体外循环全身热灌注疗法对中枢神经系统的影响及护理

目的探讨体外循环全身热灌注疗法对中枢神经系统的影响及其围手术期的护理对策.方法采用美国FCM的TEMET1000型体外循环全身热灌注治疗系统对80例各类晚期恶性肿瘤及丙型肝炎患者进行全身热疗,观察经120 min高温(42.5℃)平台期后,患者出现的相关中枢神经统系异常的临床表现,并通过动物实验,观察治疗高温(42.5℃)下脑组织的病理损伤情况.结果共有18例(占22.5%)患者在术后出现相关的中枢神经系统异常的临床表现;动物实验病理结果表现为神经元细胞的水肿,经过24～48 h后都可恢复.结论全身热疗对中枢神经系统造成的损伤是轻微的、可逆的.加强做好围手术期的针对性护理,对减轻患者中枢神经系统的损伤及相应的临床症状十分重要.     

心脏手术527例围术期的强化呼吸系统护理

目的探讨全身麻醉、体外循环下心内直视手术患者围术期呼吸系统护理,减少术后肺部感染的发生。方法对527例体外循环下心脏手术患者加强围手术期规范化的呼吸系统护理,术前戒烟、锻炼呼吸功能、加强排痰训练,术后注意气道湿化、加强体疗、协助排痰等。结果 527例全部获得满意效果,未发生肺部感染。结论通过加强并规范呼吸系统护理能有效减少全麻体外循环下心内直视手术患者术后肺部感染的发生。     

红外线全身热疗联合腹腔热灌注治疗晚期恶性消化道肿瘤53例的护理

目的 研究红外线全身热疗联合腹腔热灌注治疗晚期恶性消化道肿瘤的护理.方法 通过观察肿瘤患者红外线全身热疗联合腹腔热灌注患者的生命体征、皮肤、尿量,配合合理用药,采取有效护理手段防止并发症的发生.结果 本组患者中有3例热疗后出现皮肤浅Ⅱ度烫伤,4例热疗麻醉期出现低血压.其余46例无并发症.结论 对于红外线全身热疗联合腹腔热灌注治疗晚期恶性消化道肿瘤,加强护理监测及有效干预措施,可以使治疗顺利进行,避免各种并发症和副作用.     

高龄冠心病患者冠状动脉旁路移植术围术期护理体会

目的 :总结高龄冠心病患者冠状动脉旁路移植术围手术期的护理要点。方法 :本组 2 1例高龄患者 ,应用低温体外循环行CABG术 8例 ,非体外循环心脏跳动下行CABG术 13例 ,加强围手术期护理。结果 :无死亡病例发生 ,术后应用主动脉球囊反搏 1例 ,伤口感染 4例 ,平均住院 2 2 4天。结论 :针对高龄冠心病患者的生理心理特点 ,加强围手术期护理 ,可有效地帮助患者安全渡过围手术期     

体外循环全身热灌注治疗中高热期的观察及护理28例

体外循环全身热疗 (ＥＷＢＨ)是利用电脑控制 ,将人体体温安全升高 ,达到治疗温度以治疗各种晚期癌症、丙型肝炎及艾滋病的一种新方法[1] 。是在全身麻醉下 ,经病人的左右股静脉穿刺插管后 ,与体外热疗机连接形成一个完全密闭的循环系统 ,治疗时将静脉血液从一侧股静脉引流出来 ,经热疗机加温后 ,再从另一侧股静脉灌入体内 ,低流量灌注 ,需 4 0～ 6 0ｍｉｎ ,使全身血液温度达到 4 2 .0～ 4 2 .5℃ ,并维持 12 0ｍｉｎ ,既达到保护机体正常组织细胞的要求 ,又可最大限度杀灭肿瘤细胞。本文采用ＥＷＢＨ治疗 2 8例 ,短中期效果满意 ,现介绍如…     

恶性肿瘤患者全身热疗期间的护理

目的 探讨恶性肿瘤患者围热疗期间切实可行的护理措施。 方法 总结分析56例中晚期恶性肿瘤患者采用非侵入式远场大功率深度全身加热围热疗期的护理工作。结果 周到、细致的护理措施使全部病例完成治疗,无一例发生意外。结论 做好围热疗期各项护理工作,是围热疗期患者安全、防止意外事件发生、顺利完成热疗的保证。     

全身热化疗系统治疗恶性肿瘤20例围术期护理

目的:探讨ET-SPACE-I 型全身热化疗系统治疗恶性肿瘤患者围术期护理方法.方法:对20例恶性肿瘤患者行ET-SPACE-I 型全身热化疗系统治疗,并给予精心围术期护理.结果:本组均安全完成治疗,且未发生烫伤、心血管系统及中枢神经系统并发症,一般并发症症状与体征均于1周内消失,平均住院7 d.结论:全身热化疗系统治疗恶性肿瘤是一种安全、损伤小、副作用小的治疗方法,治疗前、中、后实施精心护理是保证治疗成功的重要环节.     

