输液反应的处理

输液反应的处理 输液反应是医疗活动中极为常见的现象，其本身并无致死性。但它可诱导病人基楚疾病恶化而带来生命危险。临床中应重在防范;一旦发生，判断要准确， ?发热反应处理方法: ?不要拨掉静脉针头，一定保留好静脉通道，以备抢救用药。一旦拨掉静脉通道，当病人需抢救时再建静脉通道，会错过抢救时机; ?换上一套新的输液器管道及与原液体性质不同的液体(如原来是糖水则换成生理盐水)，可暂不加药，待病情稳定后再议加药; ?五联用药: ?吸氧;?静注地塞米松10--15mg(小儿0.5-1mg/kg.次)或氢化可的松100mg(小儿5--10mg/kg.次);? 肌注或静注苯海拉明20--40mg(小儿0.5--1mg/kg.次);?肌注复方氨基比林2ml(小儿0.1ml/kg.次)或口服布洛芬悬液;?如未梢发凉或皮色苍白可肌注或静注654-2 5mg(小儿0.1--0.5mg/kg.次)。一般在用药30分钟后汗出热退而平稳下来。 ? 急性肺水肿 处理方法: ?注意控制输液速度和输液量尤其对老人、小儿和心肺功能不全的病人。 ?一旦出现上述症状， 立即停止输液并通知医生进行紧急处理。如病情允许，使病人呈端坐位，双腿下垂，以减少下肢静脉回流， 减轻心脏负担。 ?高流量氧气吸入。 ?遵医嘱给予镇静剂、平喘、强心、利尿和扩血管药物。 ?给予心理安慰， 解除病人的紧张情绪。 ?必要时进行四肢轮扎。方法:用橡胶止血带或血压计袖带适当加压四肢， 以阻断静脉回流， 但动脉血仍可通过。每5,10 min 轮流放松一个肢体上的止血带。症状缓解后，逐渐解除止血带。 ?静脉炎处理方法: ?严格执行无菌操作， 对血管壁有刺激性的药物应充分稀释后再用。 ?有计划地更换输液部位， 以保护静脉。 ?停止在出现炎症的静脉输液，并将该肢体抬高、制动，局部用50 %硫酸镁溶液湿敷，2 次/ d ,每次20 min。 ?超短波局部理疗，1 次/ d ,每次15,20 min。 ?中药治疗，如意黄金散加醋调成糊状， 局部外敷， 2 次/ d。 ?如合并感染，遵医嘱给予抗生素治疗。 (四) 空气栓塞 fertility better. Site preparation before planting, clearing rubble, if conditions for soil disinfection can be carried out. Thickness of planting soil: Arbor thickness not less than 90cm, shrubs not less than 60cm, to be not less than 20cm. Poor quality of the soil, should enlarge the hole (hole) specifications, and debris picked up by clearing encountered lime slag, against the growth substances such as stone, asphalt, you should pit (hole) diameter increased 1 to twice times, harmful substances removal clean and put on suitable planting soil. F, green natural trees found in the planting hole dug seriously affect the operation of the underground obstacle, get in touch with designers, the appropriate changes. ?, seedling quality of trees dug a well ... C, trees have been delivered to the site in a given place, to turn the roots covered with straw to prevent water loss. ? trees planted seedlings before planting quality requirements: should be checked according to the design drawings and seedling varieties, specifications and plant location. Principles of plant "outside the high to low, the first after the first" grown order "big tree---small tree---shrub-plants" before the tree into planting holes, you should check the planting hole size and depth, while root system requirements are not met, trimming plants dibble. A, seedling rate should be commensurate with the speed of planted seedlings, planted along, kind of finish, minimizing root exposure. On planting trench, remaining seedling exposed roots should be kept buried with soil. B, depending on the specific seedlings, good seedlings and planting depth should be identified, roots with soil plug solid rear mud balls can be under the 处理方法: ?输液前认真检查输液器的质量，将各部位衔接紧密，防止滑脱。 ?输液前排尽输液导管内的空气。 ?