电解可脱性微弹簧圈血管栓塞治疗颅内动脉瘤患者术后并发症的护理

对38例颅内动脉瘤患者采用电解可脱性微弹簧圈行血管内栓塞治疗.结果8例发生术后并发症,其中5例脑梗死、1例动脉瘤破裂再出血、1例脑血管痉挛、1例穿刺点血肿.经及时发现作相应处理后,6例痊愈、1例好转、1例死亡.提出加强栓塞治疗术后的并发症观察及护理,是保证栓塞治疗预期效果的重要环节.     

电解可脱性微弹簧圈血管栓塞治疗颅内动脉瘤患者术后并发症的护理

对38例颅内动脉瘤患者采用电解可脱性微弹簧圈行血管内栓塞治疗。结果 8例发生术后并发症。其中5例脑梗死、1例动脉瘤破裂再出血、1例脑血管痉挛、1例穿刺点血肿，经及时发现作相应处理后。6例痊愈、1例好转、1例死亡。提出加强栓塞治疗术后的并发症观察及护理，是保证栓塞治疗预期效果的重要环节。     

Onyx胶栓塞治疗脊髓动静脉畸形

目的分析Onyx胶栓塞治疗脊髓动静脉畸形的安全性及疗效。方法回顾性分析14例接受Onyx胶栓塞治疗的脊髓动静脉畸形患者的资料,综合血管造影结果及患者脊髓功能改善情况进行疗效评价。结果本组14例患者中,12例经1次栓塞治疗,2例经2次栓塞治疗。栓塞后血管造影显示,7例病变血管完全闭塞（栓塞范围100%）,4例大部分闭塞（栓塞范围80%～99%）,3例部分闭塞（栓塞范围30%～79%）。平均随访15个月,痊愈2例,好转10例,1例无变化,1例恶化,多数患者（12/14,85.71%）脊髓功能明显改善。结论 Onyx胶是治疗脊髓动静脉畸形安全、有效的栓塞材料。     

复杂脑血管畸形复合手术术后并发症的预防护理

目的总结复杂脑血管畸形复合手术治疗患者并发症的预防护理经验。方法对78例复杂脑血管畸形复合手术治疗的患者,术后加强脑出血、脑缺血、下肢深静脉血栓形成、癫痫、颅内感染等预防护理。结果患者术后共出现并发症12例,包括脑出血2例,脑缺血7例,术后感染3例;经对症治疗护理好转出院。结论术后严密观察病情变化,积极采取针对性预防护理措施,可有效防范复杂脑血管畸形复合手术患者并发症的发生,促进患者康复。     

慢性血栓栓塞性肺动脉高压患者球囊肺血管成形术的护理

目的总结球囊肺血管成形术(BPA)的围术期护理经验。方法对10例慢性血栓栓塞性肺动脉高压患者行球囊肺血管成形术治疗,做好术前准备、术中配合,术后加强体位、饮食护理及并发症观察处置等专科护理措施。结果 10例患者无手术相关死亡病例,9例手术顺利,术后肺灌注流量3级。1例直径2 mm肺动脉经球囊扩张后破裂出血约50 mL,行血管栓塞术、止血治疗5 d后好转。10例均于术后1～5 d病情好转出院,出院3个月后随访患者心肺功能均明显好转。结论严格落实围术期专科护理措施,护士掌握并发症急救与处理流程,有助于提高慢性血栓栓塞性肺动脉高压患者球囊肺血管成形术的治疗效果,确保患者安全。     

不同血管通路在连续高容量血液滤过中的应用

对11例肾损伤大出血行高选择性肾动脉栓塞治疗术患者,术前及时纠正休克、处理膀胱痉挛、加强心理护理;术后密切观察生命体征,做好栓塞综合征等并发症预防护理。结果 11例患者经1次栓塞出血停止,未发生严重并发症。     

肾损伤大出血患者行高选择性肾动脉栓塞治疗的护理

对11例肾损伤大出血行高选择性肾动脉栓塞治疗术患者,术前及时纠正休克、处理膀胱痉挛、加强心理护理;术后密切观察生命体征,做好栓塞综合征等并发症预防护理.结果 11例患者经1次栓塞出血停止,未发生严重并发症.     

