气管切开脑复苏重症病人高压氧治疗的监护

[目的]探讨气管切开重症病人高压氧治疗的安全护理。[方法]在危重病人高压氧治疗的陪舱监护中,护士执行标准的操作指引,进舱前进行全面评估和准备,舱内进行严密的观察,出舱后给予精心的护理。[结果]陪护人员和病人均未出现严重并发症,有效地配合了危重症病人的脑复苏进程。[结论]气管切开重症病人高压氧治疗风险大,需要陪舱的护士进行全面的舱前评估,舱内监护和出舱后的精心护理。     

高压氧治疗昏迷合并开放性气胸患者的护理

总结了1例交通意外导致昏迷合并开放性气胸患者高压氧治疗成功的护理体会.护理要点包括:成立急救小组与制订治疗护理方案,做好进舱前的准备,高压氧舱治疗中加压期、稳压期、减压期观察和护理.     

高压氧治疗用于压疮患者的观察及护理

总结13例压疮患者行高压氧治疗的护理。认真做好入舱前的准备工作,加强卫生宣教,入舱后分别做好升压、稳压、减压各阶段的护理,出舱后加强病情观察及书写护理记录,是确保高压氧治疗有效、安全、顺利进行的关键。     

小儿颅脑损伤行高压氧治疗的护理

总结28例颅脑损伤患儿行高压氧治疗的护理。认为入舱前对患儿认真检查,做好各项准备工作,入舱后加强加压、稳压及减压时的护理,出舱后妥然处理患儿,是确保高压氧治疗安全顺利进行的关键。     

高压氧疗早期介入改善皮瓣成活的护理进展

综述了高压氧疗治疗皮瓣的机制、临床方法以及护理进展。护理措施包括心理护理、护理评估等进高压舱的护理、进高压氧舱前的准备工作、高压氧治疗过程中加压时的注意事项以及高压氧治疗后的护理措施。认为高压氧早期介入对改善皮瓣或活有明显效果,该方法经济有效、简便,但如何使其成为常规治疗仍有待探索。     

48例取自体桡动脉行冠状动脉移植术的护理配合

总结了48例取自体桡动脉行冠状动脉移植术的护理配合,包括术前患者准备、特殊物品准备、环境准备;术中巡回护士配合、器械护士配合。认为娴熟的护理配合对于手术成功至关重要。     

经皮肾镜碎石取石术的护理配合

总结了40例经皮肾镜碎石取石术的护理配合,主要包括术前准备的病人准备、器械消毒备用、其它用物仪器准备和术中护理配合的膀胱镜下逆行插入输尿管导管的配合,肾镜碎石取石配合。认为良好的护理配合是手术顺利的重要保证。     

儿童颅脑损伤高压氧治疗中的护理

目的:总结儿童颅脑损伤高压氧治疗的护理方法。方法:对高压氧治疗的13例颅脑损伤患儿做好入舱前准备,严密观察治疗过程及出舱后的表现。结果:13例颅脑损伤患儿高压氧治疗效果显著,无1例因护理不当而导致并发症及治疗中断。结论:做好患儿入舱治疗前的准备及加强治疗过程的观察是高压氧治疗有效、安全、顺利进行的关键。     

40例微创冠状动脉搭桥术的护理配合

总结40例微创冠状动脉搭桥术的护理配合，详细介绍了手术方法、术前准备、术中配合。术前准备包括手术器械准备、药物准备、心理护理，术中配合主要是合适的手术体位、严格消毒、血管游离及血管吻合。     

支气管内膜结核患者行纤维支气管镜检查的护理配合

总结了224例支气管内膜结核患者行纤维支气管镜检查的护理配合经验,主要包括心理护理;术前护理的仪器准备,患者准备及术前用药;术中护理的协助患者摆好体位,配合插镜及组织活检,密切观察病情,治疗时配合以及术后护理。认为充分的术前准备,良好的全程心理护理,以及检查中轻、柔、快、准的护理配合是检查顺利进行的重要保障。     

