老年急性心肌梗死冠状动脉内支架置入术监护与护理

目的 总结老年急性心肌梗死患者行支架置入术的监护与护理经验.方法 对2009年1月至2010年10月住院的226例老年急性心肌梗死行急诊支架置入的患者进行回顾性分析,评价老年急性心肌梗死患者行支架置入的监护与护理效果.结果 所有老年患者经急诊行冠状动脉内支架置入术后取得满意的治疗效果,成功率达100%.结论 对老年急性心肌梗死行冠状动脉内支架置入患者实施全程的心理护理,做好术前准备,术中严密观察并与医生配合,术后加强护理和康复指导,可提高冠状动脉内支架置入术的成功率,预防和减少并发症的发生,促进老年患者早日康复,提高老年急性心肌梗死患者的生活质量.     

恶性梗阻性黄疸支架置入术337例围术期护理

目的:探讨胆道支架置入术治疗恶性梗阻性黄疸的手术护理配合方法及效果.方法:对337例恶性梗阻性黄疸患者在B超定位及X线引导下行胆道支架置入术,做好术前访视、介入器械准备、术中配合及术后病情观察.结果:本组支架置入成功325例,成功率为96.4%;12例导丝不能通过狭窄段,留置外引流管.术后1～2周复查血清总胆红素和间接胆红素下降.术后随访6个月,胆道造影示支架扩张良好,通畅无移位.发生并发症74例,其中3例术后1个月内死亡,其余经积极治疗均缓解.结论:经皮肝穿刺胆道引流与支架置入术治疗恶性梗阻性黄疸效果满意,积极的围术期护理可缩短操作时间、提高成功率、减少并发症的发生、减轻患者痛苦,值得临床推广.     

颈动脉狭窄血管支架置入术40例的护理

目的探讨颈动脉狭窄血管内支架置入术术前、术中、术后的最佳护理措施。方法对40例符合血管内支架置入术患者的护理进行总结分析。结果 40例患者共置入41枚支架,成功率100%。手术顺利、临床症状显著改善,术后无严重护理并发症。结论颈动脉狭窄血管内支架置入术的护理是保证治疗成功的重要因素。     

冠状动脉支架置入术不良反应的观察及护理

目的 :总结冠状动脉支架置入术中的不良反应及护理体会。方法 :对行冠状动脉支架置入术的 6 6例进行心理护理 ,密切观察患者病情、股动脉压力、心电图变化 ,及时发现处理并发症。结果 :6 6例中 2 1例术中发生各种不良反应 ,经及时发现并作相应处理后未发生严重并发症 ,安全送回病室。结论 :及时发现术中各种并发症并正确处理是冠状动脉支架置入成功的关键措施     

经桡动脉穿刺行冠状动脉造影及支架置入术89例围术期护理

目的:探讨经桡动脉穿刺行冠状动脉造影及支架置入术患者的围术期护理方法。方法:对89例冠心病患者开展经桡动脉穿刺行冠状动脉造影及支架置入术,给予精心围术期护理。结果:本组89例患者术后观察穿刺点渗血2例,前臂皮下瘀斑1例,桡动脉搏动消失1例,经对症处理后症状均消失,无肢体栓塞、手部缺血等严重并发症发生,手术成功率100%,手术时间(4.5±0.8)h,均康复住院。术后3～6个月后随访,76例(85.4%)显著改善,13例(14.6%)中度改善,未出现术后再狭窄。结论:精心的围术期护理是保证手术成功的关键。     

冠状动脉介入50例护理体会

冠状动脉介入具有诊断明确、疗效显著、创伤小等优点。我们对 5 0例行冠状动脉介入患者进行精心护理 ,提高了介入成功率 ,降低了并发症和病死率。现将护理体会报告如下。1　临床资料　　本组 5 0例 ,男 35例 ,女 15例 ,37～ 73岁 ,平均 5 4 .7岁。单纯冠状动脉造影 2 4例 ,经皮冠状动脉球囊成形术 (PTCA) 8例 ,植入支架 18例。临床诊断急性心梗 8例 ,陈旧性心肌梗死 2例 ,冠心病 36例 ,不明原因胸痛4例。 5 0例患者经治疗均获得成功 ,无并发症发生。2　护　理2 .1　术前护理2 .1.1　心理护理　多数患者不了解冠状动脉造影术、PTCA及支架…     