输液过程中加强巡视， 及时更换输液瓶或添加药物。输液完毕及时拔针。 ?加压输液时应有专人在旁守护。 ?一旦空气进入血管内， 应立即让病人采取左侧卧位并使头低足高， 以使气体浮向右心室尖部， 避开肺动脉入口， 随着心脏舒缩， 将空气与血液混成泡沫， 分次小量进入肺动脉内，逐渐被吸收。 ?高流量氧气吸入，提高病人的血氧浓度， 纠正缺氧状态。 ?严重观察病人的病情变化，如发生变化，及时给予对症处理。 ?有条件者，可通过中心静脉导管抽出空气。 至于输液反应时皮下注射肾上腺素则应慎重。原因是输液反应不是速发型过敏反应，用肾上腺素违背了输液反应的病理机制，肾上腺素是儿茶酚胺类药物，有快速升压效应，用于速发型过敏反应是正确的;另外，肾上腺素的升压效应会使原有高血压的病人病情恶化。当然，在一时不能判断出是输液反应还是速发型过敏反应时，小心使用也未尝不可;在输液反应又合并血压急速下降时使用也是对的。 至于烦躁不安时镇静剂的使用也应慎重。实践证明，输液反应经上述处理大多能很快安静下来，不再需要用镇静剂;对这种病人用镇静剂也会掩盖病情变化。 青霉素过敏的抢救 青霉素,PNC,是应用广泛的抗菌药物～它本身毒性很小～而较常见的却是药物的过敏～引起不良的反应以致死亡。霉素的抗菌作用是～低浓度时抑菌～高浓度时杀菌。对链球菌、肺炎双球菌等等革兰氏染色阳性球菌效果较好～对敏感的萄萄球菌也有作用～对脑膜炎双球菌～淋球菌等革兰氏染色阴性球菌～ 以及白喉杆菌、破伤风杆菌等革兰氏染色阳性杆菌和螺旋体也有作用。在临床上～青霉素对于治疗肺炎、扁桃体炎、中耳炎、蜂窝组织炎、细菌性心内膜炎、骨髓炎、流行性脑膜炎、肺炎球菌脑膜炎、梅毒、回归热、淋病、炭疽、破伤风等疾病都有较好的疗效。青霉素不论何种给药途径均能被吸收。 一般多采用肌肉注射～可以被充分吸收。可溶性结晶青霉素盐类的水溶液吸 ，30分钟内即可达最高峰～而普鲁卡因青霉素、油剂青霉收很快～血浓度在15 素的吸收则较慢。青霉素在体内主要经肾脏排泄。注射水剂者～在一小时内血浆中青霉素的浓度下降一半。皮肤、粘膜等处也很容易吸收～而且比注射更易引起过敏～所以对此给药途径更要注意预防过敏反应。采用皮肤试验使过敏发生率大大降低～但往往因为皮肤试验用量不准确而致过大～或病人本身的特殊敏感～有时也可因作皮肤试验时而发生过敏～故临床上主要为过敏反应。 严重过敏现象往往出现在作皮试或注射10几分钟内。病人首先感到胸闷气憋～浑身哆嗦以至抽搐、头晕、 头痛、呼吸困难～紫绀～ 面色苍白～手脚发凉～血压急骤下降～脉搏快而弱～如抢救不及时～常会因呼吸循环衰竭而死亡。对出现严重过敏反应的病人～应立即皮下或静脉注射0.1%肾上腺素0.5—1毫升。采用针灸疗法～针刺人中、内关等穴位。 fertility better. Site preparation before planting, clearing rubble, if conditions for soil disinfection can be carried out. Thickness of planting soil: Arbor thickness not less than 90cm, shrubs not less than 60cm, to be not less than 20cm. Poor quality of the soil, should enlarge the hole (hole) specifications, and debris picked up by clearing encountered lime slag, against the growth substances such as stone, asphalt, you should pit (hole) diameter increased 1 to twice times, harmful substances removal clean and put on suitable planting soil. F, green natural trees found in the planting hole dug seriously affect the operation of the underground obstacle, get in touch with designers, the appropriate changes. ?, seedling quality of trees dug a well ... C, trees have been delivered to the site in a given place, to turn the roots covered with straw to prevent water loss. ? trees planted seedlings before planting quality requirements: should be checked according to the design drawings and seedling varieties, specifications and plant location. Principles of plant "outside the high to low, the first after the first" grown order "big tree---small tree---shrub-plants" before the tree into planting holes, you should check the planting hole size and depth, while root system requirements are not met, trimming plants dibble. A, seedling rate should be commensurate with the speed of planted seedlings, planted along, kind of finish, minimizing root exposure. On planting trench, remaining seedling exposed roots should be kept buried with soil. B, depending on the specific seedlings, good seedlings and planting depth should be identified, roots with soil plug solid rear mud balls can be under the 根据病情～ 十几分钟后～可再注入0.1%肾上腺素0.3—0.5毫升。