心肺康复运动训练对COPD稳定期患者肺功能的影响分析

目的:探讨心肺康复运动训练对慢性阻塞性肺疾病(COPD)稳定期患者肺功能的影响。方法:选取2016年1月~2017年1月我院收治的90例COPD稳定期患者为研究对象,根据随机数字表法分为对照组和观察组,各45例。对照组予以常规治疗,观察组在对照组基础上采用心肺康复运动训练治疗。比较两组临床疗效、总住院时间及半年后再入院率,观察两组治疗前后生活质量、肺功能指标及6 min步行距离变化。结果:观察组治疗总有效率明显高于对照组,总住院时间及半年后再入院率低于对照组(P0.05);治疗后,观察组生理功能、生理职能、躯体疼痛、一般健康状况、精力、社会功能、情感职能及精神健康评分均高于对照组(P0.05);治疗后,观察组FEV1%、LVEF及6 min步行距离均高于对照组(P0.05)。结论:对COPD稳定期患者实施心肺康复运动训练,能够显著改善患者肺功能,提高生活质量,缩短住院时间,降低再入院率,效果确切,值得临床推广应用。     

物理振动疗法对肺叶切除术后患者肺功能与心肺运动耐力的影响

目的：探讨物理振动疗法对行肺叶切除术患者的肺功能与心肺运动耐力的临床效果。方法将82例择期行肺叶切除术的患者随机分为干预组42例和对照组40例,对照组按常规方法治疗,干预组在常规方法基础上辅以物理振动疗法,于治疗前、治疗后测定患者肺功能指标(肺活量、一秒用力呼气容积)和心肺运动耐力参数(最大功率、无氧阈值、最大公斤耗氧量、氧脉搏),比较组间和治疗前后差异。结果治疗前后组内比较各参数及其改变程度有明显改善,FVC、FEV1明显增加,干预组增加程度更大,治疗后组间比较干预组参数值明显高于对照组,差异具有统计学意义(P<0.05),干预组患者肺功能改善更明显。治疗前两组心肺参数比较差异无统计学意义(P>0.05),治疗后各参数均明显增加,组间比较干预组各参数值均高于对照组,干预组增加程度更大,差异具有统计学意义(P<0.05),可见干预组患者心肺运动耐力得到了明显改善。两组患者均有并发症发生,干预组患者并发症发生率为7.2%,对照组并发症发生率为10.0%,差异均无统计学意义( P>0.05)。结论对行肺叶切除术患者,术后辅以物理振动疗法可使患者肺功能与心肺运动耐力明显改善,利于患者恢复。     

专职康复护士在冠脉搭桥术后的应用效果观察

目的探讨心脏专职康复护士在冠脉搭桥术后早期康复中的应用效果。方法选取2015年6月—2017年6月在本院行冠脉搭桥的患者3224例,根据患者病案号尾数单双号随机分为试验组和对照组,对照组由管床护士实施早期康复治疗,试验组由专职康复护士实施早期康复治疗,对比两组患者的术后不良事件发生率。结果两组患者的术后不良事件发生率存在统计学差异(P0.01)。结论心脏专职康复护士在冠脉搭桥术后早期康复中的应用降低了冠脉搭桥术后不良事件的发生率。     

早期呼吸训练器治疗对冠脉搭桥术后低氧血症患者肺部并发症的影响北大核心CSCD

目的观察冠脉搭桥术后低氧血症患者早期呼吸训练器治疗的疗效。方法 2013年2月至2016年9月,冠脉搭桥术后低氧血症患者53例,随机分为对照组(n=25)和观察组(n=28)。两组均进行常规治疗,观察组在此基础上应用呼吸功能训练器进行呼吸功能锻炼。结果拔管后3 d,观察组1秒用力呼气容积(FEV_1)(实测值)和FEV_1/用力肺活量(FVC)明显高于对照组(t>3.590,P<0.01),氧分压(PaO_2)水平显著高于对照组(t=5.824,P<0.001);两组FEV_1(实测值)、FEV_1(实测值/预计值)和FEV_1/FVC均较术前降低(F>1.044,P<0.05)。观察组总住院时间短于对照组(t=-2.138,P=0.037)。两组术后1 d PaO_2水平均较术前及拔管后3 d高(P<0.001)。两组机械通气时间和ICU住院时间无显著性差异(P>0.05)。结论早期呼吸训练器肺康复治疗有助于改善冠脉搭桥术后患者肺功能,进而改善氧合状态,缩短住院时间。     

