股静脉插管导管相关并发症的处理

股静脉插管广泛应用于临床,其操作简便,方便快捷。在如血液灌流、免疫吸附或血浆置换等需行血液净化治疗方面发挥重要作用[1]。但长期置管并发症亦较多,本文对38例股静脉插管相关并发症的处理方法及护理要点总结如下。1临床资料我院2005年6月-2008年6月所留置临时双腔透析导管患者38例,男21例,女17例,年龄30~70岁。其中慢性肾炎22例,高血压肾病5例,糖尿病肾病9例,其它2例。导管留置方法:患者仰卧位,腹股沟部常规消毒、铺巾,于腹股沟韧带下方2 cm、股动脉内侧0.5cm处局麻后作2 mm切口,以45°进针2~4 cm,套管针见回血后放入引导丝,扩张器沿导丝插入股静脉穿刺孔,顺导丝置导管入血管约10 cm,抽出导丝,连接透析管路开始透析,胶布固定,外贴护皮膜。2导管相关并发症及处理2.1感染感染是最常见的并发症,一般可分为导管出口部感染、隧道感染和血液扩散性感染。导管出口局部感染时,导管口周围皮肤呈红、肿、热,并有脓性分泌物溢出,应予局部定时消毒,更换敷料后妥善固定,或口服抗生素,一般炎症即可消退。隧道感染时,皮下隧道肿胀,出口处可见脓性分泌物,必须使用有效抗生素2周,严重者拔管。临床上常见的是患者血透...     

下肢深静脉血栓的超声诊断在介入综合治疗中的价值

目的：探讨下肢深静脉血栓的彩色多普勒超声诊断在对患者进行介入综合治疗中的价值．方法：82例下肢深静脉血栓均于术前进行彩色多普勒超声检查,依据血栓回声判断其危险性,并接受血管造影行永久性或临时性下腔静脉滤器植入,术后复查,观察滤器位置、形状、内部有无血栓及血流通畅情况,并评估取出临时滤器的安全性．结果：82例下肢深静脉血栓患者,超声显示血栓以低及中低回声为主．为急性及亚急性血栓,脱落可造成肺栓塞等严重后果。而下腔静脉滤器植入术的成功开展已成为预防肺栓塞发生的有效途径．82例下肢深静脉血栓患者均进行了永久性及临时性下腔静脉滤器植入．两周后根据血栓回声的改变及滤器内有无血栓情况,共取出20枚滤器．结论：彩超对下肢深静脉血栓患者介入治疗的术前评价及术后随访有重要价值．是下腔静脉滤器植入的首选检查方法．     

股静脉置管术穿刺方法改进的临床研究

目的：探讨股静脉置管术穿刺方法,为经外周静脉管入中心静脉导管术合理应用提供论据。方法：将68例股静脉置管患者按置管日期单、双日分成两组,单日为观察组36例,采用改进穿刺方法的股静脉穿刺置管术;双日为对照组32例,采用常规的股静脉穿刺置管术,观察穿刺成功率,导管平均留置时间,液体滴入受体位影响,病人舒适度等。结果：两组穿刺成功率,导管平均留置时间,液体滴入受体位影响例数,病人舒适度例数比较,经统计学检验,P〈0.05,差异有统计学意义。结论：改进后的股静脉置管针穿刺术具有穿刺成功率高,导管留置时间长,液体流速均匀快速,受体位影响小,病人舒适等优点。     

肾癌并发下腔静脉瘤栓的诊治-附2例分析

目的:探讨肾癌伴下腔静脉癌栓的诊断及治疗。方法:回顾性分析2006年1月至2008年5月肾癌伴下腔静脉癌栓患者的临床资料,包括临床表现、术前诊断、手术方法和患者的预后。其中男1例,女1例,临床主要表现为腰痛、血尿及腹部肿物,术前经彩色多普勒超声、CT确诊有癌栓。结果:2例手术者中,术前多普勒超声及CT均可发现腔静脉癌栓。手术均行肾癌根治加腔静脉内癌栓切除,术后随访1例于术后一年肿瘤复发转移死亡,1例现无瘤存活。结论:彩色多普勒超声、CT对肾癌伴下腔静脉癌栓诊断率较高,可准确判断癌栓位置,对无淋巴结和远处转移者,积极行肾癌根治术加下腔静脉癌栓取出术是治疗肾癌合并静脉瘤栓的有效方法。     

