下肢动脉硬化闭塞合并糖尿病足围手术期护理

目的探讨下肢动脉硬化闭塞症合并糖尿病足的血管介入术患者围术期的临床护理,明确护理重点及最佳护理方式。方法对68例,81条下肢的下肢动脉硬化闭塞症合并糖尿病足的血管介入术的患者从术前、术后到出院实施有效的、有针对性的、系统的护理指导。结果经针对性的围手术期护理,术后68例、81条下肢均未截肢,症状缓解,顺利康复出院。随访1年,3例下肢动脉硬化闭塞症复发,4例因糖尿病足接受截肢手术,1例因其他原因死亡。结论系统的围手术期护理对保证介入手术效果、促进患者康复、避免手术并发症发生起着关键性的作用。     

下肢动脉硬化闭塞症腔内介入治疗的临床护理

目的：探讨下肢动脉硬化闭塞症腔内介入治疗的临床护理措施及效果。方法：选取我院2012年3月至2014年3月接受腔内介入治疗的40例下肢动脉硬化闭塞症患者为研究对象，对其行术前、术中及术后综合护理干预，观察治疗效果。结果：本组40例患者治疗有效率95%，截肢率2.5%，死亡率2.5%。另外，治疗后踝/肱指数明显高于治疗前，差异有统计学意义，P<0.05。结论：腔内介入治疗下肢动脉硬化闭塞症效果明确，需进一步提高治疗及护理水平，以降低致残率及死亡率，     

下肢动脉硬化闭塞症的个体化治疗经验

[目的]探讨下肢动脉硬化闭塞症外科手术个体化方案的合理性. [方法]对最近7年收治并行手术治疗的69例下肢动脉硬化闭塞症患者的临床类型和手术方式进行回顾性分析. [结果]根据不同情况,分别实施了血管腔内治疗、血管旁路术、腔内治疗联合血管旁路术、解剖外旁路移植术及股深动脉成形术等,效果良好. [结论]下肢动脉硬化闭塞症的个体化治疗能降低患者手术风险,改善预后;根据术前评估指导制定的个体化手术方案具有临床应用价值.     

下肢动脉硬化闭塞症腔内介入治疗的临床护理

目的:探讨下肢动脉硬化闭塞症腔内介入治疗的临床护理措施及效果。方法:选取我院2012年3月至2014年3月接受腔内介入治疗的40例下肢动脉硬化闭塞症患者为研究对象,对其行术前、术中及术后综合护理干预,观察治疗效果。结果:本组40例患者治疗有效率95%,截肢率2.5%,死亡率2.5%。另外,治疗后踝/肱指数明显高于治疗前,差异有统计学意义,P<0.05。结论:腔内介入治疗下肢动脉硬化闭塞症效果明确,需进一步提高治疗及护理水平,以降低致残率及死亡率,     

血管腔内治疗联合外科手术治疗下肢动脉硬化闭塞症

目的 评价血管腔内治疗联合外科手术治疗多节段性下肢动脉硬化闭塞症的效果.方法 对32例多节段性下肢动脉硬化闭塞症患者施行髂动脉球囊扩张及支架植入等血管腔内治疗方法开通髂血管,择期再对股胭段病变行自体大隐静脉或人工血管旁路转流术.结果 32例患者手术过程均成功,术后下肢缺血症状改善,表现为间歇性跛行消失或跛行距离明显增大,静息痛好转,肢体溃疡愈合.术后平均踝肱指数为0.65±0.18,与术前(0.28±0.14)相比有明显提高(P<0.05).术后随访30例,随访时间3～36个月.平均18个月.支架植入后髂动脉均通畅;有2例行旁路转流术患者出现吻合口狭窄,行吻合口腔内血管成形术,术后狭窄解除.1例患者人工血管内血栓形成,再次行人工血管旁路转流术治疗,余患者旁路血管通畅,血运较术前明显改善.结论 血管腔内治疗联合外科手术治疗多节段性下肢动脉硬化闭塞症,可降低手术难度与复杂性,减少术后并发症,疗效满意.     

