乳腺癌改良根治术围手术期心理护理效果观察

目的探讨乳腺癌改良根治术围手术期心理护理的效果。方法将48例接受乳腺癌改良根治术的患者随机分为对照组和观察组,每组24例。对照组给予围手术期常规护理,观察组在对照组基础上,实施心理护理干预。应用焦虑自评量表和抑郁自评量表,在心理护理干预前后对2组患者进行测量。结果心理护理干预后,2组患者焦虑和抑郁自评量表评分均较干预前有所降低,其中观察组干预后焦虑和抑郁评分较对照组显著降低,差异有统计学意义(P0.05)。结论对接受乳腺癌改良根治术的患者,实施围手术期心理护理干预,可显著降低患者焦虑、忧郁程度,有效改善预后,值得进一步推广。     

乳腺癌根治术围手术期心理护理干预效果观察

目的探讨对乳腺癌根治术患者实施围手术期心理护理干预的效果。方法随机将58例接受乳腺癌根治术的患者平均分为2组。对照组行围术期常规护理,观察组在常规护理基础上行心理护理。应用焦虑自评量表(SAS)和抑郁自评量表(SDS),测量比较2组患者在护理干预前后的焦虑和抑郁评分。结果护理干预后,2组患者SAS和SDS评分均较干预前有所降低,但观察组患者的评分较对照组显著降低,差异有统计学意义(P0.05)。结论对接受乳腺癌根治术的患者实施围术期心理护理干预,可有效缓解或消除其焦虑和抑郁不良情绪,提高治疗依从性和信心,改善患者生活质量。     

心理干预在乳腺癌围手术期患者的应用效果观察

目的探讨实施心理干预在乳腺癌围手术期患者应用疗效。方法将60例乳腺癌患者随机分为观察组和对照组各30例,对照组予乳腺癌围术期常规护理,观察组在常规护理基础上采用心理护理措施,应用焦虑自评量表(SAS)和抑郁自评量表(SPS),对两组患者在心理干预前后进行测量。结果两组患者在心理干预后前进行测量观察组患者焦虑程度明显低于对照组,两组相比,差异有统计学意义(P0.05)。结论对乳腺癌患者实施围术期心理护理干预,可提高患者治疗依从性和降低焦虑症的发生率,有效改善预后。     

心理护理对腹腔镜全子宫切除术患者不良情绪及护理满意度的影响

目的观察心理护理在改善腹腔镜全子宫切除术患者不良情绪及提高护理满意度的应用价值。方法随机将接受腹腔镜全子宫切除术的76例患者分为2组,每组38例。对照组行围术期常规护理,观察组联合心理护理。比较2组患者干预前后焦虑、抑郁等不良情绪改善和对临床护理工作的满意度等情况。结果干预前2组患者焦虑自评量表(SAS)评分和抑郁自评量表(SDS)评分差异无统计学意义。干预后2组患者的SAS评分和SDS评分均较干预前显著改善,且与对照组相比,观察组改善程度更显著,差异有统计学意义(P<0.05)。观察组患者对护理工作的满意度高于对照组,差异有统计学意义(P<0.05)。结论对腹腔镜全子宫切除术患者围术期加强心理护理干预,能有效改善其不良情绪,提高对护理工作的满意度。     

甲状腺手术围术期心理护理效果分析

目的分析甲状腺手术围术期心理护理的效果。方法将接受甲状腺手术的96例患者随机分为2组,每组48例。对照组围术期行常规护理,观察组在常规护理的基础上联合心理护理。采用汉密尔顿焦虑量表(SAS)与抑郁量表(SDS)对护理干预前后患者的焦虑、抑郁评分进行评定比较。出院时向患者及家属发放对护理工作满意度反馈表,调查2组患者对护理工作的满意率。结果护理干预前2组患者的SAS、SDS评分差异无统计学意义(P0.05)。护理干预后2组患者的SAS、SDS评分均优于护理干预前,其中观察组患者的SAS、SDS评分优于对照组,差异有统计学意义(P0.05)。观察组患者及家属对护理工作满意率高于对照组,差异有统计学意义(P0.05)。结论在甲状腺手术围术期,积极实施心理护理,可改善患者的SAS、SDS评分水平,提高其治疗依从性和对护理工作的满意率。     

早期系统心理干预对老年住院患者焦虑抑郁及自我效能的影响

目的了解老年住院患者焦虑抑郁的发生状况,探讨早期系统心理护理对其焦虑抑郁及自我效能的影响。方法将135例入院早期伴有焦虑抑郁的老年患者按时间顺序分为干预组(67例)和对照组(68例),对照组给予一般心理支持,干预组在此基础上给予早期系统心理干预,包括建立良好的护患关系、专业的心理干预、增强自我效能感、集体心理治疗等,干预2周后评价效果。结果老年早期住院患者焦虑抑郁发生率为46.7%,两组干预前后焦虑、抑郁及自我效能得分比较,差异有统计学意义(均P0.01),但干预组焦虑和抑郁得分显著低于对照组,自我效能得分显著高于对照组(均P0.01)。结论老年住院患者焦虑抑郁发生率较高,早期系统心理干预能有效降低其焦虑抑郁的负性情绪,增强自我效能感。     

