室间隔缺损合并中重度肺动脉高压41例围手术期处理的体会

１９９０年１月至１９９５年５月，手术治疗４１例室间隔缺损合并中重度肺动高压病人。其中肺动脉压力〈９．２ｋｐａ者９例，９．３－１３．２ｋｐａ者１９例，１３．３－１６．７ｋｐａ者１３例。死亡率７．３％。不室间隔缺损合并中重度肺动脉高压者手术适应征，肺动脉高压类型、肺动脉高压危象、平稳脱离呼吸机及肺部并发症的预防等问题进行讨论。     

冠状动脉旁路移植术同期行瓣膜手术病人的护理

随着人口老龄化，冠心病合并瓣膜病病人不断增加，约占手术人群10％～15％，手术后早期死亡率5％～9％，较单纯瓣膜置换或单纯搭桥要高。同期手术治疗可改善心肌缺血和心功能，但术后护理难度增加。我院自1998年-2002年共完成118例冠脉搭桥术，其中有11例同期行瓣膜手术，现将护理体会报告如下。     

高龄患者髋部骨折围手术期护理探讨

高龄髋部骨折日渐增多，手术内固定是有效治疗手段。为制定较准确、较全面的围手术期治疗、护理计划，对９７ 例６５ 岁以上髋部骨折患者进行术前全身健康状况（９ 项指标，分３ 个等级） 的综合评定；总结本组病例围手术期并发症的发生及分布情况。结果发现，围手术期并发症的发生与术前病人的全身健康状况和并存病的情况有密切关系。及时有效治疗并存病，把握手术时机，加强各系统的观察、护理，早期离床活动，是预防并发症和提高治疗效果的重要措施。     

下肢原发性静脉反流患者的围手术期护理

目的探讨采用浅静脉手术加股静脉瓣膜外修复成形术治疗下肢原发性静脉反流性疾病的围手术期护理经验。方法对我院收治的146例下肢原发性静脉反流性疾病患者进行心理护理、术后并发症的观察、康复训练指导等护理措施。结果146例中术后有5条肢体出现短暂淋巴渗漏，其余切口均一期愈合，无一例出现静脉血栓等并发症。随访6个月～10年，90．4％的患肢静脉性跛行、酸胀、疼痛等症状消失；9．6％的患肢症状明显改善；所有肢体静脉曲张消失。经彩超复查，92％的肢体深静脉瓣膜功能恢复正常。结论术前进行全面的评估，做好围手术期的心理护理，术后注重并发症的观察及康复训练指导对降低术后并发症的发生，提高手术成功率具有重要意义。     

与澳大利亚"开心行动医疗队"两次合作有感

１９９６年３月１０日—２１日和１９９７年９月３日—１２日我们两次与澳大利亚“开心行动医疗队”进行学术上的友好合作和交流。先后为２３名重症心脏病病人施行手术治疗，其中冠状动脉旁路移植术２例，心脏瓣膜置换术、瓣膜整形术１５例，巨大心脏肿瘤切除术１例，先天...     

卵巢癌单次腹腔穿刺化疗的护理

卵巢癌单次腹腔穿刺化疗的护理江苏省肿瘤医院（南京２１０００９）徐金萍自１９９２年１月至１９９６年９月，我院为２２９例卵巢癌病人进行了共８３１次单次腹腔穿刺化疗，并发症发生率仅为３１％。现将护理体会介绍如下。１临床资料：本组２２９例，均经术后病理检...     

同期行心脏瓣膜置换和冠状动脉旁路移植术后并发症的观察及护理

心脏瓣膜手术和冠状动脉旁路移植术(CABG)均已成为心脏外科的常规手术,但对部分心脏瓣膜疾病合并冠状动脉病变或冠心病合并心脏瓣膜功能不全的病人,需同期行心脏瓣膜手术和冠状动脉血运重建.由于此类病人多数病情重、病史长、年龄大、血管条件差、合并脏器功能不全者较多、手术操作复杂、手术时间长、体外循环及主动脉阻断时间长,致使病死率明显增加[1].2006年2月-2007年6月对18例行同期心脏瓣膜置换和冠状动脉旁路移植术,现对病人的临床资料进行回顾性总结,探讨其并发症的发生及护理.     

