护理在急性心肌梗死患者应用rt-PA溶栓中的作用

目的:总结护理在急性心肌梗死患者应用rt-PA溶栓疗法中的作用.方法:应用rt-PA为急性心肌梗死6例进行溶栓治疗.结果:6例溶栓均获成功.结论:急性心肌梗死早期应用rt-PA溶栓,可挽救濒死的心肌或缩小心肌梗死的范围,效果优于其他溶栓药物.溶栓疗法专业性强,对护理工作要求高.护士不但要熟练掌握护理基础理论及技术操作,而且要认识和掌握rt-PA溶栓的要点和操作步骤,在溶栓过程中及时预防和发现并发症.护士在床边迅速而准确地检测出与心梗密切相关的肌钙蛋白T(TNT)、部分凝血活酶时间(APTT)等化验结果,为临床诊断、治疗提供有效依据,积极配合医生实施治疗计划,加强对病情的监护,促进了急性心肌梗死患者的早日康复.     

重组组织型纤溶酶原激活剂治疗急性肺栓塞6例的临床观察及护理

重组组织型纤溶酶原激活剂(recombinant tissue-plasminogen activator,rt-PA)为临床上治疗急性心肌梗死常用的溶栓剂.近年来,在急性肺栓塞患者也开始尝试使用rt-PA溶栓.我院2002年10月7日～12月23日应用rt-PA治疗急性肺栓塞6例获得良好的效果.现将治疗中的临床观察及护理报告如下.     

超早期急性脑梗死急诊溶栓15例临床护理

溶栓治疗是近年来治疗急性脑梗死的主要进展之一.应用组织型纤溶酶原激活剂(rt-PA)的溶栓疗法能有效减轻发病3 h以内的缺血性脑卒中患者的神经损伤[1].2005年2月～2007年7月,我们运用爱通力(rt-PA)静脉溶栓治疗急性脑梗死患者15例,经精心护理,效果满意.现将护理体会报告如下.     

9例急性肺栓塞患者溶栓的急救护理

目的：总结急性肺栓塞溶栓的护理体会。方法：对9例急性肺栓塞溶栓患者加强呼吸道的护理、合理使用静脉、准确及时的应用溶栓药物、严密观察病情变化、预防出血并发症的发生、严格执行各项操作规程以防感染的发生。结果：本组9例中治愈7例,好转2例。结论：探讨急性肺栓塞患者早期实施溶栓治疗,并给予全面的护理,可有效减少并发症,降低死亡率,提高抢救成功率。     

重组组织型纤溶酶原激活剂与尿激酶治疗急性肺栓塞的对比研究

急性肺栓塞临床并不少见,病死率高,如果能及时诊断并给予溶栓治疗可明显降低病死率.溶栓治疗已成为急性肺栓塞治疗常规之一.溶栓药物以尿激酶(UK)应用比较广泛,也取得了较好的疗效,但有时会出现出血等并发症.重组组织型纤溶酶原激活剂(rt-PA)是新型溶栓剂,采用细胞重组DNA技术生产,不具有抗原性,其直接将纤溶酶原转变成纤溶酶,对纤维蛋白比UK更具有特异性,国内外均已开始用于急性肺栓塞的溶栓治疗.我们以我院呼吸内科收治的急性肺栓塞患者为研究对象,探讨rt-PA及UK在急性肺栓塞溶栓治疗中的应用价值.     

rt-PA溶栓匹配护理在急性脑梗死患者中的应用

目的：探讨重组人组织型纤溶酶原激活剂(rt-PA)溶栓匹配护理在急性脑梗死患者中的应用效果。方法：选取2020年12月1日～2022年4月30日收治的92例急性脑梗死患者为研究对象，应用计算机分层法分为对照组和观察组各46例，对照组均实施常规护理干预，观察组在此基础上实施rt-PA溶栓匹配护理；比较两组干预前、干预2周后、干预4周后神经功能缺损情况[采用美国国立卫生院卒中量表(NIHSS)]、肢体运动功能[采用Fugl-Meyer运动功能评定量表(FMA)]及生活自理能力[采用日常生活能力量表(ADL)]。结果：干预2、4周后，观察组NIHSS评分低于对照组(P<0.05,P<0.01),FMA、ADL评分均高于对照组(P<0.01,P<0.05)。结论：rt-PA溶栓匹配护理能够促进急性脑梗死患者神经功能的恢复，提高肢体运动功能及生活自理能力，值得临床推广。     

