血管性痴呆的心理社会干预

INTRODUCTION With the increase of average age, number of senile dementia casesincrease. Vascular dementia is the most important reason of seniledementia (VD) . Many researches showed that VD are preventableand treatable. It includes preventive therapy, drug treatment, psy-chic treatment and social intervention.     

Peripheral vascular disorders. Assessment and intervention

Peripheral vascular diseases are being seen with increased frequency in the health care setting today. It is imperative that nurses have a clear understanding of arterial, venous, and lymphatic circulatory mechanisms as well as the pathophysiologic changes that accompany common diseases of these systems. Providing the ongoing assessment to obtain a diagnosis, establish the acute versus chronic nature of findings, monitor progression, plan care, and assess the response to treatment is an important role for the nurse in order to preserve function, life, and limb in these patients.     

Nursing intervention in patients with peripheral vascular disease

Peripheral vascular disease is a chronic progressive disease. Nursing intervention will be aimed at primary prevention through risk factor modification. Quality patient care will be facilitated through the development of an individualized plan of care. An essential element to consider in promoting successful nursing intervention is collaboration of the nurse and patient when developing the plan of care. Overall goals of care for a patient with PVD include promotion of circulation, relief of pain, and prevention of tissue damage or infection.     

Global vascular intervention for peripheral vascular disease: endovascular integrated approach and future trend

Cardiovascular diseases are systemic processes frequently involving multiple vascular beds in a single individual. From carotid artery to tibial artery, evolving endovascular therapies have transformed the management of vascular disease. Endovascular therapy is more frequently employed for revascularization technique. These procedures often times are performed by a single operator. Precise vascular imaging technique and catheter handling skill are required in vascular interventionists. This article describes global vascular angiography and intervention. Integrated management on panvascular patient is introduced. The evolution of endovascular therapies will continue to change the way we treat vascular disease.     

Role of image-guided vascular intervention in therapeutic angiogenesis translational research

Therapeutic angiogenesis, the process of growing collateral blood vessels to better perfuse ischemic tissue, has been hailed as an up-and-coming treatment for symptomatic lower-extremity peripheral arterial occlusive disease. A minimally invasive durable treatment would be welcome since current treatment options for this disease carry high risk, limited efficacy or limited durability. Unfortunately, as evidenced by disappointing results in multiple clinical trials, therapeutic angiogenesis has yet to deliver in humans the success it has seen in animal models. In this review, we discuss the challenges of translating therapeutic angiogenesis into effective clinical treatments for lower-extremity peripheral arterial occlusive disease and we highlight the role that experts in image-guided vascular interventions can play in advancing the field.     

Role of image-guided vascular intervention in therapeutic angiogenesis translational research

Therapeutic angiogenesis, the process of growing collateral blood vessels to better perfuse ischemic tissue, has been hailed as an up-and-coming treatment for symptomatic lower-extremity peripheral arterial occlusive disease. A minimally invasive durable treatment would be welcome since current treatment options for this disease carry high risk, limited efficacy or limited durability. Unfortunately, as evidenced by disappointing results in multiple clinical trials, therapeutic angiogenesis has yet to deliver in humans the success it has seen in animal models. In this review, we discuss the challenges of translating therapeutic angiogenesis into effective clinical treatments for lower-extremity peripheral arterial occlusive disease and we highlight the role that experts in image-guided vascular interventions can play in advancing the field.     

Blood flow-induced physically based guidewire simulation for vascular intervention training

Purpose

A realistic guidewire behavior simulation is a vital component of a virtual vascular intervention system. Such systems are a safe, low-cost means of establishing a training environment to help inexperienced surgeons develop their intervention skills. Previous attempts to simulate the complex movement of a guidewire inside blood vessels have rarely considered the influence of blood flow. In this paper, we address this problem by integrating blood flow analysis and propose a novel guidewire simulation model.

Methods

The blood flow distribution inside the arterial vasculature was computed by separating the vascular model into discrete cylindrical vessels and modeling the flow in each vessel according to Poiseuille Law. The blood flow computation was then integrated into a robust Kirchhoff elastic model. With hardware acceleration, the guidewire simulation can be run in real time. To evaluate the simulation, an experimental environment with a 3D-printed vascular phantom and an electromagnetic tracking system was set up, with clinically used guidewire sensors applied to trace its motion as the standard for comparison.

