1例心内直视手术后心包填塞的护理

目的预防和早期发现心内直视手术后心包填塞的发生,避免导致心搏骤停.方法通过对1例心内直视手术后发生两次心包填塞患者的观察、抢救:除术中须彻底止血、纠正体外循环所致的凝血机制紊乱外,术后注意保持心包及纵隔引流通畅,全面细致观察和分析病情,应高度警惕心包填塞的发生,若有异常立即报告医生,备好急诊开胸包.结果抢救成功,痊愈出院.结论急性心包填塞是心内直视手术后严重的并发症,除术中彻底止血、术后保持引流通畅、严密观察病情、减少并早期发现该并发症的发生外,及早采取积极的治疗措施,可避免心搏骤停,提高手术的成功率.     

l例心内直视手术后心包填塞的护理

目的 预防和早期发现心内直视手术后心包填塞的发生，避免导致心搏骤停。方法 通过对1例心内直视手术后发生两次心包填塞患者的观察、抢救：除术中须彻底止血、纠正体外循环所致的凝血机制紊乱外，术后注意保持心包及纵隔引流通畅，全面细致观察和分析病情，应高度警惕心包填塞的发生，若有异常立即报告医生，备好急诊开胸包。结果 抢救成功，痊愈出院。结论 急性心包填塞是心内直视手术后严重的并发症，除术中彻底止血、术后保持引流通畅、严密观察病情、减少并早期发现该并发症的发生外，及早采取积极的治疗措施，可避免心搏骤停，提高手术的成功率。     

49例心内直视术后出血的临床研究

目的　探讨体外循环心内直视术后出血的发生原因及其诊断、治疗和预防。方法　复习本院 16a 15 12例心内直视术后出血抢救病人的临床资料 ,总结引起出血的原因 ,诊断和治疗方法以及治疗效果。结果　 15 12例心内直视手术病人中 ,4 9例发生术后出血 ,2 9例二次剖胸手术止血 ,成功 2 5例 ,死亡 4例 ,死亡率为 13 8% ;2 0例行非手术治疗 ,成功止血 9例 ,死亡 11例 ,死亡率为 5 5 %。结论　术中仔细操作、彻底止血 ,术后早期诊断并采取果断措施尽早再次剖胸手术止血是降低心内直视术后出血死亡率的关键。     

心内直视术后心包填塞和出血的早期诊治及原因分析

目的　分析 2 6例心内直视术后心包填塞和出血的临床特点 ,探讨其发生原因、预防、救治及其二次开胸的早期指征。方法　本研究就 2 0 0 0 - 0 1～ 2 0 0 2 - 0 7心内直视术 (共 170 3例 )后 2 6例二次开胸 (发生率 1 2 7% )病例进行总结分析。结果　据二次开胸手术证实结果 ,分为心包填塞组 (其中急性心包填塞 11例 ,延迟性心包填塞 2例 )和活动性出血组 (13例 )。患者经再次开胸解除心包填塞或手术止血后 2 3例痊愈出院 ,3例死亡 (其中急性心包填塞 2例 ,活动性出血组 1例 )。急性心包填塞组其pH、BE、SP、DP、尿量显著下降 (P <0 0 5 ) ,CVP、HR显著升高 (P <0 0 5 )。延迟性心包填塞发生于术后 4d ,其PaO2 进行性下降 ,CVP进行性升高 (P <0 0 5 )。活动性出血组术后其SP、DP、尿量显著下降 (P <0 0 5 ) ,HR升高 (P <0 0 5 ) ,pH、PaCO2 、PaO2 、HCO-3 、BE无显著差异 (P >0 0 5 )。与急性心包填塞组比较 ,活动性出血组心包和纵隔引流管水柱波动良好 ,引流量显著增多 (P <0 0 5 ) ,术前PT和INR明显延长 (P <0 0 5 )。结论　急性心包填塞和活动性出血是心内直视术后严重并发症 ,主要表现为循环系统不稳定 ,延迟性心包填塞主要表现为PaO2 下降 ,CVP显著升高 ;术前PT和INR明显延长 ,可能参与其     