多节段、多平面下肢动脉硬化闭塞症的临床治疗

目的 探讨多节段、多平面下肢动脉硬化闭塞症的临床治疗方法.方法 按照个体化原则,采用单一的动脉旁路重建术、序列式动脉旁路重建术和经皮血管腔内成形术联合动脉旁路重建术治疗多节段、多平面下肢动脉硬化闭塞症患者25例.结果 随访6个月至3年,25例患者肢体缺血症状明显减轻或消失,原溃疡面愈合.4例足趾干性坏疽,截趾后创面2～4个月愈合,2例移植物在术后6个月内闭塞,但肢体缺血症状明显改善,本组无重要脏器并发症和手术死亡病例,移植物通畅率92%(23/25),治愈率100%.结论 按照个体化原则,选择单一动脉旁路重建术、序列式动脉旁路重建术和经皮血管腔内成形术联合动脉旁路重建术是治疗多节段、多平面下肢动脉硬化闭塞症的有效方法.     

股动脉血管内支架治疗下肢动脉硬化闭塞症的护理

下肢动脉硬化闭塞症（arteriosclerosis obliterans,AS0）是指由于下肢动脉血管壁内出现的粥样硬化斑块引起动脉狭窄或闭塞所导致的下肢供血不足,是常见的肢体缺血性疾病,患病率逐年上升,常常因为截肢致残,严重影响患者生活质量。我科采用经皮腔内血管成形术（percutaneous translumina langioplasty,PTA）和血管内支架治疗ASO患者,取得较好效果,现将股动脉血管内支架治疗中围手术期护理报道如下。     

下肢动脉硬化闭塞症介入治疗的护理

文章回顾性分析206例介入治疗的下肢动脉硬化闭塞症患者临床资料,总结分析相关护理经验,探讨下肢动脉硬化闭塞症介入治疗的相关护理措施.实施腔内介入治疗下肢动脉硬化闭塞症疗效显著,但仍需进一步提高临床治疗及护理水平,可减少死亡或残疾率.     

老年患者下肢动脉硬化闭塞症介入治疗的观察与护理

目的：探讨老年患者下肢动脉硬化闭塞症介入治疗的护理方法，观察治疗护理后的临床效果。方法对该院收治的45例老年下肢动脉硬化闭塞症患者支架置入治疗并进行护理以及术后定期复查，了解术后血管通畅情况。结果本组45例老年患者介入治疗后，血管再通43例，再通率95．55％，再通患者术后0．5、1、2、3年血管开通率分别为95．02％、86．78％、78．35％、67．26％。结论老年患者下肢动脉硬化闭塞实施支架介入治疗有效。术后患者创伤小，恢复快，痛苦少，睡眠明显好转。故术前加强患肢护理、术后加强并发症观察护理及健康指导是促进手术成功的关键，对于患者临床获益十分重要     

介入治疗下肢动脉硬化闭塞症例围术期护理

目的:研究并分析介入治疗下肢动脉硬化闭塞症患者围术期的护理效果。方法:选取我院在2016-01~2017-01期间收治的98例下肢动脉硬化闭塞症患者进行研究,按照随机数字表法,将其分为实验组和参照组,各49例。对98例患者均采取介入治疗,并对参照组患者予以常规护理干预,对实验组患者予以围术期护理干预。对比两组患者的护理效果。结果:实验组患者的治疗总有效率均明显高于参照组,经检验,组间差异显著,且P0.05;实验组患者的护理满意度明显高于参照组,均经统计学分析,组间差异显著,具备统计学意义(P0.05)。结论:对下肢动脉硬化闭塞症患者予以介入治疗的同时采取围术期护理干预,提高了治疗总有效率和护理质量,值得临床上借鉴以及进一步普及。     

糖尿病下肢血管病变球囊成形术后高灌注损伤患者的护理效果评价

目的比较两组球囊成形术后发生高灌注损伤的糖尿病患者是否采用加强护理干预的疗效差异。方法 18例糖尿病下肢血管病变患者,经皮经腔球囊成形术(PTA)后发生高灌注损伤,所有患者随机分为护理组(n=9)和对照组(n=9)。护理组采用我科制定的抬高患肢、加强屈伸运动和外敷硫酸镁等加强护理干预方法,对照组仅采用一般冷敷和暴露创口等对症护理计划。通过对照研究,评价加强护理干预对于减轻PTA术后高灌注引起的下肢疼痛、肿胀和皮下淤点等症状的疗效。结果两组相比较,护理组患者经加强护理干预后,下肢肿胀、疼痛及皮下淤点等症状改善评分较对照组有显著性差异(P<0.01)。结论糖尿病患者下肢PTA术后引起的高灌注损伤,经加强护理干预后,具有良好的治疗效果。     