个性化心理护理在高位复杂性肛瘘围手术期患者中的应用

为探讨个性化心理护理对高位复杂性肛瘘围手术期患者焦虑、抑郁、疼痛及术后恢复的影响,将57例高位复杂性肛瘘围手术期患者随机分为观察组（28例）和对照组（29例）。对照组采用传统心理护理方式干预,观察组采用个性化心理护理方式干预,对比两组患者围手术期焦虑、抑郁及疼痛情况,以及住院时间、住院费用、创面愈合时间、患者生活质量。结果显示,观察组手术当日及术后第7天焦虑、抑郁、疼痛评分均明显低于对照组,P〈0．05;观察组住院时间、住院费用明显少于对照组,P〈0．05;两组术后创面愈合时间差异无统计学意义,P〉0．05;两组患者治疗后生活质量评分较治疗前均显著提高,P〈0．05,但组间比较差异无统计学意义,P〉0．05。结果表明,个性化心理护理可缓解高位复杂性肛瘘手术患者围手术期焦虑、抑郁等不良心理反应,减轻疼痛,有助于患者术后恢复。     

心脏瓣膜置换患者围手术期加速康复外科护理

目的探索加速康复外科护理应用于心脏瓣膜置换患者围手术期的效果。方法将2015年1~12月行低温体外循环下瓣膜置换术患者37例作为对照组,给予常规心外科治疗与护理;2016年1~12月行相同手术的患者39例作为观察组,应用加速康复外科护理进行围手术期管理。结果观察组术后腹胀、切口感染、肺部感染发生率显著低于对照组,术后首次下床时间、ICU观察时间及住院时间显著短于对照组,且住院费用显著少于对照组(P0.05,P0.01);观察组出院时满意度显著高于对照组(P0.05)。结论心脏瓣膜置换患者围手术期实施加速康复外科护理,可有效促进患者术后康复,减少术后并发症,缩短患者住院时间,降低住院费用,从而提升患者满意度。     

心理护理干预在肛门病患者围手术期的应用效果

为探讨心理护理干预在肛门病患者围手术期的应用效果,将2012年6月至2013年6月于我院接受手术治疗的120例肛门病患者随机分为对照组和观察组,各60例。对照组患者接受常规护理干预,观察组在常规护理干预基础上接受心理护理干预,对比观察两组患者术前焦虑、抑郁评分,术中配合程度、不良反应发生情况,以及患者术后满意度。结果显示,观察组患者术前焦虑、抑郁评分明显低于对照组,P〈O．05;与入院时相比,对照组患者术前30min心率、血压明显升高,P〈0．05,而观察组息者无明显变化,P〉O．05;观察组术中配合程度及术后满意度明显高于对照组,P〈O．05;观察组术中不良反应发生率明显低于对照组,P〈O．05。结果表明,心理护理干预可减轻肛门病患者术前焦虑、抑郁程度,稳定生命体征,使其积极配合手术治疗,提高其满意度,在临床中有较高的应用价值。     

无张力疝修补术围手术期心理护理对改善老年患者焦虑抑郁情绪的效果

目的分析无张力疝修补术围手术期心理护理对改善老年患者焦虑、抑郁情绪的效果。方法随机将接受无张力疝修补术的80例老年患者分为2组,各40例。对照组围术期行常规护理,观察组在对照组基础上开展心理护理。以焦虑自评量表(SAS)与抑郁自评量表(SDS)评定2组患者护理后抑郁、焦虑的改善效果。出院时评价患者及家属对护理工作的满意度。结果干预前2组患者的SAS及SDS评分差异无统计学意义(P0.05)。干预后2组患者的SAS及SDS评分较干预前均有改善,观察组的改善效果优于对照组,差异均有统计学意义(P0.05)。观察组患者及家属对护理工作满意度高于对照组,差异均有统计学意义(P0.05)。结论对接受无张力疝修补术的老年患者,在做好围术期护理的基础上给予针对性心理护理,可有效缓解其焦虑、抑郁情绪,提高对护理工作的满意度。     

Cardiac Valve Prostheses: Pathological and Bioengineering Considerations

Cardiac valve replacement with mechanical prosthetic or bioprosthetic devices enhances patient survival and quality of life. Nevertheless, prosthesis-associated complications are frequent and contribute significantly to outcome. Thrombo-embolic complications are the most important problems in patients with mechanical valves, necessitating chronic anticoagulation in all patients receiving them. In contrast, patients with bioprosthetic valves, composed of chemically treated animal tissues, generally do not require anticoagulants. However, bioprostheses fail frequently by degeneration, especially that involving cuspal calcification. This paper reviews the pathological and bioengineering considerations in the selection of cardiac prosthetic valves and the management of patients who have received these devices. The significance, morphology, and pathogenesis of the observed major complications and other alterations during function are described in detail. Contemporary investigative trends are summarized, including studies of inhibition of mineralization and other degenerative changes in bioprostheses, improved design rigid mechanical valves with pyrolytic carbon occluders and the development of central-flow, flexible polymeric leaflet valves.     