有条件者～应作静脉输液～输入5%葡萄糖或葡萄生理盐水,GS,～液体中可加氢化可的松100—200毫克～对血压急剧下降者～输液中加入升压药物如阿拉明或去甲肾上腺素。有条件者可予氧气吸人。使用脱敏药物如注射非那根(异丙嗪)25毫克～以及采用其它方法对症处理。 当现场无输液条件者～可予静脉注射25%葡萄糖60—80毫升～静脉注射升压药物～但推药速度应缓慢～如无静注条件～亦可肌注阿拉明。青霉素过敏的发生虽然来势急骤～但只要处理得当～病人的恢复和预后都较良好～而这急救措施(主要的如肌注肾上腺素)～在农村基层医疗单位也都能采用。如遇严重过敏休克病人～急转送医院～当时不作处理～往往会在途中即出现各种险情。 对此～ 应引起救护人员的高度重视。 对于一般的过敏反应～如荨麻疹等～可使用脱敏药物～如苯海拉明～每次口服25毫克～一日3次～或应用扑尔敏～每次口服4毫克～一日3次。 预防过敏～主要是用药前～必须了解病人既往有无青霉素过敏史～如有～则决不能使用,如无过敏吏～则此次注射应按照规定剂量作皮肤试验(常用的青霉素皮试液每毫升内含药100-1000单位～用0.1毫克作皮内试验～即皮内注入10-100单位青霉素)～20分钟后～如局部出现红肿并有伪足～肿块直径大于1厘米时为阳性反应～即不应注射。如阴性～则可予注射。 当注射完毕后～病人不应立即离开～观察10几分钟无反应后再走。连续用后停药～通常24小时后继续用药～建议重新做皮试。 皮内试验方法 ,一,皮内试验液的配制皮内试验液以每毫升含200,500u的青霉素G等渗盐水溶液为标准,即皮试液浓度为200,500u/ml,具体配制如下: 以青霉素一瓶,80万u,为例～注入等渗盐水4ml则每ml含20万u.(加入质量不便～浓度和体积成反比) 取0.1ml加等渗盐水至1ml～每ml含2万u. 取0.1ml加等渗盐水至1ml～每ml含2000 u. 取0.1ml加等渗盐水至1ml～每ml含200 u. 每次配制时～均需将溶液混匀。 ,二,试验方法 取青霉素皮试液0.1ml,含20u,作皮内注射～观察20分钟后～判断试验结果。 ,三,结果判断 阴性:皮丘无改变～周围不红肿～无自觉症状。 阳性:局部皮丘隆起～并出现红晕硬块～直径大于1cm～或红晕周围有伪足～痒感～严重时可出现过敏性休克 ,四,注意事项 1(试验前详细询问病人的用药史、过敏史和家族过敏史。 2(凡首次用药～停药3天后再用者～以及更换药物批号～均须按常规做过敏试验。 3(皮肤试验注入必须新鲜配制～皮试液浓度与注射剂量要准确,溶媒、注射器及针头应固定使用。 4(青霉素过敏试验或注射前均应做好急救的准备工作,备好盐酸肾上腺素和注射器等,。 fertility better. Site preparation before planting, clearing rubble, if conditions for soil disinfection can be carried out. Thickness of planting soil: Arbor thickness not less than 90cm, shrubs not less than 60cm, to be not less than 20cm. Poor quality of the soil, should enlarge the hole (hole) specifications, and debris picked up by clearing encountered lime slag, against the growth substances such as stone, asphalt, you should pit (hole) diameter increased 1 to twice times, harmful substances removal clean and put on suitable planting soil. F, green natural trees found in the planting hole dug seriously affect the operation of the underground obstacle, get in touch with designers, the appropriate changes. ?, seedling quality of trees dug a well ... C, trees have been delivered to the site in a given place, to turn the roots covered with straw to prevent water loss. ? trees planted seedlings before planting quality requirements: should be checked according to the design drawings and seedling varieties, specifications and plant location. Principles of plant "outside the high to low, the first after the first" grown order "big tree---small tree---shrub-plants" before the tree into planting holes, you should check the planting hole size and depth, while root system requirements are not met, trimming plants