原发性肝癌行肝脾动脉双栓塞术后并发症的观察与护理

对21例原发性肝癌患者经股动脉穿刺行超选择性肝脾动脉双栓塞治疗,术后发生并发症52本次．其中发热20例、腹痛20例、顽固性腹胀6例、胸腔积液5例、重度胸腔积液1例．无脾脓肿等严重并发症发生。经加强并发症的观察与护理,临床症状缓解．患者均好转或痊愈出院。     

颈动脉海绵窦瘘介入栓塞治疗病人的护理

对16例颈内动脉海绵窦瘘的病人采用经皮股动脉插管行血管内栓塞治疗。结果15例栓塞治疗一次成功,1例因瘘口大而栓塞失败,改为外科手术治疗。术后并发颅内出血1例,经手术止血后痊愈。提出加强栓塞治疗术前、术后的病情观察及护理,是保证栓塞治疗疗效,降低并发症的基础。     

350例脊髓血管畸形介入治疗的护理分析

目的探讨护理工作在脊髓血管畸形介入治疗中的价值。方法通过对我院介入中心350例脊髓血管畸形患者介入治疗,针对脊髓血管畸形患者的临床特点和介入治疗方法的适应证、操作过程和预后等特点,从护理学的角度对术前、术中、术后等阶段进行讨论分析。结果术前进行有效的心理护理和健康教育;术中与介入医生及技术操作人员进行有机的配合、熟练使用输液微量泵、准确使用相关药物及认真观察病情变化;术后对患者进行严密的护理观察,可减少并发症的发生,将有助于该手术的成功。结论介入护理工作对脊髓血管畸形介入治疗手术的成败起着至关重要的作用。     

Somatosensory evoked potentials during spinal angiography and therapeutic transvascular embolization

Somatosensory evoked potentials (SEP's) were monitored during 42 angiographic examinations and 33 therapeutic embolization procedures in 41 patients. The SEP amplitude decreased in 36 of the 42 angiographic techniques, but recovered to baseline within 2 to 4 minutes in all but one case. Angiographic opacification of the anterior spinal artery reduced SEP amplitude in all but two patients, who had lost their proprioceptive sense and had no recognizable SEP prior to the procedure. No neurological complications resulted from any of the angiography procedures. Of the 33 embolizations, 15 were performed in 12 patients with arteriovenous malformations (AVM's) and 18 in 17 patients with spinal canal tumors. There was only one complication associated with embolization: that occurred in a patient with an intramedullary spinal cord AVM. Monitoring SEP amplitude in this series of patients provided a means of rapidly and reliably identifying the anterior spinal artery, served to assess the potential risk of contemplated steps in embolization, and aided in the execution of the angiographic procedures.     

Therapeutic percutaneous embolization for extra-axial vascular lesions of the head, neck, and spine.

Therapeutic percutaneous embolization of extra-axial vascular tumors and arteriovenous malformations was performed 41 times in 27 patients. Twenty-one patients (78%) had a clinically favorable result. In 11 of these patients, the procedure was preoperative and caused a dramatic reduction of surgical blood loss. In the remaining 10 patients with a favorable result, therapeutic embolization alone resulted in a significant clinical amelioration documented by a detailed follow-up varying from 2 to 5 years. In patients with uncontrollable epistaxis, the procedure was life-saving. The guidelines and instrumentation for a safe and effective technique are presented, based on the authors' experience with more than 100 cases of vascular lesions of the brain and spinal cord. A low-viscosity silicone polymer was developed by the authors and used clinically as an intravascular adhesive for the embolization of vascular tumors.     

心脏转复除颤器植入术患者的护理

目的总结植入型心脏转复除颤器(ICD)植入术的护理要点和常见并发症的处理方法。方法对收治的心源性猝死抢救成功的7例患者行ICD植入术,术前加强心电监护及病情观察;术后持续心电、血压监测,尤其注意观察心率、心律的变化,做好休息与饮食、疼痛及生命体征护理和健康教育,及时处理常见并发症和意外。结果 7例患者住院14~30 d,出院时的心功能NHYA分级Ⅱ~Ⅲ级。随访2~52个月,1例患者术后14个月因肺部感染、泵衰竭死亡。其余6例存活患者共记录到4次放电过程,3次室性心动过速和1次室上性心动过速,放电后均成功转复窦律;1例并发电击幻觉,1例囊袋渗液,经对症处理均好转。结论加强ICD植入术患者生命体征的观察,完善基础护理和心理护理,对可能发生的并发症采取针对性防护措施,能降低并发症及意外的发生,延长ICD的使用寿命。     

Superselective embolization of spinal arteriovenous malformations using the Tracker catheter.

