早期气管切开在重症脑出血患者中的应用

我科2006一01～2009—12共收治重症高血压脑出血手术后患者126例,根据病情需要均早期（切开时间〈48h内）气管切开,取得良好效果,现报告如下。     

气管切开时机对大量高血压脑出血外科治疗患者生存状况的影响

目的研究气管切开时机对大量高血压脑出血外科治疗患者生存状况的影响。方法回顾2011-04—2015-04我院收治的大量高血压脑出血患者80例,按照气管切开的时机分为早期气管切开组35例,晚期气管切开组45例。对于早期气管切开组患者,急诊手术同时行气管切开。患者进入手术室行术前准备后,由手术医师快速行经皮微创气管切开术(PDT)。晚期气管切开组根据病情于术后2~14d内行气管切开术,操作同上。结果 35例早期气管切开组患者好转32例(91.4%),死亡3例(8.6%);45例晚期气管切开组好转出院35例(77.8%),死亡10例(22.2%);早期气管切开组肺部感染23例(65.7%),晚期气管切开组肺部感染45例(100%)。早期气管切开组肺部感染率明显低于晚期气管切开组,差异有统计学意义(P0.05);早期气管切开组术后2个月日常生活能力(ADL)Ⅱ~Ⅲ级25例(71.4%),ADLⅣ级7例(20%)。晚期组术后2个月ADLⅡ~Ⅲ级20例(44.4%),ADLⅣ级15例(33.3%)。术后2个月后早期组日常生活能力明显高于晚期组;早期气管切开组平均住院时间(34.13±6.51)d,晚期气管切开组为(43.45±10.72)d,早期组平均住院时间少于晚期组,早期组再出血2例(5.71%),晚期组再出血5例(11.11%),差异有统计学意义(P0.05)。结论早期气管切开可有效提高患者的好转出院率,减轻肺部感染,提高日常生活能力,且可以缩短住院时间,降低再出血风险。     

气管切开患者护理体会

气管切开术是指颈段前壁切开,通过切口将适当大小的气管套管插入气管的手术,病人可直接通过气管套管呼吸[1],气管切开后患者的呼吸道与外界相通,正常的防御功能减弱,护理质量直接关系到患者的安全及预后。本资料收集神经内科自2009-05～2011-05收治的31例气管切开患者。现将气管切开患者的护理方法和体会报告如下。     

气管切开患者护理体会

气管切开术是指颈段前壁切开,通过切口将适当大小的气管套管插入气管的手术,病人可直接通过气管套管呼吸[1],气管切开后患者的呼吸道与外界相通,正常的防御功能减弱,护理质量直接关系到患者的安全及预后。本资料收集神经内科自2009-05～2011-05收治的31例气管切开患者。现将气管切开患者的护理方法和体会报告如下。     

脑外伤患者气管切开的护理

重型颅脑外伤患者咳嗽反射差,呼吸道分泌物增多且不易排出,易引起肺部感染,导致机体缺氧,加重脑水肿,早期气管切开可改善脑缺氧状况,促使脑组织功能恢复[1].因此,气管切开术后护理是否正确完善,会直接影响脑外伤患者抢救效果和愈后,是预防肺部感染、呼吸困难、呼吸衰竭等并发症的有效护理措施.     

气管切开病人的护理

气管切开的护理是否得当直接关系到病人的预后。通过对我科60例病人的护理实践总结了一套行之有效的护理方案。现报告如下。1临床资料我科自1999-06~2004-06共护理气管切开病人60例,其中重型颅脑损伤36例,脑出血24例;男40例,女20例;年龄10~75岁。2护理体会2·1术前护理2·1·1密切观察病情变化:脑出血或重型颅脑损伤病人病情极其危重,护士接诊后应首先观察病人的神志、瞳孔并测量生命体征。注意有无呼吸困难及呼吸道阻塞,如有应及时查找原因并排除(如清除口腔和鼻腔分泌物,有舌后坠者应采取措施)。2·1·2术前准备:重型颅脑损伤或脑出血病人…     