体外循环全身热灌注治疗术的围手术期护理

目的 探讨应用体外循环全身热灌注治疗(EWBH)术，预防和减少术后并发症的发生，缩短恢复期，提高疗效。方法 全身麻醉状态下，将病人体内的血液从一例股静脉引流出来，经加温后再从另一例股静脉灌注回体内，使身体的中心温度达到42-42．5℃，并持续120分钟，达到杀死肿瘤细胞及病毒的治疗目的。结果 我院2001年7月-2002年3月先后治疗此种病人28例。结论 就其围手术期护理进行总结，并提出相应的护理措施，可缩短术后恢复期，近期效果满意。     

膀胱癌局部灌注化疗合并射频热疗的护理

膀胱癌切除后复发或不能手术切除者 ,传统的局部放化疗疗效较差。采用射频热疗合并局部灌注化疗有助于提高膀胱癌的疗效 ,肿瘤消退率可达 82 1 %～ 84 5 % [1 ] 。我科自 2 0 0 0年 8月至 2 0 0 2年 1 2月对 1 7例膀胱癌患者进行局部灌注化疗药加射频热疗 ,有效率 82 4 %。现将方法及护理体会报道如下。1　资料和方法1 1　临床资料　本组患者 1 7例 ,均为男性 ,年龄 39～ 6 8岁 ,经B超、CT及病理学检查确诊为移行细胞癌 ,其中术后局部复发 1 1例 ,未行手术治疗 6例。1 2　治疗方法　根据病人年龄及肿瘤大小 ,本组病人采用羟基喜树碱 …     

婴幼儿心脏术后全身毛细血管渗漏综合征的护理

在体外循环 (ＣＰＢ )下实施心脏手术的婴幼儿 ,术后易出现独特的并发症———全身毛细血管渗漏综合征 (ＧＣＥＳ )。ＧＣＥＳ临床表现独特 ,涉及多个重要脏器 ,病死率高。 1995年 6月～ 2 0 0 1年 12月 ,在我院心外科监护室发生体外循环手术后全身毛细血管渗漏综合征 5例 ,经综合治疗和精心护理 ,患者均痊愈。1　临床资料　　本组男 3例 ,女 2例 ;年龄 2～ 16个月 ,平均 ( 10± 3 2 1)个月 ;体重 4 5～ 10ｋｇ。均患复杂先心病 ,全组患儿心脏畸形手术矫治满意。手术均在麻醉低温体外循环下进行。术毕回ＩＣＵ后 ,应用西门子ＳＶ30 0定容呼…     

预警护理在EV71型重症手足口病合并神经系统损害患儿中的应用研究

目的探讨预警护理在EV71型重症手足口病合并神经系统损害患儿中的应用效果。方法选取360例EV71型重症手足口病合并神经系统损害患儿为研究对象,分为观察组和对照组各180例,对照组给予常规护理,观察组在此基础上给予中枢神经系统、呼吸系统、循环系统症状及高热、血糖及白细胞监测等方面的预警护理,对比两组患儿临床治疗效果。结果观察组患儿总病程、发热持续时间、神经系统受累持续时间以及临床症状改善时间均缩短(P<0.01);观察组患儿体温、心率、呼吸频率、收缩压、外周血白细胞计数、血糖均低于对照组(P<0.05);观察组患儿的并发症发生率降低,家长满意度提高(P<0.01或P<0.05)。结论预警护理策略可有效缩短EV71型重症手足口病合并神经系统损害患儿的病程,改善症状,降低并发症风险,促进患儿预后。     

长期染发导致中枢神经系统铅中毒及其MRI表现

【目的】报道长期染发导致中枢神经系统铅中毒的临床和MRI表现。【方法】对5例经血铅检测证实的长期染发导致中枢神经系统铅中毒患者的临床资料进行回顾性分析。【结果】5例患者均为亚急性起病,主要表现为反应迟钝、记忆力下降;头颅MRI示双侧基底节区对称性等T1 长 T1、等 T2 长 T2 异常信号灶。经驱铅治疗后,症状好转、血铅水平下降,磁共振异常信号灶水肿明显减轻。【结论】含铅超标的染发剂是一种新的生活铅中毒来源,长期应用可导致中枢神经系统铅中毒和MRI双侧基底节区对称性改变。     