系统化针对性护理对冠脉搭桥术后患者精神障碍的干预效果

目的:探究系统化针对性护理对冠脉搭桥术后患者住院期间精神障碍的干预效果。方法:选取2015年3月~2017年2月在我院行冠脉搭桥手术的90例患者作为研究对象,随机分为对照组和观察组,每组45例。对照组给予常规护理,观察组给予系统化针对性护理,比较两组患者住院期间精神障碍的发生情况和生活质量。结果:观察组术后精神障碍发生率为2.22%,明显低于对照组的13.33%,差异有统计学意义,P0.05;观察组的生活质量评分为(82.70±5.69)分,高于对照组的(77.44±5.77)分,差异有统计学意义,P0.05。结论:对冠脉搭桥手术患者实施系统化针对性护理,有助于降低患者住院期间精神障碍的发生风险,并可提高患者的生活质量。     

渐进式康复运动对促进冠脉内支架植入术患者康复效果的影响

目的：分析渐进式康复运动对促进冠脉内支架植入术患者康复效果的影响。方法选取2013年1月至2015年10月本院收治的接受冠脉内支架植入手术的患者126例随机分为两组,对照组患者进行常规护理,观察组在基础护理的同时进行渐进式康复运动,比较两组护理效果。结果观察组患者护理后的焦虑自评量表评分低于对照组;射血分数、活动强度均比对照组高;心理失常、迷走反射、血压异常等并发症并发率比对照组低。差异显著,具有统计学意义（P＜0．05）。结论渐进式康复运动对促进冠脉内支架植入术患者康复效果良好,值得在临床上推广使用。     

肺康复运动训练对肺叶切除术后患者肺功能的影响

目的探讨肺康复运动训练对肺叶切除术后患者肺功能的影响。方法选择我院胸外科肺叶切除术后患者40例,随机分为观察组20例和对照组20例。观察组进行常规护理和肺康复运动训练1个月,对照组给予常规护理。两组患者分别于术前及术后1个月进行肺功能测定。结果患者术后一个月肺功能指标FVC、FEV1及MVV与术前比较,差异均具有显著意义（p〈0．01）。实施肺康复运动训练1个月后,两组患者肺功能指标FEV1及FEV1／FVC比较,差异具有显著意义（P〈0．05）。结论肺切除术后患者的肺功能下降;肺康复运动训练能有效改善肺叶切除术后患者的肺功能,促进患者术后康复。     

心脏运动康复对PCI术后病人心肺功能和运动耐力的影响

[目的]观察个性化、标准化心脏运动康复方案对经皮冠状动脉介入(PCI)术后病人心肺功能改善以及运动耐力的影响。[方法]选取2018年5月-2019年2月于我科住院治疗的51例PCI术后病人为对照组,2019年3月-2019年12月住院治疗的49例病人为试验组。对照组采用PCI围术期常规护理,试验组在对照组的基础上实施由心脏运动康复小组提供的个性化、标准化心脏运动康复方案。比较两组干预前及干预后6个月心肺运动实验指标、6 min步行试验等指标。[结果]干预后6个月试验组心肺运动试验指标最大代谢当量(METs)为(6.64±1.21)MET、无氧阈值为(14.05±1.53)kg·min、最大摄氧量(VO2max)为(1.63±0.36)L/min、最大千克摄氧量(VO2max/kg)为(22.11±3.75)mL/(kg·min)、最大氧脉搏(VO2max/HR)为(12.42±3.12)mL/beat均优于对照组(P均<0.05);6 min步行试验结果为(468.34±14.78)m,高于对照组的(435.29±15.65)m(P<0.05)。[结论]心脏运动康复方案有效改善了PCI术后病人的心肺功能和运动耐力,具有一定的临床应用价值。     

