第一篇:布料成份對(duì)照表
布料成份對(duì)照表
厚棉氨綸:人棉92% 氨綸8%(60-270克)薄棉氨綸:人棉92% 氨綸8%(190-200克)絲光棉:
人棉92% 氨綸8%(90-200克)摩力卡: 精棉:
棉絨:
尼綸:
氨綸:
汗布:
瑜伽:
TC:
珍珠麻:
人棉92% 氨綸8%(260-270克)棉100%
(130-150克)棉100%
(260-280克)錦綸絲100%
(120-130克)錦綸絲88% 氨綸120%(220-230克)棉100%
(120-140克)天絲92% 氨綸8%(220-230克)棉65% 滌35%
(210-220克)人棉92% 氨綸8%(230-240克)
6306腰鏈 6305腰鏈
氨綸背心半體群 湖藍(lán)135# 氨綸背心半體群 湖藍(lán)140# 氨綸背心半體群 湖藍(lán)150#2件 兒童舞襪10雙
135#同140#有幾多羅幾多
第二篇:句子成份
一、句子成分
1、用符號(hào)劃出下列短文各句中的主語(yǔ)(—)、謂語(yǔ)(=)、賓語(yǔ)(~):
I hope you are very well.I'm fine, but tired.Right now it is the summer vacation and I'm helping my Dad on the farm.August is the hottest month here.It is the time of year for the rice harvest, so every day I work from dawn until dark.Sometimes we go on working after dark by the lights of our tractors.We grow rice in the south of the States, but in the north where it is colder they grow wheat.We have a lot of machines on the farm.Although the farm is large, my Dad has only two men working for him.But he employs more men for the harvest.My brother takes care of the vegetable garden.It doesn't often rain in the summer here.As a result, we have to water the vegetable garden.Every evening we pump water from a well.It then runs along channels to different parts of the garden.2、用符號(hào)劃出下列短文各句中的定語(yǔ)()、狀語(yǔ) [ ]、補(bǔ)語(yǔ) ~:
Most Saturday evenings there is a party, even at harvest time.These parties often make us very happy.We cook meat on an open fire outside.It's great!Americans eat a lot of meat — too much in my opinion.Some of my friends drink beer.I don't, because I have to drive home after the party.In your letter you asked about the time in different areas of the States.There are five different time areas in the States.In my state we are fourteen hours behind Beijing time.How many different time areas do you have in China? Well, I must stop and get some sleep.Please give my best regards to your parents.二、簡(jiǎn)單句、并列句和復(fù)合句
(一)句子種類兩種分類法
1、按句子的用途可分四種:
1)陳述句(肯定、否定):He is six years old;She didn’t hear of you before.2)疑問(wèn)句(一般、特殊、選擇、反意):Do they like skating? How old is he? Is he six or seven years old? Mary can swim, can’t she?
3)祈使句:Be careful, boys;Don’t talk in class
4)感嘆句:How clever the boy is!
2、按句子的結(jié)構(gòu)可分三種:
1)簡(jiǎn)單句:只有一個(gè)主語(yǔ)(或并列主語(yǔ))和一個(gè)謂語(yǔ)(或并列謂語(yǔ))。
e.g.He often reads English in the morning.Tom and Mike are American boys.She likes drawing and often draws pictures for the wall newspapers.2)并列句:由并列連詞(and, but, or等)或分號(hào)(;)把兩個(gè)或兩個(gè)以上的簡(jiǎn)單句連在一起構(gòu)成。
e.g.You help him and he helps you.The future is bright;the road is tortuous.前途是光明的,道路是曲折的。
3)復(fù)合句:含有一個(gè)或一個(gè)以上從句的句子。復(fù)合句包含:名詞性從句(主語(yǔ)從句、賓語(yǔ)從句、表語(yǔ)從句和同位語(yǔ)從句)、定語(yǔ)從句和狀語(yǔ)從句等。
e.g.The foreign visitors took a lot of pictures when they were at the Great Wall.(二)簡(jiǎn)單句的五種基本句型
1、主語(yǔ)+系動(dòng)詞+表語(yǔ):e.g.He is a student.2、主語(yǔ)+不及物動(dòng)詞:e.g.We work.3、主語(yǔ)+及物動(dòng)詞+賓語(yǔ):e.g.Henry bought a dictionary.4、主語(yǔ)+及物動(dòng)詞+雙賓語(yǔ)(間接賓語(yǔ)+直接賓語(yǔ)):e.g.My father bought me a car.5、主語(yǔ)+及物動(dòng)詞+復(fù)合賓語(yǔ)(賓語(yǔ)+賓補(bǔ)):e.g.Tom made the baby laugh.注:其他各種句子都可由這一種基本句型擴(kuò)展、變化或省略而構(gòu)成。
(三)并列句的分類
1、表示連接兩個(gè)同等概念,常用and, not only…but also…, neither…nor…, then等連接。e.g.The teacher’s name is Smith, and the student’s name is John.2、表示選擇,常用的連詞有or, either…or…, otherwise等。e.g.Hurry up, or you’ll miss the train.3、表示轉(zhuǎn)折,常用的連詞有but, still, however, yet, while, when等。e.g.He was a little man with thick glasses, but he had a strange way of making his classes lively and interesting.4、表示因果關(guān)系,常用的連詞有so, for, therefore等。e.g.August is the time of the year for rive harvest, so every day I work from dawn until dark.練習(xí)
