伽玛刀治疗脑动静脉畸形患者的护理

伽玛刀因其创伤小、恢复快、疗效好而被广泛的运用于脑动静脉畸形（arteriovenous malformation,AVM）患者的治疗中,本文通过对AVM患者在伽玛刀治疗过程中的护理措施和术后并发症的护理预防措施进行了综述,阐述了伽玛刀治疗AVM患者的主要护理 措施,从而进一步提高护理质量,提高治愈率。     

伽玛刀治疗脑动静脉畸形的近况

简述了脑动静脉畸形用伽玛刀治疗后的病理组织变化、疗效及一些影响因素。实践证明,伽玛刀是治疗脑动静脉畸形的一种良好方法,其并发症少,但亦受一些影响因素的干扰。     

血管内栓塞、手术及伽玛刀综合治疗脑动静脉畸形

目的应用栓塞、手术切除及伽玛刀综合治疗脑动静脉畸形（AVMs）。方法经股动脉插管用微导管技术超选择血管内栓基治疗、栓基加手术切除、栓塞加伽玛刀综合治疗脑AVMs共419例。男189例，女230例，年龄4—75岁，平均年龄35．3岁。首发症状头痛头晕266例，廊痫发作52例，意识障碍（昏迷）39例，肢体麻木18例，肢体无力（偏瘫）27例。脑AVM的直径大于6cm者161例，3—6cm者213例，小于3cm者35例。单支动脉供血59例，2支98例，3支以上262例。栓塞加手术切除巨大型脑AVMs31例，栓塞加γ-刀治疗脑AVMs121例。结果完全栓塞病变83例，90％以上124例，70％-90％142例，50％-70％59例，栓塞〈50％者11例。结论根据脑AVM的部位、大小以及供血动脉数，酌情选择血管内栓塞、手术切除．栓塞加手术切除、γ-刀或栓塞加γ-刀治疗。     

脑动静脉畸形介入术后患者伽玛刀治疗的护理

总结12例脑动静脉畸形介入术后畸形血管团未完全闭塞患者实施伽玛刀治疗的护理。治疗过程中,护士积极配合医生,准确定位,提供舒适环境,做好患者的心理护理,提供健康教育,降低治疗后脑出血、脑水肿等严重并发症的发生率。     

脑动静脉畸形的治疗进展

脑动静脉畸形（AVM）是最常见的脑血管畸形，治疗目的在于消除病灶、制止出血、改善脑血液循环。本文对其内科治疗、外科治疗、立体定向放射治疗、血管内栓塞治疗及综合治疗进展进行综述。     

脑动静脉畸形栓塞治疗的围术期护理

颅内脑动静脉畸形（artery venous realformations，AVM）是一种先天性局部脑血管发生上的变异，形成脑动静脉之间的短路，而导致一系列脑血流动力学紊乱，是神经外科常见的脑血管疾病之一。临床上表现为反复的颅内出血，部分或全身性抽搐发作，短暂脑缺血发作以及进行性神经功能障碍等。我院较早开展了应用α-氰基丙烯酸丁酯（NBCA）血管内栓塞治疗AVM，取得了较好疗效，并积累了一定的临床护理经验，现将围术期护理体会报告如下。[第一段]     

血管内栓塞治疗脑动静脉畸形

目的 :探讨血管内栓塞治疗脑动静脉畸形 (AVM)的临床效果及安全性。方法 :应用血管内栓塞治疗脑AVM 42例 ,栓塞剂为二氰基丙烯酸正丁酯 (NBCA)。结果 :16例完全闭塞 ,90 %～ 10 0 %闭塞 8例 ,70 %～ 90 %闭塞 11例 ,5 0 %～ 70 %闭塞 6例 ,<5 0 %闭塞 1例。并发症有导管断裂滞留畸形团 3例 ,NBCA意外泄露 1例。结论 :血管内栓塞治疗脑AVM是一种安全、可靠、有效的治疗手段。     

伽玛刀治疗颅内动脉瘤伴动静脉畸形一例

1病例介绍 患儿男,8岁。入院前无明显诱因出现剧烈头痛,并伴随恶心、呕吐胃内容物数次,无昏迷、肢体抽搐、大小便失禁。院外头部CT提永左侧脑内血肿破入脑室,病情较重于该院治疗22d,于2010年10月22日,病情稳定后转入我院。     

Onyx栓塞治疗复杂型脑动静脉畸形

目的探讨Onyx胶在复杂型脑动静畸形血管(AVM)治疗中的临床应用价值。方法采用Onyx胶栓塞20例复杂型脑AVM,其中位于功能区9例,大脑半球深部5例,小脑半球4例,脑膜脑AVM 2例,AVM大小3~6 cm16例,6 cm以上4例。结果畸形血管团完全栓塞1例,90%栓塞10例,80%栓塞8例,50%~70%栓塞1例。术后复查CT均无脑出血。术后患者随访效果满意。结论Onyx胶的应用能安全有效地提高复杂脑AVM血管内治疗的效果。     