青光眼小梁切除术后浅前房的分析

目的分析青光眼小梁切除术后浅前房的原因和处理方法。方法我院近5年来134例（150眼）青光眼患者，行小梁切除手术，术后观察浅前房的发生并给予相应处理。结果150眼中12眼发生浅前房，占8％。滤过道引流过畅，缝线松脱、房水渗漏，恶性青光眼是术后浅前房发生的主要原因。术后对并发症相应处理后，12眼发生浅前房均恢复正常。结论青光眼小梁切除术术前、术后有效地控制眼压，术中保持前房深度，注意伤口缝线的松紧，术后观察眼压及前房的变化，及时对症处理并发症能取得较好效果。     

超声生物显微镜观察睫状突形态与青光眼的关系

目的 利用超声生物显微镜(UBM)定性、定量研究原发性闭角型青光眼患者的睫状突形态,探索其与青光眼的关系. 方法 浅前房组为80例＞40岁前房深度浅患者,包括急性闭角型青光眼(AACG)患者28例,慢性闭角型青光眼(CACG)患者26例,可疑房角关闭(PACS)者26例.对照组为80例相同年龄段前房深度正常患者.对双眼进行UBM检查,记录上、鼻、下、颞4个象限睫状突矢状和冠状切面扫查图像,测量睫状突高度(CPH)、睫状突厚度(CPT)、睫状突间距(CPI)、睫状突数量(CPN)、A角以及α角.进一步比较上述生物学参数在浅前房组与对照组间的差异、AACG、CACG以及PACS亚组间的差异、PACS亚组与对照组间的差别,并对A角与α角进行相关性分析. 结果 浅前房组较对照组CPH、CPT测值增加,CPI、CPN、A角以及α角测值减小(P＜0.05).CACG与PACS亚组的CPH、CPN差异无统计学意义,其余各组数据差异均有统计学意义(P＜0.05).PACS亚组较对照组CPH测值增加,CPI、CPN、A角以及α角测值减小(P＜0.05),α角与A角呈正相关. 结论 原发性闭角型青光眼患者睫状突形态有明显变化,超声检测其参数可能成为早期筛查原发性闭角型青光眼的较敏感指标之一.     

The first year experience with the dual chamber ICD

In July 1997, a dual chamber pacemaker combined with a tiered therapy implantable cardioverter defibrillator (ICD) first became available in the United States. We report the first-year experience of one center in the United States with this dual chamber ICD. Of a total of 174 ICDs, 95 (55%) were dual chamber devices and 79 (45%) were single chamber. New dual chamber ICD insertions averaged 57.4 +/- 8.9 minutes, though there was a learning curve as the last 30 implants averaged 45.1 +/- 6.1 minutes with a negative slope to the regression line of procedure duration (-0.52, P < 0.05). New single chamber ICD implants were 18.5 minutes quicker (38.9 +/- 7.2 minutes). The most challenging implants were dual chamber upgrades (mean procedure duration 64.9 +/- 15.8 minutes), especially if there was a previously implanted pacemaker and ICD at separate sites. Indications for a new dual chamber device were grouped into classic pacemaker indications (52.5%), which comprised the Class I ACC/AHA guidelines, ICD-specific indications (24.6%), and other (23.0%). In the 34 patients undergoing dual chamber upgrade, the classic and ICD-specific groups were equal (47.0% each). Complications were rare (2.8%), though 3 (8.8%) of 34 undergoing a dual chamber upgrade developed late infections requiring explantation. In its first year, the dual chamber ICD has become a common device at our institution comprising 55% of new implants. As experience grows, we anticipate similar usage at most institutions.     

Clinical Comparison of Acute Single to Dual Chamber Pacing in Chronotropically Incompetent Patients with Left Ventricular Dysfunction

Dual chamber, rate responsive (DDDR) pacing is felt to be superior to ventricular, rate responsive (VVIR) pacing since it more closely mimics the normal electrical and hemodynamic activity of the heart. This reasoning has been used to justify the higher initial costs and increased complexity of dual chamber systems. This study was designed to determine if objective criteria could be identified during acute testing to justify implanting a dual chamber instead of a single chamber system in patients with left ventricular dysfunction. Eight patients with DDDR pacemakers (implanted for chronotropic incompetence) and left ventricular dysfunction underwent exercise radionuclide angiography and graded exercise treadmill testing. Each patient performed the tests in the single (VVIR) and dual (DDDR) chamber modes in a randomized, blinded fashion. We found that objective parameters such as ejection fraction (31%± 13% vs 31%± 10%), exercise tolerance (6.1 ± 2.7 min vs 6.3 ± 2.9 min), oxygen consumption (VO₂) (941 ± 286 mL/min vs 994 ± 314 mL/min), carbon dioxide production (VCO₂) (995 ± 332 mL/min vs 1054 ± 356 mL/min), and maximum attainable workload (43 ± 24 W vs 46 ± 22 W) did not differ between the single and dual chamber pacing modes. These findings suggest that in the acute setting, the additional cost and complexity of dual chamber, rate responsive pacing cannot be justified by objective improvements in exercise tolerance in patients with underlying left ventricular dysfunction.     