冠脉搭桥术后患者行食管Ca切除的护理

冠状动脉搭桥术是治疗重症冠心病的一种有效手段。食管Ca是本地区的一种常见病，手术治疗是首选方案，病人所受到创伤也比较大。我科于2006年5月18日收治1例冠状动脉搭桥术后4年。患食管Ca的患者，经过积极的手术治疗和精心护理，患者于两周后好转出院，现将护理体会总结如下。     

康复治疗对重症冠心病患者冠状动脉搭桥术后生活质量的影响

目的观察康复治疗对重症冠心病患者冠状动脉搭桥术后患者生活质量(QOL)的影响。 方法58例拟行冠状动脉搭桥的重症冠心病住院患者随机分为康复组（n=31）和对照组(n=27)。康复组于手术前、后均给予逐渐递增的运动和适当的心理干预治疗,对照组采取常规治疗。2组均于手术前、后采用SF-36量表、6 min步行距离(6MWD)和术后平均住院时间来观察患者生活质量的改善情况。 结果与对照组比较,康复组SF-36量表中躯体功能、一般健康状况、精力、情感职能和心理健康差异有统计学意义（P＜0.01）,康复组6MWD明显高于对照组（P＜0.01）,康复组患者术后平均住院时间较对照组明显缩短（P＜0.01）。 结论康复可以提高重症冠心病患者冠状动脉搭桥术后的生活质量。     

Stressors and anxiety in patients undergoing coronary artery bypass surgery.

BACKGROUND: Patients undergoing coronary artery bypass surgery who have increased anxiety levels have poorer outcomes than patients with lower levels, yet few studies have identified the concerns associated with this anxiety. OBJECTIVE: To describe the concerns of patients undergoing coronary artery bypass surgery and to identify concerns that were associated with higher levels of anxiety. METHOD: Patients (n = 172) were interviewed to determine their concerns and anxiety levels before surgery, before discharge, and 10 days after discharge. Multiple regression was used to determine the predictors of anxiety. RESULTS: Although individual concerns changed over time, anxiety levels did not change from before to after surgery, remaining low to moderate. Being female and having more concerns about waiting for the surgery, being in pain/discomfort, and resuming lifestyle were predictors of increased anxiety before surgery. Predictors of increased anxiety while hospitalized after the surgery included taking anxiolytic or antidepressant medications, higher anxiety levels before surgery, concerns about personal things being inaccessible, and difficulty sleeping. Patients with higher anxiety levels after discharge were older, more anxious before surgery, and had concerns about being in pain/discomfort. CONCLUSION: Patients waiting for coronary artery bypass surgery should be routinely assessed for anxiety before the procedure, and interventions to prevent or reduce anxiety should be provided. Interventions must be multifactorial, including information and support for pain management and realistic information about surgery schedules and resuming lifestyle after the surgery. Women and older patients may need to be targeted for intervention.     

Perioperative risk of patients undergoing noncardiac surgery after coronary artery bypass surgery

BACKGROUND: Most data suggesting that noncardiac surgery early after coronary artery bypass surgery carries low risk are derived from post hoc analyses of randomized controlled trials, with only limited data derived from contemporary, nonselected, and nontrial patients. METHODS: We retrospectively reviewed the medical records of patients who underwent coronary artery bypass surgery at our institution between January 1999 and October 2006 to determine whether they subsequently had major noncardiac surgery and what the outcomes of the noncardiac surgery were. RESULTS: During the study period, 1065 patients underwent coronary artery bypass surgery, and 272 (26%) subsequently underwent 467 major noncardiac surgeries. The mean interval from coronary artery bypass to noncardiac surgery was 1.9 +/- 1.9 years (range, 0-7.8 years). A major complication occurred in 3 surgeries (0.6% [95% confidence interval, 0.1%-1.9%]). Two patients died (both from respiratory arrest during the postoperative period: 1 patient had a tongue cancer excision, and the other patient had polycythemia vera), and the third patient had a perioperative arrhythmia. CONCLUSIONS: Noncardiac surgery is often required early after coronary artery bypass surgery and carries very low risk for cardiac complications, suggesting that preoperative cardiac evaluation may not be required in most such patients.     