Results

The virtual guidewire motion trace was assessed by comparing it to the comparison standard. The root-mean-square (RMS) value of the newly proposed guidewire model was 2.14 mm ± 1.24 mm, lower than the value of 4.81 mm ± 3.80 mm for the previous Kirchhoff model, while maintaining a computation speed of at least 30 fps.

Conclusion

The experimental results revealed that the blood flow-induced model exhibits better performance and physical credibility with a lower and more stable RMS error than the previous Kirchhoff model.

     

血管介入在难治性产后出血治疗中的应用

目的 评价介入治疗用于难治性产后出血的临床价值.方法 选择该院2004年4月～2009年4月难治性产后出血患者采用介入治疗15例,采用Seldinger技术行右侧股动脉穿刺术,将导管插入子宫动脉,在数字减影血管造影术(DSA)监视下注入明胶海绵颗粒对出血血管进行栓塞.结果 13例患者经介入治疗均达到有效止血,且保留了子宫,无1例死亡.发热及栓塞后综合征为栓塞后最常见的并发症,通常不需特别处理.结论 血管介入在难治性产后出血治疗中具有快速、有效、创伤小、恢复快、保留子宫等优点,值得在临床推广.     

Hemorrhagic and vascular complications after percutaneous coronary intervention with adjunctive abciximab

OBJECTIVES: To examine the frequency and nature of hemorrhagic and peripheral vascular complications associated with use of abciximab during percutaneous coronary intervention and to characterize high-risk patients. PATIENTS AND METHODS: We report the frequency and severity of bleeding and vascular complications recorded prospectively in 2,559 consecutive nonselected patients who underwent percutaneous coronary intervention at Mayo Clinic, Rochester, Minn, between July 1, 1996, and April 30, 1998, 831 of whom received abciximab and 1,728 did not. Abciximab and heparin were administered according to guidelines of the Evaluation of PTCA [percutaneous transluminal coronary angioplasty] to Improve Long-Term Outcome With Abciximab GP IIb/IIIa Blockade (EPILOG). RESULTS: Patients who received abciximab were more likely to be men, were more often treated within 12 hours of an acute myocardial infarction, and were more likely to have received heparin after the procedure (8.7 % vs 4.5%, P<.001). Major bleeding occurred in 18 patients (2.4%) who received abciximab and in 10 patients (0.6%) who did not receive abciximab (P<.001). Minor bleeding occurred in 108 patients (14.3%) and in 92 patients (5.9%), respectively (P<.001). Both major bleeding and minor bleeding were more frequent among patients within 12 hours of an acute myocardial infarction and were more frequent if abciximab had been used. Multivariate analysis revealed that use of abciximab was independently associated with major and minor bleeding. CONCLUSION: In this clinical setting, use of adjunctive abciximab during percutaneous coronary intervention was associated with a significantly increased risk of both major and minor bleeding.     

A music intervention to reduce anxiety before vascular angiography procedures.

Patients scheduled for vascular angiography are often anxious and frightened. High levels of anxiety may result in more difficult and painful procedures. Past research has reported mixed results for anxiety reduction techniques in other procedures settings, such as education, cognitive-behavioral skills, coping and relaxation skills, combinations of techniques, and music. Music as an intervention for pre-procedural anxiety prior to vascular angiography has not been studied. A randomized controlled trial of 170 patients was undertaken to determine whether 15 minutes of self-selected music reduced pre-procedure anxiety. The State Trait Anxiety Inventory was used to measure patients' anxiety. One-hundred sixty-six men and 4 women comprised the sample with an average age of 66.8 years (SD 9.95, range 37 to 85 years). Patients who listened to music (n=89) reduced their anxiety score from 38.57 (SD 10.46) to 35.2 (SD 9.7), while those who did not listen to music (n=81) reduced their anxiety score from 36.23 (SD 10.54) to 35.1 (SD 10.59); the difference between the groups was statistically significant (t=1.95, df 161, p=0.05). Pulse achieved a statistically significant reduction in the music group (t=2.45, df 167, p=0.02). Music is a noninvasive nursing intervention that patients enjoy and reduces their anxiety and their pulse rate. Further research should address using music to reduce anxiety in other interventional vascular angiography settings with equal numbers of men and women and comparing self-selected versus investigator-selected music.     

