人工心脏起搏器病人的家庭指导

随着介入治疗技术的不断成熟，安置人工心脏起搏器的病人逐渐增多，并取得了十分理想的治疗效果。但护理人员必须对安置起搏器的病人进行家庭健康指导，使他们了解起搏器的相关知识，调动病人维护自身健康的潜能，促进病人参与康复护理活动，帮助病人建立健康行为，有效提高生活质量。     

安装人工心脏起搏器病人的出院指导

心脏起搏器的安装对抢救和治疗危及生命的缓慢型心律失常是较好的办法之一,对某些心力衰竭也有一定的治疗作用。安装人工心脏起搏器的病人日益增多,此类病人出院后的自我保健和自我护理至关重要。我们通过对安装起搏器病人的出院指导,使其学会预防及处理可能发生意外的情况,以保证起搏器的正常功能。现将出院指导内容及方法报告如下。     

安装人工心脏起搏器病人家庭护理实践

安装人工心脏起搏器后，病人病情平稳１－２周就可以出院。由于术后护理专业性较强，病人对其术后长时间的自我护理方法、注意事项及起搏器的性能等有关知识了解不多，担心出院后发生意外。因此，他们希望在家中能得到及时治疗和护理。１９９６年６月－１９９７年１０月，...     

老年病人安置人工心脏起搏器的健康指导

人工心脏起搏器是治疗各种原因引起的不可逆的心脏起搏和传导功能障碍性疾病的重要方法.老年病人由于长期受疾病折磨,有其自身的生理特点和心理特点.我科2006年-2008年收治57例老年病人安置人工心脏起搏器,结合老年病人具体病情特点,进行全面、有效的健康指导.     

安装人工心脏起搏器病人家庭整体护理实践

安装人工心脏起搏器病人家庭整体护理实践ＦａｍｉｌｙＮｕｒｓｉｎｇＰｒａｃｔｉｃｅｉｎＰａｔｉｅｎｔｓＷｉｔｈＩｎｓｔａｌａｔｉｏｎｏｆＣａｒｄｉａｃＰａｃｅｍａｋｅｒ王卫红李春红高灿英刘振君①ＷａｎｇＷｅｉｈｏｎｇ，ＬｉＣｈｕｎｈｏｎｇ，ＧａｏＣａｎ...     

安装永久性人工心脏起搏器术后病人的康复指导

１９９１～２０００年我院对２２例安装永久性人工心脏起搏器病人进行康复指导，获得满意效果。１对象与方法本组２２例，男１２例，女１０例，年龄５０～８９岁。其中Ⅲ度房室传导阻滞１２例，病态窦房结综合征８例，其他２例。方法：（１）术后康复：术后嘱病人绝对卧床１周。术后前３d要求绝对平卧于床上，除可略微偏右卧位和下肢活动以及抬高床头外，禁忌右侧卧位、过剧翻身及右侧上肢的过度外伸外展。３d后可略微做上肢活动和轻度翻身。１周拆线后方可下床活动。在绝对卧床期间，协助病人在床上大小便以减少病人自身活动。每日以湿热毛…     

植入人工心脏起搏器病人的护理

对植入人工心脏起搏器病人实施护理是一项专业性较强的工作。此类病人情绪较复杂,对术后长期自我护理方法、注意事项及起搏器的性能等有关知识了解不多,担心出院后发生意外。因此,做好术前、术中、出院后护理工作极为重要。本院对2003年3月～2005年5月植入心脏起搏器病人20例进行针对性护理,收到满意效果,现报告如下。     

