营养教育在腹主动脉瘤患者根治术后的临床应用

目的 探讨营养教育在腹主动脉瘤患者根治术中的应用价值。 方法 选取2017年10月至2019年10月青岛市市立 医院收治的行根治术的腹主动脉瘤患者96例，采用随机数字表法分为对照组（48例，行常规护理）和观察组（48例，行常规护理 联合营养教育），比较两组康复效果、营养指标和生活质量，另参照焦虑自评量表（SAS）和抑郁自评量表（SDS）判定患者心理状 态。 结果 观察组首次排气时间、下床活动时间和住院时间短于对照组，心理状态评分低于对照组，依从性和生活质量综合评 定问卷评分高于对照组，差异有统计学意义（P<0.05）；观察组患者体重为(68.16±6.32) kg，体质指数为（23.02±0.54）kg/m2，血清 白蛋白水平为（37.2±2.4）g/L,血清转铁蛋白水平为（2.45±0.36）g/L，血清前白蛋白水平为（267.27±25.12）mg/L，总铁结合力为 （56.17±6.24）μmol/L，高于对照组的（64.32±5.44）kg、（21.72±0.78）kg/m2 、（32.1±1.8）g/L、（2.16±0.32）g/L、（215.12±22.26）mg/L和 （50.34±5.21）μmol/L，差异有统计学意义（P<0.05）。 结论 在腹主动脉瘤患者根治术中联合营养教育可促进患者术后康复，对 患者负面情绪有缓解作用，可提高患者依从性，改善营养不良状态，促进生活质量的提升。     

Effects of the Cerebral Aneurysm Treatment Method on Coil Packing Density and Its Relationship with the Ostium Area

PurposeTo test the following hypotheses: (a) balloon or stent assistance increases coil packing density (CPD) in the endovascular treatment of intracranial aneurysms, and (b) CPD correlates to ostium area (OA) and aneurysm volume (AV).Materials and MethodsThis retrospective study included 60 aneurysms (54 ruptured and 6 unruptured) treated with simple coiling (SC) (n = 18), balloon-assisted coiling (BAC) (n = 7), or stent-assisted coiling (SAC) (n = 35) at the authors’ institution between August 2017 and December 2019. AV and OA measurements were obtained from 3-dimensional digital subtraction angiography images using commercial software. Coil sizes were retrieved from patient files, and coil volume (CV) measurements were obtained from https://www.angiocalc.com/. Analysis of covariance, multivariate covariance analysis, and Pearson correlation analyses were performed.ResultsThe median value for AV, CV, CPD, and OA was 63.4 mm³ (range, 5.5–1,771.4 mm³), 23.13 mm³ (range, 2.03–296.95 mm³), 33.29% (range, 13.41%–81.02%), and 10.7 mm² (range, 2.7–49.9 mm²), respectively. Multivariate analysis showed that the CPD values were not significantly different among the treatment groups, although OA significantly differed between the SC and SAC groups (P < .05). Pearson correlations showed that similar to AV, OA was negatively correlated with CPD (r = ?0.321, P < .05).ConclusionsThe CPD value in cerebral aneurysms treated with BAC or SAC did not differ from that in aneurysms treated with SC.     

血流导向装置治疗大脑中动脉M2段以及远部位动脉瘤的围术期重症护理

目的:探讨血流导向装置治疗大脑中动脉M2段以及远部位动脉瘤的围术期护理方法和价值。方法:选取2021年1月—2021年6月山西省某三级甲等医院神经外科16例大脑中动脉M2段以及远部位动脉瘤病人,均进行血流导向装置Pipeline治疗,总结围术期护理要点。结果:16例病人的手术成功率为100%,术后无相关并发症发生。结论:医务人员需高度关注围术期颅内动脉瘤病人,术前给予病人足够的心理支持和疏导,术中与医生、麻醉师、手术室护士紧密配合,术后密切监测并发症的发生,使病人能够安全度过围术期,顺利康复出院。     

