气管插管拔除对老年冠脉搭桥术患者生命体征影响的研究

目的探讨气管插管拔除对60岁以上冠脉搭桥术（Coronary Artery Bypass Grafting,CABG）患者生命体征主要指标的影响作用,进一步明确对老年患者气管插管拔除前后的护理要点,制定护理计划。方法2004年9月～2005年3月在我院行CABG患者39例,术后入重症监护室（ICU）后予呼吸机支持,当患者病情符合拔管指征时予以拔管,观察记录拔管前后血流动力学参数和动脉血气主要指标值。结果患者拔管后10min的收缩压（SBP）与拔管前显著升高（P〈0．05）,拔管后30min与拔管前比较差异无显著性（P〉0．05）;拔管前后的舒张压（DBP）、氧饱和度（SatO2）、中心静脉压（CVP）和肺动脉嵌压（PAwP）比较差异无显著性（P〉0．05）;拔管前后动脉血气分析中pH值、二氧化碳分压（PaCO2）和氧分压（PaO2）与拔管前比较差异无显著性（P〉0．05）。结论气管插管拔除对老年CABG患者的收缩压有短暂的升高作用,应在拔管后加强血压监护,同时做好胸部体疗,预防肺部并发症发生。     

两种冠状动脉搭桥术对肾功能的影响

目的研究体外循环与微创冠状动脉搭桥术对肾功能的影响。方法适合冠状动脉搭桥术患者42例,随机分成C(体外循环,CCABG)组和O(微创术,OPCABG)组各21例。分别留取术前24 h(T0)、术中(T1)、术后24 h(T2)、术后48 h(T3)四个时段的尿液及血液标本,记录尿量,通过血、尿标本中的肌酐测定结果计算内生肌酐清除率(C cr);同时检测尿微量白蛋白(ALB)、尿视黄醇结合蛋白(RBP)、N-乙酰-β-D-氨基葡萄糖苷酶(NAG)浓度,计算尿蛋白或酶排量(蛋白或酶浓度与C r之比)。结果①C cr:两组病人T1明显高于T0,T2、T3快速回降低于T0(P<0.01)。组间比较,T1C cr水平C组明显高于O组,T2、T3C cr水平C组明显低于O组(P<0.05);②尿ALB/C r:两组病人T1ALB/C r值明显高于T0水平,T2、T3有不同程度的回落,但仍高于T0(P<0.01)。T1ALB/C r,C组明显高于O组(P<0.01);③尿RBP/C r、NAG/C r:T0两组病人尿RBP/C r、NAG/C r水平均高于正常值,并在T1-T3各时点持续上升高于T0(P<0.01)。两组T1、T2、T3各相应时点值比较,C组明显高于O组(P<0.01,P<0.05)。结论微创术与非体外循环对肾小球和肾小管功能均有可逆的亚临床影响,对肾小管影响大于肾小球。微创术对肾功能的影响较小于体外循环的影响。     

非体外循环冠状动脉搭桥术

目的 :探讨非体外循环冠状动脉搭桥术的优点、适应征及移植材料的选择。方法 :手术在全麻常温下进行 ,正中切口。例 1搭桥 2支 ,例 2搭桥 3支。结果 :例 1,手术时间 2 .5h ,带气管插管时间 4 .5h ,例 2 ,手术时间 3h ,带气管插管时间 4h ,均在术后 9d痊愈出院。结论 :非体外循环下的冠状动脉搭桥术安全可行 ,拓宽了搭桥术的指征。且可减少手术创伤与并发症 ,降低医疗费用 ,在移植材料上 ,首选动脉材料。     

冠状动脉旁路移植术患者术前焦虑状况的调查

目的了解冠状动脉旁路移植术患者术前的焦虑状况,为制订针对性的干预措施提供依据。方法采用一般资料调查表及焦虑自评量表(self-rating anxiety scale,SAS)对2012年1月至2013年12月南京大学医学院附属鼓楼医院心胸外科收治的行冠状动脉旁路移植术的128例患者进行调查。结果 128例患者中,50例患者存在焦虑症状,其中轻度焦虑16例、中度焦虑32例、重度焦虑2例;不同性别、年龄、文化程度、病程、家庭人均月收入及医疗费用支付方式、患者术前焦虑情况的差异有统计学意义(P0.05或P0.01);不同婚姻状况患者术前焦虑情况的差异无统计学意义(P0.05)。结论年龄大、病程长、文化程度低、家庭人均月收入低、医疗费用自付、女性患者在冠状动脉旁路移植术术前易出现焦虑症状,护理人员应加强对这部分患者的观察和心理护理,针对性地采取护理干预,以减轻患者的心理负担,从而有利于手术的顺利进行和术后的康复。     