脑动静脉畸形76例治疗分析

目的探讨脑动静脉畸形危险因素的诊断与治疗。方法充分依据＂损伤控制＂原则,对脑动静脉畸形患者积极治疗,并分析其治疗结果。结果根据＂损伤控制＂原则制订脑动静脉畸形患者的治疗方案,患者治疗结果比较满意。结论应用＂损伤控制＂原则指导脑动静脉畸形危险因素综合处理,有效控制疾病的危险因素,提高疾病治疗的总有效率。     

个性化健康教育在伽玛刀治疗颅咽管瘤中的应用

目的:探讨个性化健康教育在伽玛刀治疗颅咽管瘤患者中的应用效果。方法:67例颅咽管瘤患者在伽玛刀治疗同时辅以个性化健康教育,观察其肿瘤有效抑制率、并发症发生率及症状改善率。结果:随访12个月时患者肿瘤有效抑制率为82.09%,随访期间并发症发生率为31.34%,症状改善率为80.60%。结论:个性化健康教育是颅咽管瘤患者完成伽玛刀治疗的一种较为有效、简单且经济的护理措施。     

伽玛刀治疗患者的健康教育需求调查及分析

目的了解伽玛刀治疗患者对健康教育的需求。方法对99例伽玛刀治疗患者进行调查。自行设计调查问卷,内容包括健康教育内容需求、健康教育方式选择、出院后健康教育知识获取途径。结果健康教育内容需求第一位是伽玛刀治疗原理和方法;92.9%患者选择个别咨询指导的健康教育方式;91.9%患者选择出院后获得健康知识途径是返院咨询。结论健康教育要根据患者对健康知识的需求,有计划、针对性地进行教育。     

Targeted embolization reduces hemorrhage complications in partially embolized cerebral AVM combined with gamma knife surgery

This study investigated the effect and safety of targeted embolization in partially embolized cerebral arteriovenous malformation (AVM) followed by gamma knife surgery (GKS). We retrospectively analyzed 86 AVM patients who were targeted embolized by Onyx followed by GKS for residual nidus. Embolization-related complications were collected and the clinical effect was evaluated. During targeted embolization, intranidus or hemodynamic aneurysms and AVM-related fistula were evaluated and targeted embolized. Patients with AVM-related aneurysms and fistula were divided into a targeted embolization group and non-targeted embolization group based on the retrospectively determined treatment strategy. The effect of targeted embolization on hemorrhage risk was evaluated. The overall annual hemorrhage rate was 1.66% with 2.26% for ruptured AVMs and 1.08% for unruptured lesions. The annual mortality rate was 0.4%. Only one in 16 patients with embolization-related complications had permanent neurologic deficit. Twenty-four of 29 cases with intranidus aneurysms were targeted embolized, four of five cases with hemodynamic aneurysms were targeted embolized and eight of nine cases with arteriovenous fistula were targeted embolized. Chi square results showed the hemorrhage complications in the target embolization group were significantly lower than those in the non-target embolization group (p < 0.01). Targeted embolization combined with GKS treatment decreased the annual hemorrhage rate and improved clinical outcome with low permanent complications in partially embolized AVMs. This method could be proposed for the treatment of large brain AVMs when a single-technique treatment is not feasible.     

体部γ刀治疗中晚期胰腺癌36例临床观察与护理

目的探讨体部γ刀治疗中晚期胰腺癌患者的护理要点。方法对体部γ刀治疗36例中晚期胰腺癌患者进行临床观察及护理。结果γ刀治疗36例胰腺癌患者治疗期间胃肠道反应26例(72.2%),经对症治疗后均按计划完成治疗,治疗后患者上腹部及腰背部疼痛明显减轻22例(61.1%),减黄2例(50%)。结论体部γ刀治疗中晚期胰腺癌是较安全有效的治疗方法,护理人员在治疗前中后期给予患者正确有效的指导并对治疗过程中存在的危险因素采取有效的护理干预措施,可提高治疗效果,降低死亡率。     

伽玛刀治疗原发性三叉神经痛疗效观察

Objective To evaluate the therapeutic efficacy of gamma knife in treatment of primary trigeminal neuralgia Methods Retrospectively analysis of 120 cases with primary trigeminal neuralgia treated by gamma knife in our department From Jan. 2003 to Mar. 2008 were performed. All cases were treated with the 4 mm collimator and targeted at the proximal nerve at the root entry zone located by MRI. The target dose varied from 80 -90 Gy. Results After a follow-up of 20. 0 ±4. 5 months, complete relief of pain occurred in 69 patients (57. 5%), 50% -90% relief in 34 (28. 3%), relief less than 50% in 12(10.0%) but no relief in 5(4.2 %).The efficient rate was 95. 8% . The common complications include numbness, absence of corneal reflex. 83 patients (69. 2%) experienced temporal facial numbness and 14 patients (11. 7%) reported continuous numbness after treatment of the gamma knife. Conclusions Gamma knife radiosurgery is a minimally invasive technique for the treatment of primary trigeminal neuralgia with few complications.     