二、簡(jiǎn)單句、并列句和復(fù)合句
一、判斷下列句子是簡(jiǎn)單句、并列句還是復(fù)合句:
1.We often study Chinese history on Friday afternoon.2.The boy who offered me his seat is called Tom.3.There is a chair in this room, isn’t there?
4.My brother and I go to school at half past seven in the morning and come backhome at seven in the evening.5.He is in Class One and I am in Class Two.6.He was fond of drawing when he was yet a child.7.Neither has he changed his mind, nor will he do so.8.What he said at the meeting is very important, isn’t it?
9.The farmer is showing the boy how to plant a tree.10.Both Tom and Jack enjoy country music.二、判斷下列短文中各句是簡(jiǎn)單句、并列句還是復(fù)合句:
I hope you are very well().I'm fine, but tired().Right now it is the summer vacation and I'm helping my Dad on the farm().August is the hottest month here().It is the time of year for the rice harvest, so every day I work from dawnuntil dark.()Sometimes we go on working after dark by the lights of our tractors().We grow rice in the south of the States, but in the north where it is colderthey grow wheat().We have a lot of machines on the farm().Although thefarm is large, my Dad has only two men working for him().But he employsmore men for the harvest().My brother takes care of the vegetable garden().It doesn't often rain in the summer here().As a result, we have to water thevegetable garden().Every evening we pump water from a well().It then runs along channels to different parts of the garden().Most Saturday evenings there is a party, even at harvest time().These parties often make us very happy().We cook meat on an open fire outside().It's great()!Americans eat a lot of meat — too much in my opinion().Some of my friends drink beer().I don't, because I have to drive home after the party().In yourletter you asked about the time in different areas of the States().There are five
different time areas in the States().In my state we are fourteen hours behindBeijing time().How many different time areas do you have in China()? Well, I must stop and get some sleep().Please give my best regards to your parents().三、選擇填空:
1.Give me one more minute ____ I’ll be able to finish it.A.andB.orC.ifD.so
2.It’s the third time that John has been late, ____?
A.hasn’t heB.isn’t heC.isn’t itD.hasn’t it
3.____ joyful he was to meet his brother again!
A.HowB.WhatC.What aD.What an
4.Let us pass, ____?
A.shan’t weB.shall weC.won’t weD.will you
5.I suppose he’s serious, ____ ?
A.do IB.don’t IC.is heD.isn’t he
6.You had better not smoke here, ____?
A.will youB.had youC.shall youD.have you
7.Train as hard as you can ____ you’ll win the swimming competition.A.thenB.butC.andD.or
8.I’m sorry to have to say this, ____ you forgot to turn off the lights when you left the room last night.A.andB.butC.soD.because
9.John has not yet passed the driving test, and ____.A.Henry hasn’t tooB.Henry also has not eitherC.neither Henry hasD.neither has Henry
10.There are many sports lovers in his office.Some love climbing, ____ others enjoy swimming.A.orB.forC.whileD.so
11.----Do you feel like going out ____ would you rather have dinner at home?
----I’d like to go out.A.orB.andC.butD.so
12.----“____ is the temperature today?”----“It’s 38 degrees.”
A.WhichB.HowC.How hotD.How high
13.----Your uncle isn’t an engineer, is he?----____.A.Yes, he isn’tB.No, he isn’tC.No, he isD.He is
14.____ friendly ____ to everyone!