重症手足口病患儿早期临床表现及高危因素分析

目的探讨手足口病患儿并发中枢神经系统损害的高危因素。方法回顾性分析调查2011年2月至2012年5月河源市人民医院确诊的手足口病52例重症患儿和113例普通型患儿48h内的早期临床表现。结果两组患儿比较,年龄、热程、发病48h内神经系统表现、血糖、外周血白细胞计数、肌酸激酶同工酶CK．MB、EV71阳性、脑电图异常差异有统计学意义（P〈0．05）,而性别、呼吸、心率、血压、肺部啰音、毛细血管再充盈时间比较差异无统计学意义（P〉0．05）。Logistic回归多因素分析示早期神经系统表现、血糖升高、EV71阳性是重症手足口病并发中枢神经系统损害的高危因素。结论早期出现神经系统表现、血糖升高、EV71感染是重症手足1：7病早期高危因素。     

以神经系统损害为主要表现的钩端螺旋体病误诊研究

目的　对以神经系统损害为主要表现的钩端螺旋体病 2 2例误诊原因进行分析 ,以期提高早期对本病的确诊率。方法　系统回顾分析了以神经系统损害为主要表现的钩端螺旋体病 2 2例误诊病例的临床资料。结果　在 2 2例误诊病例中 ,误诊为脑梗死 10例 ,短暂性脑缺血发作 2例 ,中枢神经系统感染 7例 ,急性脊髓炎、格林巴利综合征、先天性颅内动脉瘤破裂出血各 1例。结论　表现为神经系统损害的钩端螺旋体病变早期误诊率高 ,误诊原因与钩端螺旋体病表现复杂多变有关 ,也与医务人员认识不足有关 ,提示对于原因不明出现神经系统损害的青壮年患者 ,需警惕钩端螺旋体病感染的可能。     

尿毒症患者内瘘的护理问题及干预

目的探讨尿毒症患者动-静脉内瘘围手术期及内瘘使用期的护理问题并通过护理干预总结护理体会。方法对我院1999-2005年12月以来以动-静脉内瘘为血管通路的70例门诊尿毒症患者内瘘围手术期及内瘘使用期进行系统的护理干预。结果70例患者内瘘手术一次性成功64例,占91.4%;6例手术不成功行二次手术,占8.6%;内瘘使用长期通畅者60例,占85.7%。因栓塞不通者4例,占5.7%。内瘘使用期最长达8年。结论通过对尿毒症患者动静脉内瘘围手术期及内瘘使用期的系统护理,能较好地保障内瘘通畅率及减少并发症。     

Emergency Department Presentations of Naltrexone-accelerated Detoxification

OBJECTIVES: To analyze emergency department (ED) presentations after naltrexone-accelerated detoxification. METHODS: This was a retrospective cohort analysis of patient presentations to Sir Charles Gairdner Hospital Emergency Department over a six-month period (November 2000 to April 2001). RESULTS: During the six-month study period, 42 patients presented to the ED after naltrexone-accelerated detoxification. This represented 7% of patients treated at a single clinic over the same period. Presentation occurred within 24 hours in 40% of cases and within 48 hours in 74%. Clinical features on presentation included gastrointestinal (GI) symptoms (vomiting, 60%; abdominal pain, 55%; diarrhea, 45%), central nervous system [CNS] symptoms (excessive drowsiness, 55%; agitation requiring sedation, 50%), and respiratory symptoms (tachypnea, 33%; respiratory difficulties, 19%). Gastrointestinal symptoms were managed adequately with supportive therapy in most cases (intravenous fluids; antiemetics). Agitation sometimes required large doses of intravenous benzodiazepines (up to 730 mg in 44 hours), one-to-one nursing, and security staff. Two of 14 patients presenting with predominantly CNS disturbance required intubation (14%). Mean in-hospital stay for all patients was 18 hours (range 1 to 92 hours). CONCLUSIONS: A few patients undergoing outpatient naltrexone-accelerated detoxification during a six-month period subsequently required ED management. The clinical features encountered in this group of patients can be subdivided into GI or CNS predominance, with different management strategies. Most presentations can be managed in the ED or an associated observation ward, but departmental resources must be available for one-to-one nursing and security personnel. Patients presenting with agitation should be sedated with benzodiazepines; large doses may be required. Close monitoring of respiratory function is mandatory, and advanced airway management may be required.     