64例非体外循环冠状动脉旁路移植患者手术后低氧血症的监护

总结64例非体外循环冠状动脉旁路移植患者手术后低氧血症的护理经验,认为心功能维护、呼吸管理以及出血监护和疼痛护理,是监护重点和难点。尤其要严密监测心率、血压、中心静脉压、心输出量、血氧饱和度和氧合指数的变化,及时掌握心功能和氧的供需平衡情况;实施限制性液体管理对策,术后早期保持轻度负平衡状态,特别对高龄、心肺功能较差的患者,以助于改善氧合;掌握低氧血症患者吸痰的正确方法,进行加温湿化氧疗,做到合理通气管理。经精心护理,63例低氧血症患者得以纠正,1例患者因重度低心排、低氧血症不能纠正而死亡。     

高龄危重病人冠状动脉旁路移植术术后并发症护理

总结80例高龄危重病人冠状动脉旁路移植术术后并发症的护理。80例病人术后并发症有心律失常、低心排血量综合征、肺部并发症、急性肾功能不全、神经系统并发症、切口感染等。针对并发症采取措施:维持酸碱和电解质平衡,应用抗心律失常、血管活性药物,能使病人安全度过围手术期,提高了手术成功率和病人生存率。     

非体外循环冠状动脉旁路移植术进展

对非体外循环冠状动脉旁路移植术(OPCAB)的现状、围术期监护进行了综述,强调了OP-CAB后的心肌保护及血流动力学监测。     

经食管超声心动图在冠状动脉旁路移植术中的应用价值

经食管超声心动围监测24例冠状动脉旁路移植术患者。结果显示：①术中经食管超声心动图检测冠脉左前降支、左旋支及右支供血区缺血敏感度为92％、91％及93％，特异度及阳性预告值均为100％，阴性预告值均为67％，总符合率为93％、92％及93％；②监测缺血室壁运动状态，弥补术前经胸超声心动图对节段室壁运动异常的遗漏。冠状动脉旁路移植术对运动减弱区节段收缩功能的改善强于运动消失和矛盾运动区域；③监测冠状动脉旁路移植术中左室容积、收缩功能，指导人工心肺机的脱离和麻醉用药的调整；④监测术中并发症，为冠状动脉旁路移植术患者恢复创造有利条件。     

舒芬太尼在非体外循环下冠状动脉旁路血管移植术的应用

目的:通过对芬太尼和舒芬太尼应用于冠状动脉旁路血管移植术(OPCABG)的安全性、术后清醒时间和拔除气管导管时间的比较,了解舒芬太尼对于OPCABG是否较芬太尼更具优势。方法:拟择期行OPCABG病人40例,年龄40～70岁,体重50～90kg,美国麻醉医师协会(ASA)病情分级Ⅱ～Ⅲ级,随机分为舒芬太尼组(观察组,n=20)和芬太尼组(对照组,n=20)。2组均记录手术时间、术后清醒时间、气管导管拔除时间。结果:2组病人术中血流动力学变化平稳且相似,但清醒时间和气管导管拔除时间差异具有显著性意义。结论:舒芬太尼用于OPCABG安全平稳,术后病人清醒时间和气管导管拔除时间均明显短于芬太尼组,可作为快通道麻醉的首选药物之一。     

微创冠状动脉旁路移植术同时行双极消融治疗房颤

目的:分析不停跳冠状动脉旁路移植术同时行双极房颤消融的手术效果。方法:3例需要手术的冠心病患者中2例合并永久性房颤,1例合并阵发性房颤,术中先常规完成血管序贯吻合,然后钝性分离肺静脉,插入双极房颤消融电极,在肺静脉开口消融2次,消融线重叠呈"X"形,最后电刀切断Marshall韧带,切除左心耳。结果:手术操作过程顺利,无手术相关并发症,手术结束时,3例患者均为窦性心律,病人顺利恢复,术后7d出院。3例患者随访6个月,其中1例在随访过程中心律始终为窦性,2例患者在出院时心律为房扑,随访过程中心律为窦性。结论:不停跳冠状动脉旁路移植术同时行双极房颤消融手术是安全、有效、可行的。     

Effects of Extremity Massage on Preoperative Anxiety: A Three-Arm Randomized Controlled Clinical Trial on Phacoemulsification Candidates