A.How, is sheB.What, is sheC.How, she isD.What, she is
15.Mary went to bed early, ____ she felt very tired.A.orB.soC.forD.yet
16.Mother ____ a dress when she cut her finger.A.was makingB.makesC.is makingD.made
17.He lay in bed ____ read something borrowed from library.A.butB.andC.orD.yet
18.----I’d really like some lunch but I have so much work to do.----____ what you want and I can get it for you.A.Tell meB.If you would say to me C.You will tell meD.If you tell me
19.As he is strong, ____ can lift one hundred pounds.A.yet heB.but heC.andD.he
20.----I thought you had an umbrella.----I had, ____ I’ve lost it.A.sinceB.butC.becauseD.so
21.____ down the radio----the baby’s asleep in the next room.A.TurningB.To turnC.TurnedD.Turn
22.----I don’t like chicken ____ fish.----I don’t like chicken ____ I like fish very much.A.and, andB.and, butC.or, andD.or, but
23.----Would you like to come to dinner tonight?----I’d like to, ____ I’m too busy.A.andB.soC.asD.but
24.Would you like a cup of coffee ____ shall we get down to business right away?
A.andB.thenC.orD.otherwise
25.She set out soon after dark ____ home an hour later.A.arrivingB.to arriveC.having arrivedD.and arrived
26.“Can’t you read?” Mary said ____ to the notice.A.angrily pointingB.and point angrilyC.angrily pointedD.and angrily pointed
27.She thought I was talking about her daughter, ____, in fact, I was talking about my daughter.A.whomB.whereC.whichD.while
28.____ it with me and I’ll see what I can do.A.When leftB.LeavingC.If you leaveD.Leave
29.----Alice, you feed the bird today, ____?----But I fed it yesterday.A.do youB.will youC.didn’t youD.don’t you
30.____ him and then try to copy what he does.A.MindB.Glance atC.Stare atD.Watch
練習(xí)二:
一、1、簡(jiǎn)單句;
2、復(fù)合句;
3、簡(jiǎn)單句;
4、簡(jiǎn)單句;
5、并列句;
6、復(fù)合句;
7、并列句;
8、復(fù)合句;
9、簡(jiǎn)單句;
10、簡(jiǎn)單句
二、I hope you are very well(復(fù)合句).I'm fine, but tired(簡(jiǎn)單句).Right now it is the summer vacation and I'm helping my Dad on the farm(并列句).August is the hottest month here(簡(jiǎn)單句).It is the time of year for the rice harvest, so every day I work from dawn until dark.(并列句)Sometimes we go on working after dark by the lights of our tractors(簡(jiǎn)單句).We grow rice in the south of the States, but in the north where it is colder they grow wheat(并列復(fù)合句).We have a lot of machines on the farm(簡(jiǎn)單句).Although the farm is large, my Dad has only two men working for him(復(fù)合句).But he employs more men for the harvest(簡(jiǎn)單句).My brother takes care of the vegetable garden(簡(jiǎn)單句).It doesn't often rain in the summer here(簡(jiǎn)單句).As a result, we have to water the vegetable garden(簡(jiǎn)單句).Every evening we pump water from a well(簡(jiǎn)單句).It then runs along channels to different parts of the garden(簡(jiǎn)單句).Most Saturday evenings there is a party, even at harvest time(簡(jiǎn)單句).These parties often make us very happy(簡(jiǎn)單句).We cook meat on an open fire outside(簡(jiǎn)單句).It's great(簡(jiǎn)單句)!Americans eat a lot of meat — too much in my opinion(簡(jiǎn)單句).Some of my friends drink beer(簡(jiǎn)單句).I don't, because I have to drive home after the party(復(fù)合句).In your letter you asked about the time in different areas of the States(簡(jiǎn)單句).There are five different time areas in the States(簡(jiǎn)單句).In my state we are fourteen hours behind Beijing time(簡(jiǎn)單句).How many different time areas do you have in China(簡(jiǎn)單句)? Well, I must stop and get some sleep(簡(jiǎn)單句).Please give my best regards to your parents(簡(jiǎn)單句).三、1~5 ACADD6~10 BCBDC11~15 ADBCC16~20 ABADB21~25 DDDCD26~30 ADDBD
四、1.He doesn’t dare to tell the truth.或He dare not tell the truth.2.How long have they lived here?3.won’t there4.Be careful with your pronunciation.5.Did they go for a walk after supper yesterday evening?6.What an interesting story(it is)!或How interesting the story is!7.How often does this magazine come out?8.could they9.How brightly the moon is shining!10.Who is always encouraging us to speak English in class?