风湿性心脏病围手术期焦虑状态的护理干预

目的观察护理干预对风湿性心脏病患者围手术期焦虑心理状态的影响。方法采用焦虑自评量表(SAS)对80例风湿性心脏瓣膜病变患者在护理干预前、后进行调查。结果护理干预前患者焦虑人数为46例(57·5%),护理干预后患者焦虑人数为15例(18·7%),干预前后比较,p<0·01,差异有统计学意义;干预前后患者焦虑分值比较,p<0·01,差异有统计学意义。结论心理护理、信息支持、现身说法、鼓励家属支持、环境干预等能有效减轻风湿性心脏病患者围手术期焦虑心理状态。     

275例经桡动脉路径行冠状动脉介入治疗的围手术期护理

目的：探讨经桡动脉路径行冠状动脉介入治疗的围手术期护理。方法：总结了275例经桡动脉路径行冠状动脉介入治疗的围手术期护理经验,主要包括：术前的心理护理及完善术前准备,术中注意手术配合并密切观察患者反应,术后的病情观察、患肢的护理及健康指导等。结论：完善的围手术期护理是经桡动咏路径行冠状动脉介入治疗成功的重要保证。     

Explaining cost variations in DRGs 'Acute Myocardial Infarction' by severity of illness

The empirical relationship is analyzed between the severity of illness and costs of medical care for 464 patients classified into DRGs 121-123, Acute Myocardial Infarction (AMI), in the University Hospital, Maastricht. Severity of cardiac and cardiovascular disorders characteristic of acute myocardial infarction is defined and operationalized in a sense that closely resembles the clinical practice of cardiologists. The effect of the severity of illness on DRG cost variations is studied separately for the costs of acute care (such as thrombolytic therapy, cardiac catheterization and percutaneous transluminal coronary angioplasty (PTCA)), length of hospital stay, costs of intensive nursing care at the coronary care unit (CCU) and the costs of ECGs, laboratory tests, echocardiography, exercise tests and drugs. For AMI patients, severity of illness measured by specific clinical criteria is found to give better predictions (higher R2) for costs of medical care than the DRG classification.     

急性心肌梗塞行急诊冠状动脉介入治疗的护理

目的探讨急性心肌梗塞(AMI)行急诊经皮冠状动脉腔内成形术(PTCA)+支架植入术的护理。方法对168例行急诊PTCA的AMI患者术中护理,术后严密观察病情、心电监护、预防并发症等护理。结果急诊PTCA术中出现严重心律失常,术后血管出血等并发症比择期手术高,病人及家属缺乏相关知识,有焦虑、恐惧心理。结论术中密切配合,术后严密观察病情、心电监护、预防出血等并发症、做好心理护理及健康教育,是决定患者早日康复出院的关键。     

Restricted access to care: the role of race, managed care, and type of insurance

This article compares African American patients who entered the hospital with the same medical condition-acute myocardial infarction-to similar white patients to assess the relative contributions of insurance type and managed care to the race gap in access to three expensive invasive procedures for treating heart disease: cardiac catheterization, percutaneous transluminal coronary angioplasty (angioplasty or PTCA), and coronary artery bypass surgery (CABG). With data from the state of Maryland, we find that the races differ markedly in their insurance coverage and African Americans have significantly less access to the procedures. Type of insurance and HMO explained little of the difference in access to procedures. Medicare appears to offer as much access to African Americans as commercial providers. We conclude that equalizing access to types of insurance coverage would reduce only a small proportion of the race gap in access to the three procedures.     

增殖性糖尿病视网膜病变患者围手术期护理

目的探讨增殖性糖尿病视网膜病变患者围手术期护理的方法。方法对98例增殖性糖尿病视网膜病变患者施行精心护理,包括日常护理、术前术后常规护理、严密病情观察、积极做好对症治疗和出院指导,以及贯穿始终的心理护理。结果经过围手术期精心护理,本组98例患者疾病认知度、血糖控制良好率、心理承受能力和遵医行为均明显提高,均顺利康复出院。结论对增殖性糖尿病视网膜病变患者实施围手术期精心护理是增殖性糖尿病视网膜病变患者顺利康复的再要保证。     

Where do elderly veterans obtain care for acute myocardial infarction: Department of Veterans Affairs or Medicare?

