脊髓血管畸形患者栓塞治疗的护理

目的探讨脊髓血管畸形栓塞治疗的护理经验。方法对20例脊髓血管畸形患者采用ONYX和GLUBRAN进行栓塞治疗,术前备好物品,做好安全护理及健康教育;术中加强监护、防止血栓及气栓发生;术后加强穿刺点护理、并发症的预防护理。结果病灶痊愈11例,显效4例,好转3例,无变化1例,加重1例;随访栓塞术后痊愈、显效、好转的18例患者24个月,有14例完全恢复正常,4例复发,经再次栓塞或手术治疗后未再发生出血。结论脊髓畸形栓塞治疗成功的关键是密切的护理观察、并发症预防和规范化护理配合。     

先天性心脏病介入治疗的护理体会

目的:探讨先天性心脏病介入治疗的护理。方法:对35例先天性心脏病患者行介入手术并给予术前护理、术后护理、出院指导。结果:35例先天性心脏病介入手术成功率100%,病人均成功出院。结论:完善术前护理是保障手术顺利进行的前提,术后护理及健康指导是获得介入治疗手术成功的重要保证。     

血管介入远端球囊保护器在急诊PTCA中的应用护理

对69例急性心肌梗死(AMI)患者在急诊PTCA术中应用血管介入远端球囊保护器,以预防和减少介入治疗术后心脏不良事件。结果69例患者术后病情稳定,随访1~4个月均无并发症发生。提示血管介入远端球囊保护器有预防AMI及急诊介入治疗时血栓脱落造成远端血管栓塞并发症的作用,提出进行充分的术前准备和术中、术后的精心护理配合,是患者平稳安全的渡过手术期重要措施。     

颈椎后路融合术后畸形愈合致脊髓压迫患者的护理

目的 探讨前咽后入路脊髓减压治疗颈椎后路融合术后畸形愈合致脊髓压迫患者的护理方法.方法 对8例颈椎后路融合术后畸形愈合致脊髓压迫患者进行前咽后入路脊髓减压手术,同时加强围术期护理.结果 术后8例患者神经功能均恢复.平均随访22.0个月,植骨均融合,JOA评分(13.8±1.0)分.结论 术前做好心理护理、进行气管推移训练,术后严密观察生命体征、选择正确体位、预防护理并发症、加强功能锻练有利于患者康复.     

对冠状动脉介入治疗患者手术前后睡眠障碍的护理调查分析

目的 调查冠状动脉介入手术患者手术前后睡眠障碍发生的情况、主要原因 探讨专科护理措施对改善介入治疗患者术前、术后失眠的效果.方法 自行设计调查问卷对笔者所在医院180例介入治疗的患者手术前后的睡眠状况进行调查,针对所出现的失眠状况评估原因,给予个性化综合护理.结果 经过专业的评估后发现介入术前约27%的患者出现睡眠障碍,介入手术后有约54%的患者出现睡眠障碍,发生睡眠障碍的主要原因为体位不适、腰背酸痛、噪音、治疗等.结论 PCI患者术前及术后睡眠质量较差,采取有效的护理措施后能在一定程度上改善患者的睡眠质量.     

血管介入远端球囊保护器在急诊PTCA中的应用护理

对69例急性心肌梗死(AMI)患者在急诊PTCA术中应用血管介入远端球囊保护器．以预防和减少介入治疗术后心脏不良事件。结果69例患者术后病情稳定．随访1～1个月均无并发症发生。提示血管介入远端球囊保护器有预防AMI及急诊介入治疗时血栓脱落造成远端血管栓塞并发症的作用．提出进行充分的术前准备和术中、术后的精心护理配合．是惠者平稳安全的渡过手术期重要措施。     

心血管疾病患者介入治疗前心理护理重要性及体会

目的:探讨心血管疾病患者介入治疗前心理护理的重要性及心理护理的体会.方法:对来自2011年10月份至11月份我院心血管内二科进行介入治疗的50位患者进行术前心理护理的情况进行回顾性分析及资料整理.结果:介入手术成功率100％,术中患者98％配合良好手术顺利进行术后情绪稳定,有一位患者因害怕,担心术后不愿接受穿刺致使手术时间延长.结论:介入手术前做好心理护理对手术的顺利进行十分重要,不仅有利于手术顺利完成提高手术效率,而且利于患者术后情绪的稳定.     