第三篇:成份心情日記
我現(xiàn)在不愿回憶我的童年。我的干媽就是在那時(shí)候含冤而去的。她戴著高帽游行鄉(xiāng)間的情景,我永遠(yuǎn)無(wú)法忘記。后來(lái),我才知道她是地主的女兒,她為她的地主成份付出了年輕的生命。當(dāng)年,我出生的那個(gè)農(nóng)村,沒(méi)有幾戶人家有個(gè)叫得響的好成份,原因是那個(gè)農(nóng)村以前是地主的莊園,生活在這個(gè)莊戶的人家都與地主有著或遠(yuǎn)或近的聯(lián)系。他們無(wú)法擺脫一張錯(cuò)綜復(fù)雜的社會(huì)網(wǎng)絡(luò),他們被成份緊緊地釘死在這張網(wǎng)絡(luò)上。離我家不遠(yuǎn)的陳氏兩兄弟,因?yàn)橛幸粋€(gè)“罪惡”的父親而成了光棍,他們的母親也因終日批斗發(fā)了瘋。
在那個(gè)政治色彩濃郁的年代,成份,要么是你手中握著的一張王牌,要么是你身上背著的一座大山。握著它,你可以打遍天下;背著它,你將被壓趴。當(dāng)時(shí),我家的成份是下中農(nóng),不算最好,但在那個(gè)農(nóng)莊已經(jīng)不錯(cuò)了,況且我爺爺還參加過(guò)解放戰(zhàn)爭(zhēng)。就因?yàn)橛羞@樣的家庭成份和社會(huì)背景,我父親入了黨,我叔叔參了軍,我姑姑也被推薦為上大學(xué)的人選。我至今還記得那是個(gè)初夏的早晨,我家突然來(lái)了一群陌生人,他們說(shuō)是來(lái)找我姑姑的,讓她填推薦上大學(xué)的表格。那天,我姑姑一早就到隊(duì)里做工去了,家人叫我趕快去喊她回來(lái)。我一路狂奔,一邊走一邊喊,沖進(jìn)了露水未干的棉花田。姑姑得知此事,興奮得丟了農(nóng)具就往田頭跑,當(dāng)我們跑到家中,才發(fā)現(xiàn)我和姑姑的身上都被露水浸濕了。我想那一天我的心情,不亞于我后來(lái)考取大學(xué)。
然而,我姑姑卻未能如愿。原因是在極其嚴(yán)格的政審中最終沒(méi)過(guò)關(guān)。據(jù)說(shuō)我姑姑的一個(gè)不在本地的遠(yuǎn)房表叔,娶了一個(gè)出身不好的女人為妻,在那場(chǎng)運(yùn)動(dòng)中受不了打擊上吊自盡,屬于歷史不清。得到這個(gè)消息后,我姑姑哭腫了眼睛,幾天吃不下飯。她至今還憎恨那位死去多年的陌生表叔,不是他,我姑姑肯定和我一樣坐在明亮的辦公室里,再也不用扛著鋤頭下田了。有一段時(shí)間我也恨他,怕他像顆炸彈,還會(huì)在我的人生之途中炸響。
我曾經(jīng)把我的家庭網(wǎng)絡(luò)梳理過(guò)若干次,就像順著一株瓜藤,我仔細(xì)掂量每一個(gè)瓜,而這個(gè)瓜就是成份。我因此記住了我家族中不少的成員,盡管有許多至今還未見(jiàn)過(guò)面,只要家人提起,我肯定知道他,當(dāng)然我再也不會(huì)說(shuō)他的家庭成份及其背景。這在現(xiàn)在已經(jīng)毫無(wú)意義了。
第四篇:成份輸血護(hù)理常規(guī)
成分輸血護(hù)理常規(guī) 一 常用的成分血種類 懸浮紅細(xì)胞(紅細(xì)胞懸液)
這是一種從全血中盡量移除血漿和抗凝保存液后的高濃縮紅細(xì)胞,然后加入紅細(xì)胞添加劑制備成的,紅細(xì)胞壓積可高達(dá)0.90.保存期隨添加劑成分不同而異,一般為21-35天。懸浮紅細(xì)胞制劑濃度高,能提高攜氧能力,輸注量少,可避免循環(huán)超負(fù)荷,2 洗滌紅細(xì)胞