dibble. A, seedling rate should be commensurate with the speed of planted seedlings, planted along, kind of finish, minimizing root exposure. On planting trench, remaining seedling exposed roots should be kept buried with soil. B, depending on the specific seedlings, good seedlings and planting depth should be identified, roots with soil plug solid rear mud balls can be under the 5(严密观察病人～首次注射后须观察30分钟以防迟缓反应的发生。注意局部和全身反应～倾听病人主诉。 6(试验结果阳性者禁止使用青霉素～同时报告医生～在医嘱单、病历、床头卡上醒目地注明青霉素过敏试验阳性反应～并告知病人及其家属。 在执行青霉素皮试前必须做好相应的抢救准备工作:一是不在饥饿或空腹状态下使用,二是备用常规的抢救药品和设备,三不到无抢救条件的诊所特别是非法场所去就医～一旦出现青霉素过敏情况应遵照下述步骤进行抢救。 青霉素过敏的抢救 1 试验及阳性:青霉素试液 0.1 毫升(含 20u )，皮内注射， 20 分钟后观察结果。 阳性特征为局部皮丘隆起，红晕硬尬的直径大于 1 厘米，有痒感，严重时可休克。 2 反应表现:由于喉头水肿，肺水肿所至胸闷，气促，伴濒危感。面色苍白，出冷汗，紫绀，脉细弱，血压下降，烦躁不安，也可因脑组织缺氧所致头晕，眼花，面用四肢麻木，意识丧失，抽搐，大小便失禁，也可见皮肤瘙痒，荨麻疹及其他皮疹。血清反应于用药后 7-12 天内发生。如发热，关节肿痛，皮肤发痒， 哮喘或哮喘发作，消化系统可见荨麻疹，全身淋巴结肿大，腹痛等。也有的引起 过敏性紫癜，腹痛，便血等。 3 急救措施: ?立即停药，平卧，就地抢救，采用头低足高位。 ?皮下注射 0.1% 盐酸肾上腺素 0.5-1 毫升，儿童酌减，每隔半小时可再皮下注射 0.5 毫升，直至脱离危险期。 ?心脏停跳者，行心脏胸外按压术或心内注射 0.1% 盐酸肾上腺素 1 毫升。 ?吸氧，呼吸抑制时口对口人工呼吸，并肌肉注射尼可刹米或山梗菜碱等呼吸中枢兴奋剂。 喉头水肿影响呼吸时行气管切开术。 ?用氢化考的松 200 毫克，或地塞米松 5-10 毫克加入 50%G ? S40 毫升中静脉注射，或加入 5-10%G ? S500 毫升中静滴。 ?根据病情需要可用血管活性药物如多巴胺，阿拉明等。 ?纠正酸中毒及组织胺药物的应用。 ?注意保暖，防止感冒，要做好护理记录，不要搬动。 ?可针刺人中、内关、印堂、合谷、涌泉等急救穴位。 ?可用艾条灸内关、合谷、涌泉、关元，中脘等穴位。 4、在皮试时，用药中、用药后三个易引起反应的阶段内，要密切观察表现，出现问题及时处理。 fertility better. Site preparation before planting, clearing rubble, if conditions for soil disinfection can be carried out. Thickness of planting soil: Arbor thickness not less than 90cm, shrubs not less than 60cm, to be not less than 20cm. Poor quality of the soil, should enlarge the hole (hole) specifications, and debris picked up by clearing encountered lime slag, against the growth substances such as stone, asphalt, you should pit (hole) diameter increased 1 to twice times, harmful substances removal clean and put on suitable planting soil. F, green natural trees found in the planting hole dug seriously affect the operation of the underground obstacle, get in touch with designers, the appropriate changes. ?, seedling quality of trees dug a well ... C, trees have been delivered to the site in a given place, to turn the roots covered with straw to prevent water loss. ? trees planted seedlings before planting quality requirements: should be checked according to the design drawings and seedling varieties, specifications and plant location. Principles of plant "outside the high to low, the first after the first" grown order "big tree---small tree---shrub-plants" before the tree into planting holes, you should check the planting hole size and depth, while root system requirements are not met, trimming plants dibble. A, seedling rate should be