胆管内支架置入术治疗恶性阻塞性黄疸36例临床护理

目的:探讨经十二指肠镜胆管支架置入术治疗恶性阻塞性黄疸的护理方法。方法:对36例进行经十二指肠镜胆管支架置入术治疗的恶性阻塞性黄疸患者进行术前、术中及术后护理。结果:36例患者总共置入塑料支架40枚,所有患者对手术依从性好,成功率100%。术后所有患者皮肤瘙痒症状均消失,TBIL、APK、ALT等生化指标比术前明显下降(P<0.05)。结论:对胆管内支架置入术治疗恶性梗阻性黄疸患者进行术前、术中及术后精心护理对提高患者手术依从性、手术成功率以及减少并发症等方面具有积极意义。     

冠状动脉内支架植入术的护理

冠状动脉内支架植入术是冠心病介入治疗的新方法,但术后可能出现支架内血栓和出血等严重并发症。作者分析了冠状动脉支架植入术治疗ZO例冠心病患者的护理方法,其重点是术中生命体征的监护,术前术后抗凝治疗的护理,术后预防支架内血栓及出血的护理。通过这些护理措施,保证了疗效,减少了并发症。所有患者手术成功,无患者在住院期间死亡,1例患者术后发生穿刺部位皮下血肿,其余患者未发生出血性并发症,未发生支架内血栓。结果提示：冠状动脉内支架植入术是治疗冠心病的安全有效的方法,有正确的植入技术和密切的护理,其成功率高,并发症低。因此,正确的专科护理技术和方法,对确保手术的质量和疗效具有重要意义。     

护理干预在冠状动脉内支架置入术患者中的应用

目的:探讨护理干预在冠状动脉内支架置入术患者中的应用效果.方法:将126例冠状动脉内支架置入术患者随机分为对照组62例和观察组64例.入院后对照组给予常规护理,观察组在此基础上给予心脏康复知识健康教育指导;出院后对照组常规随访,进行数据收集,观察组则给予电话督导药物服用及改善生活方式指导.结果:观察组与对照组在生活质量等方面差异有统计学意义(P<0.05).结论:护理干预有助于改善冠状动脉内支架置入术患者术后生存质量.     

冠状动脉支架置入术后常见并发症的观察及护理

冠状动脉支架置入术后常见并发症很危险,甚至威胁患者生命。通过对397例行冠状动脉支架置入术的患者进行术后常见并发症的观察及护理,减少了病人并发症的发生,提高了患者的存活率。     

Changes in the way diagnostic coronary arteriography is performed due to the interventional prospect: the clinical impact

Our study was aimed at assessing whether diagnostic coronary angiography has changed in the interventional era. We have studied consecutive 1073 patients with coronary artery disease that was detected by a first angiographic study 2 years prior to (group 1: 545 patients) and after (group 2: 528 patients) the start of an interventional cardiology program in our catheterization laboratory. Radiological data and the use of intracoronary nitrates were recorded as well as demographic data and angiographic results. Pre- and post-interventional era comparison demonstrated: a significant increase in cranial, caudal and left anterior oblique angles, 19.3 degrees +/- 14.8 degrees vs. 24.3 degrees +/- 15.4 degrees, -18.4 degrees +/- 17.4 degrees vs. -23.3 degrees +/- 13.9 degrees, and 29.0 degrees +/- 23.3 degrees vs. 36.2 degrees +/- 25.4 degrees, respectively; a decrease in mean number of angiographic views and mean fluoroscopy time, 9.5 degrees +/- 1.6 degrees vs. 8.9 degrees +/- 1.8 degrees (p = 0.04) and 4.1 +/- 4.2 vs. 3.6 +/- 3.2 min (p = 0.008), respectively. The percentage of patients with normal coronary arteries on coronary arteriography decreased from 9.78 to 8.07% in the pre- and post-interventional era comparison. The way coronary arteriography is performed has changed, thanks to the new interventional attitude of invasive cardiologists. Trainees and young fellows should be trained right from the start of their fellowship to assess coronary artery disease from an interventional point of view.     