Effects of N-acetylcysteine on pulmonary function in patients undergoing coronary artery bypass surgery with cardiopulmonary bypass

Cardiopulmonary bypass (CPB) has been implicated in causing poor pulmonary gas exchange postoperatively in patients undergoing coronary artery bypass grafting (CABG) procedures. In this prospective, randomized, double-blind, placebo-controlled study, we examined the pulmonary effects of N-acetylcysteine (NAC) in patients undergoing CABG. Twenty patients undergoing elective CABG and early tracheal extubation were randomized into two groups. Group I (ten patients) received a physiologic salt solution as a placebo in a continuous intravenous infusion for one hour before CPB and 24 hours after CPB; Group II (ten patients) received 100 mg/ kg NAC intravenously for one hour before CPB and 40 mg/kg/day at 24 hours after CPB. Perioperative hemodynamic and pulmonary data were recorded. Postoperative tracheal extubation was accomplished at the earliest appropriate time. The postoperative clinical course was similar in the two groups. Both groups exhibited significant postoperative increases in A-a oxygen gradient (p < 0.01), but patients in Group II exhibited significantly lower increases in postoperative A-a oxygen gradient (p < 0.006). Other hemodynamic and pulmonary data (pulmonary capillary wedge pressure, pulmonary vascular resistance (PVR), cardiac index (CI), shunt flow, dynamic lung compliance and static lung compliance) exhibited no differences between the groups. There was no significant difference in terms of intubation time. The malondialdehyde (MDA) increase in Group II following CPB was found to be significantly lower than in Group I (p = 0.043). This clinical study reveals that administration of NAC to patients undergoing elective CABG with CPB improves systemic oxygenation. There was no effect in other pulmonary parameters and in terms of intubation time.     

冠状动脉搭桥手术的体外循环方法

目的:总结冠状动脉搭桥手术的体外循环方法.方法:对1998～2003年的132例冠状动脉搭桥手术的体外循环情况进行总结,分析其临床资料、术中搭桥支数、体外循环时间、阻断时间、转流温度、停跳液使用情况、术后呼吸机时间、多巴胺支持率和IABP使用的情况.结果:132例患者平均搭桥3.2支,体外循环时间63～213min,平均132min,升主动脉阻断时间39～148min,平均52min.4:1(血:晶体液)含血停跳液温-冷-温方法灌注结合桥灌,较好地保护了心肌.应用抑肽酶和乌司他丁,更好地做好血液保护和心肌保护.主动脉内球囊反搏在救治低心排患者时起到重要而有效的作用.结论:含血停跳液温-冷-温方法灌注结合桥灌,合理的体外循环方法,充分的血液保护对提高冠状动脉搭桥手术成功率起重要作用.     

Anxiety, depression and sleep in male patients undergoing coronary artery bypass surgery

The aim of this study was to examine the prevalence of depression and anxiety following coronary artery bypass surgery (CABG) and to see how those patients with depression and anxiety differ in sleeping pattern. The individual reaction to sleep loss was tested as a predictor of certain emotional symptoms in the follow-up period. Thirty-eight males, between 45 and 68 years, were interviewed prior to, and 1 month after, surgery, and received a questionnaire at the 6-month follow-up. Eighty per cent scored moderate anxiety prior to surgery and six patients were depressed. An anxiety-prone individual reactivity persisted in the same patients in 38.9% (n = 14) following CABG, with significantly more sleep disturbances, firedness, energy deficits, immobility, and lower degree of quality of life (QoL). Sad/depressed mood or cognitive/behavioural fatigue symptoms as reactions to sleep loss were predictors of sleep problems and daytime sequelae, whereas a higher postoperative NYHA class was predicted by cognitive/behavioural fatigue and dysphoria reactions. Being less refreshed by sleep on final awakening prior to surgery related to 44.5% of the variance in QoL outcome 6 months following surgery. In conclusion, an anxiety-prone individual reactivity is significantly associated with sleep disturbances. Reactions to sleep loss prior to surgery are associated with emotional distress after surgery.     