一例第3次瓣膜手术同期冠状动脉搭桥术患者的护理

一例第３次瓣膜手术同期冠状动脉搭桥术患者的护理中国医学科学院阜外医院张玉琴我院于１９９０年５月２２日成功地进行了我国首例心脏瓣膜第３次手术同期冠状动脉搭桥术。现将我们对本例患者的术前、术后护理报告如下。病例介绍患者男，６２岁，干部。１９６５年患者因风...     

经内镜放置金属胆道支架24例的体会

采用内镜法为２４例无法手术切除的恶性胆道梗阻病人放置金属胆道支架２７次，成功率８８．９％，术后黄疸完全消退７例，明显减退８例，３例病人后出现黄疸及胆管炎复发。作者对金属胆道支架放置的指证，支架长度与引流部位的选择，鼻胆管的应用以及并发症的处理等问题进行了初步探讨。     

联合瓣膜病变患者的术后护理

总结75例联合瓣膜病变患者手术后的护理。包括呼吸、循环系统的护理、引流管护理、心理护理、基础护理等。认为做好联合瓣膜病变患者手术后护理可以降低手术并发症，促进康复。     

急性主动脉夹层动脉瘤行全弓置换术后并发症的处理

目的 总结34例急性Stanford A型主动脉夹层动脉瘤行全弓置换术后并发症的发生及处理经验.方法 2005年1月至2010年10月,我院共为34例急性Stanford A型主动脉夹层动脉瘤的患者行全弓置换手术治疗,其中男28例,女6例;年龄34.0～ 60.0岁.发病至入院的时间为4～18h.术前超声检查发现合并主动脉瓣关闭不全8例,二尖瓣关闭不全1例.结果 全组术后死亡3例,病死率8.8％.术后发生严重并发症包括急性肾功能损伤13例,呼吸功能不全12例,截瘫l例,精神障碍10例,术后出血再次手术止血2例.结论 急性Stanford A型主动脉夹层动脉瘤的患者行全弓置换手术后各种并发症的发生率较高而且严重.对行全弓置换手术的患者,应加强围术期的监护,针对可能出现的各种并发症做出早期诊断和及早处理.     

浅谈麻醉手术苏醒的护理体会

目的:总结麻醉手术后患者的护理方法。方法:收集178例患者麻醉手术后的观察情况及护理康复情况,做出评价。结果:32例患者出现头痛、呕吐症状,21例患者术后有精神症状,19例患者术后出现尿潴留,17例患者术后有咽痛及声音嘶哑等症状,经过护理治疗后,均康复出院,没有其他并发症的产生,其他患者均无不良反应。结论:麻醉手术后部分患者会出现并发症,但及时的观察和良好的护理可保证患者的安全,正确的护理对患者的康复尤其重要。     

Aortic valve bypass for aortic stenosis: imaging appearances on multidetector CT

Object Aortic valve bypass is a technique used in high-risk patients with critical aortic stenosis that consists of placement of a conduit from the left ventricular apex to descending aorta. We describe the imaging appearances of this apicoaortic conduit on multidetector CT (MDCT). Methods Each patient underwent retrospective ECG-gated MDCT using a 16-detector-row scanner several days after placement of an apicoaortic conduit. All images were assessed by two radiologists who reviewed the appearance of the apicoaortic conduit and any post-operative complications. Follow-up studies were available for several patients. Results Twelve patients (9 men, 3 women, mean age - 78 years) underwent evaluation and the conduit was visible in each. The valve within the conduit was visible in ten (91%) of the 11 patients who received intravenous contrast material. Common findings were periconduit outpouching and hypoperfusion involving the left ventricle. Complications included pericardial hemorrhage, hemothorax and ventricular pseudoaneurysm. Mild to moderate increase in wall thinning was identified in the three patients who underwent follow-up imaging. Conclusion Aortic valve bypass with an apicoaortic conduit appears to be a feasible alternative to aortic valve replacement in high-risk patients. MDCT is an excellent method to assess the imaging features of such conduits.     