洗滌紅細(xì)胞是用生理鹽水反復(fù)洗滌除去全血中80%以上的白細(xì)胞和99%以上的血漿,保留了至少70%的紅細(xì)胞,在洗滌過(guò)程中同時(shí)去除了鉀、氨、乳酸、抗凝劑和微小凝塊等,血小板也隨血漿被去除。主要適用于有輸血過(guò)敏史、血身免疫性盆血及IgA缺乏等;對(duì)已產(chǎn)生白細(xì)胞抗體的病人,而又需要輸血時(shí),可輸洗滌紅細(xì)胞,以降低同種免疫反應(yīng)的發(fā)生率。3 濃縮血小板 手工分離血小板,采集新鮮全血后立即分離制備而成,外觀淡黃色無(wú)明顯可見(jiàn)的紅細(xì)胞,如同混濁的血漿,每200ml全血制備的血小板為一單位,含量2.4×1010個(gè)血小板,容量25~30ml.機(jī)器單采血小板是用血細(xì)胞分離機(jī)從單一獻(xiàn)血者采集血小板,純度高,外觀半透明,橙黃色,目前主要用機(jī)器單采血小板,主要適用于各種原因引起血小板減少的病人。4 血漿
新鮮冰凍血漿是血液采集后6-8小時(shí)內(nèi)分離出來(lái),在-20度以下快速冰凍而成,含有全部的凝血因子,保存期為1年;普通冰凍血漿是血液采集8小時(shí)以后分離出來(lái),在-20度以下快速冰凍而成,保存期為5年。其主要是適用于抗休克、止血、解毒、免疫功能低下和肝病引起的多種凝血因子缺乏等。5 冷沉淀
冷沉淀是新鮮冰凍血漿在4℃條件下融化后分離制備出不溶解的白色沉淀物,其容量為20~30m。主要成分為Ⅷ因子、第XIII因子、纖維蛋白原和血管性血友因子等,在-30℃以下冰箱內(nèi)貯存有效期1年。主要用于兒童血友病甲、血管性血友病、先天性或獲得性纖維蛋白原缺乏癥患者。
二 成分輸血護(hù)理技術(shù)操作程序
(一)輸血前的護(hù)理
1.充分掌握病人的病情(如疾病的診斷、輸血史、過(guò)敏史、妊娠史、傳染病史、有無(wú)休克和肝腎衰竭等)、輸血的目的、輸注的血液類型等資料,有助于護(hù)士在輸血前合理安排輸注的順序、速度和時(shí)間,預(yù)計(jì)輸血中可能發(fā)生的潛在危險(xiǎn)。2.向病人及其家屬說(shuō)明輸血的目的和必要性,以消除病人對(duì)輸血的恐懼心理,增強(qiáng)對(duì)輸血治療的信心;說(shuō)明輸血可能發(fā)生的輸血不良反應(yīng)及并發(fā)癥,讓病人及其家屬有一定的思想準(zhǔn)備。
(二)采血
1.護(hù)士在抽取交叉配血標(biāo)本前,必須事先將試管貼上條型碼或交叉配血通知單上的聯(lián)號(hào)(必須完整、規(guī)范填寫(xiě)病人的住院號(hào)、病床號(hào)、姓名)。
2.檢查病人在輸血前,醫(yī)生是否已履行告之義務(wù),并按要求簽定《輸血治療同意書(shū)》。3.準(zhǔn)確、無(wú)誤采集患者的交叉配血標(biāo)本(禁止在病人輸液管處采集標(biāo)本,以保證交叉配血標(biāo)本質(zhì)量)。如果同時(shí)為2名以上的患者采集交叉配血標(biāo)本,應(yīng)加強(qiáng)核對(duì),避免混淆,按一人一次一管的順序逐個(gè)完成。4.抽血完畢,應(yīng)記錄采血時(shí)間,并將標(biāo)本盡快送輸血科或血庫(kù)。
(三)取血
1.護(hù)士接到取血通知(最好能記錄通知時(shí)間和通知者姓名),應(yīng)憑取血憑證盡快到輸血科(或血庫(kù))取血。
