冠状动脉旁路移植术患者护理体会

笔报道50例冠状动脉旁路移植术患的护理，阐述了术后在血流动力学监测、呼吸道护理、血管活性药物的应用护理、维持电解质平衡、患肢的护理、心理护理以及出院指导等方面所采取的措施，无1例出现肺部感染等重要并发症，随访5——22月，无死亡及心绞痛发作。认为术后精心监护是减少和预防冠状动脉旁路移植术后并发症的发生，使患顺利康复的重要因素。     

非体外循环下冠状动脉搭桥术围手术期护理

目的探讨非体外循环下冠状动脉搭桥术围手术期护理方法。方法对50例非体外循环下行冠状动脉搭桥患者,术前加强心理护理、控制血压、合理氧疗、呼吸功能训练、备选血管的护理等措施,术后加强患者心血管系统和呼吸系统的监测、血管活性药物应用、引流管护理、血糖监测、维持电解质平衡等措施。结果 50例患者中切口感染6例,并发快速型房颤5例,经药物治疗好转。除2例死亡外,其余患者均痊愈出院,无护理并发症。结论冠状动脉搭桥术风险大,细心、细致、周到的护理是保证手术成功的关键。     

Predictors for heparin resistance in patients undergoing coronary artery bypass grafting

Heparin resistance (HR) is a common event in cardiac operations. At present, no clear recognition of the risk factors for HR has been reached. The aim of this study was to determine a predictive model for HR, based on the preoperative patient's profile. Two hundred consecutive patients scheduled for elective coronary artery bypass operations were enrolled in a prospective trial. Demographics, type of preoperative anticoagulation therapy and preoperative coagulation profile were collected and statistically analysed with respect to the evidence of a HR. Heparin resistance was defined as at least one activated clotting time < 400 s after heparinization and/or the need for purified antithrombin III (AT-III) administration. With a multivariate analysis we could identify five predictors for HR: AT-III < or = 60%; preoperative subcutaneous heparin therapy; intravenous heparin therapy; platelet count > or = 300000 cells/mm3; age > or = 65 years. We conclude that HR is a predictable event. In the presence of all the risk factors, the likelihood of HR is 99%; in the absence of all of them, it is 10%. Predicting HR allows us to apply many possible therapeutic strategies.     

1386例不停跳冠状动脉旁路移植术经验总结

目的 总结2002年1月至2008年3月全国多中心1386例冠心病患者实施不停跳冠状动脉搭桥术的经验.方法 常温下全身麻醉气管插管,胸骨正中切口,取左侧乳内动脉、桡动脉及大隐静脉,行不停跳冠状动脉旁路术.70岁以上患者占32.35%,年龄最大为99岁,急诊或亚急诊手术111例,二次冠状动脉旁路术52例.结果 围术期死亡24例,总病死率1.73%,其余患者均痊愈出院,术后心绞痛症状明显缓解,生活质量较术前明显提高.结论 不停跳冠状动脉旁路移植术对高龄及合并其他慢性老年疾病患者是可行的,熟练的手术技术,对手术适应证的把握,积极的围术期处理是手术成功的关键.     

Racial disparities in outcomes following coronary artery bypass grafting

More than 12 million people in the United States have coronary heart disease, the second leading cause of hospitalization in the United States. It is known that persons within racial minorities, specifically African Americans, have a higher prevalence of coronary heart disease, yet are much less likely to undergo invasive cardiac treatment interventions. An invasive intervention commonly used to treat coronary heart disease is coronary artery bypass grafting, with over 140,000 operations performed annually in the United States. However, blacks are known to experience higher post-coronary artery bypass graft morbidity and mortality. The causes for racial disparities in post-coronary artery bypass graft outcomes are not well known but may include factors related to the individual, provider, system, and society/environment, either alone or in combination. The purpose of this article is to provide an overview of the literature regarding disparities in the health and healthcare of black patients with coronary heart disease with respect to CABG, and examine potential hypotheses for variant outcomes after surgery.     

非体外循环冠状动脉搭桥术的护理配合

非体外循环冠状动脉搭桥术(OPCABG)是利用特殊的手术器械,在跳动的心脏上创造一个相对静止、相对无血的环境进行冠状动脉搭桥术.由于创伤小、术后恢复快、住院时间短、医疗费用低,成为目前冠心病手术治疗的一种重要选择[1].但此类病人病情重,心功能储备差,需要尽快完成搭桥步骤,这给手术的配合提出了新的要求.我院从2007年7月-2009年7月实施OPCABG手术21例.现将手术配合介绍如下.     