Five-year clinical evalution of the St. Jude medical valve prosthesis in 136 patients

One hundred and thirty-six patients (June 1979, through May 1984) underwent mitral, aortic or double valve replacement and apico-aortic bypass with the St. Jude Medical (SJM) prosthesis, at Ryukyu University Hospital, Okinawa. Operative mortality for the entire group was 4.4 per cent. Late mortality from 1979–1984 was 6.1 per cent. There were no deaths related to mechanical failure. Warfarin anticoagulation was recommended for all patients. The incidence of thromboembolism was 0.76/100 patient years. Post operative catheterization studies in 21 patients one year after operation showed a satisfactory recovery of cardiac function. The SJM valve seems to be the satisfactory artificial valve in present use.     

人工心脏瓣膜-患者不匹配现象研究现状

自1978年Rahimtoola首次提出人工心脏瓣膜-患者不匹配（prosthesis-patient mismatch，PPM）的定义以来，在国外对该现象的研究就得到了重视。瓣膜-患者不匹配现象被认为是影响患者生存率和生存质量的一个重要的因素，迄今为止，还有很多方面值得研究，而国内对此问题的认识并不充分。现就人工心脏瓣膜-患者不匹配的定义、研究现状、防治措施和研究进展等方面进行综述，希望能加强临床医生对瓣膜-患者不匹配现象的认识。     

瓣膜置换术后人工心脏瓣膜-患者不匹配现象研究现状

人工心脏瓣膜置换术是目前治疗瓣膜病变的主要手段,但随着对人工瓣膜研究的不断深入,人工心脏瓣膜-患者不匹配现象日益凸现,成为国内外学者研究的热点,本文就人工心脏瓣膜-患者不匹配现象的临床研究现状作一综述.     

Use of an inverted On-X mitral valve in the aortic position in a resource limited setting

Implanting an inverted aortic valve prosthesis in the mitral position has shown to be a viable solution for a small mitral annulus. We describe a case of implanting an inverted in the mitral prosthesis in the aortic position in a patient with an excessively large aortic annulus. A 46-year-old male with severe aortic insufficiency underwent aortic valve replacement during a surgical outreach program in Tegucigalpa, Honduras. Aortic valve annulus measured 30 mm on preoperative echocardiogram. An inverted On-X mechanical mitral heart valve with Conform-X sewing ring 25/33 mm was implanted with an excellent hemodynamic result and no paravalvular leak. To the best of our knowledge, this case demonstrates the first inverted mitral prosthesis implanted in the aortic valve position.     

Surgical considerations in the correction of valve dysfunction following heart transplantation

Valve dysfunction is not an uncommon occurrence following heart transplantation but when present can be managed medically with diuretics and vasodilator therapy. If medical therapy fails, these patients are considered for retransplantation. Due to the scarcity of donor hearts, efforts aimed at limiting the pool of cardiac retransplantation candidates are being focused lately on preservation of cardiac allograft function by conventional operations in lieu of a retransplant. A review of the literature for patients who underwent valve operations following their heart transplants yielded 26 cases. Four of these had isolated mitral valve procedures, 18 had tricuspid procedures, two had combined mitral and tricuspid operations and two had aortic valve replacements. In this communication, we present a case of severe aortic insufficiency developing 7 yr after heart transplantation and leading to progressive clinical deterioration and NYHA class IV heart failure symptoms. The aortic valve was replaced with a 21-mm Carbo Medics supra-annular mechanical prosthesis (CarboMedics Inc.). She had a favorable postoperative course and remains well 7 months after her operation. Surgical correction of valvular lesions is warranted if the function of the previously transplanted heart is reasonably preserved.     

瓣膜成形环在治疗功能性三尖瓣关闭不全中的疗效分析

目的 分析评价三尖瓣成形环成形术在治疗中、重度三尖瓣功能性关闭不全中的效果.方法 自2008年1月至2010年1月对75例中度至重度功能性三尖瓣反流的患者行三尖瓣成形手术,其中31例采用传统Devega法成形术(对照组);44例采用国产佰仁思瓣膜成形软环(成形环组),分析对比两组手术方法及成形效果. 结果 75例患者中围手术期死亡4例,死亡率为5.3％,其中69例(97.2％)患者于术后1个月、1年、18个月进行随访,随访末期,对照组与成形环组左室射血分数、肺动脉收缩压差异无明显统计学意义(P＞0.05),而对照组48.1％ (13/27)出现中度以上三尖瓣反流,成形环组16.7％ (7/42)出现中度以上反流,两组间差异有统计学意义(P＜0.01). 结论 三尖瓣成形环在治疗功能性三尖瓣反流方面具有较好的中期效果.