心内直视手术后急性呼吸窘迫综合征发生的危险因素

目的分析心内直视手术后急性呼吸窘迫综合症(ARDS)发生的危险因素,以提高心内直视手术后呼吸并发症的救治水平。方法采用自行设计的心脏外科数据库收集本院在1996年1月至2004年3 月期间ICU收治的52例ARDS患者的临床资料,并采用配比方法按1∶6选择同期手术、病种类似而术后未发生ARDS的心内直视手术的患者行二分类Logistic回归分析,评价各影响因素的作用大小。结果本组 ARDS患者死亡率为21．2％。经二分类Logistic回归分析结果显示:术前肾功能不全(OR=6．443)、肥胖 (OR=14．331)、术前存在合并疾病(OR=11．455)、围术期出现了意外情况(OR=7．988)、术后引流多 (OR=3．804)、术后输血量大(OR=9．763)等是心内直视手术后发生ARDS的危险因素。结论针对具有 ARDS高危因素的心内直视手术患者,采取积极的防范措施,对防止心内直视手术后发生ARDS及对早期诊断和处理具有重要的实际意义。     

体外循环心内直视手术后急性心包填塞的监护

急性心包填塞是体外循环心内直视手术后的一种严重并发症。 1999年 2月至 2 0 0 2年 2月我院共行体外循环心直视手术 36 0例 ,术后发生心包填塞 8例 ,占 2 2 % ,其中 6例经急行减压手术转危为安 ,2例死亡。现将监护体会报告如下。1　临床资料心内直视手术后发生心包填塞 8例 ,     

心内直视术后急性心包填塞18例的护理

目的预防和早期发现心内直视术后心包填塞的发生,及时救治。方法回顾性分析18例心脏手术后患者床边开胸心包探查前后血流动力学、尿量、引流量的变化。结果探查前心率、CVP增高(P<0.05),血压、尿量下降(P<0.05);探查后血压、尿量回升(P<0.01),心率、CVP回落(P<0.01)。结论心内直视术后心包填塞的临床表现主要为非特异性血流动力学紊乱,术后保持引流通畅、对其进行动态观察分析,并及早床边心包探查,可降低死亡率。     

心内直视手术后急性心包填塞的监护

急性心包填塞是心内直视手术后的一种严重并发症,据报道其发生率为3～6％。我院自1958年1月至1977年2月共进行心内直视手术248例,术后发生心包填塞者4例(占1.6％)。其中3例经急行减压手术,1例采取保守治疗,均转危为安。现将我们在监护中如何观察与配合抢救的体会介绍如下。     

血小板减少症患者心脏直视手术36例的护理

目的 探讨血小板减少症（TP）患者心脏直视手术的护理方法,为今后的相关护理工作提供经验.方法 对河南省胸科医院2002年7月至2010年2月36例行心脏直视手术TP患者行及时针对性的护理,以减少并发症的发生,提高手术成功率.结果 36例患者术后有2例因心包填塞二次开胸止血,其余患者未发生重大并发症,所有病例均痊愈出院.结论 血小板减少症患者患者行心内直视手术尽管出血风险较大,但经过精心手术和及时恰当的护理处理,能取得满意疗效.     

浅低温心脏不停跳心内直视手术215例临床分析

目的：总结215例浅低温体外循环下不停跳心内直视手术的临床应用经验。方法：215例行心脏不停跳心内直视手术病例,并行循环者阻断上下腔静脉而不阻断升主动脉,不使用心脏停跳液;逆行灌注者,阻断升主动脉后经冠状静脉窦逆行持续灌注机器氧合血,鼻咽温度在（33±1）℃,均在心脏空跳下完成心内直视手术。结果：心脏手术完毕后顺利停机,术后血液动力学平稳,低心输出量综合征发生率低,无1例发生神经系统并发症及空气栓塞,早期死亡率0．93％（2／215）。结论：浅低温体外循环下不停跳心内直视手术技术安全可行,是一种接近生理状态的心肌保护方法,可应用于绝大部份心内直视手术。     

心脏介入治疗合并急性心包填塞的早期识别和处理

目的：探索介入治疗并发急性心包填塞的早期识别和治疗方法。方法：采用回顾分析的方法,分析介入治疗病人心包填塞发病特点、发生原因、治疗方法和预后。结果：9例急性心包填塞,5例为女性,4例男性；年龄在45～70(平均50±10．8)岁。3例发生在冠状动脉造影术,2例发生在体内埋藏式DDD起搏器安置术中,3例发生在射频消融术中。1例发生在二尖瓣球囊分离术。5例急性心包填塞病人给予了穿刺引流成功治愈,3例急性心包填塞病人因为生命体征不稳定,开胸手术后皆抢救成功,1例死亡。结论：起搏器安装、PTCA、射频消融和瓣膜成形术均可引起急性心包填塞。早期识别、正确处理对预后至关重要。     