布加综合征置入下腔静脉支架术患者的护理

布加综合征是指肝静脉或下腔静脉肝段部分阻塞而产生的一种肝后性门静脉高压症。支架置入方法是腹股沟区常规消毒,股静脉穿刺成功后,在C臂机透视下送扩张球囊至肝静脉狭窄处扩张到满意后置入弹簧式静脉支架,即可见下腔静脉血流通畅[1]。我科采用下腔静脉支架置入术治疗本病5例,其疗效较为满意。现将围术期的护理体会报告如下。     

未触及包块的乳癌12例诊治体会

目的：探讨未触及包块的早期乳癌的诊断、治疗方法。方法：对12例未触及到包块的乳癌患者进行回顾性分析。结果：在乳腺囊性增生病、乳腺导管内乳头状瘤早期癌变或导管内癌、乳腺派杰氏病和早期浸润性导管癌等均可在未触及包块期发现。结论：乳腺局限性增厚、患肢不明原因水肿、乳头溢液、糜烂均需进一步进行相应的检查和精确的定位活检。提示乳癌疗效有赖于早期发现、早期治疗以降低死亡率。     

一例高压注射碘海醇导致严重药液外渗的护理

目的：根据静脉高压注射碘海醇导致药液严重外渗后局部皮肤特征,总结应急处置方法,防止肢端坏死,遏制医疗纠纷.方法：给予75%硫酸镁注射液局部湿敷外缠保鲜膜,并给予抬高患肢及局部冰袋冷敷,肤温明显降低后外涂地塞米松软膏,同时做好病人心理护理,严密观察病情.结果：患者心理状态良好,未发生溃疡、水疱、组织坏死,炎性反应逐渐减轻,三天后恢复正常.结论：针对大剂量碘海醇注射液外渗,应用75%酒精与硫酸镁粉剂调和后湿敷,并抬高患肢及冷敷能迅速促使组织水肿消退,联合地塞米松软膏局部涂抹,治疗有效.     

下腔静脉滤器的临床应用

目的：应用下腔静脉滤器（VCF）置入术预防深静脉血栓形成（DVT）患者发生肺栓塞（PE）。方法：对396例DVT患者行VCF置入术，术后随访3～71个月，观察其疗效及并发症的发生率。结果：本组396例VCF均成功释放，术后1例患者出现肺栓塞。穿刺部位血栓形成8例，下腔静脉血栓形成13例。未出现滤器偏斜、移位等并发症。结论：VCF可以有效的预防致命性PE的发生。     

综合治疗肩关节周围炎个案分析

通过肩周炎判断标准、关节角度测量方法、疼痛程度测量方法、患肢的位置感觉程度等测试方法对1例肩周炎患者进行诊断并确定治疗方案．经过2次,周、共4周的治疗,患者左、右两侧患肢活动角度无差异,肩关节功能评分方法治疗前为中度受限,治疗后恢复到正常,肩部各肌肉的疼痛完全消失,左侧患肢的位置感觉恢复正常．治疗结果达到预期,治疗方法可以为肩周炎的治疗提供借鉴．     

Fogarty导管在血透患者前臂动静脉内瘘失功再次手术中的应用

为了探讨Fogarty球囊导管在前臂动静脉内瘘失功再次手术的应用效果,本研究将40例急性自体动静脉内瘘失功患者分为2组:观察组和对照组,每组20例。观察组行Fogarty球囊导管取栓术。对照组行原位动静脉内瘘重建术。观察2组患者术后透析时血流量、内瘘3、6、12个月通畅率及再次血栓、肿胀手综合征发生率的情况。结果观察组3个月内瘘透析时血流量、内瘘通畅率与对照组比较差异均无统计学意义(均P>0.05),观察组再次血栓、肿胀手综合征发生率均与对照组比较差异均无统计学意义(均P>0.05)。组间总有效率比较,观察组较对照组有显著性差异(P<0.05)。观察组6个月与12个月时间点和对照组相比具有显著性差异(P<0.05)。应用Fogarty球囊导管处理失功动静脉内瘘效果满意,长期通畅率较常规手术组有明显优势。     