OBJECTIVE: To examine Department of Veterans Affairs (VA) and Medicare hospitalizations for elderly veterans with acute myocardial infarction (AMI), their use of cardiac procedures in both systems, and patient mortality. DATA SOURCES: Merging of inpatient discharge abstracts obtained from VA Patient Treatment Files (PTF) and Medicare MedPAR Part A files. STUDY DESIGN: A retrospective cohort study of male veterans 65 years or older who were prior users of the VA medical system (veteran-users) and who were initially admitted to a VA or Medicare hospital with a primary diagnosis of AMI at some time from January 1, 1988 through December 31, 1990 (N = 25,312). We examined the use of cardiac catheterization, coronary bypass surgery, and percutaneous transluminal coronary angioplasty in the 90 days after initial admission for AMI in both VA and Medicare systems, and survival at 30 days, 90 days, and one year. Other key measures included patient age, race, marital status, comorbidities, cardiac complications, prior utilization, and the availability of cardiac technology at the admitting hospital. PRINCIPAL FINDINGS: More than half of veteran-users (54 percent) were initially hospitalized in a Medicare hospital when they suffered an AMI. These Medicare index patients were more likely to receive cardiac catheterization (OR 1.24, 95% C.I. 1.17-1.32), coronary bypass surgery (OR 2.01, 95% C.I. 1.83-2.20), and percutaneous transluminal coronary angioplasty (OR 2.56, 95% C.I. 2.30-2.85) than VA index patients. Small proportions of patients crossed over between systems of care for catheterization procedures (VA to Medicare = 3.3%, and Medicare to VA = 5.1%). Many VA index patients crossed over to Medicare hospitals to obtain bypass surgery (27.6 percent) or coronary angioplasty (12.1 percent). Mortality was not significantly different between veteran-users who were initially admitted to VA versus Medicare hospitals. CONCLUSIONS: Dual-system utilization highlights the need to look at both systems of care when evaluating access, costs, and quality either in VA or in Medicare systems. Policy changes that affect access to and utilization of one system may lead to unpredictable results in the other.     

Underuse of invasive procedures among Medicaid patients with acute myocardial infarction.

OBJECTIVES: The purpose of this study was to determine whether underuse of cardiac procedures among Medicaid patients with acute myocardial infarction is explained by or is independent of fundamental differences in age, race, or sex distribution; income, coexistent illness; or location of care. METHODS: Administrative data from 226 hospitals in New York were examined for 11,579 individuals hospitalized with a primary diagnosis of acute myocardial infarction. Use of various cardiac procedures was compared among Medicaid patients and patients with other forms of insurance. RESULTS: Medicaid patients were older, were more frequently African American and female, and had lower median household incomes. They also had a higher prevalence of hypertension, diabetes, lung disease, renal disease, and peripheral vascular disease. After adjustment for these and other factors, Medicaid patients were less likely to undergo cardiac catheterization, percutaneous transluminal coronary angioplasty, and any revascularization procedure. CONCLUSIONS: Factors other than age, race, sex, income, coexistent illness, and location of care account for lower use of invasive procedures among Medicaid patients. The influence of Medicaid insurance on medical practice and process of care deserves investigation.     

Veterans'' System-of-care Preferences for Percutaneous Transluminal Coronary Angioplasty in a Rural Setting

CONTEXT: In the Veterans Health Administration (VHA), regionalization of high-technology health care services may influence veterans who live far from referral centers to obtain care locally, through the private sector. PURPOSE: To understand veterans' system-of-care preferences for a high-technology regionalized service. METHODS: The charts of 142 veterans who were referred for percutaneous transluminal coronary angioplasty (PTCA) by their VHA cardiologists were reviewed. FINDINGS: Fifty-two percent of these veterans obtained the procedure outside the VHA system. Insurance coverage and out-of-pocket costs were strongly associated with veterans' obtaining PTCA outside of the VHA system; travel distance was not. CONCLUSIONS: As the VHA begins to understand veterans' use of multiple systems of care, it will be important to understand the relationship between out-of-pocket costs and the system of care used for high-technology health care services.