Aortoiliac remodeling and 5-year outcome of an ultralow-profile endograft

BackgroundRemodeling of the aortoiliac anatomy is a challenge to the long-term performance of stent grafts for endovascular aneurysm repair. Changes in vessel diameter and length can result in loss of seal at attachment sites, limb disunion, or kinking, with the development of high-pressure endoleaks, migration, or limb occlusion. The aim of this study was to assess the durability and conformability of the ultralow-profile INCRAFT AAA endograft (Cordis Corporation, Milpitas, Calif) during 5-year follow-up.MethodsFrom 2010 to 2011, there were 60 patients (median age, 74 years; range, 60-94 years) with intact abdominal aortic aneurysms who were enrolled in the INNOVATION trial to evaluate the safety, effectiveness, and durability of the INCRAFT AAA device. Clinical and technical success was assessed with protocol-specified, monitored follow-up clinic visits and core laboratory-assessed computed tomography (CT) at 1 month, 6 months, and 12 months after implantation and annually through 5 years thereafter. Diameter and angulation changes at the proximal aortic neck and diameter changes at the iliac attachment zones were measured in addition to the standard CT assessments.ResultsSignificant aortoiliac remodeling was observed throughout long-term follow-up after endovascular aneurysm repair. Proximal aortic neck diameter 15 mm below the lowest main renal artery increased from 23.5 ± 2.5 mm at 1 month to 27.3 ± 2.8 mm at 5 years (P = .002). Neck dilation >5 mm was observed in 8 of 38 patients with 5-year CT studies (21%). The aortic neck straightened, with angulation decreasing from 34 ± 14 degrees preoperatively to 31 ± 11 degrees at 1 month (P < .001) and to 20 ± 12 degrees at 5 years (P = .018). Straightening of the neck was most prominent in patients who presented with a high degree of preoperative angulation (r = 0.61; P < .001). Between 1 month and 5 years, iliac attachment zone diameter increased from 13.5 ± 1.9 mm to 15.0 ± 2.4 mm on the right (P = .002) and from 13.9 ± 2.3 mm to 16.8 ± 2.7 mm on the left (P < .001). During 5 years, 9 of 72 (13%) iliac arteries enlarged >5 mm. There was a significant relationship between main body oversizing and aortic neck enlargement (r = 0.42; P = .009). No similar association was observed between iliac limb oversizing and iliac dilation over time (r = 0.10 and P = .549, right side; r = 0.14 and P = .400, left side). There were no aneurysm-related deaths in the series. There were two type IA endoleaks, both of which were present on the 1-month CT scan and associated with challenging aortic neck anatomy. No patient experienced endograft migration or rupture through 5 years. Type IB endoleaks occurred in two patients, both accompanied by iliac artery dilation and loss of seal. Stent fracture occurred in two struts of the bare transrenal stent of one patient, without loss of fixation or seal. One patient experienced graft limb occlusion and was observed without intervention. There were three patients (5%) with aneurysm sac enlargement (>5 mm) through 5 years, each of whom had type II endoleak.ConclusionsSignificant aortoiliac remodeling occurs after endograft implantation, including proximal aortic neck dilation, straightening of the neck, and iliac artery enlargement. The ultralow-profile INCRAFT device adapted well to these changes, with acceptably low 5-year rates of device-related endoleaks, endograft migration, and limb occlusion.     

Ehlers-Danlos Syndrome: It’s Not Your Normal Hoofbeats

The purpose of this article is to acquaint the reader with the presentation, diagnosis, and management of Ehlers-Danlos syndrome (EDS), a group of genetic connective tissue disorders. Progressive weakness of connective tissue is the underlying cause of all types of EDS. The symptoms of EDS are numerous, with variability in presentation. However, decreased quality of life caused by chronic pain and fatigue is a commonality of all types of EDS. This article will assist the nurse practitioner in recognizing EDS and offer guidance for treatment.     

Increased hospital costs are associated with low skeletal muscle mass in patients undergoing elective open aortic surgery

Objective

Low psoas muscle area is shown to be an indicator for worse postoperative outcome in patients undergoing vascular surgical. Additionally, it has been associated with longer durations of hospital stay in patients with cancer who undergo surgery and subsequently greater health care costs in Europe and the United States. We sought to evaluate this effect on hospital expenditure for patients undergoing vascular repair in a health care system with universal access.

Giant right coronary artery aneurysm secondary to Kawasaki disease in an infant

Kawasaki disease (KD) is a potentially decapacitating multisystemic vasculitis with unknown etiology that acquired worldwide attention due to associated coronary aneurysms leading to life-threatening complications in very young babies including thrombosis, ischemia, and rupture. High levels of suspicion for early diagnosis and prompt treatment are crucial in preventing serious complications. We report here one of the patients who developed a giant coronary aneurysm but fortunately not a life-threatening complication after 5?years of follow-up. We conclude that later intravenous immunoglobulins (IVIG) treatment could be an important factor—among others—that precipitate into such complications.