commensurate with the speed of planted seedlings, planted along, kind of finish, minimizing root exposure. On planting trench, remaining seedling exposed roots should be kept buried with soil. B, depending on the specific seedlings, good seedlings and planting depth should be identified, roots with soil plug solid rear mud balls can be under the 糖 尿 病 足 创 面 的 处 理 糖尿病足的定义:发生于糖尿病患者的与局部神经异常和下肢外周血管病变相关的足部感染、溃疡和,或深层组织破坏。 一.糖尿病足溃疡和坏疽病变的分类:,病因, ,.神经性:神经病变在病因上起主要作用～血液循环良好～这类足通常是温暖的、麻木的、干燥的～痛觉不明显～足部动脉搏动良好～溃疡主要发生于足底压力增高处～如出现胼胝的部位～或形成神经关节病～形成夏柯氏关节。 ,.缺血性:下肢血管缺血病变造成肢端坏疽～单纯缺血无神经病变则很少见。 ？.混合性,神经,缺血性,:患者同时有周围神经病变和周围血管病变～这类足通常是凉的～可伴有休息时疼痛、间歇性跛行～足部动脉搏动减弱或消失～溃疡好发于足边缘部。 二.足坏疽的临床分型: ,.湿性坏疽:多因肢端循环及循环障碍～伴有周围神经病变所致皮肤损伤感染化脓～局部常有红、肿、热、痛、功能障碍～严重者伴有全身不适、毒血症或败血症等临床表现～临床上多此种类型～占.糖尿病足？,,。 ,.干性坏疽:多发生在下肢动脉、肢端动脉硬化、狭窄、管腔闭塞～或动脉栓塞～导致阻塞动脉供血的远端肢体响应区域发生缺血～出现干性坏疽～其坏疽的程度与血管阻塞的部位有关。较小动脉阻塞则坏疽面积较小～常形成灶性干性坏死～较大动脉阻塞则坏疽面积较大～甚至整个肢端完完全坏死～占.糖尿病足,,,,。肢端干性坏疽时常并有其他部位血管栓塞～如脑血栓～冠心病等。 ？.混合性坏疽:因肢端某一部位动脉阻塞～血流不畅～引起干性坏疽～而另一部位感染化脓引起湿性坏疽。其特点是:干、湿性坏疽的病灶同时发生在同一个肢端的不同部位。此种类型病情重～溃烂部位多～面积大～常累积大部或全部肢端～感染严重时可有全身不适～体温及白细胞增高～发生毒血症或败血症。临床上比较多见～占.糖尿病足,,,。 三.糖尿病足的wangner溃疡分级: ,级:有发生足溃疡危险因素的足～目前无溃疡。 ,级:表面溃疡～临床上无感染。 ,级:较深的溃疡～影响到肌肉～无脓肿或骨的感染。 ？级:深度感染～伴有骨组织病变或脓肿。 ,级:局限性坏疽,趾、足跟或前足背,。 ,级:全足坏疽。 四.糖尿病足慢性溃疡伤口的处理原则:通过清创使慢性伤口转化为急性伤口 ,能过全面清创～使伤口转化为急性伤口改善受累皮肤部位的血供和微循环状态～从生理上提供细胞按时间顺序出现的愈合过程机会:炎症期～增生期～修复期, fertility better. Site preparation before planting, clearing rubble, if conditions for soil disinfection can be carried out. Thickness of planting soil: Arbor thickness not less than 90cm, shrubs not less than 60cm, to be not less than 20cm. Poor quality of the soil, should enlarge the hole (hole) specifications, and debris picked up by clearing encountered lime slag, against the growth substances such as stone, asphalt, you should pit (hole) diameter increased 1 to twice times, harmful substances removal clean and put on suitable planting soil. F, green natural trees found in the planting hole dug seriously affect the operation of the underground obstacle, get in touch with designers, the appropriate changes. ?, seedling quality of trees dug a well ... C, trees have been delivered to the site in a given place, to turn the roots covered with straw to prevent water loss. ? trees planted seedlings before planting quality requirements: should be checked according to the design drawings and seedling varieties, specifications and plant location. Principles of plant "outside the high to low, the first after the first" grown order "big tree---small tree---shrub-plants" before the tree into planting holes, you should check the planting hole size and depth, while root system requirements are not met, trimming plants