2.與輸血科(或血庫(kù))工作人員共同核對(duì)輸血科(或血庫(kù))的登記、交叉配血單、血袋標(biāo)簽等內(nèi)容,并仔細(xì)檢查血液質(zhì)量。確認(rèn)無(wú)誤后應(yīng)簽名并登記取血時(shí)間,以備查驗(yàn)。3.取血過(guò)程中避免劇烈震蕩。
(四)輸血及輸血過(guò)程中的護(hù)理
1.取回血液后,應(yīng)盡快輸注。
2.必須由兩名醫(yī)護(hù)人員到病人床前嚴(yán)格、認(rèn)真履行“三查八對(duì)”程序,即查血的有效期、血的質(zhì)量和輸血裝置是否完好;對(duì)姓名、床號(hào)、住院號(hào)、血袋號(hào)、血型、交叉配血實(shí)驗(yàn)結(jié)果、血液種類和劑量。如果病人處于昏迷、意識(shí)障礙狀態(tài),必須反復(fù)核對(duì),確認(rèn)無(wú)誤后方可輸血。3.輸血前詢問(wèn)病人血型,如病人不知道自己血型,應(yīng)告知病人,囑其牢記,并懸掛血型牌。4.記錄核對(duì)和輸血護(hù)士的姓名及輸注時(shí)間,以備查驗(yàn)。
5.在輸血過(guò)程中加強(qiáng)巡視,以盡早發(fā)現(xiàn)異常情況,一定程度上也可以消除病人對(duì)輸血的恐懼和顧慮。
(五)輸血后的護(hù)理
1.輸血完畢,妥善保存血袋,統(tǒng)一送回輸血科(或血庫(kù)),以備查驗(yàn)。2.多關(guān)心詢問(wèn)病人,密切觀察病人是否出現(xiàn)遲發(fā)性的輸血反應(yīng)。三.各種成分血的輸注注意事項(xiàng)
(一)紅細(xì)胞的輸注和護(hù)理
1.選擇比較粗大的靜脈穿刺;輸注前需將血袋反復(fù)顛倒數(shù)次,使紅細(xì)胞與添加劑充分混合。
2.嚴(yán)格掌握輸注時(shí)間,先慢后快,輸注時(shí)間一般不超過(guò)4h;洗滌紅細(xì)胞應(yīng)盡快輸注,必
須在2h內(nèi)輸完,如因故未能及時(shí)輸注,只能在4℃冰箱保存24h。
3。紅細(xì)胞內(nèi)不能加任何藥品,尤其是乳酸鈉復(fù)方氯化鈉注射液、5%葡萄糖液或5%葡萄糖氯化鈉注射液,否則會(huì)發(fā)生凝固、凝集或溶血,兩袋血之間心須用0.9%氯化鈉注射液沖洗管路。對(duì)于有ABO新生兒溶血病的患兒應(yīng)輸注O型洗滌紅細(xì)胞,幼兒也盡可能輸注洗滌紅細(xì)胞;骨髓、血干細(xì)胞、臍帶血移植病人輸血有特殊要求,應(yīng)特別注意。
(二)血小板的輸注和護(hù)理
1.20~24℃震蕩保存,嚴(yán)禁置4℃冰箱,嚴(yán)禁靜置或劇烈振搖,以免血小板聚集、破壞。2.血小板從輸血科取回,必須立即輸注。輸注速度越快越好(以患者可以耐受為準(zhǔn)),一般80~100滴/分。
(三)血漿的輸注和護(hù)理
1.保存條件為-20℃以下,融化后應(yīng)盡快取回。
2.輸注前必須檢查血漿外觀,正常應(yīng)為淡黃色半透明液體,如顏色異常或有絮狀物則不能輸注。
3.新鮮冰凍血漿應(yīng)盡快輸注,以避免血漿蛋白變性和不穩(wěn)定的凝血因子喪失活性。4.輸注速度一般為5~10ml/min;新鮮冰凍血漿一經(jīng)融化不可再冰凍保存,如因故融化后未能及時(shí)輸注,可在4℃冰箱暫時(shí)保存,但不能超過(guò)24h。
(四)冷沉淀的輸注和護(hù)理
1.冷沉淀融化后,應(yīng)以患者可以耐受的最快速度輸注,一般應(yīng)在30min內(nèi)輸注完畢。2.未能及時(shí)輸注的冷沉淀不宜在室溫放置過(guò)久,不宜放于4℃冰箱,也不宜再冰凍保存。