冠状动脉造影对心肌桥的检测及临床意义

目的 探讨冠脉造影中心肌桥的检出率及其临床意义。 方法 根据冠状动脉造影显示冠状动脉管腔收缩期狭窄判定心肌桥，并根据收缩期狭窄程度分为3级。 结果 1447例行冠状动脉造影的患者中共检出心肌桥10例，检出率2．2％，全部位于左前降支。2例在心肌桥近端有粥样硬化病变，管腔固定狭窄达70％以上，置入支架。其他有症状病例经药物治疗，临床症状消失。 结论 冠状动脉造影时收缩期狭窄是判定心肌桥的惟一依据，心肌桥可导致缺血性心脏事件，对有缺血症状者应予适当治疗。     

Successful implantation of a coronary sinus lead after stenting of a coronary vein stenosis

Dislodgment of the coronary sinus lead was observed in a 79-year-old patient 8 months after implantation of a biventricular pacing system. A severe stenosis in the posterolateral branch, in which the lead was previously positioned, prohibited reinsertion of the lead. Because no other branches with adequate anatomy for lead insertion were available in the targeted area, the stenosis was dilated and stented. Subsequently, the left ventricular lead could be reimplanted in the same vessel.     

Echocardiographic Diagnosis of a Right Coronary Artery-Coronary Sinus Fistula

In this case report, we describe a 67-year-old woman with right coronary artery-coronary sinus fistula. This woman had complaints of chest pain. Ischemic ECG changes and a ventricular tachycardia were detected on her electrocardiogram. Transthoracic echocardiography showed a large right coronary artery and a dilated coronary sinus. Drainage of the coronary artery to the coronary sinus was detected by colour flow mapping during transesophageal echocardiographic examination, and a 94 mmHg peak gradient was recorded by continuous wave Doppler at the drainage site. These findings were confirmed by cardiac catheterization. Transthoracic and transesophageal echocardiography can provide definitive confirmation of the right coronary artery-coronary sinus fistula, and can be the diagnostic procedure of choice when this anomaly is suspected.     

老年冠心病及血运重建对QT离散度的影响

目的 观察老年冠心病患者经皮冠状动脉介入治疗(PCI)术前后QT离散度(QTd)的变化特点与趋势,并与正常对照组进行对比,探讨QTd与冠状动脉狭窄程度和范围的关系及经皮冠状动脉腔内成形术和PCI对其的影响,以期为临床寻找一种评价PCI术预后的有效无创方法.方法 已行冠状动脉造影术的≥60岁冠心病患者679例,分为冠心病组(经冠状动脉造影证实有单支或多支病变,狭窄程度≥50％)536例.对照组(同期住院冠状动脉造影狭窄程度＜50％)143例.术前分别描记两组的常规12导联心电图,测量QTd、校正QT离散度(QTcd).经冠状动脉造影证实狭窄程度≥75％的393例冠心病患者行PCI术,并再分为3个亚组:单支病变组176例,双支病变组118例,3支病变组99例.对照组:同期住院冠状动脉造影狭窄程度＜50％患者143例.PCI各组术前、术后1天、7天,分别检测QTd、QTcd,进行比较.结果 冠心病组胆红素明显低于对照组(P＜0.01).冠心病组的总胆固醇 (TC)、低密度脂蛋白胆固醇(LDL-C)和血尿酸明显高于对照组(P＜0.01),QTd和QTcd明显比对照组延长(P＜0.01),冠心病3个亚组的QTd和QTcd在术前、术后1天和术后7天均呈逐渐下降趋势,3个亚组在组间、不同时点以及组间和不同时点的交互作用中差异均有统计学意义.单支病变组术前QTd(48.52±12.35)ms,术后1天(41.23±13.35) ms,术后7天(41.12±12.61) ms,术前QTcd(55.34±15.81)ms,术后1天(48.62±14.93) ms,术后7天(48.23±13.65) ms;双支病变组术前QTd(53.26±16.95) ms,术后1天(44.54±14.63)ms,术后7天(43.96±15.32) ms,术前QTcd(59.41±16.72)ms,术后1天(50.35±15.43) ms,术后7天(49.94±15.35)ms;3支病变组术前QTd(58.43±13.72) ms,术后1天(52.82±13.66)ms,术后7天(52.76±13.32)ms,术前QTcd(65.91±18.53)ms,术后1天(60.21±16.38) ms,术后7天(60.19±15.74) ms.结论 QTd、QTcd在冠心病患者明显升高,PCI术后明显降低,并与冠状动脉狭窄的程度和范围有关.说明QTd、QTcd可以作为临床上预测心肌缺血,评估PCI术后预后的有效无创指标.     