PTCA术后血管闭合装置与Femo-Stop的临床应用研究

目的比较PTCA术后应用血管闭合装置与常规压迫对血管并发症的影响和患者的满意度.方法483例患者经股动脉途径行PTCA术,术后穿刺部位处理接受常规压迫装置(Femo-Stop)298例,血管闭合装置185例(Angio-SealTM162例,Perclose 23例).观察并记录止血时间,开始早期行走时间,血管并发症情况,并由专门护士进行随访,调查出院48 h后患者的满意度.结果两组应用GPⅡb-Ⅲa受体拮抗剂的比率分别是56.8%vs 18.8%(P＜0.0001).应用Angio-SealTM、Perclose、Femostop股动脉止血时间分别是(1.7～1.2)min(P＜0.0001),(13.7±6.1)min(P＜0.001),(115.7±35.3)min.开始早期行走时间分别是(4.1±2.4)h(P＜0.01),(7.6±8.2)h(P＜0.05),(10.7±4.3)h.血管并发症的发生率分别是1.9%(P＜0.005),13.0%,6.4%(P＜0.05).两组总血管并发症的发生率分别是3.2%与6.4%(P＞0.05).两组患者出院后48 h随访满意度分别是92.4%,65.4%(P＜0.0001);住院时间分别是(23.1±12.3)h,(22.8±12.3)h(P＞0.05)差异无显著性.结论应用血管闭合装置可以使患者更早开始行走,缩短住院时间.尤其是Angio-SealTM的应用成功率和患者的满意度最高,止血时间和开始行走时间最短,血管并发症最少.     

沙利度胺对肠道血管畸形出血患者的干预作用

目的探讨沙利度胺对肠道血管畸形出血的干预作用。方法选取该院2010年1月至2012年12月的肠道血管畸形患者84例,按照随机数表法分为对照组和沙利度胺组。对照组36例,给予一般性输液,补充电解质;沙利度胺组38例,给予沙利度胺,100mg/d口服,连续4个月。观察2组患者治疗前1年以及治疗1年后患者临床疗效评分、输血量、血红蛋白、血管内皮生长因子(VEGF)、肿瘤坏死因子-α(TNF-α)、血管生成素-2(Ang-2)、低氧诱导因子-1(HIF-1)水平的变化。结果沙利度胺组患者治疗前头晕乏力情况及其持续时间、平均出血次数及其持续时间评分分别为(3.14±0.37)分、(2.99±0.41)分、(5.90±0.83)分、(3.10±0.90)分,治疗后为(0.71±0.42)分、(0.68±0.86)分、(2.02±0.79)分、(0.03±0.81)分,差异均有统计学意义(P0.05)。治疗前后输血量显著减少[(139.22±153.60)pg/mL,(113.00±161.26)pg/mL,P0.05],血红蛋白含量明显升高[(51.20±18.36)pg/mL,(90.09±21.63)pg/mL,P0.05]。服药前血清VEGF、TNF-α、HIF-I、Ang-2分别为(1.99±0.41)pg/mL、(2.10±0.90)pg/mL、(105.67±15.47)ng/mL、(616.70±93.72)ng/mL,治疗后为(0.68±0.86)pg/mL、(1.03±0.81)pg/mL、(63.01±21.28)ng/mL、(233.75±54.90)ng/mL,差异有统计学意义(P0.05)。对照组患者临床症状治疗前后差异无统计学意义(P0.05)。治疗前沙利度胺组各项评分与对照组比较,差异无统计学意义(P0.05),治疗后2组比较差异有统计学意义(P0.05)。结论沙利度胺能明显抑制肠道血管畸形出血,疗效显著。     

Blood pressure and risks of vascular complications after percutaneous coronary intervention.