肝癌介入治疗的护理体会

目的探讨实施有效的围介入期护理，对预防和减轻介入治疗的不良反应和并发症的发生，提高患者的生存质量的效果。方法总结2003年6月～2007年12月接受肝癌介入治疗156例患者资料。结果通过术前详细给患者介绍治疗目的、方法及效果，做好心理护理，调节饮食，完善各项辅助检查，备皮备药并按时术前用药；术中配合医生做好各方面护理；术后采取正确卧位，密切观察穿刺局部和术侧肢体情况，及时处理介入栓塞后综合征。156例患者均顺利完成血管内介入治疗并度过介入后反应期，减轻了并发症的发生。结论周密细致的护理对保证介入治疗的顺利实施和减轻并发症发生具有重要作用。     

护理干预对冠状动脉介入术患者心理状况的影响

目的:探讨护理干预对冠状动脉介入(PCI)术患者焦虑、抑郁等心理状况的影响。方法:将80例行冠状动脉介入治疗的患者随机分为干预组及对照组,两组均采用一般情况调查问卷及焦虑自评量表(SAS)、抑郁自评量表(SDS)进行调查。术前对照组进行常规治疗及护理,干预组给于系统的护理干预,术日晨及术后测心率血压,观察其变化并记录。术后当日用SAS及SDS表对两组患者进行测评并比较,观察其改变。结果:干预组患者通过护理干预后,焦虑、抑郁症状的发生明显低于对照组(P<0.05)。患者术前术后心率血压差值也有明显变化(P<0.05)。结论:护理干预可明显改善冠状动脉介入术患者的焦虑、抑郁,有效地减轻患者心理负担,从而减少术后不良反应和术后并发症。     

60岁以上患者脑动静脉畸形23例临床分析

目的分析60岁以上患者脑动静脉畸形的特点及治疗策略。方法回顾性分析23例60岁以上脑动静脉畸形患者的临床资料,根据患者病情特点,采取介入栓塞、放射治疗、显微手术及联合治疗等不同的治疗方法,通过随访,分析疗效及预后。结果介入栓塞治疗7例,其中3例为完全栓塞,另外4例部分栓塞后3例择期手术切除,1例接受放射治疗;放射治疗者共5例,其中2例随访过程中出现出血;手术治疗者共15例,其中急诊手术5例,1例患者术后出现再出血,择期手术10例,1例术后出现癫痫发作。所有患者治疗后术前症状得到不同程度改善。结论 60岁以上患者脑动静脉血管畸形有较高出血率,显微手术为主能有效改善患者的生活质量。     

支气管动脉化疗栓塞术导致脊髓损伤的原因与对策

目的探讨肺部病变支气管动脉介入治疗致脊髓损伤的因素及对策。方法常规组采用支气管动脉灌注化疗或加栓塞术治疗肺癌，采用支气管动脉明胶海绵颗粒栓塞术治疗大咯血；试验组术前加行利多卡因脊髓功能诱发试验。结果常规组583例中，肺癌373例，发生脊髓损伤11例；大咯血210例（其中支气管扩张150例、肺结核44例、肺血管畸形12例和肺隔离症4例）．未发生脊髓损伤，两者相比差异显著（P〈0．05）。试验组403例（肺癌318例和大咯血85例）中，脊髓功能诱发试验阳性58例，经微导管超选择治疗无一例发生脊髓损伤。结论支气管动脉介入治疗中，肺癌较易并发脊髓损伤，可能主要与高浓度的毒性药物损伤有关，而颗粒性栓塞影响较小。术前应用利多卡因脊髓功能诱发试验判断支气管动脉是否与脊髓根动脉共干，能有效避免脊髓动脉损伤。     

颈段脊髓血管畸形的血管内栓塞治疗

目的：探讨颈段脊髓血管畸形的临床及影像学特征,研究血管内治疗的方法和效果,方法：选择1991年1月至2000年6月收治的21例颈段脊髓血管畸形患者,分析其临床表现和血管造特征,所有病例均行血管内栓塞治疗。结论：其中3例于术后6个月－2年,因病灶巨大,行第2次治疗,栓塞材料选用真丝微粒或线段10例,NBCA胶3例,线段和NBCA胶联合应用8例,病灶闭塞90％以上7例,闭塞80％－90％8例,60％－80％4例,60％以下2例,临床症改善15例,无变化5例,例术后3个月死亡,结论：血管内栓塞是颈段脊髓血管畸形有效的治疗方法。     