四.常見(jiàn)的輸血反應(yīng)與防治措施:
(一)發(fā)熱反應(yīng) 是輸血中最常見(jiàn)的反應(yīng)。1.原因:(1)可由致熱源污染引起,如保養(yǎng)液或輸血用具被致熱源污染。(2)受血者在輸血后產(chǎn)生白細(xì)胞抗體和血小板抗體所致的免疫反應(yīng)。(3)違反操作原則,造成污染。
2.癥狀: 可在輸血中或輸血后1-2h內(nèi)發(fā)生,有畏寒或寒戰(zhàn)、發(fā)熱,體溫可達(dá)40℃,伴有皮膚潮紅、頭痛、惡心、嘔吐等,癥狀持續(xù)1-2h后緩解。3.防治
(1)預(yù)防:嚴(yán)格管理血庫(kù)保養(yǎng)液和輸血用具,有效預(yù)防致熱源,嚴(yán)格執(zhí)行無(wú)菌操作。
(2)處理:反應(yīng)輕者,減慢滴數(shù)即可使癥狀減輕。嚴(yán)重者停止輸血,密切觀察生命體征,給予對(duì)癥處理,并通知醫(yī)生。必要時(shí)按醫(yī)囑給予解熱鎮(zhèn)痛藥和抗過(guò)敏藥,如異丙嗪或腎上腺皮質(zhì)激素等。(二)過(guò)敏反應(yīng) 1.原因 :
(1)病人是過(guò)敏體質(zhì),輸入血中的異體蛋白同過(guò)敏機(jī)體的蛋白質(zhì)結(jié)合,形成完全抗原而致敏。(2)獻(xiàn)血員在獻(xiàn)血前用過(guò)可致敏的藥物或食物,使輸入血液中含致敏物質(zhì)。(3)多次輸血者體內(nèi)產(chǎn)生過(guò)敏性抗體。
2.癥狀: 大多數(shù)病人發(fā)生在輸血后期或?qū)⒔Y(jié)束時(shí)。表現(xiàn)輕重不一,輕者出現(xiàn)皮膚瘙癢、蕁麻疹、中度血管性水腫(表現(xiàn)為眼瞼、口唇水腫);重者因喉頭水腫出現(xiàn)呼吸困難,兩肺聞及哮鳴音,甚至發(fā)生過(guò)敏性休克。3.防治
(1)預(yù)防:①勿選用有過(guò)敏史的獻(xiàn)血員;②獻(xiàn)血員在采血前4h內(nèi)不吃高蛋白和高脂肪食物,宜清淡飲食。
(2)處理:①過(guò)敏反應(yīng)時(shí),輕者減慢輸血速度,繼續(xù)觀察,重者立即停止輸血;
②呼吸困難者給予吸氧,嚴(yán)重喉頭水腫者行氣管切開(kāi),循環(huán)衰竭者應(yīng)給予抗休克治療;
③根據(jù)醫(yī)囑給予0.1%腎上腺素0.5~1ml皮下注射,或用抗過(guò)敏藥物和激素如異丙嗪、氫化可的或地塞米松等(三)溶血反應(yīng)
溶血反應(yīng)是指輸入的紅細(xì)胞或受血者的紅細(xì)胞發(fā)生異常破壞,而引起的一系列臨床癥狀。為輸血中最嚴(yán)重的反應(yīng)。1. 原因:
(1)輸入異型血,多由于ABO血型不相容引起,獻(xiàn)血者和受血者血型不符而造成;(2)輸入變質(zhì)血,輸血前紅細(xì)胞已變質(zhì)溶解,如血液儲(chǔ)存過(guò)久、血溫過(guò)高,輸血前將血加熱或震蕩過(guò)劇,血液受細(xì)菌污染均可造成溶血;
(3)血中加入高滲或低滲溶液或能影響血液pH變化的藥物,致使紅細(xì)胞大量破壞所致。(4)輸入Rh因子不同的血液
2. 癥狀:典型的癥狀在輸入10-20ml血后發(fā)生,隨輸入血量增加而加重。