PurposeThe present study aimed to compare the effects of foot and hand massage on preoperative anxiety.DesignThree-arm randomized, nonblinded, placebo-controlled, parallel group trial.MethodsThis study was conducted on 90 female candidates waiting for phacoemulsification cataract surgery in Arak Amirkabir Hospital, Iran. Patients were consecutively selected and randomly divided into three groups of hand (n = 30), foot (n = 30), and placebo (n = 30), using a random number generator software program. In each group, massage was performed 5 minutes for each hand or foot in the surgical waiting room about 10 minutes before surgery. Anxiety was measured before and after the intervention by visual analog scale and also assessing physiological indicators (heart rate, respiratory rate, systolic and diastolic blood pressures).FindingsAll the 90 patients completed the study and were included in the final analysis. Both hand and foot massage resulted in a significant decrease compared with placebo massage in anxiety and heart rate. However, no significant difference was found between hand and foot massage in any of the measured parameters. In the foot group and hand group, a significant reduction was observed in heart rate and anxiety after the intervention, whereas the anxiety increased significantly in the placebo group after the intervention. Moreover, systolic blood pressure in the foot group and the respiratory rate in the hand group significantly decreased after the intervention.ConclusionsApplication of hand or foot massage seems to be effective in managing anxiety in patients waiting for phacoemulsification cataract surgery.     

瑞芬太尼和芬太尼在冠状动脉旁路移植术麻醉中的应用

目的:比较瑞芬太尼与芬太尼在非体外循环下冠状动脉旁路移植术麻醉中的效果。方法:2008年1月-2010年6月,将40例接受非体外循环下冠状动脉旁路移植术的患者随机分为芬太尼麻醉组(芬太尼组,n=20)和瑞芬太尼麻醉组(瑞芬太尼组,n=20)。比较2组患者围术期血流动力学改变、术后恢复的情况及住院总费用。结果:瑞芬太尼组患者术中血流动力学稳定,术后患者拔管时间和出监护室时间均显著短于芬太尼组(P均<0.05),瑞芬太尼组平均住院总费用亦显著少于芬太尼组(P=0.029)。结论:将瑞芬太尼用于非体外循环下心脏外科手术的麻醉不仅是安全的,而且患者苏醒和恢复时间较短,降低了患者的住院费用。     

非体外循环下行冠状动脉搭桥术的手术配合

目的 探讨非体外循环即心脏不停跳状态下行冠状动脉搭桥手术的手术配合。方法 选择2001年12月—2002年6月我院在非体外循环即心脏不停跳下行多支冠状动脉搭桥术共27例，术中控制血压、心率的变化，保证有效循环血量，充分利用CTS局部心肌固定器及冠状动脉塞子，使吻合口局部心肌处于相对静止和冠状动脉处于无血状态。结果 本组病例无1例死亡，术后9d—16d均痊愈出院。结论 护士熟悉手术步骤，娴熟的配合技术，有利于手术的顺利进行。     

冠脉旁路移植术患者生存质量随访研究

目的观察研究冠状动脉旁路移植（CABG）术患者在术前、术后生存质量。方法分为体外循环冠状动脉旁路移植（ONCAB）组和非体外循环冠状动脉旁路移植（OPCAB）组，于手术前一周内、术后三月和半年进行西雅图心绞痛调查表（SAQ）和SF-36量表的测评。结果完成术前及术后随访测试者共72例；SAQ评分术前以心绞痛稳定状态（AS）得分最低，在术后各项目有明显好转；SF-36的生理健康内容（PCS）和心理健康内容（MCS）在术后均有不同程度改善；ONCAB和OPCAB两组之间各纬度得分无论是在术后3月还是在术后6月比较均无显著差异。结论随着CABG术对心绞痛的有效缓解，患者生存质量随之提高；比较术后ONCAB和OPCAB两组患者的生存质量无显著统计学差异。     

Recovery and Quality of Life One Year after Coronary Artery Bypass Grafting

In order to study recovery and quality of life after bypass surgery, both objective and subjective data were collected during structured interviews. A total of 56 patients participated in the study. Data were collected during hospital admission and during two home visits at 6 and 12 months after Coronary Artery Bypass Grafting (CABG). Patients reported improved state of health and quality of life. Most of the changes occurred within the first six months after discharge. However, for most patients life had more or less returned to normal one year after CABG. It was also found that few of the patients changed their risk behaviour after surgery.     