Phase contrast magnetic resonance of the spinal cord preliminary results in spinal cord arterio-venous malformations

Summary In spite of the recent advances in neuroradiology including the CT scan and the spin-echo-magnetic resonance (MR), accurate diagnosis of arteriovenous malformations (AVMs) involving the spinal cord is still based on selective angiography. This last procedure is invasive and needs to be repeated during the follow up. Phase contrast angio MR was performed with a 0.5 Tesla unit on 12 patients with an AVM involving the spinal cord (7 intramedullary AVMs, 4 perimedullary fistulas, and 1 dural fistula with perimedullary venous drainage); 4 of these were investigated before and after treatment. Angio MR showed abnormal vascular patterns within the spinal canal in all cases, without distinguishing between arteries and veins; the nidus of the intramedullary AVMs was displayed in all cases. Angio MR provided images of the whole AVMs comparable to the angiographic pictures, in contrast to the spin-echo MR, which provided only discontinued images of the vessels. The efficient range of velocity providing images varied, according to the type of the malformation (slow for dural fistulas, rapid for intra-medullary AVMs). In the 4 patients investigated after treatment, comparison of the images obtained before and after treatment permitted assessment of the degree of occlusion of the malformation. Finally, angio MR as a complement of spin-echo MR can now be used as a reliable tool for detection of spinal cord AVMs, assessing the indication for angiography, and, furthermore, it can probably replace most of the postoperative control angiographies. The value of the efficient imaging velocity is disputable but seems to depend on the haemodynamic characteristics of the malformation and may then serve as a guide to angiography.     

Intermittent propofol sedation during embolization of cerebral arteriovenous malformations

Embolization procedure was performed for a 12-year-old boy with a left parietal arteriovenous malformation. Although provocative tests for the feeders to be occluded were considered very informative, the patient had to be sedated during microcatheter insertion. We used intermittent sedation with propofol during the interventional procedure, and obtained successful embolization.     

Intraoperative spinal digital subtraction angiography: technique and results

OBJECTIVE: To evaluate technical and methodological aspects of intraoperative spinal digital subtraction angiography (ISDSA) in our clinical practice and to assess its practicability, safety, and accuracy for the surgical treatment of spinal vascular malformations. METHODS: Between August 1997 and February 2002, a total of 30 patients were treated either surgically (n = 18) or endovascularly (n = 12) for spinal vascular lesions at our institution. The clinical records of five patients who underwent ISDSA were analyzed retrospectively. The thoracic segment was involved in three patients and the medullary cone in two. RESULTS: ISDSA could be performed in four cases. In one patient, the segmental artery could not be probed sufficiently while the patient was prone. No complications occurred from the application of ISDSA. The method was beneficial for the neurosurgeon in all but one patient because the vascular anatomy of the malformation was shown with respect to the surgical approach, including the nidus, and immediate resection control could be performed before wound closure. The duration of the procedure was prolonged by 45 minutes on average. CONCLUSION: ISDSA is safe and effective, especially in surgery for complex vascular and recurrent malformations. Benefits to the patient outweigh the additional expense and prolongation of the surgical procedure.     