Evidence-based protocols are needed for care of the nearly 1,000,000 patients in the United States who undergo percutaneous coronary interventional procedures. This article describes a case-matched control study of 300 patients undergoing percutaneous coronary intervention in which specific demographic, physician-sensitive, and nurse-sensitive factors were tested to determine their relative contribution to the incidence of vascular complications. Findings included that patients with a mean systolic blood pressure of 160 mm Hg or higher were 8 times more likely to have vascular complications (P < .001). Patients receiving heparin (with and without glycoprotein IIb/IIIa inhibitors) versus bivalirudin were 3 times more likely to have vascular complications (P = .008). Patients with hemostasis by AngioSeal and those with a history of hypertension were 77% (P =.031) and 61% (P = .005), respectively, less likely to have complications.     

运动干预对2型糖尿病病人血管功能的影响

[目的]探讨运动干预对2型糖尿病(T2DM)病人血管功能的影响.[方法]选择无运动禁忌证的T2DM病人80例,随机分为两组,每组40例,两组均给予一般护理治疗,干预期间饮食、用药基本不变.运动组另外进行运动干预6个月,并对血糖、血脂、糖化血红蛋白(HbAIc)、超敏C反应蛋白(hs - CRP)、颈股动脉脉搏波传导速度(cfPWV)及内皮依赖性舒张功能(FMD)等各项指标进行监测.[结果]6个月后,运动组和对照组HbAlc均显著降低,运动组cfPWV由治疗前的1160 cm/s±213 cm/s降低到1039cm/s±118 cm/s,FMD由治疗前的(6.51±0.91)％升高到(7.44±1.04)％,其差异均具有统计学意义,而对照组的cfPWV和FMD无显著变化.[结论]运动干预能够显著改善T2DM病人的血管功能,从而降低心血管并发症的风险.     

运动干预对2型糖尿病病人血管功能的影响

[目的]探讨运动干预对2型糖尿病（T2DM）病人血管功能的影响。[方法]选择无运动禁忌证的T2DM病人80例,随机分为两组,每组40例,两组均给予一般护理治疗,干预期间饮食、用药基本不变。运动组另外进行运动干顸6个月,并对血糖、血脂、糖化血红蛋白（HbAlc）、超敏C反应蛋白（hs-CRP）、颈股动脉脉搏波传导速度（cfPWV）及内皮依赖性舒张功能（FMD）等各项指标进行监测。[结果]6个月后,运动组和对照组HbAlC均显著降低,运动组cfPWV由治疗前的1160cm／s±213cm／s降低到1039cm／S±118cm／s,FMD由治疗前的（6．51±0．91）％升高到（7．44±1．04）％,其差异均具有统计学意义,而对照组的cfPWV和FMD无显著变化。[结论]运动干预能够显著改善T2DM病人的血管功能,从而降低心血管并发症的风险。     

经股动脉介入术后外周血管并发症的原因分析及护理

2018年11月-2019年12月于我院神经外科行经股动脉介入术治疗的1 085例患者中,共发生术后并发症35例,其中穿刺部位皮下血肿24例、假性动脉瘤5例、腹膜后血肿2例、动静脉瘘3例、血栓1例,分析并发症发生原因,并提出相应护理对策。     

血管性痴呆照顾者心理评估及护理干预

目的:对血管性痴呆(VD)照顾者进行心理评估,探讨其护理干预效果。方法:对76例VD患者的照顾者采用精神症状自评量表(SCL-90)、焦虑自评量表(SAS)及抑郁自评量表(SDS)进行评估,并根据评估存在的心理问题给予护理干预,观察照顾者干预前后的心理状况并与国内常模相比较。结果:VD照顾者SCL-90总分为136.12±35.17,SAS评分为32.12±5.17,SDS评分为36.81±6.15,均高于国内常模(Ρ<0.01);经过3个月的护理干预后,VD照顾者的SCL-90总分及各因子分(除强迫、恐怖、精神病性外)、SAS及SDS评分均较干预前降低(Ρ<0.05),与常模相比无显著性差异(P>0.05)。结论:VD照顾者存在不同程度的心理问题,护理干预可有效改善VD照顾者的心理状况。