健康管理对冠状动脉旁路移植术后患者的康复作用

目的:以生活质量及血压、血糖、血脂等为指标,调查健康管理对冠状动脉旁路移植术后患者的康复作用。方法:选择2004-08/2005-08入院行冠状动脉旁路移植术的患者368例,均同意接受指定量表评估,并且得到了同济大学医学伦理委员会批准。按随机数字表法分为健康管理组和对照组进行随访观察:①对照组术后采用传统康复方式,即术后带药,遵医嘱复查。患者多根据自己的实际情况选择复查时间和医院,患者主动,医生被动。②健康管理组术后有精心安排的康复计划和内容,包括运动疗法、心理护理、健康教育及血压、血糖、血脂等的管理及干预措施,有指定的社区医疗单位,有指定的医生为患者复查,医生主动,患者被动或主动。所有患者入院后及术后1年由专职医生进行生活质量调查,填写SF-36健康状况问卷(共包括有关生理及精神健康的8个方面,每个方面分值范围均为0～100分,分数越高说明生活质量越高);测量血压;抽血检测血糖、血脂等。结果:368例患者中有342例坚持随访,随访率92.9%,其中健康管理组183例,对照组159例。①坚持随访的两组患者入院时生活质量评分差异无显著性意义(P>0.05),术后1年,健康管理组患者的生活质量评分显著高于对照组[生理机能:80.34±16.33,76.19±15.47;生理职能:55.78±38.57,46.18±40.22;躯体疼痛:82.28±22.79,76.10±21.37;一般健康状况:66.45±21.03,52.32±20.16;精力:67.66±19.51,61.34±21.31;社会功能:78.43±25.22,71.12±24.29;情感职能:68.07±33.60,57.50±35.75;精神健康:81.26±12.24,75.36±15.29(t=2.2439～6.3363,P<0.05～0.01)]。②坚持随访的两组患者入院时异常血压、血糖、血脂的发生率差异无显著性意义(P>0.05),术后1年,健康管理组患者的异常血压、血糖、血脂发生率均显著低于对照组[9%,27%;6%,17%;9%,23%(χ2=9.2859～17.3320,P<0.01)]。结论:冠状动脉旁路移植术后实行健康管理能明显提高患者的生活质量,降低异常血压、血糖、血脂的发生率;社区医疗单位在冠状动脉旁路移植术后患者的康复中起到重要作用。     

尼可地尔对体外循环冠脉搭桥患者心肌标志物的影响

目的 探讨尼可地尔对体外循环(CPB)冠状动脉旁路移植(CABG)的心肌保护作用.方法 拟CPB下行CABG患者28例,随机分为对照组和尼可地尔组,每组14例.尼可地尔组在麻醉诱导后静脉给予0.1 mg/(kg·h)持续输注尼可地尔,CPB开始2 h后将其调整为0.05 mg/(kg·h),手术结束时停止输注.对照组给予同样容量的生理盐水.在下列时间点:即麻醉诱导结束(T0)、CPB 2 h后(T1)、术后第1 天(T2)和术后第3天(T3)测定动脉血浆肌钙蛋白T(TnT)、血肌钙蛋白I(TnI)、肌酸激酶-MB(CK-MB)和脑钠肽(BNP);记录以上各个时间点心率和收缩压.结果 两组血浆TnT、TnI、CK-MB 和BNP浓度在手术后均明显升高,尼可地尔组TnT和BNP在T3恢复到术前水平,两组在T2 和T3时比较差异有统计学意义.CK-MB在T1达到峰值,T3恢复到术前水平,两组比较差异无统计学意义.尼可地尔组T1、T2和T3心率和收缩压乘积(RPP)较对照明显低.结论 术中输注尼可地尔对CPB下行CABG患者有心肌保护作用.     

冠状动脉旁路移植术同期行瓣膜手术病人的护理

随着人口老龄化,冠心病合并瓣膜病病人不断增加,约占手术人群10 %～15 % [1] ,手术后早期死亡率5 %～9% [2 ] ,较单纯瓣膜置换或单纯搭桥要高。同期手术治疗可改善心肌缺血和心功能,但术后护理难度增加。我院自1998年—2 0 0 2年共完成118例冠脉搭桥术,其中有11例同期行瓣膜手术,现将护理体会报告如下。1　临床资料　　本组11例中男8例,女3例;年龄45岁～72岁,平均5 9岁。其中二尖瓣病变4例,主动脉瓣病变6例,双瓣1例。心绞痛3例。心功能(NYHA)分级:Ⅱ级7例,Ⅲ级4例。术前行冠状动脉造影检查显示1支血管病变6例,2支病变4例,3支病变1例,左心…