神经内科气管切开患者的护理干预

目的探讨神经内科气管切开患者的护理干预措施及效果。方法本文以神经内科2010-01—2012-01所收治的100例气管切开患者为对象,随机分为对照组和实验组,对照组患者接受常规临床护理,实验组患者接受护理干预,对比2组临床护理效果。结果实验组患者GCS评分、并发症发生率、食管反流和带管时间等临床指标,以及HAMA评分均显著优于对照组,2组对比差异有统计学意义(P<0.05)。结论本次结果表明,神经内科气管切开患者接受护理干预,有助于改善患者的各项临床症状,巩固临床治疗效果,因而临床应用价值较高。     

气管切开病人的护理

气管切开的护理是否得当直接关系到病人的预后。通过对我科60例病人的护理实践总结了一套行之有效的护理方案。现报告如下。     

重症脑挫裂伤患者气管切开的护理体会

目的探讨重症脑挫裂伤患者气管切开后可能出现的问题及护理措施,减少气管切开的并发症,降低重症脑挫裂伤患者的病死率。方法通过对37倒重症脑挫裂伤患者气管切开后实施严格套管护理、吸痰的护理、气管切口的护理、堵管和拔管等措施进行观察和评价。结果37例重症脑挫裂伤患者,痊愈26例,好转10例,死亡1例,3例发生肺部感染,其余34例无导管阻塞、气道狭窄、脱管、切口感染等并发症发生。结论重度脑挫裂伤患者气管切开后采用合理护理措施能够提高治愈率,减少并发症的发生。     

重型颅脑损伤患者气管切开护理

目的研究重型颅脑损伤病人气管切开后降低并发症的方法。方法对气管切开病人实施相应的护理措施。结果对25例气管切开病人采取相应的护理措施后,5例于手术后4~15d内死亡,20例均无发生严重并发症。结论对气管切开病人,在术后的护理中应严格执行消毒隔离及无菌技术操作规程,掌握好吸痰的指征及方法,加强生活护理,降低术后病人的并发症,治疗效果满意。     

低热量肠内营养护理对重症高血压脑出血术后患者的临床价值

目的研究低热量肠内营养护理对重症高血压脑出血术后患者肠黏膜屏障功能和营养状况的影响。方法回顾性分析我院收治的90例重症高血压脑出血病人,随机分为观察组45例(采用常规治疗),对照组45例(常规治疗的同时采用低热量肠内营养和护理)。对比护理后2组患者的肠黏膜屏障功能(D-LAC、DAO水平)、营养状况(TP、ALB、Hb、TFN水平)和并发症发生情况。结果观察组D-LAC、DAO水平均明显低于对照组(P0.05),营养状况(TP、ALB、Hb、TFN水平)改善情况均明显优于对照组(P0.05),并发症发生率明显低于对照组(P0.05)。结论低热量肠内营养护理可减轻肠黏膜屏障功能损伤,利于肠黏膜屏障的修复,提高患者的营养指标,降低并发症发生率。     

立体定向微创治疗高血压性脑出血

目的 探讨立体定向微创治疗高血压性脑出血的疗效及优越性。方法 对32例高血压性脑出血行立体定向血肿排空术或小骨窗开颅、显微镜辅助手术清除颅内血肿。结果本组32例术后立即复查头颅CT，血肿均清除70％以上，瞳孔散大者均有不同程度回缩。32例分刖住院12～31d，死亡4例。结论 立体定向微创治疗高血压性脑出血具有定位准确、创伤小、恢复快、病死率低等优点。     

Recurrent hypertensive intracerebral hemorrhage

Hypertensive intracerebral hemorrhage has been considered as a one-time event with rare recurrence. This observation is quite different from our experience in Taiwan. We, therefore, conducted a systematic review of our series of consecutive patients with recurrent bleeding. During a 2-year period, we encountered 47 patients with recurrent hypertensive intracerebral hemorrhage from a total of 892 consecutive patients with hypertensive hemorrhage (5.3%). There were 25 men and 22 women with a mean age of 59 ± 10 (range: 36–78) years at the onset of the first hemorrhage and 62 ± 9 (range: 39–80) years at the second hemorrhage. The median interval between 2 hemorrhages was 2 years and 4 months (range: 1 month to 8.5 years). All except one recurrent hemorrhages occurred at a site different from the previous one. Of the 38 patients admitted to our hospital for both hemorrhages only 5 were regularly treated with antihypertensive therapy. The outcome for the recurrent bleeding was grave: 26% died and 51% became totally dependent or vegetative. Recurrent hypertensive hemorrhage is not as rare as previously thought; it comprises 5.3% of our patients with hypertensive intracerebral hemorrhage. The recurrent hemorrhage, however, rarely occurs at the same location as the previous one. Uncontrolled hypertension appears to be an important risk factor for the recurrence. Control of blood pressure after the first bleeding should be attempted to prevent recurrent hemorrhage.     

