盆腔器官脱垂病人的围手术期护理

[目的]探讨盆腔器官脱垂病人围手术期的护理要点。[方法]对100例手术治疗的盆腔器官脱垂病人的临床资料进行回顾性分析。[结果]100例病人手术后均无感染、出血及盆腔血肿,其中5例出现术后尿潴留。[结论]手术治疗是治疗盆腔器官脱垂的主要方法,恰当的围手术期护理是手术成功的重要因素之一。     

肺癌围术期感染因子和N末端脑钠肽前体血清水平动态变化

目的观察降钙素原(PCT)、C反应蛋白(CRP)、白细胞介素6(IL-6)、N末端脑钠肽前体(NT-proBNP)在肺癌围术期的血清水平的动态变化,评估其在术后监测中的应用价值。方法对72例肺癌患者分别在术前和术后1~5d进行PCT、CRP、IL-6、NT-proBNP血清水平检测,检测指标在有心脏损伤或感染并发症的患者之间进行比较。结果术后PCT、CRP、IL-6、NT-proBNP水平在所有患者中均升高。有并发症的患者PCT、CRP、NT-proBNP的峰值出现早于无并发症者,而且峰值显著高于无并发症者的峰值(P0.05);有并发症患者PCT、CRP、IL-6、NT-ProBNP下降速度均比无并发症者慢。结论联合检测PCT、CRP、IL-6和NT-proBNT可以成为肺癌术后并发症鉴别的有效手段。     

急性胆囊炎的围术期护理观察

目的 对围术期急性胆囊炎患者的护理效果进行观察和分析.方法 随机选取2015年12月1日~2016年12月1日期间该院收治的行急性胆囊炎切除术患者96例作为研究对象,将其随机分为观察组和对照组各48例.对照组患者在围术期行常规护理,观察组患者在围术期行优质护理.比较两组患者的护理效果、患者首次下床活动时间、首次进食时间和住院时间,比较两组患者的并发症发生率和护理满意度.结果 从护理效果来看,观察组患者的护理效果(93.75%)显著优于对照组(79.16%),差异有统计学意义(P<0.05);从两组患者的首次下床活动时间、首次进食时间来看,观察组患者显著早于对照组,且观察组患者的住院时间明显短于对照组,差异有统计学意义(P<0.05);从两组患者的并发症发生率来看,观察组患者的并发症发生率(16.67%)显著低于对照组(35.42%),差异有统计学意义(P<0.05);从两组患者的护理满意度来看,观察组患者的护理满意度(95.83%)显著优于对照组(81.25%),差异有统计学意义(P<0.05).结论 对急性胆囊炎手术患者在围术期采用优质护理干预方式能够显著缩短患者首次下床活动时间、首次进食时间,缩短患者住院时间,降低患者的并发症发生率,提高患者的护理满意度,提高护理效果,促进患者的痊愈,具有临床推广价值.     

心脏介入性治疗失败后急诊手术的围术期处理

心脏介入性治疗失败后造成严重并发症需急诊手术治疗者7例，其中术前经皮二尖瓣成形术5例；经皮冠状动脉成形术2例，并发心源性休克4例；术后死亡4例。处理好围手术期间诸环节是手术成功的关键，术前尽最大努力避免心源性休克的发生，术中加强心肌保护以及尽早实施脑保护措施对减少手术早期死亡率有重要意义。     