dibble. A, seedling rate should be commensurate with the speed of planted seedlings, planted along, kind of finish, minimizing root exposure. On planting trench, remaining seedling exposed roots should be kept buried with soil. B, depending on the specific seedlings, good seedlings and planting depth should be identified, roots with soil plug solid rear mud balls can be under the 创面正常的愈合过程包括:炎症期～增生期～修复期。一般说来～急性创面的愈合过程遵循这个过程～而慢性创面的愈合似乎并没有遵循这个过程～对糖尿病足溃疡而言～创面“停滞”在炎症期或增生期。慢性创面的细胞表型发生了改变～从而影响了细胞的增殖和移动能力。 ,. 湿性坏疽:早期首先制动～卧床休息～抬高患肢～促进静脉回流。对皮下组织感染形成脓肿或蜂窝织炎的应先消炎～形成局灶性或多发性小脓肿～必须切开引流排脓～在局部波动处、张力最大处切开引流减压、减张～尽量避开血管及神经走行～既顺行切开～防止小脓肿融合形成大脓腔～但避免挤压和过度冲洗～以免感染沿肌间隙蔓延扩大。彻底过早的清创往往起到事与愿违之效～势必扩大了创面～影响愈合。主张对创面分期分批蚕食清创,对已明确坏死的组织～及时清创,对于界限不清、难以确定是否完全坏死的组织暂时保留～随着全身基础治疗的加强～有些没有完全坏死的组织仍有一定的自愈能力～既便观察术日后组织进一步坏死～只要创面引流通畅～到时再清创不迟,对于失去生机的皮下组织、脂肪组织、筋膜、肌肉都应切除,对坏死的肌腱～为保留患肢功能～应做最大限度的保留,对感染严重造成骨质破坏、骨髓炎者～可逐步清除坏死的碎骨片～窦道必要时适时切开,对疑有厌氧菌感染或窦道较深、伤口脓性分泌物多、恶臭者～可用双氧水清洗。 ,肉芽生长阶段创面的处理:肉芽生长阶段～注意保持创面环境的湿润～建立肉芽生长的良好微循环境,此即湿性伤口愈合理论,,若创面过于干燥～则应注意伤口的保湿～可在湿润的抗生素纱条外覆以凡士林油纱～避免凡士林油纱直接接触创面～以防堵塞分泌物出口～使创面引流不畅,在换药揭除敷料时～避免粗暴操作～以免肉芽组织因每次换药时的细胞剥脱～而重新回到或部分回到创面的炎性反应期～从而使创面愈合延迟,若创面渗液过多～可选用一些吸收能力强、通透性好的新型敷料～增加换药次数～保障创面的清洁和通透性,切忌肉芽组织的过度增长～不适时的、过度的增长促进肉芽组织转变为炎性肉芽～对上皮组织的生长极为不利～对于已经有迹象形成的炎性肉芽要及时予以清除～待创面基础条件好转后～再使其长出新的正常肉芽组织,正常肉芽组织形成的先决条件和基础是～及时切开引流、适时的坏死组织清创、骨髓炎的纠正、抗生素的及时应用,正常颜色为粉红色～有光泽度。 在肉芽生长阶段～创面局部可用一些改善微循环～促进肉芽生长的药物～如川穹嗪～654-2等～以水性制剂为宜～避免用膏状～油状的药物。 3上皮生长阶段:成熟的肉芽组织和湿润光滑的创面是最终上皮生长的必要条件。注意创面的保湿与清洁。此期可以用一些促进上皮组织生长的药物～如表皮生长因子。 4.干性坏疽:早期制动～休息～抬高患肢～减轻下肢缺血～待其与健康组织分界清楚再做处理～在改善大血管病变～改善血供状况的前提下～及时切除坏死组织～按照湿性坏疽处理原则处理截面。 5水疱、血泡的处理:小的水疱、血泡可自行吸收～可不予处理,如较大的水疱、血泡不能自行吸收者～在基础治疗的基础上～严格消毒下～用无菌注射器～在水疱、血泡低位处将内容物抽出使其干瘪～并涂以,.,,碘酒或碘伏无菌包扎。 五.常用药物引流纱条,药量根据伤口面积大小来定 fertility better. Site preparation before planting, clearing rubble, if conditions for soil disinfection can be carried out. Thickness of planting soil: Arbor thickness not less than 90cm, shrubs not less than 60cm, to be not less than 20cm. Poor quality of the soil, should enlarge the hole (hole) specifications, and debris picked up by clearing encountered lime slag, against the growth substances such as stone, asphalt, you should pit (hole) diameter increased 1 to twice times, harmful substances removal clean and put on suitable planting soil. F, green natural trees found in the planting hole dug seriously affect the operation of the underground obstacle, get in touch with designers, the appropriate changes. ?, seedling quality of trees dug a well ... C, trees have been delivered to the site in a given place, to turn the roots covered with straw to prevent water loss. ? trees planted seedlings before planting quality requirements: should be checked according to the