Eighteen patients with spinal arteriovenous malformations had been treated with conventional embolization, surgical removal, feeder ligation, and/or feeder coagulation between February 1985 and March 1990. The lesions included six glomus, four juvenile, three extramedullary, and five dural arteriovenous malformations or fistulas. Embolic therapy was conducted in 14 patients by introducing the tip of a catheter into the segmental arteries and injecting polyvinyl alcohol strips (500-1000 microns) (conventional embolization). Follow-up spinal angiography disclosed recanalization in 10 patients (71.4%) and the appearance of new feeding arteries in five patients (35.7%). We introduced the Tracker vascular access system in April 1990. Eight patients (four glomus, one juvenile, and three dural arteriovenous malformations) were treated with the minicatheter and Ivalon particles (150-350 microns). Five patients showed neurological improvement immediately after treatment. The other three patients had severe paraparesis before treatment and did not show any improvement. One patient with a glomus-type arteriovenous malformation showed transient neurological deterioration just after embolization with the Tracker-10 to occlude a lesion fed by the posterior spinal artery, because the Ivalon particles migrated into the anterior spinal artery via the anterior spinal canal artery. In one patient with a juvenile arteriovenous malformation, the Tracker-18 catheter perforated the radiculomedullary artery originating from the right vertebral artery, and subarachnoid hemorrhage occurred. However, the Tracker-10 could later successfully occlude the arteriovenous malformation. The rates of recanalization and appearance of the new feeding vessels were 4/8 (50.0%) and 2/8 (25%), respectively.     

Transcatheter Embolization of Extremity Vascular Malformations: The Long-term Success of Multiple Interventions

Vascular malformations of the extremities present a difficult therapeutic challenge. Ligation of feeding vessels may lead to tissue necrosis and limb loss and can make subsequent attempts at transcatheter therapy impossible. The purpose of this study was to review our results with transcatheter embolization therapy in symptomatic vascular malformations in the upper and lower extremities in 50 patients. A retrospective review was conducted of a computerized database of all patients undergoing transcatheter therapy of peripheral vascular malformations at our institution. The mean age of the patients was 22 years (range 1-51 years), and 34% were male. The most common presenting symptoms included pain (80%), swelling (68%), ulceration or distal ischemia (18%), and hemorrhage (6%). Previous unsuccessful surgical treatment or embolization had been performed in 24% and 18% of patients, respectively. Predominantly venous lesions were treated by sclerotherapy with injection of ethanol. Arteriovenous and arterial lesions were treated by embolization via the arterial branch feeding vessels with cyanoacrylate. The most common vessels involved and treated were branches of the profunda femoris and tibial arteries (83% of lower extremity lesions), and branches of the brachial and radial arteries (82% of upper extremity lesions). Patients required a mean of 1.6 embolization procedures (range 1-5) over a mean period of 57 months. Sixteen patients (32%) underwent more than one embolization procedure. Of these, one was a planned staged procedure and 15 were performed secondary to residual or recurrent symptoms. Adjunctive surgical procedures were performed subsequent to embolization in three cases (6%). Ninety-two percent of patients remained asymptomatic or improved at a mean follow-up of 56 months. There was one case of limb loss (2%). Diffuse extremity vascular malformations are difficult to eradicate completely and recurrences are common. Although patients may require multiple embolization procedures and occasional adjunctive surgical resection, directed transcatheter embolization should be the treatment of choice for symptomatic extremity vascular malformations. Presented at the Annual Meeting of the Society for Clinical Vascular Surgery, Boca Raton, FL, April 5, 2001.     

Treatment of cerebral arteriovenous malformations by neuroradiological intervention and surgical resection

Summary We present the results of a series of 105 patients with cerebral arteriovenous malformations (AVMs) who were treated by a combined protocol including endovascular occlusive measures and open surgical resection. 25 patients were treated only by surgical intervention, 72 patients underwent preoperative endovascular embolization and 8 patients were treated only by embolization, seven of which were only treated for palliation.After superselective angiography the vascular territories suitable for endovascular or microsurgical approach were defined, and in most cases these territories were complementary to each other. In 56 cases, only one embolization was necessary and due to an advantageous co-localization of the departments the whole combined endovascular/neurosurgical procedure was done in one anesthesia. If several endovascular sessions were necessary (16 patients), the resection was mostly carried out immediately after the last neuroradiological session in the same anesthesia with total time of such combined procedure now averaging about 7 hours. According to the proposed grading system by Spetzler we treated 25 grade 1, 24 grade 2, 40 grade 3, 11 grade 4, and 5 grade 5 lesions. The overall success rate defined as complete resection without additional permanent neurological deficit was 89.6% (87 out of 97 surgical cases). The benefits of such combined approach to cerebral AVMs become apparent in shortened and safer surgical procedures as well as in a low complication rate.     