老年糖尿病患者脂肪餐后甘油三酯的变化及其对血管内皮功能的影响

目的探讨老年糖尿病患者餐后甘油三酯(TG)的动态变化及其对血管内皮功能的影响。方法随机选取空腹血脂正常的老年2型糖尿病患者及非糖尿病患者各30例,进行6 h口服脂肪餐试验,应用高分辨超声检测空腹及餐后4 h的颈动脉内-中膜厚度(IMTc)与肱动脉血流介导的血管舒张功能(FMD)。结果两组脂肪餐后TG水平均较空腹时显著增高,但糖尿病组TG曲线下面积(TG-AUC)显著高于非糖尿病组[(10．46±2,34)mmol／L对(6．48±1．26)mmol／L,P< 0．05];两组餐后IMTc均无明显改变,但FMD明显受损,糖尿病组餐后FMD下降程度(△FMD)明显高于非糖尿病组[(53．02±25．50)％对(29．19±20．42)％,P<0．05]。相关分析显示,糖尿病组TG-AUC与餐后4 h TG增加值(△TG4)呈正相关(r=0．79,P<0．05);其△FMD与△TG2呈独立相关(r=0．74,P<0．05)。结论老年糖尿病患者存在餐后高TG血症,它可导致血管内皮功能受损,促进动脉粥样硬化的发生与发展。     

Treatment and complications in flaccid neuromuscular scoliosis (Duchenne muscular dystrophy and spinal muscular atrophy) with posterior-only pedicle screw instrumentation

Literature has described treatment of flaccid neuromuscular scoliosis using different instrumentation; however, only one article has been published using posterior-only pedicle screw fixation. Complications using pedicle screws in paralytic neuromuscular scoliosis has not been described before. To present results and complications with posterior-only pedicle screws, a retrospective study was carried out in 27 consecutive patients with flaccid neuromuscular scoliosis (Duchenne muscular dystrophy and spinal muscular atrophy), who were operated between 2002 and 2006 using posterior-only pedicle screw instrumentation. Immediate postoperative and final follow-up results were compared using t test for Cobb angle, pelvic obliquity, thoracic kyphosis and lumbar lordosis. Perioperative and postoperative complications were noted from the hospital records of each patient. Complications, not described in literature, were discussed in detail. Average follow-up was 32.2 months. Preoperative, immediate postoperative and final follow-up Cobb angle were 79.8°, 30.2° (63.3% correction, p < 0.0001) and 31.9°, respectively; and pelvic obliquity was 18.3°, 8.9° (52% correction, p < 0.0001) and 8.9°. Postoperative thoracic kyphosis remained unchanged from 27.6° to 19.9° (p = 0.376); while lumbar lordosis improved significantly from +15.6° to −22.4° lordosis (p = 0.0002). Most patients had major to moderate improvement in postoperative functional and ambulatory status compared to the preoperative status. Thirteen (48.1%) perioperative complications were noted with five major complications (four respiratory in the form of hemothorax or respiratory failure that required ventilator support and one death) and eight minor complications (three UTI, two atelectasis, two neurological and one ileus). Postoperatively, we noted complications, such as coccygodynia with subluxation in 7, back sore on the convex side in 4 and dislodging of rod distally in 1 patient making a total of 12 (44.4%) postoperative complications. Of 12 postoperative complications, 6 (50%) required secondary procedure. We conclude that although flaccid neuromuscular scoliosis can be well corrected with posterior-only pedicle screw, there is a high rate of associated complications.     