Emergency exploratory sternotomy: the nurse's role

Emergency exploratory sternotomy (EES) is a life-saving procedure performed in the recovery room or ICU within the first 24 hours following cardiac surgery. Complications that may necessitate this procedure include: tamponade, hemorrhage, acute profound hypotension, atypical tamponade, coronary artery spasm, clotted grafts, refractory dysrhythmias, and cardiac arrest. The nurse plays an important role in the early recognition of these life-threatening situations and therefore must be able to recognize clinical signs that may preclude the need for EES. This article details the four clinical scenarios the nurse will see, which are: (1) cardiac tamponade, (2) acute profound hypotension where the etiology is unclear, (3) cardiac arrest unresponsive to standard CPR and drug therapy, and (4) acute massive hemorrhage where tamponade is not the primary presenting condition. The procedure for EES is discussed, including preprocedure preparations, the nurse's role in EES, and the post-EES nursing assessment. Nursing diagnoses appropriate to this event are outlined. There is a discussion on how to educate staff on EES as well as a discussion of the research outcomes of EES. Nurses caring for adult and pediatric cardiac surgery patients will find this information useful in establishing protocols for EES as well as in educating staff on how to respond effectively during this life-threatening event.     

Early Diagnosis and Rescue Pericardiocentesis for Acute Cardiac Tamponade during Radiofrequency Ablation for Arrhythmias. Is Fluoroscopy Enough?

Background: With the number of complex catheter ablation procedures increasing, procedure‐related acute cardiac tamponade is encountered more frequently in the cardiac catheterization laboratory. Survival depends on prompt recognition and rescue pericardiocentesis. Objective: The aim of this report was to validate fluoroscopic heart silhouette characteristics associated with cardiac tamponade as a diagnostic method, and evaluate the safety and effectiveness of fluoroscopy‐guided pericardiocentesis during catheter ablation. Methods: All cases of acute cardiac tamponade that occurred in the cardiac catheterization laboratory during radiofrequency catheter ablation from March 2004 to November 2009 were reviewed retrospectively. Results: Of 1,832 catheter ablation procedures performed during a 5‐year period, 10 (0.55%) were complicated by cardiac tamponade. Fluoroscopic examination confirmed the diagnosis in all 10 patients and demonstrated effusions before hypotension in four patients. All patients were stabilized by fluoroscopy‐guided pericardiocentesis with placement of an indwelling catheter and autologous transfusion. The time interval between recognition of cardiac tamponade and completion of pericardiocentesis was 6.0 ± 1.8 minutes (range 3–9 minutes). The mean aspirated blood volume was 437 mL (range 110–1,400 mL), and the mean autotransfused blood volume was 425 mL (range 100–1,384 mL). Surgical repair of the cardiac perforation was needed in one patient. No procedure‐related death occurred. Conclusion: A reduction in the excursion of cardiac silhouette on fluoroscopy is an early diagnostic sign of cardiac tamponade during radiofrequency ablation. Fluoroscopy‐guided pericardiocentesis is a safe and effective management strategy for cardiac tamponade developed in the cardiac catheterization laboratory. (PACE 2011; 9–14)     

Endothelin-1 blockade corrects mesenteric hypoperfusion in a porcine low cardiac output model

OBJECTIVE: To study the importance of endothelin-1-induced vasoconstriction in a model of acute and maintained low cardiac output, by investigating regional changes within the mesenteric and particularly the intestinal mucosal circulation. DESIGN: Prospective, controlled animal study. SETTING: University-affiliated research laboratory. SUBJECTS: Thirteen fasted, anesthetized, mechanically ventilated landrace pigs. MEASUREMENTS AND MAIN RESULTS: Cardiac output, portal venous blood flow, renal arterial flow, jejunal mucosal microcirculation by laser Doppler flowmetry, jejunal capnotonometry (Pco2 gap), and jejunal mucosal oxygenation (tPo2) were monitored. Cardiac tamponade was established to reduce portal venous blood flow to a preset end point at two thirds of baseline. Measurements were made at baseline, after 90 mins of cardiac tamponade, and 90 mins after the administration of the combined endothelinA/endothelinB antagonist tezosentan at 1 mg.kg-1.hr-1 during tamponade in seven animals. Six animals served as time controls and received only the vehicle. Cardiac tamponade decreased portal venous blood flow, renal arterial flow, and laser Doppler flowmetry, whereas the Pco2 gap increased. The change in tPo2 failed to gain statistical significance (p =.08). Administration of tezosentan during tamponade restored portal venous blood flow and laser Doppler flowmetry to baseline values, increased tPo2 above baseline, and decreased Pco2 gap. No effect on renal arterial flow was observed. Investigated variables remained unchanged in control animals after induction of cardiac tamponade. CONCLUSIONS: Endothelin-1 blockade in acute cardiac failure improves mesenteric, but not renal, perfusion, illustrating the regional importance of endothelin-1-induced vasoconstriction. Importantly, endothelin-1 blockade restored mucosal blood flow and oxygenation, which might be particularly interesting considering the implications for maintenance of mucosal barrier integrity in low output states.     