80岁以上患者行冠状动脉旁路移植术后的护理

目的总结80岁以上高龄冠状动脉旁路移植术后护理经验。方法对101例冠状动脉旁路移植高龄患者严密监测血液动力学变化,加强心功能维护,合理使用血管活性药物,纠正心律失常,加强呼吸道管理,做好并发症的观察和护理。结果 91例手术后恢复顺利,死亡10例。术后发生严重低心排17例,11例主动脉内球囊反搏辅助循环,心律失常20例,低氧血症21例,2次开胸探查9例,肾功能衰竭7例,床旁连续血液滤过治疗3例,呼吸机相关性肺炎4例。结论加强高龄非体外循环下冠状动脉搭桥术患者术后监护,是高龄冠状动脉搭桥手术患者顺利康复的关键因素。     

Direct intramyocardial injection of VEGF mRNA in patients undergoing coronary artery bypass grafting

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Sleep and quality of life assessment in patients undergoing coronary artery bypass grafting

OBJECTIVE: To examine sleep before and after coronary artery bypass grafting (CABG) as well as measuring of quality of life (QoL), and to see if changes in subjectively rated sleep can be shown objectively by polysomnographic recordings. Sample: A consecutive sample of 38 male patients, aged 45-68, underwent CABG, Twenty-two patients were graded in New York Heart Association (NYHA) classes III or IV, and 16 in class I-II before surgery. METHODS: 24-hour polysomnographic recordings, using the Oxford Medilog 9000 recorder, were performed 2 days prior to surgery, on the first 2 post-operative days and 1 month after surgery. The Nottingham Health Profile instrument (NHP) was used to measure QoL before and after surgery. RESULTS: Following surgery there was a profound decrease in sleep at night, and an increase in daytime sleep. During the second post-operative recording period nocturnal sleep duration was reduced to 253.6 +/- 94.1 minutes, with suppressed stages 3 and 4 sleep and lack, or slight recovery, of REM sleep. Even though there were evident changes in both the distribution and nature of sleep at night, daytime sleep increased and the total duration of sleep during the 24-hour period was not significantly changed. The total sleep time was 421.1 +/- 76.8 minutes before surgery, 483.2 +/- 201.2 in the first period, 433.2 +/-201.4 minutes in the second 24-hour period post-operatively and 443.2 +/- 44.0 minutes at the 1-month follow-up. The NHP instrument demonstrated that 6 months after surgery the quality of life was significantly improved. Polysomnographically measured slow wave sleep was compared with the sleep section in the NHP instrument both before surgery and at 1 month post-operatively. CONCLUSIONS: In the immediate period following CABG, there is a change in distribution of sleep, with reduction in nocturnal sleep duration and an increase in daytime sleep, which had almost returned to pre-operative values 1 month after surgery. QoL scores were improved 6 months after surgery. This study demonstrates the importance of careful assessment of sleep and sleep disturbances for more individualized nursing care in order to promote sleep in the immediate post-operative period.     

再次冠状动脉旁路移植术25例总结

目的总结再次冠状动脉旁路移植术(Re-CABG)治疗冠心病的临床经验及手术效果。方法1997年3月~2007年5月共完成Re-CABG手术25例,男22例,女3例;年龄50~72岁,平均(62.5±8.1)岁;2次手术时间间隔3~109个月,平均(48.7±35.2)个月。体外循环Re-CABG手术17例,不停跳非体外循环Re-CABG手术8例。结果全组25例患者恢复顺利,无手术死亡,无心肌梗死,心绞痛症状消失。术后随访8~90个月,平均(38.7±30.6)个月,无心绞痛复发,无冠心病相关事件发生。失访4例。结论正确掌握手术指征和时机,合理应用各种技术和方法及良好围手术期管理,Re-CABG可以取得满意的临床疗效。     

心脏不停跳冠状动脉旁路移植术患者手术室全期护理期问的需求调查

目的了解冠心病患者在手术室全期护理期间的需求及护士实际护理情况,以便更好地满足患者的需求,提高手术室护理质量。方法采用问卷法,对90例冠心病患者在手术室全期护理期间的需求和护士实际护理情况进行调查。结果90例患者术前对各项护理措施实施必要性态度总分为（71．44±22．28）分,其中男性患者得分为（74．10±21．78）分,女性得分为（62．70±22．17）分,差异具有统计学意义（t=2．092,P〈0．05）。患者术中对各项护理措施实施必要性态度总分为（75．37±15．13）分,术后态度总分为（50．89±29．47）分;术前与术中态度点分比较差异无统计学意义（P〉0．05）;术前、术中分别与术后比较,差异均有统计学意义（￡分别为6．791,7．922;P〈0．01）。结论手术室护士术前应结合护理工作重点和患者需求,有重点地开展术前护理,术中应热情接待患者,缓解患者紧张情绪;而今后应进一步探讨如何实施高质量的术后护理。     

Nursing care of the patient undergoing coronary artery bypass grafting

The role of the professional nurse in the perioperative care of the patient undergoing open heart surgery is beneficial for obtaining a positive outcome for the patient. This article focuses on the preoperative and postoperative nursing care of patients undergoing coronary artery bypass graft surgery. Risk assessment, preoperative preparation, current operative techniques, application of the nursing process immediately after surgery, and common postoperative complications will be explored.     

