissue. Human A1M has antioxidation properties and has been shown to prevent radiation-induced in vitro cell damage and protect non-irradiated surrounding cells. It has recently been shown in mice that exogenously infused A1M and the somatostatin analogue octreotide are co-localized in proximal tubules of the kidney after intravenous infusion. In this review we describe the current situation of kidney protection during PRRT, discuss the necessity and implications of more precise dosimetry and present A1M as a new, potential candidate for renal protection during PRRT and related targeted radionuclide therapies.     

静脉滴注丙种球蛋白治疗小儿原发性血小板减少性紫癜的远期疗效

作者对3种不同疗法治疗小儿ITP效果进行了远期随防,结果IVIg疗效最佳,血小板数升高快,血小板抗体消失决,血清IgG水平稳定,复发率低。而其它2组不如前者。提示IVIg是目前治疗小儿ITP疗效最佳的新方法。