直接经皮冠状动脉介入治疗急性心肌梗死围手术期护理措施

目的探讨急性心肌梗死(AMI)行直接经皮冠状动脉介入治疗(PCI)围术期系统整体护理的安全有效性。方法将AMI并行直接PCI患者200例,随机分为2组,整体护理组和对照组,观察2组住院天数及并发症情况。结果2组患者围术期卧床时间、住院天数、需导尿例数、需清洁洗肠例数、血肿发生例数均有显著性差异。系统整体护理组无下肢静脉栓塞病例。结论AMI行直接PCI患者实施围术期整体护理缩短住院天数,减少并发症。     

HISTOLOGICAL STUDIES ON HOG CHOLERA : I. LESIONS IN THE CENTRAL NERVOUS SYSTEM

1. A more or less marked encephalomyelitis and meningitis was found in 33 out of 39 cases of virus hog cholera which had been infected either intramuscularly or by contact and killed between 6 and 49 days after infection. 2. This hog cholera encephalitis is characterized by a varying amount of vascular and perivascular infiltration with small lymphocytes, mononuclear elements, a few plasma cells, and occasionally a few eosinophilic leucocytes. The glia shows a proliferation surrounding infiltrated vessels or forming small nodules or more diffuse foci. Satellitism and in a few instances true neuronophagia have been observed. Both microglia and macroglia participate in this process. There is no essential increase of glia fibers. In nearly all parts of the central nervous system degenerating lesions of the nerve cells such as tigrolysis and degeneration of the nucleus, including a slight atrophy of endocellular neurofibers, are encountered. No demyelinization has been observed. Specific inclusion bodies in the nerve cells are absent. In addition, in a certain number of cases microscopic and macroscopic hemorrhages are present in the brain, spinal cord, and meninges. 3. These lesions in varying degrees have been found in swine infected with four different strains of hog cholera virus. Two were laboratory strains and two were obtained from fresh field outbreaks. 4. Histological changes in the central nervous system were found as early as 6 days after infection before the animal showed central nervous system symptoms. In two cases which were paralyzed no lesions in the central nervous system could be demonstrated. 5. The lesions in the central nervous system are considered to be the anatomical substratum for the various nervous symptoms commonly found in hog cholera.     

血液净化治疗急性中毒患者的心功能监护

目的了解接受血液净化治疗的急性中毒患者心肌损害及循环功能改变情况,探讨保障血液净化治疗安全的应对措施。方法分析广州市第十二人民医院2000年1月～2004年5月的47例急性中毒患者在105次血液净化治疗阶段的心肌酶谱和心电图检查结果,发生急性并发症的情况等,总结心功能损害对血液净化治疗安全性的影响。结果本组病例80.9%存在心功能损害情况,68.1%在中毒后24～48h内出现心肌酶指标改变,接受血液净化治疗期间心电图检查异常63次(60%),心肌酶谱异常115次(71.0%);23例(48.9%)发生急性并发症,共40次(38.1%),其中血压降低18次(45%),升高1次(2.5%),心律不齐5次(12.5%),呼吸困难2次(5.0%),过敏反应6次(15.0%),出血、溶血4次(10.0%),躁动4次(10.0%),与其他疾病行血液净化治疗患者相比,发生次数多、情况复杂且程度严重,有非常显著的统计学意义(χ2=16.1,P=6E-05)。结论中毒患者存在较严重的心功能损害,接受血液净化治疗中应严密监测循环指标和心功能指标,控制各环节平稳转流,转流前后加强支持疗法,提高患者机体承受能力,保证治疗安全。     

Oxidative variables in the rat brain after sepsis induced by cecal ligation and perforation

OBJECTIVE: The underlying mechanisms of the changes in mental status, septic encephalopathy, and long-term cognitive symptoms in sepsis survivors have only been defined in part. The present study was undertaken to assess different variables of oxidative stress in several brain structures after cecal ligation and perforation in the rat. DESIGN: Prospective animal study. SETTING: Animal basic science laboratory. SUBJECTS: Male Wistar rats, weighing 250-350 g. INTERVENTIONS: Rats were subjected to cecal ligation and perforation (sepsis group) with saline resuscitation (at 50 mL/kg immediately and 12 hrs after cecal ligation and perforation) or sham operation (control group). MEASUREMENTS AND MAIN RESULTS: Oxidative damage, assessed by the thiobarbituric acid reactive species and the protein carbonyl assays, occurred early (after 6 hrs) in the course of sepsis development in the hippocampus, cerebellum, and cortex. At longer times after sepsis induction (12-96 hrs), there was no evidence of oxidative damage in all analyzed structures. Except for the striatum, earlier in sepsis development (6 hrs) we demonstrated an increase in superoxide dismutase activity without a proportional increase in catalase activity with a consequent increase in the relation of superoxide dismutase/catalase. The balance between these enzymes was restored in the studied structures 12-96 hrs after sepsis induction. CONCLUSIONS: The short-term oxidative damage demonstrated here could participate in the development of central nervous system symptoms during sepsis development, or even septic encephalopathy. The alterations in the superoxide dismutase/catalase relation were temporally related to the occurrence or not of oxidative damage in the central nervous system.