The effects of intermittent prebypass heparin dosing in patients undergoing coronary artery bypass grafting

In this study, 10 patients (Group B) were given three consecutive prebypass doses of heparin (100 IU/kg) with a 4 min interval prior to cardiopulmonary bypass (CPB) institution. They were compared with 10 patients (Group A) receiving the standard single prebypass heparin dose (300 IU/kg). The haemostatic response and anticoagulant monitoring during the perioperative period were investigated by point-of-care and several coagulation tests. Results of both groups were also correlated to blood loss. Three patients in Group B required additional heparin during bypass as compared with six patients in Group A. This suggests that intermittent prebypass heparin dosing is more effective in maintaining adequate levels of anticoagulation during CPB. Group B had a lower mean decrease in factor VIII (13.9% versus 43.2%), fibrinogen (38.5% versus 46.6%), antithrombin III (34.7% versus 40.1%) and platelet count (23.2% versus 28.9%) during bypass while only one unit of red cell concentrate was required postoperatively as compared with four units in Group A. In one patient, high fibrinolytic assays were associated with a haemorrhagic pericardial effusion occurring beyond 24 hours postsurgery.     

应变率显像定量评价冠状动脉旁路移植术后左心室局部功能

目的 探讨应变率显像(SRI)技术在评价冠心病患者冠状动脉旁路移植术前后左心室局部功能变化中的应用价值.方法 对16例冠心病患者分别于冠状动脉旁路移植术前3 d、术后12 d及3个月行超声心动图检查,应用SRI技术对左室各壁基底段和中间段的局部心肌功能进行定量分析,共分析192个节段.根据术前二维超声心动图室壁运动情况将心肌节段分为运动正常组(152个节段)和运动异常组(40个节段).结果 术前运动正常组收缩期心肌峰值应变率(SRs)和舒张早期心肌峰值应变率(SRe)与运动异常组相比差异无统计学意义(P>0.05).运动异常组术后3个月的房缩期心肌峰值应变率(SRa)较术前3 d增高(P<0.05).运动正常组术后3个月与术前3 d相比,SRs、SRa及SRe均增高(分别P<0.05和0.01),术后3个月与术后12 d相比,SRs增高(P<0.05).结论 应用SRI技术能定量评价冠状动脉旁路移植术前后左室局部心肌功能的改变.     

Improving quality and outcomes of coronary artery bypass grafting procedures

The evolution in the approach, clinical care and outcomes of ischemic heart disease, has been dramatic over the past decade. Optimizing medical therapy initially and throughout the care delivery process has been transformative. The addition of new physiologic data to the traditional anatomic framework for diagnosis and therapy of more extensive stable ischemic heart disease (SIHD) enables quality and outcomes improvements in this patient population overall and in the patient subsets of acute coronary syndrome and SIHD. In patients undergoing coronary artery bypass grafting (CABG), these developments have changed the objective goal of surgical revascularization over this time interval. This review discusses the opportunities for quality and outcomes improvement in CABG, in the context of SIHD overall.     

锁骨下动脉人工血管转流术患者的围手术期护理

目的探讨左-右锁骨下动脉人工血管转流术患者围手术期的临床护理要点。方法回顾并总结11例锁骨下动脉转流术围手术期的患者从术前、术中、术后护理到出院指导所实施的有效的护理干预措施。结果经系统护理，术后11例患者均顺利康复。结论系统的围手术期护理在保证手术效果，促进疾病康复方面起着关键的作用。     

Psychological state in patients undergoing coronary artery bypass grafting surgery or percutaneous coronary intervention and their spouses

Percutaneous coronary intervention (PCI) and the coronary artery bypass grafting surgery (CABG) are well accepted treatments for coronary artery disease. Many patients and their spouses experience increased level of stress, anxiety and depression before and after going under the procedure. One hundred and ninety‐six cardiac patients who were candidate for CABG or PCI procedures and their spouses were asked to complete Hospital Anxiety and Depression Scale and General Health Questionnaire‐12 before and 1 month after procedures. Anxiety, depression and stress level in patients and their spouses going under the procedures significantly reduced over time. Scores of anxiety, depression and stress in patients and their spouses were correlated. There was no difference in the level of anxiety, depression and stress between CABG and PCI groups before to after procedures. We suggest providing information about the procedures to both patients and their spouses to deal better with their own psychological state.