Experience with a dual chamber implantable defibrillator

An implantable defibrillator with dual chamber pacing may have advantages for pacing, sensing, and detection of brady- and tachyarrhythmias. This study evaluates the safety and performance of a dual chamber implantable cardioverter defibrillator that incorporates an algorithm to discriminate supraventricular from ventricular arrhythmias. The 300 patients in this study had the device implanted for the following indications: ventricular tachycardia (47%), sudden cardiac death survivorship (51%), and prophylactic implants (2%). Patients received dual chamber pacing for accepted bradyarrhythmic (51.7%) or investigational indications. During a mean follow-up period of 1.7 months a total of 1,092 arrhythmia episodes in 96 patients were fully documented in the device memory: 66 patients experienced a total of 796 ventricular tachyarrhythmia episodes and 42 experienced a total of 296 supraventricular episodes. The device appropriately detected 100% of sustained ventricular tachyarrhythmias while reducing the inappropriate detection of supraventricular tachyarrhythmias by 72% compared to single chamber rate only detection. The positive predictive value was 90.5% for ventricular tachyarrhythmia detection in episodes that exceeded the tachycardia detection rate. Adverse events observed in at least 2% of the patients were incisional pain (22%), inappropriate ventricular detection (7%), atrial lead dislodgement (4%), atrial oversensing/undersensing (3%), hematoma (3%), incessant ventricular tachyarrhythmia (2%), and pneumothorax (2%). There were 13 deaths, none of which were attributed to device failure. The Gem DR is safe and effective for the detection and treatment of ventricular tachyarrhythmias. The dual chamber detection algorithm appropriately recognized supraventricular tachycardia with rapid ventricular rates 72% of the time while maintaining 100% detection of sustained ventricular tachyarrhythmias.     

超声乳化人工晶状体植入联合青光眼小梁切除的临床观察

目的探讨闭角型青光眼合并白内障行超声乳化人工晶状体植入联合小梁切除术的临床效果。方法对62例闭角型青光眼合并白内障行白内障超声乳化人工晶状体植入联合小梁切除术,观察术后视力、眼压、眼底改变。随访时间为术后12月。结果术后视力、眼压、房角均较术前改善。并发症包括:术后一过性浅前房、角膜水肿、后发障。结论白内障超声乳化人工晶状体植入联合小梁切除术是治疗闭角型青光眼合并白内障的有效方法。     

白内障超声乳化术联合房角分离术在晶状体膨胀性青光眼患者中的近远期疗效

目的探析白内障超声乳化术联合房角分离术在晶状体膨胀性青光眼患者中的近远期疗效。方法选取2017年1月至2018年6月于我院行手术治疗的89例晶状体膨胀性青光眼患者,根据随机数字表将其分为参照组(n=44)和研究组(n=45)。参照组患者行白内障超声乳化术,研究组患者行白内障超声乳化术联合房角分离术。观察两组患者眼压、前房结构、角膜内皮细胞密度和视力。结果手术后1周,两组患者的眼压均较手术前降低,且研究组低于参照组(P<0.05)。手术后1周,两组患者前房深度、房角开放距离和前房角隐窝面积均较手术前增大,且研究组大于参照组(P<0.05)。手术后6个月,两组患者的角膜内皮细胞密度均降低,但研究组高于参照组(P<0.05)。手术后6个月,两组患者的视力均改善,且研究组优于参照组(P<0.05)。结论白内障超声乳化术联合房角分离术治疗晶状体膨胀性青光眼,可降低眼压,重建前房结构,减小对角膜内皮细胞的损伤,有助于改善患者的视力。     