冠状动脉介入治疗后痉挛的原因分析及护理对策

回顾分析了2003年1月-2005年1月行冠状动脉支架植入术后4例发生冠状动脉痉挛的原因,认为可能与血管的狭窄、术中造影剂或机械刺激、精神紧张等因素有关。针对冠状动脉支架植入术后发生冠状动脉痉挛的时间和规律,认真做好术前评估,尤其是高危患健康教育和心理护理,术后严格床头交接班,了解介入治疗血管及未治疗血管狭窄的情况．并对患发作冠状动脉痉挛时的心电图变化进行分析,加强围手术期的病情观察。     

Revascularization strategies in patients with Type 2 diabetes mellitus

This review aims to describe new developments in coronary revascularization strategies for patients with pre-existing Type 2 diabetes mellitus (DM). Recommended strategies for revascularization have been an active area of study with recent important developments. In patients with Type 2 DM and multivessel coronary artery disease (CAD), coronary artery bypass graft (CABG) surgery is the preferred method for revascularization. Patients with DM are at increased risk for diffuse cardiovascular disease due to the proinflammatory, prothrombotic effects of chronic hyperglycemia. In patients undergoing percutaneous coronary intervention, drug-eluting stents and more potent antiplatelet agents especially in those presenting with acute coronary syndromes should be employed.     

Whole blood versus plasma measurements of glutamate and alanine across the human myocardium

Comparisons of whole blood and plasma aorto-coronary sinus concentration differences of glutamate and alanine were made before, during and after coronary sinus pacing in seven patients with normal and six patients with stenotic coronary arteries. Mean differences between duplicate analyses were greater in whole blood than plasma both of glutamate (7.5±5.8 vs. 3.3±3.0 μmol/l, p<0.001) and of alanine (7.9±7.0 vs. 3.8±3.4 μmol/l, p<0.001). Concentrations of glutamate were 3.4 and of alanine 1.4 times higher in whole blood than in plasma. Blood cells were calculated to be responsible for about 20% of glutamate and alanine blood exchanges across the heart. Plasma and whole blood fluxes were closely positively correlated (glutamate:r=0.81, alanine:r=0.88) and had always the same direction. Differences in myocardial exchanges of amino acids between the patients with and without coronary artery disease, as well as rapid changes during pacing, could be demonstrated in plasma analyses but were not significantly reflected in whole blood glutamate determinations. This seemed to be due to the greater variations in whole blood analysis. In conclusion, differences in aorto-coronary sinus plasma concentrations reflected, although underestimated, whole blood fluxes. Because of considerable gains in precision of analysis, plasma should be preferred to whole blood for evaluations of glutamate and alanine exchanges across the human heart.