颈段脊髓血管畸形的血管内栓塞治疗

目的：探讨颈段脊髓血管畸形的临床及影像学特征,研究血管内治疗的方法和效果,方法：选择1991年1月至2000年6月收治的21例颈段脊髓血管畸形患者,分析其临床表现和血管造特征,所有病例均行血管内栓塞治疗。结论：其中3例于术后6个月－2年,因病灶巨大,行第2次治疗,栓塞材料选用真丝微粒或线段10例,NBCA胶3例,线段和NBCA胶联合应用8例,病灶闭塞90％以上7例,闭塞80％－90％8例,60％－80％4例,60％以下2例,临床症改善15例,无变化5例,例术后3个月死亡,结论：血管内栓塞是颈段脊髓血管畸形有效的治疗方法。     

Outcome after the treatment of spinal dural arteriovenous fistulae: a contemporary single-institution series and meta-analysis

OBJECTIVE: Spinal dural arteriovenous fistulae (Type I spinal AVMs) are the most common type of spinal vascular malformations. The optimal treatment strategy has yet to be defined, and endovascular embolization is being offered with increasing frequency. A 7-year single-institution retrospective review of outcome with surgical management of Type I spinal AVMs is presented along with a meta-analysis of existing literature. METHODS: For the institutional analysis, a retrospective review of all patients who underwent treatment at our institution for Type I spinal AVMs was performed. Between 1995 and the present (the time frame during which endovascular treatments were available), 19 consecutive patients were treated. Follow-up was performed by clinical examination or telephone interview, and functional status was measured by use of the Aminoff-Logue score. For the meta-analysis, a MEDLINE search between 1966 and the present was performed for surgical, endovascular, or combined treatment of spinal dural arteriovenous fistula. These series were included in a meta-analysis to evaluate success and failure rates, complications, and functional outcome. Specifically, embolization and microsurgery were compared. RESULTS: For the institutional analysis, 18 of 19 patients were available for long-term follow-up after surgery. There were no surgical failures, but one complication was seen. Patients demonstrated a statistically significant improvement in gait and bladder function after surgery. For the meta-analysis, 98% of those patients treated with microsurgery had their dural arteriovenous fistulae successfully obliterated after the initial treatment, compared with only 46% with embolization, as judged by radiographic or clinical follow-up. 89% percent of patients demonstrated improvement or stabilization in neurological symptoms after surgical treatment. Few complications were demonstrated with either surgery or embolization. CONCLUSION: At this point, surgery seems to be superior to embolization for the management of spinal dural arteriovenous fistula. The fistula is usually obliterated after the initial treatment, with few clinical or radiographic recurrences. The majority of patients either improve or stabilize after treatment. Few worsen, and the morbidity is minimal. It is reasonable to attempt initial embolization, especially at the time of the initial diagnostic spinal angiogram. The treating physicians and patients should be aware of the high chance of recurrence, and patients may ultimately require surgery or repeat embolization. After endovascular therapy, patients are committed to repeat angiography and probably embolization. For these reasons, it is the authors' opinion that surgery should be used as the first-line therapy for spinal dural arteriovenous fistulae.     

心脏介入术中有创血压监测及护理体会

目的探讨心脏介入术中有创血压监测及护理措施。方法收集实施心脏介入术治疗的患者370例,在心脏介入术过程中进行动脉测压管的护理、并发症观察和护理。结果置管期间穿刺部位少量渗血9例,少量出血5例,肿胀2例;测压管受压扭曲12例,体位及感应器调整后波形正常;寒战、发热2例,抗生素治疗后好转。其余患者均不明显并发症发生。结论心脏介入术中,护理人员在置管期间要严密观察,采取正确护理措施,最大限度降低并发症的发生风险,有利于手术顺利完成。