高血压脑出血的手术治疗

我院自1998年至2001年手术治疗高血压脑出血24例。现总结报导如下。     

微创手术治疗高血压脑出血

高血压脑出血是目前严重威胁人类健康的一类脑血管疾病,其具有发病突然,进展迅速,死亡率及致残率高的特点。目前对于高血压脑出血的手术治疗一般采取开颅血肿清除术或微创血肿清除术。自2007年6月至2009年6月本院应用微创手术对50例高血压患者进行治疗,取得满意疗效,现报     

影响高血压脑出血病人的预后因素

目的探讨影响高血压脑出血(HICH)病人的预后因素。方法回顾性分析2008年12月~2010年6月以来42例HICH病例,从入院时年龄、临床表现、GCS评分、平均动脉压、CT检查、手术干预时间等多因素来评价患者的预后。结果经统计学处理,发现年龄、GCS、呼吸和瞳孔的改变(脑疝)、合并症、中线移位和出血的部位、出血量、平均动脉压、手术干预的时间与高血压脑出血的预后密切相关。结论综合分析多种量化因素,能前瞻性预测HICH病人的预后,指导选择合理的治疗手段。     

Cardiac function estimated by Doppler echocardiography in patients with hypertensive intracerebral hemorrhage]

We carried out transthoracic Doppler echocardiography on 38 patients with hypertensive intracerebral hemorrhage(ICH) to examine cardiac functions. The ratio of myocardial hypertrophy and the prevalence of valvular regurgitation were investigated. The E/A ratio which reflects left ventricular diastolic function and the ejection fraction(EF) of each patient were also studied to demonstrate cardiac functions in patients with hypertensive ICH. Myocardial hypertrophy was found in 39.5% of patients with hypertensive ICH. The aortic regurgitation showed a trend to have a higher prevalence in patients with hypertensive ICH when compared to normal volunteer group. Although there was no significant differences in the ejection fraction between groups, the E/A ratio in patients with hypertensive ICH showed a significantly lower value than in normal volunteer group. Therefore, transthoracic Doppler echocardiography demonstrated that patients with intracerebral ICH showed a trend to have a myocardial hypertrophy, aortic valvular regurgitation, and the lower ventricular diastolic function. Thus, transthoracic Doppler echocardiography is useful to evaluate cardiac functions in patients with hypertensive ICH.     

尼莫地平治疗高血压脑出血术后患者疗效观察

目的:探讨尼莫地平治疗高血压脑出血术后患者的临床效果。方法:将60例高血压脑出血术后患者分治疗组和照组各30例,治疗组在术后6小时开始泵点尼莫地平并持续14天。盲法对两组患者进行治疗前后功能评分并分析。结果:治疗组27例存活,3例死亡;存活病人中恢复良好19例,重残6例,植物生存2例;有效率为83.33%。尼莫地平治疗组临床效果显著优于对照组。结论:尼莫地平治疗高血压脑出血术后患者是安全有效,降低死亡率,提高了患者生存率和生活质量。     

Progression of hypertensive intracerebral hemorrhage

Hypertensive intracerebral hemorrhage (HICH) is generally considered to be a monophasic event. Enlargement of the initial hematoma after several hours or days has rarely been documented. We describe the clinical and CT findings in 8 patients (5 men, 3 women, aged 39 to 68 years) with continued bleeding or rebleeding during the acute phase of HICH. The thalamus was the most frequent site of hemorrhage (6/8). The neurologic status deteriorated in all: 6 within 24 hours, and 2 after 5 and 7 days. Persistent hypertension was common (6/8) prior to extension of the hemorrhage. The 2nd CT revealed an obvious increase in hematoma size in all cases. Four patients died and 4 survived with severe neurologic disability. These serial studies indicate that active bleeding or rebleeding can occur in HICH and suggests that the risk is particularly high with thalamic hemorrhage. We conclude that meticulous control of hypertension after HICH may be justified in selected patients.