心脏介入治疗中并发急性心脏压塞的抢救和护理体会

目的 总结心脏介入性治疗中发生急性心脏压塞抢救成功和失败的护理经验。方法 回顾性分析我院1986年1月至2004年5月1818例心脏介入手术导致急性心脏压塞的资料。结果 5例患者在介入治疗术中或术后即刻出现急性心脏压症状，发0．28％，4例经心包穿刺引流和积极抢救成功，1例因射频导管消融导致左心房穿孔．心包穿刺失败，抢救无效死亡。结论 急性心脏压塞是心脏病介入性治疗操作中可危及生命的严重并发症，及早发现病情变化，积极抢救与护理能使病人转危为安。     

Reintervention in C-cell carcinoma

Cervical re-exploration in persistent medullary thyroid cancer usually fails to normalize serum calcitonin levels, which is the most sensitive criterion of tumour-free status (2 out of 21 patients in our re-exploration series). Positive lymph nodes - even at an early tumour stage - seem much more important (postoperative normal serum calcitonin: 86% in the occult tumour group, 71% in patients with palpable primary tumour and negative lymph nodes, as opposed to only 18% with a palpable cervical mass and positive lymph nodes). However, local re-exploration in case of persistent medullary thyroid cancer seems to offer a possible curative chance for the control of recurrence, especially after inadequate primary surgery. In cases without visible distant metastases a marked reduction in serum calcitonin level may be expected (21% of the preoperative level for stages N1 and N2 and 16% for stage N3 on average). In patients with elevated calcitonin levels after stimulation as sole indicator of persistent tumour the indication for reoperation should be handled cautiously. Thus, in 3 out of 5 patients with occult medullary thyroid cancer diagnosed only on the basis of venous sampling who were subjected to multiple cervical re-explorations, distant metastases were subsequently found during follow-up.     

心内直视术后出血再次开胸手术常见原因及临床防治

【目的】探讨体外循环心内直视术后出血和心脏压塞的临床特点。[方法】回顾性分析湘雅二医院因心脏直视术后出血和心脏压塞再次开胸手术87例病例,采集相关数据,进行统计学分析。【结果】术后活动性出血21例,急性心脏压塞63例,延迟性心脏压塞3例,死亡11例（活动性出血组3例,急性心脏压塞8例）。活动性出血组术后动脉收缩压、舒张压、中心静脉压、尿量进行性下降,心率增快,引流量显著增多（P〈0．05）。急性心脏压塞组术后pH值、动脉收缩压和舒张压突然快速降低及尿量显著减少,中心静脉压及心率很快增高,引流量突然减少（P〈0．05）。术后活动性出血以心脏切口、胸腺、骨膜及骨髓腔、剑突血管、心包切缘、钢丝穿孔点等多见。【结论】术前心功能不全及继发多脏器功能失调,体外循环凝血机制紊乱,术中止血不彻底,术后处理不及时是心内直视术后出血或心脏压塞的主要原因。调整术前脏器功能,加强血液保护,止血彻底,术后严密监护,必要时及时开胸止血是防治术后出血的关键。     

心脏手术后延迟性心脏压塞的诊断与治疗

目的：探讨心脏手术后延迟性心脏压塞的诊断与治疗方法。方法：回顾性分析16例心脏手术后延迟性心脏压塞的临床资料。结果：延迟性心脏压塞发生于术后7-27d，平均13．7d。12例经超声检查，3例经床边X线检查诊断延迟性心脏压塞。行心包穿刺抽液12例，行心包开窗引流2例，开胸探查1例。治愈15例，死亡1例。结论：延迟性心脏压塞临床表现不典型，易误诊误治，提高对延迟性心脏压塞的认识很重要，经正确的诊断和治疗，大多数患可治愈。     

心脏介入治疗患者并发心脏压塞的早期识别与抢救护理

目的总结心脏介入治疗患者并发心脏压塞的早期识别、急救与护理措施。方法回顾性分析12例介入性治疗导致心脏压塞患者的临床资料。结果介入性治疗术中立即出现心脏填塞症状患者6例,迟发症状6例;12例患者均经心包穿刺引流,其中11例心脏压塞解除。救治成功11例,死亡1例。结论早期识别和果断处理是成功救治心脏压塞患者的关键;心包穿刺引流是缓解心脏压塞的首选方法;详细的术前指导和术中术后密切观察病情对早期识别及赢得宝贵的抢救时间至关重要。