介入治疗联合放射治疗对原发性肝癌的治疗效果研究

回顾分析60例因晚期肝癌不能行手术切除的肝癌患者的临床资料,对介入手术联合放射治疗前后原发生肝癌的癌栓大小的变化进行比较,发现21例癌栓完全消失,13例癌栓缩小,24例无变化,2例进展,癌栓消失和缩小占55.67%,所以介入治疗联合放射治疗对原发性肝癌的治疗的有效的、可行的、安全的.     

High density porous polyethylene material （Medpor） as an unwrapped orbital implant

Objective： To introduce the clinical effect among patients who received an unwrapped orbital implant with high density porous polyethylene material （Medpor） after enucleation or evisceration. Methods： Retrospective analysis of a series of 302 patients with anophthalmia who underwent placement of an unwrapped high density porous polyethylene orbital implant. We compared the patients （n=180） who accepted primary implant placement with those （n=122） who accepted secondary implant placement. Parameters evaluated included： age at time of surgery, date of surgery, sex, implant type and size, surgery type, the surgical procedure and technique performed, and complications. Results： The time of follow-up ranged from 2.0 to 58.0 months （mean 32.5 months）. A total of 5 of 302 （1.66%） cases had documented postoperative complications. The following problems were noted after surgery： implant exposure, 3 patients （0.99%）; implant removed due to orbital infection, 1 patient （0.34%）; ptosis, 1 patient （0.34%）. There were no significant complications＇observed in other 297 cases and all implants showed good orbital motility. The clinical effect of primary implant placement is better than that of secondary placement. Conclusion： High density porous polyethylene material can be used successfully as an unwrapped orbital implant in anopthalmic socket surgery with minimal complications. The material is well tolerated, nonantigenic and has low rate of infection and migration.     

A new plastic surgical technique for adult congenital webbed penis

Objective: To introduce a novel surgical technique for correction of adult congenital webbed penis. Methods: From March 2010 to December 2011, 12 patients (age range: 14–23 years old) were diagnosed as having a webbed penis and underwent a new surgical procedure designed by us. Results: All cases were treated successfully without severe complication. The operation time ranged from 20 min to 1 h. The average bleeding volume was less than 50 ml. All patients achieved satisfactory cosmetic results after surgery. The penile curvature disappeared in all cases and all patients remained well after 1 to 3 months of follow-up. Conclusions: Adult webbed penis with complaints of discomfort or psychological pressure due to a poor profile should be indicators for surgery. Good corrective surgery should expose the glans and coronal sulcus, match the penile skin length to the penile shaft length dorsally and ventrally, and provide a normal penoscrotal junction. Our new technique is a safe and effective method for the correction of adult webbed penis, which produces satisfactory results.     

脑挫裂伤脑水肿高峰后脑疝的诊治

目的：探讨脑挫裂伤脑水肿高峰后脑疝的早期诊断和治疗。方法：回顾分析9例脑挫裂伤脑水肿高峰后脑疝患者临床资料、手术与治疗效果及疗效相关因素。结果：9例患者死亡3例，重残2例，中残1例，生存良好3例。结论：脑疝发生的主要原因是颅腔内各部位的压力不平衡。脑挫裂伤脑水肿高峰后脑疝有其独特的临床特点，脑疝发生后治疗效果差。     

57例显微镜下泪小管断裂吻合手术临床分析

目的：探讨在显微镜下泪小管断裂断端的寻找方法及泪小管断裂吻合联合泪道引流管置管术的疗效,提高泪小管吻合术的成功率。方法：选择2006年1月至2013年5月收治泪小管断裂57例患者,采用在显微镜直视下寻找的方法,找到泪小管鼻侧断端和泪囊侧断端,置入硬膜外管作为泪小管内支撑物,吻合泪小管断端,留置引流管3-6个月,拔管后3-12个月随访观察疗效。结果：治愈53例,拔管后泪道冲洗均通畅,无溢泪现象,4例主观感觉有少许溢泪症状,但冲洗泪道试验通畅,行泪道扩张冲洗2-3次后症状消失,无眼睑内外翻或泪小管撕裂等症状。结论：在显微镜下行泪小管断端吻合术,较容易寻找到泪小管鼻侧断端,手术成功率高,恢复泪道排泪功能效果肯定。     