伽玛刀治疗原发性三叉神经痛疗效观察

Objective To evaluate the therapeutic efficacy of gamma knife in treatment of primary trigeminal neuralgia Methods Retrospectively analysis of 120 cases with primary trigeminal neuralgia treated by gamma knife in our department From Jan. 2003 to Mar. 2008 were performed. All cases were treated with the 4 mm collimator and targeted at the proximal nerve at the root entry zone located by MRI. The target dose varied from 80 -90 Gy. Results After a follow-up of 20. 0 ±4. 5 months, complete relief of pain occurred in 69 patients (57. 5%), 50% -90% relief in 34 (28. 3%), relief less than 50% in 12(10.0%) but no relief in 5(4.2 %).The efficient rate was 95. 8% . The common complications include numbness, absence of corneal reflex. 83 patients (69. 2%) experienced temporal facial numbness and 14 patients (11. 7%) reported continuous numbness after treatment of the gamma knife. Conclusions Gamma knife radiosurgery is a minimally invasive technique for the treatment of primary trigeminal neuralgia with few complications.     

健康教育对扩张型心肌病患者安装三腔起搏器后健康状况的影响

目的探讨健康教育对扩张型心肌病患者安装三腔起搏器后健康状况的影响。方法根据系统性健康教育实施情况将本科2010年1月-2012年1月收治的38例扩张型心肌病并安装三腔起搏器患者分为对照组（n=17）和实验组（n=21）,并对其进行为期18个月的随访,比较2组患者随访期间预后转归情况,并电话邀约至本院复查。比较2组相关临床指标、各项生活量表及心理量表的差异。结果与对照组相比,实验组患者18个月内进展至终末期心力衰竭的人数显著降低,且实验组患者的自我保健意识明显提高;实验组平均动脉压、低密度脂蛋白、左心室收缩末期内径显著降低,每搏输出量显著增加;实验组患者SF-36量表、WHOQOL-BREF量表部分项目评分显著升高;实验组患者的HAMA量表显著降低、MUIS量表显著降低、SCL-90量表显著降低。结论对扩张型心肌病并安装三腔起搏器患者实施健康教育可显著改善预后,提高临床疗效,增强患者自我保健意识,提高患者生活质量,消除患者负面情绪,从而达到稳定病情、提升患者整体健康状况的效果,值得临床推广。     

伽玛刀治疗原发性三叉神经痛疗效观察

目的 探讨伽玛刀治疗原发性三又神经痛的疗效.方法 2003年1月至2008年3月,我院应用伽玛刀治疗原发性三又神经痛120例;治疗靶点为三叉神经根,用4 mm准直器,靶点中心计量为80～90 Gy.疗效评估采用患者自我报告疼痛的控制程度及药物用量的变化.结果 所有患者进行了随访,平均随访期(20.0±4.5)个月.本组病例中治愈69例(57.5%);显效34例(28.3%)、有效12例(10.0%)、无效5例(4.2%);总有效率为95.8%.5例患者疼痛复发后行其他治疗.83例患者(69.2%)曾出现一过性、局限性的面部麻木.14例患者(11.7%)在疼痛缓解后留下持续性的面部麻木;部分患者还伴有味觉减退、口嚼无力等主诉.结论 伽玛刀治疗原发性三又神经痛能够显著缓解疼痛、提高生活质量,不良反应发生率较低:是一种较为理想的治疗方法.     

对造口患者健康指导的体会

目的探讨直肠癌结肠造口患者围手术期的健康指导对术后康复的影响。方法对18例直肠癌造口患者实施系统的、有计划的、有针对性的健康教育。结果患者在术后止痛剂的应用、自行排气时间、术后并发症的发生及住院时间等方面效果满意。结论做好直肠癌患者的围手术期健康指导,是保证手术成功,帮助患者适应新生活、提高生活质量的有效措施。     

应用健康教育路径对垂体瘤患者实施健康教育的效果观察

目的探讨应用健康教育路径实施健康教育的效果。方法将56例经鼻蝶显微手术切除垂体瘤患者随机分为实验组和对照组,每组28例。实验组采用健康教育路径进行健康教育,对照组采用传统方法进行健康教育。结果实验组患者及家属对护理工作的满意度高于对照组(P<0.05),健康教育达标率高于对照组(P<0.01)。结论应用健康教育路径对患者实施健康教育,是目前比较理想的一种健康教育方式。