改良采血法避免ICU冠状动脉旁路移植术后患者诊断性失血的效果

目的改良冠状动脉旁路移植术后患者的采血方法,以避免ICU诊断性失血的发生。方法便利抽样选取2011年7-12月我院ICU收治的冠状动脉旁路移植术后患者42例,采用随机数字表法将其分为常规采血组和改良采血组,每组21人。观察两组患者手术后3d平均采血总量、红细胞、血红蛋白检验值以及深静脉感染和动脉血栓发生率。结果改良采血组患者采血总量明显减少,红细胞、血红蛋白明显增高,与常规组比较差异有统计学意义(均P0.05);两组间深静脉感染和动脉血栓发生率差异无统计学意义(P0.05)。结论改良采血法能有效避免ICU冠状动脉旁路移植术后患者诊断性失血的发生,值得在临床推广应用。     

Underutilization of Implantable Cardioverter Defibrillators Post Coronary Artery Bypass Grafting in Patients with Systolic Dysfunction

Background: Evaluation of the need for prophylactic internal cardiac defibrillators among patients with ischemic cardiomyopathies should be deferred until at least 3 months after revascularization procedures to allow adequate time for recovery of ventricular function. Methods: Among patients with left ventricular systolic dysfunction (LVSD) who undergo coronary artery bypass grafting (CABG), the proportion of patients who are risk stratified postoperatively with reassessment of left ventricular ejection fraction (LVEF) is unknown. Results: One hundred and six patients with LVSD (LVEF < 40%) who underwent CABG during 2004–2006 and survived 3 months post CABG were evaluated. Follow‐up was assessed by chart review and telephone contact. LVEF was not reassessed in 24% (25/106) of the population, none of whom underwent internal cardioverter defibrillator (ICD) implantation. Of those with LVEF reassessed, persistent LVSD was present in 20/81 (25%), 12 of whom were referred for prophylactic ICD placement. Conclusion: One‐fourth of patients with LVSD who undergo CABG do not have LVEF reassessed postoperatively which may lead to underutilization of ICDs. (PACE 2010; 33:727–733)     

The Effects of Acupressure on Nausea,Vomiting, and Vital Signs in Patients Undergoing Gynecologic Surgery: A Randomized Controlled Trial

PurposeThis randomized controlled experimental study was conducted to determine the effect of acupressure on nausea, vomiting, and vital signs in patients undergoing gynecologic surgery.DesignA randomized controlled experimental study.MethodsStudy participants consisted of females aged 18 to 65 years who underwent surgery in the gynecology clinic of the related hospital between October 2016 and March 2017. The sample originally consisted of 111 patients: K-K9 group (n = 39), P6 group (n = 37), and control group (n = 35). The point P6 in both wrists was determined, and the patients in that group wore a wristband 1 hour before the operation. The point K-K9 in both hands was determined, and one Black Pepper Seed was fixed on the point with the help of a plaster almost 1 hour before the operation. Once the wristband and the seed were placed, they remained in place for 24 hours. The control group received routine care, with no application of acupressure devices.FindingsFinal sample number was 103 after six were lost to follow-up. Vital signs of the patients showed a difference between the intervention groups and control group after the surgical procedure. The pulse values varied at statistically significant levels according to groups in the first and second measurements. The respiratory values of the K-K9 and P6 groups were statistically lower than those in the control group in the first, second, fourth, and fifth measurements (P < .05). The first measurement of nausea scores varied statistically according to the groups. The K-K9 group nausea scores were statistically lower than those in the control group (P < .05). At the time of the first measurement, the number of those who retched in the P6 group was statistically higher than those in the K-K9 group (P < .05).ConclusionsWe examined the effect of two types of acupressure in the management of postoperative nausea and vomiting in the first 24 hours after gynecologic surgeries. Although some findings of ours did not show a statistically significant difference, these alternative therapies showed promise.     

冠状动脉旁路移植患者围术期分级心理护理的实施与效果

目的 探讨适用于冠状动脉旁路移植择期手术患者的心理护理对策.方法 将2012年1月至2013年2月88例冠状动脉旁路移植术患者随机分为干预组和对照组各44例,对照组给予冠状动脉旁路移植术围术期常规护理,干预组按照术前后SCL-90症状自评量表评分及匹兹堡睡眠质量指数（Pittsburgh sleep quality index,PSQI）进行分级心理护理,比较两组患者手术前后心理、睡眠、疼痛等主观指标及住院天数、护理工作满意度.结果 干预组术后除SCL-90总均分外,PSQI及疼痛评分低于对照组,食欲得分高于对照组,总住院天数、ICU住院天数及术后住院天数少于对照组,护理工作满意度评分高于对照组,差异均有统计学意义（P＜0.05或P＜0.01）.结论 针对不同心理特点的冠状动脉旁路移植围术期患者实施分级心理护理,有助于促进患者康复、提高患者的满意度,并在一定程度上缩短了患者的住院时间,减少了医疗费用,体现了较好的经济效益及社会效益.