异丙酚或咪达唑仑复合麻醉下心脏手术患者心肌细胞凋亡及术后早期恢复的比较

Objective To compare the cardiomyocyte apoptosis and early postoperative recovery in patients undergoing cardiac valve replacement under propofol-or midazolam-combined anesthesia.Methods Forty NYHA class Ⅱ or Ⅲ patients (aged 48-64 yr and weighing 45-78 kg) undergoing cardiac valve replacement with cardiopulmonary bypass (CPB) were randomly divided into midazolam group (Group M) and propofol group (Group P) (n=20each). The patients were premedicated with morphine 0.1 mg/kg i.v. and scopolamine 0.3 mg i.v. Anesthesia was induced with midazolam 0.2 mg/kg (in Group M) or propofol 2 mg/kg (in Group P) combined with fentanyl 10 μg/kg and vecuronium 0.1 mg/kg, and maintained with propofol 5 mg. kg-1·h-1 (in Group P) or midazolam 0.1 mg·kg-1·h-1(in Group M) and intermittent i.v. boluses of fentanyl and vecuronium after tracheal intubation. The patients were mechanically ventilated with PETCO2 maintained at 35-45 mm Hg. Myocardial tissues were obtained from the right atrium before and after CPB for determination of apoptosis in cardiomyocytes (by TUNEL). The apoptotic index was calculated. The expression of caspase-3 and caspase-9 was determined by immunohistochemical avidin-biotin-peroxidase complex (ABC) technique staining. The mean airway pressure (MAP) and heart rate (HR) were monitored. Aortic cross-clamping time, surgical and CPB times, spontaneous recovery of normal heart beat, emergence from anesthesia, extubation time and duration of ICU stay were recorded and compared between the two groups.Results The percentage of spontaneous recovery of normal heart beat after release of aortic cross clamp was significantly higher and the need for dobutamine support was significantly less in Group P than in Group M ( P ＜ 0.05). The emergence from anesthesia was significantly more rapid, the extubation time and the ICU stay were significantly shorter in Group P than in Group M (P＜0.05). There were no significant differences in apoptosis index and expression of caspase-3 and caspase-9 before CPB between the two groups. The apoptosis index and expression of caspase-3 and caspase-9 were significantly increased after CPB in Group M and significantly higher than those after CPB in Group P (P＜0.05).Conclusion Cardiomyocyte apoptosis in patients undergoing CPB can be inhibited and the postoperative recovery is more rapid under propofol-combined anesthesia.     

冠状动脉支架术后非心脏外科手术围手术期抗栓治疗

随着经皮冠状动脉介入技术的发展,其中合并其他疾病需要限期行非心脏外科手术者逐渐增多。这部分患者抗栓治疗有其特殊性,但相关研究和报道仍为数不多。现主要对近期拟行非心脏外科手术的支架术后患者围手术期抗栓策略、近期疗效及安全性进行探讨。     

心脏再同步化治疗的总结及分析

目的对心脏再同步化治疗(CRT)围手术期的处理进行探讨。方法对104例符合CRT植入指证的患者行CRT/心脏再同步化除颤器(CRTD)治疗和随访,并对围手术期的注意事项进行总结和分析。结果共成功植入CRT73例,CRTD28例。总手术成功率为97%(101/104),经心内膜成功率为93%(97/104),3例手术失败(2例术中发生急性肺水肿,1例术中发生心室颤动),另外4例因未找到冠状静脉窦开口或心脏静脉成角畸形明显或固定不可靠而分别改为右室双部位和心外膜电极。随访92%(93/101)有效,7例死亡,其中4例死于终末期心力衰竭,2例为心源性猝死,1例死于脑出血。结论 CRT手术安全、疗效可靠,应重视围手术期的管理。     

围术期老年糖尿病患者心率变异性的监测及临床意义

目的探讨围术期老年糖尿病患者非心脏手术后心脏自主神经功能的变化及意义。方法选择择期非心脏手术的老年患者160例分为糖尿病组（DM组,78例）和非糖尿病组（NDM组,82例）。用动态心电图监测仪分别记录术前（患者入院后）、术后第1天（从手术开始记录）、术后第2天（第2个24h）的心率变异性（HRV）,包括SDNN、SDANN和RMSSD。结果术前与NDM组比较,DM组SDNN、SDANN降低（P〈0．01）,RMSSD差异无统计学意义;术后第1天DM组SDNN、SDANN、RMSSD均低于术前（P〈0．05）,NDM组SDNN、SDANN低于术前（P〈0．05）,RMSSD与术前相比差异无统计学意义;术后第2天两组各指标均低于术前及术后第1天（P〈0．01）;DM组低于NDM组。结论麻醉、手术创伤及术后疼痛对患者的自主神经功能有显著的影响。与非糖尿病患者相比,糖尿病患者手术后发生自主神经功能紊乱更为严重。