開(kāi)始階段:由于紅細(xì)胞凝集成團(tuán),阻塞部分小血管,可引起頭脹痛、四肢麻木、腰背部劇烈疼痛和胸悶等癥狀。第二階段:由于凝集的紅細(xì)胞發(fā)生溶解,大量血紅蛋白散布到血漿中,可出現(xiàn)黃疸和血紅蛋白尿。同時(shí)伴有寒戰(zhàn)、高熱、呼吸急促和血壓下降癥狀。第三階段:因大量血紅蛋白從血漿中進(jìn)入腎小管,遇酸性物質(zhì)變成結(jié)晶體,致使腎小管阻塞;又因?yàn)檠t蛋白的分解產(chǎn)物使腎小管內(nèi)皮細(xì)胞缺血、缺氧而壞死脫落,也導(dǎo)致腎小管阻塞。病人出現(xiàn)少尿、無(wú)尿等急性腎功能衰竭癥狀,嚴(yán)重者可導(dǎo)致死亡。3.防治
1.預(yù)防:認(rèn)真作好血型鑒定和交叉配血試驗(yàn),輸血前仔細(xì)查對(duì),杜絕差錯(cuò)。嚴(yán)格執(zhí)行血液保存規(guī)則,不可使用變質(zhì)過(guò)期血液。2.處理:(1)停止輸血并通知醫(yī)生,保留余血,采集病人血標(biāo)本重做血型鑒定和交叉配血試驗(yàn);
(2)維持靜脈輸液通道,供給升壓藥和其他藥物;
(3)靜脈注射碳酸氫鈉堿化尿液,防止血紅蛋白結(jié)晶阻塞腎小管;(4)雙側(cè)腰部封閉,并用熱水袋敷雙側(cè)腎區(qū),解除腎血管痙攣,保護(hù)腎臟;(5)嚴(yán)密觀察生命體征和尿量,并做好記錄,對(duì)少尿、尿閉者,按急性腎能衰竭處理;(6)出現(xiàn)休克癥狀,即配合抗休克治療。(7)Rh系統(tǒng)血型反應(yīng)中,一般在一周或更長(zhǎng)時(shí)間出現(xiàn)反應(yīng),體征較輕,有輕度發(fā)熱伴乏力、血膽紅素升高。對(duì)此種病人應(yīng)查明原因,確診后,盡量避免再次輸血。
(四)與大量輸血有關(guān)的反應(yīng)
大量輸血一般指在24h內(nèi)緊急輸血量大于或相當(dāng)于病人總血容量。常見(jiàn)的反應(yīng)有循環(huán)負(fù)荷過(guò)重、出血傾向、枸櫞酸鈉中毒等。
1. 循環(huán)負(fù)荷過(guò)重 其原因、癥狀及護(hù)理同靜脈輸液反應(yīng)。2.出血傾向
(1)原因:長(zhǎng)期反復(fù)輸血或超過(guò)病人原血液總量的大量輸血,由于庫(kù)血中的血小板破壞較多,使凝血因子減少而引起出血。(2)癥狀:表現(xiàn)為皮膚、粘膜瘀斑,穿刺部位大塊淤血,或手術(shù)后傷口滲血。
(3)處理:短時(shí)間內(nèi)輸人大量庫(kù)血時(shí),應(yīng)密切觀察病人意識(shí)、血壓、脈搏等變化,注意皮膚、粘膜或手術(shù)傷口有無(wú)出血。可根據(jù)醫(yī)囑間隔輸入新鮮血或血小板懸液,以補(bǔ)充足夠的血小板和凝血因子。
3.枸櫞酸鈉中毒反應(yīng)
(1)原因:大量輸血隨之輸人大量枸櫞酸鈉,如肝功能不全,枸櫞酸鈉尚未氧化即和血中游離鈣結(jié)合而使血鈣下降,以至凝血功能障礙、毛細(xì)血管張力減低、血管收縮不良和心肌收縮無(wú)力等。(2)癥狀:表現(xiàn)為手足抽搐、出血傾向、血壓下降、心率緩慢,心室纖維顫動(dòng),甚至發(fā)生心跳停止。(3)處理:①嚴(yán)密觀察病人的反應(yīng)。
②輸入庫(kù)血1000ml以上時(shí),須按醫(yī)囑靜脈注射10%葡萄糖酸鈣或氯化鈣lOml,以補(bǔ)充鈣離子。
(五)其他
如空氣栓塞,細(xì)菌污染反應(yīng),遠(yuǎn)期觀察還可有因輸血傳染 的疾病,如病毒性肝炎、瘧疾、艾滋病等。
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