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130 例肺癌患者機采血小板輸注療效的分析

目的 分析肺癌患者機采血小板的輸注情況，探討其療效的影響因素及預防措施。 方法 收集 2010 年 1 月—2016 年 6 月 130 例肺癌患者輸注機采血小板 205 例次的臨床資料，根據血小板糾正增加指數來評價輸注的臨床療效。從疾病類型、性別、年齡、體質量、血小板輸注次數以及紅細胞懸液輸注情況對患者血小板輸注療效進行分析。 結果 130 例肺癌患者 205 例次血小板輸注中，158 例次有效，其有效率為 77.1%；小細胞肺癌和非小細胞肺癌有效率分別為 81.5% 和 75.5%，差異無統計學意義（P=0.369）；而非小細胞肺癌中的鱗狀細胞癌和腺癌有效率分別為 82.3% 和 70.8%，差異無統計學意義（P=0.107）；不同性別、年齡和體質量有效率差異無統計學意義（P>0.05）；按血小板輸注次數為第 1 次、第 2～4 次和第 4 次以上分組比較，有效率差異有統計學意義（P=0.022）。 結論 肺癌患者血小板輸注次數可能是影響血小板輸注療效的因素，隨著血小板輸注次數的增加，發生血小板輸注無效的可能性越大。

橈動脈采血后致右手背伸及曲腕功能障礙一例

庫欣綜合征伴足潰瘍兩例

口服藥發藥盤應用于靜脈采血中的護理體會

目的觀察將廢棄口服藥發藥盤應用于病房靜脈采血管放置的效果。 方法2013年7月1日-28日采用前后對照的方法，比較靜脈采血管放置盤改進前后對夜班護士當天整理、發放靜脈采血管的時間和護士對采血流程滿意度的影響。 結果改進后護士每天整理、發放采血管花費的平均時間由（112.38±7.73）s下降到（73.51±8.34）s，護士對采血流程的滿意度由（1.40±0.81）分提高到（4.80±0.61）分，差異有統計學意義（P＜0.05）。 結論改良后的靜脈采血管放置盤可以提高采血管整理和發放的效率，提高護士滿意度。

Clinical study on blood sampling test of arteriovenous reversal in continuous renal replacement therapy

ObjectiveTo explore the feasibility of pipeline blood sampling test of continuous renal replacement therapy (CRRT) when arteriovenous reversal connection occurs, and to explore the influence of pipeline blood sampling test on the results of CRRT when arteriovenous reversal connection occurs under different anticoagulation methods.MethodsSelected patients with arteriovenous reversals treated by CRRT in a third-class A hospital was selected from June 2018 to May 2019. Blood samples were collected from the front end of the CRRT pipeline (0-, 3-, and 5-min after the cease). Blood samples collected from the catheterization site were compared with those from the body vein for acid and alkali, respectively. The electrolyte and other results were analyzed and compared.ResultsA total of 80 patients were enrolled, including 40 with low molecular weight heparin and non-heparin, and 40 with citric acid. Under the anticoagulation condition of low molecular weight heparin and non-heparin, there was no difference in acid-base or electrolyte between body venous blood samples and pipeline blood samples (P>0.05). Under the anticoagulation condition of citric acid, 0-, 3-, and 5-min after the cease, the difference in free calcium between body venous blood samples and pipeline blood samples was significant (F=7.866, 6.691, 5.590, P<0.001). There was no difference in other acid-base or electrolyte results (P>0.05).ConclusionsLow molecular weight heparin and heparin-free anticoagulation can be tested by collecting blood samples from the front end of the pipeline without suspension of treatment in the case of arteriovenous reversal in CRRT. There was a difference between free calcium and body venous blood in anticoagulation with citric acid. It is not recommended to collect blood from pipes for examination Under the anticoagulationcondition of citric acid.