design drawings and seedling varieties, specifications and plant location. Principles of plant "outside the high to low, the first after the first" grown order "big tree---small tree---shrub-plants" before the tree into planting holes, you should check the planting hole size and depth, while root system requirements are not met, trimming plants dibble. A, seedling rate should be commensurate with the speed of planted seedlings, planted along, kind of finish, minimizing root exposure. On planting trench, remaining seedling exposed roots should be kept buried with soil. B, depending on the specific seedlings, good seedlings and planting depth should be identified, roots with soil plug solid rear mud balls can be under the ,.庆大霉素，,,,,, ,.甲硝唑 ？.优锁 ,.,.,,雷佛奴尔 级联“瀑布”反应 机体对创伤的反应包括一系列病理生理过程 1炎症反阶段 2成纤维细胞的增殖 3毛细血管增殖,血管生成, 4结缔组织合成 5重新上皮化 伤口的愈合就是在所谓的级联“瀑布”反应下发生的～是急性伤口的愈合反应过 程。 糖尿病足慢性溃疡创面的特点: 1创面深在～感染多见 2动脉硬化多见～管壁增厚明显 3肉芽组织脆弱～生机低下 4瘢痕组织较薄～时有骨化发生 5反复发作～长期不愈 fertility better. Site preparation before planting, clearing rubble, if conditions for soil disinfection can be carried out. Thickness of planting soil: Arbor thickness not less than 90cm, shrubs not less than 60cm, to be not less than 20cm. Poor quality of the soil, should enlarge the hole (hole) specifications, and debris picked up by clearing encountered lime slag, against the growth substances such as stone, asphalt, you should pit (hole) diameter increased 1 to twice times, harmful substances removal clean and put on suitable planting soil. F, green natural trees found in the planting hole dug seriously affect the operation of the underground obstacle, get in touch with designers, the appropriate changes. ?, seedling quality of trees dug a well ... C, trees have been delivered to the site in a given place, to turn the roots covered with straw to prevent water loss. ? trees planted seedlings before planting quality requirements: should be checked according to the design drawings and seedling varieties, specifications and plant location. Principles of plant "outside the high to low, the first after the first" grown order "big tree---small tree---shrub-plants" before the tree into planting holes, you should check the planting hole size and depth, while root system requirements are not met, trimming plants dibble. A, seedling rate should be commensurate with the speed of planted seedlings, planted along, kind of finish, minimizing root exposure. On planting trench, remaining seedling exposed roots should be kept buried with soil. B, depending on the specific seedlings, good seedlings and planting depth should be identified, roots with soil plug solid rear mud balls can be under the