持续性非卧床腹膜透析治疗慢性肾衰

采用持续性非卧床腹膜透析CAPD治疗24例慢性肾衰病人,疗效肯定。24例高血钾、水肿、心衰症状均消失;19例高血压降至正常,5例下降;16例代谢性酸中毒纠正,8例好转;血肌酐(μmol/L):9例由2400±124降至1000±96,4例由1700±90降至900±74,8例由1200±65降至500±48,3例由800±36降至150±30。结合我国目前情况,CAPD治疗慢性肾衰具有广泛采用价值。     

Catch-up growth assessment in long-term physically neglected and emotionally abused preschool age male children

OBJECTIVE: To assess the catch-up growth of long-term physically neglected and emotionally abused preschool male children who have entered foster residential care and remained 1 year after initial placement. METHOD: Longitudinal study over a 7-year period (1994-2001). So that a child was eligible for the study, three selection criteria were included: (1) aged between 24 and 48 months at the time of entry into residential facility, (2) having suffered both long-term (more than 6 months) physically neglected and emotionally abused, and (3) having stayed in foster care for 1 year after initial placement. Weight, height, and head circumference were established upon entry and re-assessed 1 year after initial placement, calculating the annual growth velocity. Results were compared with normal regional longitudinal standards of reference (Z score). Student's t test was used to assess statistically significant differences. RESULTS: During the study period, 87 children aged between 24 and 48 months (54 male/33 female) were admitted to residential facility after having suffered both long-term physical neglect and emotional abuse. Nevertheless, only 20 children (23% of the total admissions) met the third selection criteria (having remained 1 year after initial placement). Of these children, all were males and at placement they were between the ages of 30 and 42 months, with an average age of 36 months (1.9 SD). At placement, the analyzed parameters were below the normal standards, showing a statistically significant difference for height (Z score = -1.29; p = .008) and weight (Z score = -.75; p = .038). The annual growth velocity for all parameters was above the normal standards showing a statistically significant difference for height (Z score = +1.43; p = .009). One year after initial placement, the significant differences for height (Z score = -.68; p = .102) and weight (Z score = -.31; p = .435) with respect to the normal standards disappeared, though still remained below, showing a significant catch-up growth for height (improvement height Z = +.61 SD). CONCLUSIONS: At placement, the both long-term physically neglected and emotionally abused preschool age male children showed a mild form of chronic malnutrition with growth failure. Growth failure was reversible after the first year of stay, which demonstrates that this delay in growth was secondary to nutritional and psychosocial factors. Placement in foster residential care was beneficial for the catch-up growth of these patients.     

生长抑素在急性肠梗阻中使用时限的临床研究

目的：探讨有效肠减压的有效性和生长抑素在有效肠减压中的使用时限;方法：选取2009年4月至2010年12月收治的肠梗阻病例46例,在常规治疗的基础上,使用生长抑素和营养支持的有效的肠减压方法,比较患者治疗前后腹痛腹胀症状改善情况,手术中转率,术中所见肠管水肿情况及治疗前、使用生长抑素后的血象、生化指标、X—ray变化情况。结果：使用生长抑素加肠外营养支持的有效肠减压明显改善临床症状,总的有效率高,可明显降低手术探查率,使用有效肠减压的平均有效时间约为5．3天。     

门脉高压症门奇静脉断流术失败原因及防治措施

目的:探讨门脉高压症门奇静脉断流失败的原因及防治措施.方法:回顾分析1995.1～2003.2月65例肝硬化门脉高压症患者,行门奇静脉断流术后,5例发生消化道再出血.结果:65例患者再出血发生率7.7%(5/65).1例胃底静脉曲张破裂出血;2例胃黏膜广泛充血、糜烂、渗血;2例出血与胃及食道无关.结论:术中规范操作,术后综合治疗可有效防止术后再出血.