The Underlying Heart Rhythm in Patients with an Artificial Cardiac Pacemaker

One-hundred forty-two patients with atrioventricular block (AVB) and 61 patients with sick sinus syndrome (SSS) were followed for an average of 50 months after permanent pacemaker insertion. Their underlying heart rhythms (UHR) were evaluated repeatedly by chest wall stimulation (CWS). A deficient UHR was defined as ventricular asystole lasting 4 seconds or longer. The underlying conduction disturbance increased in 14% of AVB patients, decreased in 14%, and remained constant in 68%. The occurrence of Adams-Stokes attacks before pacemaker implantation was associated with a higher incidence of deficient UHR both in AVB and SSS; a deficient UHR was seen more frequently in AVB than in SSS. Among AVB patients (1) atrial fibrillation, flutter or tachycardia and (2) sinus rhythm with incomplete AVB, especially Mobitz 1, when present before pacemaker implantation, were associated with a significantly lower incidence of deficient UHR during subsequent pacing in comparison with other AVB patients. CWS is a non-invasive method which allows the evaluation of UHR and which can contribute to the early recognition of pacemaker-dependent patients.     

人工心脏起搏器安装术后病人足底推拿的效果评价

目的探讨足底推拿对人工心脏起搏器安装术后病人便秘、体位性低血压、伤口愈合时间、睡眠时间、伤口疼痛的作用效果。方法将60例人工心脏起搏器安装术后病人,采用分层随机抽样法分为对照组30例和实验组30例,对照组予常规护理(止血、心电监护、皮肤护理、心理疗法等),实验组在对照组的基础上应用足底推拿护理技术。结果两组病人采用不同的护理方法对病人术后伤口疼痛、睡眠时间、便秘、体位性低血压、伤口愈合时间有显著性差异(P<0.01)。结论足底推拿能有效疏通全身经络,加速血液循环,改善全身症状,减少术后病人伤口疼痛和改善失眠,防止便秘,减少下床活动时体位性低血压等并发症,有利于提高病人的生活质量,加快了术后康复。     

舒适护理在人工心脏起搏器病人中的应用

目的:将舒适护理应用于心脏起搏器术后病人中,减轻病人心理压力,提高病人舒适度.方法:针对术后病人个性化的特点,为病人营造安全舒适的环境,增强生理、心理、社会舒适感.结果:减轻了病人术后引起的不适及心理压力,提高了病人舒适感.结论:舒适护理强调人性化、个体化服务,使患者在生理、心理、社会方面都处于最佳的舒适状态,提高了护理服务质量,提高了病人的满意度.     

Pneumopericardium With Cardiac Tamponade as a Complication of Cardiac Pacemaker Insertion One Year After Procedure

Background: Lead dislodgement has been shown to be the most common complication in the first 30 days after pacemaker insertion. Although it is rare, pneumopericardium with tamponade can also result. Objectives: We present a case of an extremely rare delay from cardiac pacemaker insertion to lead migration with resulting pneumopericardium and cardiac tamponade. Case Report: A 65-year-old woman with a past medical history significant for congestive heart failure, chronic obstructive pulmonary disease, and third-degree heart block, requiring pacemaker insertion 2 years prior with a revision 1 year prior, presented to the Emergency Department complaining of sudden-onset pleuritic chest pain. Her work-up revealed a pneumopericardium with atrial pacemaker lead migration into the right middle lobe of the lung. She suddenly developed hypotension and respiratory distress and required pericardiocentesis and, ultimately, surgical repair for a perforated right atrium. Conclusion: Pacemaker migration can lead to pneumopericardium and tamponade, even up to 1 year after placement.     

安装心脏永久起搏器病人健康教育需求调查分析

心脏起搏器是以一定强度的脉冲电流刺激心脏 ,使起搏和传导功能障碍的心脏达到人工控制 ,并以一定的频率有效的收缩 ,维持心脏“泵”功能的作用。随着高科技产品的广泛使用 ,核磁共振、直线加速器、微波炉、电磁灶等频频进入医院和家庭 ,对安装起搏器的病人有一定的威胁 ,对起搏器的功能有致命性的干扰[1] 。为此 ,对 72例安装永久起搏器病人进行了健康教育需求调查 ,旨在根据病人的需求 ,探索新的健康教育方法。1　对象与方法1.1　调查对象　于 2 0 0 1年至今安装起搏器病人 72例 ,男 63例 ,女 9例 ,年龄 47岁～ 76岁 ,文化程度 :高中及以…     