The Potential Usage of Dual Chamber Pacing in Patients with Implantable Cardioverter Defibrillators

Bradycardia support by ICDs has been limited to fixed rate, ventricular pacing. Concomitant placement of a pacemaker and an ICD exposes a patient to potentially life-threatening device interactions. ICDs capable of dual chamber pacing have recently become available. The number of ICD recipients who stand to benefit from the addition of dual chamber pacing is debated, but no data have addressed this question. This retrospective study analyzed all patients who received nonthoractomy ICD system placement at the Mayo Clinic in Rochester, MN between March 1991 and October 1996 in order to determine the proportion of patients in whom a dual chamber pacing ICD may be indicated. Definitions: (1) Definitely indicated = pacemaker present at ICD implant or NASPE Class I pacing indication; (2) Probably indicated = NASPE Class II pacing indication, NYHA Functional Class III or IV, or history of systolic congestive heart failure; (3) Possibly indicated = history of paroxysmal atrial fibrillation or an ejection fraction ≤ 20%. The results were that nonthoracotomy ICDs were placed in 253 patients. A dual chamber ICD would have been definitely indicated in 11% of the study group, probably indicated in 28%, and possibly indicated in 14%. Chronic atrial fibrillation was present at ICD implant in 6.7% of patients and developed in 0.9%/yr during follow-up. The addition of dual chamber pacing to ICDs stands to potentially benefit approximately half (53%) of ICD recipients. These data do not address all patients who may benefit from dual chamber sensing.     

Dual chamber pacing for patients with hypertrophic obstructive cardiomyopathy: a clinical perspective in 2000

In some patients with hypertrophic cardiomyopathy, the dynamic left ventricular outflow tract obstructive gradient results in exercise-limiting symptoms of dyspnea, angina, and syncope. Dual chamber pacing has been proposed as a widely available alternative treatment for a subset of patients with symptomatic hypertrophic obstructive cardiomyopathy. Initial studies showed a reduction in gradient and an improvement in symptoms in almost 90% of patients with severe symptoms. We report the Mayo Clinic experience with dual chamber pacing in 38 patients with hypertrophic obstructive cardiomyopathy who had permanent pacemakers implanted for limiting symptoms intractable to medical therapy. After a mean +/- SD follow-up of 24 +/- 14 months, subjective improvement was reported in 47% of patients. However, there was no statistical difference between the maximal oxygen consumption at last follow-up and AAI pacing (atrial sensing and atrial pacing) (18.6 +/- 1.1 mL.kg-1.min-1) (i.e., when the pacemaker was implanted but not pacing continuously). This article discusses the clinical perspective on the utility of dual chamber pacing for patients with hypertrophic obstructive cardiomyopathy.     

DDD versus VVIR Pacing in Patients,Ages 70 and Over,with Complete Heart Block

Background : Dual‐chamber pacing is believed to have an advantage over single‐chamber ventricular pacing. The aim of the study was to determine whether elderly patients with implanted pacemaker for complete atrioventricular block gain significant benefit from dual‐chamber (DDD) compared with single‐chamber ventricular demand (VVIR). Methods : The study was designed as a double‐blind randomized two‐period crossover study—each pacing mode was maintained for 3 months. Thirty patients (eight men, mean age 76.5 ± 4.3 years) with implanted PM were submitted to a standard protocol, which included an interview, functional class assessment, quality of life (QoL) questionnaires, 6‐minute walk test, and transthoracic echocardiographic examinations. QoL was measured by the SF‐36. All these parameters were obtained on DDD mode pacing and VVIR mode pacing. Paired data were compared. Results : QoL was significantly different between the two groups and showed the best values in DDD. Overall, no patient preferred VVIR mode, 18 preferred DDD mode, and 12 expressed no preference. No differences in mean walking distances were observed between patients with single‐chamber and dual‐chamber pacing. VVI pacing elicited marked decrease in left ventricle ejection fraction and significant enlargement of the left atrium. DDD pacing resulted in significant increase of the peak systolic velocities in lateral mitral annulus and septal mitral annulus. Early diastolic velocities on both sides of mitral annulus did not change. Conclusion : In active elderly patients with complete heart block, DDD pacing is associated with improved quality of life and systolic ventricular function compared with VVI pacing. (PACE 2010; 583–589)