心脏机械瓣膜置换术后抗凝治疗中颅内出血的防护

回顾性总结我院14例心脏机械瓣膜置换术后抗凝治疗中,因抗凝强度不当导致颅内出血的病例。探讨术后抗凝治疗的防护。作者认为:术后抗凝治疗从开始治疗的第1日起即应监护至一生,这对减少抗凝治疗中出现的并发症,提高病人的生活质量,有重要的意义。     

微小型甲状腺癌围手术期护理

目的探讨微小型甲状腺癌围手术期护理方法。方法对病理诊断为乳头状癌的微小型甲状腺癌患者进行术前宣教、术后心理、伤口及引流管、并发症等综合护理。结果42例患者通过护理人员的心理疏导术前宣教和术后指导,围手术期情绪稳定,能积极配合治疗,未发生严重的术后并发症,全部顺利出院。结论微小型甲状腺癌围手术期护理有助于患者术后康复。     

Variable definitions: implications for the prediction of pulmonary complications after adult cardiac surgery.

AIM: The aim of this paper was to review the implications that variable definitions have for the prediction of post-operative pulmonary complications after cardiac surgery. METHOD: A review of the literature from 1980 to 2002. Selected studies demonstrated an original attempt to examine multivariate associations between pre, intra or post-operative antecedents and pulmonary outcomes in patients undergoing coronary artery bypass grafting (CABG). Reports that described the validation of established clinical prediction rules, testing interventions or research conducted in non-human cohorts were excluded from this review. RESULTS: Consistently, variable factor and outcome definitions are combined for the development of multivariate prediction models that subsequently have limited clinical value. Despite being prevalent there are very few attempts to examine post-operative pulmonary complications (PPC) as endpoints in isolation. The trajectory of pulmonary dysfunction that precedes complications in the post-operative context is not clear. As such there is little knowledge of post-operative antecedents to PPC that are invariably excluded from model development. CONCLUSION: Multivariate clinical prediction rules that incorporate antecedent patient and process factors from the continuum of cardiovascular care for specific pulmonary outcomes are recommended. Models such as these would be useful for practice, policy and quality improvement.     

Complications following spine fusion for adolescent idiopathic scoliosis

Complications following spine fusion for adolescent idiopathic scoliosis can be characterized as either intra-operative or post-operative. The most serious and feared complication is neurologic injury, both in the intra- and post-operative period. Other intra-operative complications include dural tears and ophthalmologic or peripheral nerve deficits, which may be related to positioning. Among the most common post-operative complications are surgical site infection, venous thromboembolism, gastrointestinal complications, and implant-related complications. Significant blood loss requiring transfusion, traditionally considered a known sequelae of spine fusion, is now being recognized as a “complication” in large national databases. Pediatric spine surgeons who care for patients with AIS must be thoroughly familiar with all potential complications and their management.     

Patients' and health care professionals' views of complications after elective surgery

In this study, which is a part of a clinical-epidemiological study of post-operative complications, the Project Peri-operative Risk (PROPER), patients' and health professionals' perceptions of complications during the patients' stay in hospital are analysed. Five hundred and ten patients admitted for elective (= planned) surgery and attending a pre-operative outpatient clinic set up for this project were seen pre-operatively and then monitored closely during and after surgery. Three months after having been operated on, they were sent a postal questionnaire in which they were asked to indicate whether they had suffered post-operative complications and to evaluate the care process. The incidence of complications reported by patients and staff was similar, but there were large differences at the individual level. Two-thirds of the staff-reported complications were not reported by the patients and vice versa. Patients generally classified complications as more severe than the staff did. Patients' evaluation of the care process was clearly related to reported complications. Most dissatisfied were those patients who reported complications not reported by the staff, and the most satisfied were those who had complications according to the staff but no complications according to themselves. The implication of these findings is discussed.     

3例经心尖行二尖瓣瓣中瓣手术老年患者的护理

总结3例二尖瓣置换术后老年患者经心尖行二尖瓣瓣中瓣手术的护理。护理内容如下。组建多学科照护团队,制订术前评估策略。术后监测血流动力学,改善心功能;优化气道管理,降低肺部并发症;监测凝血功能、肾功能,做好血糖管理,临时起搏器的护理,积极预防并发症的发生。实施多层面干预措施,改善患者预后。3例经过精心的治疗和护理,顺利出院,1个月后随访,恢复良好。     

喉癌围手术期护理

目的探讨喉癌围手术期护理方法。方法做好手术期心理护理,术后病情观察,确保呼吸道通畅,做好颈部伤口护理,发音功能训练及出院指导。结果无1例护理并发症发生。结论做好喉癌围手术期护理,能提高手术成功率,减少术后并发症,改善患者生存质量。