Image-guided hypo-fractionated stereotactic radiosurgery to spinal lesions

OBJECTIVE: This article demonstrates the technical feasibility of noninvasive treatment of unresectable spinal vascular malformations and primary and metastatic spinal tumors by use of image-guided frameless stereotactic radiosurgery. METHODS: Stereotactic radiosurgery delivers a high dose of radiation to a tumor volume or vascular malformation in a limited number of fractions and minimizes the dose to adjacent normal structures. Frameless image-guided radiosurgery was developed by coupling an orthogonal pair of x-ray cameras to a dynamically manipulated robot-mounted linear accelerator that guides the therapy beam to treatment sites within the spine or spinal cord, in an outpatient setting, and without the use of frame-based fixation. The system relies on skeletal landmarks or implanted fiducial markers to locate treatment targets. Sixteen patients with spinal lesions (hemangioblastomas, vascular malformations, metastatic carcinomas, schwannomas, a meningioma, and a chordoma) were treated with total treatment doses of 1100 to 2500 cGy in one to five fractions by use of image-guided frameless radiosurgery with the CyberKnife system (Accuray, Inc., Sunnyvale, CA). Thirteen radiosurgery plans were analyzed for compliance with conventional radiation therapy. RESULTS: Tests demonstrated alignment of the treatment dose with the target volume within +/-1 mm by use of spine fiducials and the CyberKnife treatment planning system. Tumor patients with at least 6 months of follow-up have demonstrated no progression of disease. Radiographic follow-up is pending for the remaining patients. To date, no patients have experienced complications as a result of the procedure. CONCLUSION: This experience demonstrates the feasibility of image-guided robotic radiosurgery for previously untreatable spinal lesions.     

Congenital intrahepatic portohepatic shunt managed by interventional radiologic occlusion: a case report and literature review

Congenital intrahepatic portosystemic shunts are rare hepatic vascular anomalies that often lead to severe secondary conditions. A 6-year-old boy was referred for assessment of severe hypoxia, and a large liver mass was diagnosed with such a malformation and was managed by direct closure of the venous fistula by interventional radiology. Follow-up assessment shows normalization of the respiratory condition and a progressive reduction of the vascular liver lesion. Review of literature suggests that radiologic interventions are currently the criterion standard for managing these conditions, with surgery reserved for patients who are not eligible for radiologic procedure and those requiring liver transplantation.     

Superselective embolization of spinal arteriovenous malformations using the Tracker catheter.

Eighteen patients with spinal arteriovenous malformations had been treated with conventional embolization, surgical removal, feeder ligation, and/or feeder coagulation between February 1985 and March 1990. The lesions included six glomus, four juvenile, three extramedullary, and five dural arteriovenous malformations or fistulas. Embolic therapy was conducted in 14 patients by introducing the tip of a catheter into the segmental arteries and injecting polyvinyl alcohol strips (500-1000 microns) (conventional embolization). Follow-up spinal angiography disclosed recanalization in 10 patients (71.4%) and the appearance of new feeding arteries in five patients (35.7%). We introduced the Tracker vascular access system in April 1990. Eight patients (four glomus, one juvenile, and three dural arteriovenous malformations) were treated with the minicatheter and Ivalon particles (150-350 microns). Five patients showed neurological improvement immediately after treatment. The other three patients had severe paraparesis before treatment and did not show any improvement. One patient with a glomus-type arteriovenous malformation showed transient neurological deterioration just after embolization with the Tracker-10 to occlude a lesion fed by the posterior spinal artery, because the Ivalon particles migrated into the anterior spinal artery via the anterior spinal canal artery. In one patient with a juvenile arteriovenous malformation, the Tracker-18 catheter perforated the radiculomedullary artery originating from the right vertebral artery, and subarachnoid hemorrhage occurred. However, the Tracker-10 could later successfully occlude the arteriovenous malformation. The rates of recanalization and appearance of the new feeding vessels were 4/8 (50.0%) and 2/8 (25%), respectively.     

Training,certification, and reimbursement for nephrology procedures

The field of interventional nephrology is rapidly developing as an important new area of nephrology practice that holds great promise for improved patient care, outcomes, and cost control. This development is contingent on nephrologists acquiring the necessary knowledge and skills through suitable training and experience, and obtaining hospital privileges to perform these interventions. As more training programs are created, and credentialing criteria are established and accepted, it will become more practical for nephrologists to become interventionists. Reimbursement for interventional procedures can be complicated and confusing, with special problems applicable to a nephrology practice involved in the overall care of end-stage renal disease (ESRD) patients. It is essential to become familiar with applicable procedure codes, global periods, and code modifiers to correctly describe these procedures and receive correct reimbursement. Nephrologists work together with vascular access surgeons and interventional radiologists to provide care for dialysis patients. The role of each specialist in the management of vascular access depends on his or her level of interest, knowledge, and technical skill. These roles may vary considerably from one practice to another. There is potential for this area to become highly contentious, especially if one specialist feels threatened by the activities of another. Optimal patient care will be achieved only if all involved physicians take a serious intellectual interest in vascular access, develop superior clinical skills, and maintain cooperative, collegial, relationships.