高龄患者植入心脏起搏器的并发症及处理

[目的]分析高龄患者(年龄>80岁)心脏起搏器植入后并发症情况及处理策略.[方法]39 例行心脏起搏治疗的高龄患者,年龄>80(84.5±5.7)岁,植入单腔起搏器26例,双腔起搏器13例,分析其并发症及处理策略.[结果]术后并发囊袋血肿2例,电极脱位1例,囊袋感染1例,气胸1例,急性脑梗死1例,急性心肌梗死1例,心绞痛加重1例;7例患者经对症处理及调整起搏模式等处理后好转出院,1例脑梗死患者死亡.[结论]高龄患者心脏起搏器植入术后并发症发生率高,术后密切观察,及时处理可改善预后;选择合适的起搏器及模式可减少伴发疾病的恶化.     

Precision of Impedance Cardiography Measurements of Cardiac Output in Pacemaker Patients

Objective hemodynamic assessment of pacemaker patients is necessary for gauging responses to changes in programming or other conditions that affect the circulation. Impedance cardiogrphy permits noninvasive, repetitive determinations of cardiac output at short intervals, but data regarding variability of this method in patients with pacemakers is unavailable. Thirty-eight patients with implanted pacemakers (24 DDD, 14 VVI) and six normal subjects were studied, A computerized impedance cardiograph was used to calculate cardiac output from the product of the first derivative of the thoracic impedance signal (dZ/dt), the ventricular ejection time, and heart rate. Each patient was studied while supine after a period of at least 15 minutes of rest and repeated impedance measurements (about ten) were performed. Fourteen patients were studied in sinus rhythm, 24 were studied during DDD pacing, and 32 patients were studied during VVI pacing. Cardiac and stroke indices were calculated 706 times on the basis of 11,296 accepted beats. Variability was assessed by methods that analyzed serial measurements and variability between two consecutive and nonconsecutive measurements. The mean indices and coefficients of variation of two measurements and of serial measurements in sinus rhythm and during DDD pacing were 4%; in VVI it was 6%. The precision of impedance Cardiography in all pacing modes, as demonstrated by analysis of variability, indicates that detected changes of stroke volume and cardiac output > 7% on serial (two and more) measurements, performed by the same operator and during the same session, represent true hemodynamic alterations with 95% confidence. Conclusions are that the precision of impedance Cardiography may be comparable or superior to other commonly used techniques and that the data obtained by this technique is valuable investigationally and clinically.     

起搏器植入术后患者抑郁和焦虑的发生和干预

[目的]了解植入心脏起搏器术后一年以内和一年以后患者的心理特点及其进行健康教育的干预效果。[方法]患者60例,均经静脉植入心脏起搏器,时间超过3个月。其中一年以内的患者24例,一年以后且经过健康教育干预的患者36例。在术后随访过程中要求患者填写完成医院焦虑抑郁量表。对照组为门诊体格检查的健康人30例。[结果]起搏组患者抑郁、焦虑等心理症状得分高于对照组（P〈0.05）。起搏组一年以内的患者的抑郁、焦虑等心理症状得分高于一年以后且经过健康教育干预的患者（P〈0.05）。[结论]与正常人比较植入心脏起搏器患者的平均心理健康水平较低。健康教育干预有利于术后患者心理健康恢复。在随访过程中,应重视患者的心理问题,并进行针对性的心理干预。     

人工肝治疗重型肝炎的体会

目的 探讨人工肝在治疗各型重型肝炎患者中的临床疗效。方法 本文应用日本kurany生产的KM8800型血浆交换仪进行血浆置换治疗各型重型肝炎17例31次,以血清总胆红素(TBIL)、转氨酶(ALT)、血小板(PLT)、凝血酶原时间(PT)为主要指标,观察应用人工肝治疗后变化。结果 应用人工肝治疗重型肝炎前后TBIL、PT均有明显差异(P<0.001,P<0.005),ALT、PLT无明显变化。结论 重型肝炎患者应用人工肝治疗后能使相应生化指标好转,为肝细胞修复再生争取时间,是一种有价值的支持疗法。