心理干預在體檢人員采血暈針中的應用

目的　在體檢采血中對體檢人員實施心理干預，有效解除體檢人員的心理障礙，達到預防暈針的目的。 方法　選擇2011年1月－6月行健康體檢的33 372人（對照組），2011年7月－12月行健康體檢的46 796人（干預組）進行比較分析。對照組采用常規體檢服務程序方式，干預組采用靈活的個性化心理干預方法，觀察兩組體檢人員采血時暈針發生率。 結果　對照組和干預組在接受采血時暈針發生率比較，干預組暈針發生率低于對照組，差異具有統計學意義（P＜0.05）。 結論　使用靈活的個性化心理干預方法對采血體檢人員進行語言疏導，在注意力分散及松弛療法的情況下完成采血過程，可降低體檢人員暈針發生率， 值得臨床推廣。

以頑固性低鉀血癥為首發癥狀的 MRI陰性庫欣病一例

真空負壓靜脈采血的研究進展

【摘要】　真空負壓靜脈采血法，使血標本在采集、運輸、保存環節處于全封閉狀態，能最大限度保持血液標本的原始狀態，保護醫護人員免受職業傷害，可提高一次性采血成功率，是靜脈血標本采集的一大改革。由于其具有使實驗數據準確可靠、無污染、工作省時省力等優點，已被廣泛使用。近年來，研究人員就真空負壓采血的臨床應用進行了大量的實踐，對采血針的選擇、壓脈帶的使用、穿刺技術及方法改進、采血質量控制、護理措施等進行了一系列研究。醫務人員加強采血知識的學習可減少采血并發癥，保證標本質量，減少醫療資源的浪費和減輕患者痛苦。

根本原因分析在降低門診采血護患糾紛中的應用

目的用根本原因分析法（RCA）分析門診采血工作中不斷增多的護患糾紛的原因，并采取相應的對策，減少護患糾紛的發生。 方法整理分析2014年某院門診采血室護患糾紛案例發生情況，采用RCA法分析發生原因，得出其原因主要為護患溝通不良、護理人員主動服務意識不強、護理人員操作欠規范、護理人力資源不足、環境因素等，針對各原因于2015年采取綜合整改措施。比較分析實施相應防范措施前后的護患糾紛發生情況。 結果2014年護士總數18人，抽血患者總數約為87萬例次，發生護患糾紛72例次，護均糾紛發生率為4.0例次/護，患均糾紛發生率約為8.28/10萬；2015年護士總數32人，抽血患者總數約為88萬例次，發生護患糾紛20例次，護均糾紛發生率為0.6例/護，患均糾紛發生率約為2.27/10萬。 結論RCA法能夠找出引起護患糾紛的根本原因，優化護理環節，有效降低門診采血室護患糾紛發生率，提高患者滿意度。

Accidental Rupture of Balloon Tube during Endotracheal Intubation in Mechanical Ventilation: Clinical Application of No. 8 Blood Collection Needles for Connection

ObjectiveTo investigate the clinical effect of No. 8 blood collection needles in connecting broken balloon tubes. MethodsThirty-six patients who underwent mechanical ventilation in the Intensive Care Unit between January 2010 and December 2013 were included as the study subjects. We divided them into two groups. Patients who had accidental rupture of balloon tube during intubation were regarded as the trial group, while those with normal ventilation were regarded as the control group, with each group having 18 patients. The trial group used No. 8 disposable blood collection needles to connect the balloon tubes. Pressure gauge produced in Germany was used to measure the balloon pressure continuously for four hours. Balloon pressure level, balloon leakage and tube dislocation within 24 hours were observed. ResultsThe balloon pressure at different time periods was not significantly different between the two groups (P > 0.05). The leakage rate and complication rate were also not significantly different between the two groups (P > 0.05). ConclusionsUsing No. 8 blood collection needles for connecting broken balloon tubes is effective, easy, and convenient, and the balloon can be maintained at a constant pressure. It solved many previous clinical problems such as high cost, high complication rate, high death rate and medical disputes.