急性脑梗死病人rt-PA溶栓的护理体会

目的探讨急性脑梗死病人rt-PA静脉溶栓治疗的护理要点。方法选择经严格筛选后符合rt-PA静脉溶栓指征的5例进行rt-PA静脉溶栓治疗的急性脑梗死病人进入溶栓后护理程序,观察护理效果。结果 5例病人溶栓过程护理配合得当,1例完全康复,3例患者患肢肌力和神经肌肉功能均有显著改善,1例继发颅内出血。结论严格掌握rt-PA静脉溶栓治疗的适应证、禁忌证,充分的物品、环境及抢救准备,特别是溶栓过程中的血压观察、心理疏导、并发症的识别与处理等,均是溶栓护理的重要环节。     

护理管理在急性脑梗死rt-PA静脉溶栓护理技术中的作用

总结8例急性脑梗死病人行重组组织型纤溶酶原激活剂(rt-PA)溶栓的护理过程中存在的问题,包括溶栓前评估不到位、溶栓箱内物品掌握不熟悉、应急预案及溶栓药物配制不熟悉等问题。认为通过加强相关理论、操作的技术培训及不断修订rt-PA溶栓护理常规,加强溶栓急救箱的管理能提高急性脑梗死病人rt-PA溶栓护理的质量,从而提高治疗的效果。     

应用rt-PA静脉溶栓治疗急性脑梗死的疗效观察及护理

目的 探讨应用rt-PA静脉溶栓治疗急性脑梗死患者的疗效及护理体会。方法 对95例急性脑梗死患者进行rt-PA静脉溶栓治疗,采用NIHSS评估短期预后,溶栓后90天mRS评分和生活质量指数Barthal指数(BI)标准评定。结果 95例静脉溶栓的患者中溶栓有效53例(55.79%), mRS评分≤2分61例,3-6分34例,预后良好61例( 64.21%);生活质量指数Barthal指数80～100分有61例,＜80分有34例,预后良好共61例(64.21%)。结论 急性脑梗死患者rt-PA静脉溶栓治疗过程中护士的密切配合,及时用药,有效观察病情     

应用rt-PA溶栓治疗急性心肌梗死20例临床护理

目的:探讨急性心肌梗死患者使用rt-PA溶栓治疗的护理方法.方法:对20例急性心肌梗死患者进行溶栓治疗,并在溶栓前、中、后实施全程护理.结果:20例患者均痊愈出院,其中18例活动耐力恢复良好,2例活动耐力恢复稍差.结论:rt-PA溶栓疗效好,可减少并发症,提高存活率.护士在早期积极配合溶栓用药、观察和护理,可促进患者尽快康复,提高生活质量.     

个体化综合护理干预在肺栓塞药物溶栓患者中的应用

目的：探讨个体化综合护理干预在肺栓塞药物溶栓患者中应用的效果。方法：通过对本院2016年7月～2018年8月间收治的76例肺栓塞患者作为研究对象,按入院时间先后将其分为对照组和干预组。其中对照组38例,干预组38例。对照组运用常规护理手段,干预组采取个体化的综合护理干预措施,在患者出院前进行干预效果的评价。结果：干预组患者在并发症的发生率、出院6个月后肺栓塞复发率与对照组无明显差异,在制动期间舒适度、制动治疗依从性、康复锻炼的开始时间、护理满意度方面均明显优于对照组（P<0.05）。结论：个体化综合护理干预在肺栓塞药物溶栓患者的护理中较常规护理效果佳,护理方法更规范明确,值得借鉴。     

妇科肿瘤病人术后并发下肢深静脉血栓形成的护理

[目的]总结妇科肿瘤病人术后并发下肢深静脉血栓形成(DVT)的护理.[方法]对12例妇科肿瘤术后并发DVT病人行抗凝、溶栓治疗,同时加强心理护理、饮食护理、溶栓的护理、预防肺栓塞的护理、恢复期的护理.[结果]12例病人均治愈,未发生肺、脑栓塞等并发症.[结论]加强妇科肿瘤病人术后并发DVT的护理是保证治疗成功的关键.     

妇科肿瘤病人术后并发下肢深静脉血栓形成的护理

[目的]总结妇科肿瘤病人术后并发下肢深静脉血栓形成（DVT）的护理。[方法]对12例妇科肿瘤术后并发DVT病人行抗凝、溶栓治疗,同时加强心理护理、饮食护理、溶栓的护理、预防肺栓塞的护理、恢复期的护理。[结果]12例病人均治愈,未发生肺、脑栓塞等并发症。[结论]加强妇科肿瘤病人术后并发DVT的护理是保证治疗成功的关键。     

Should thrombolysis be contraindicated in patients with cerebral arteriovenous malformations?

OBJECTIVES: To report the successful and uncomplicated use of systemic thrombolysis for massive pulmonary embolism in a patient with a known cerebral arteriovenous malformation and to suggest that the presence of an unruptured arteriovenous malformation or aneurysm should not be considered an absolute contraindication to systemic thrombolysis. DESIGN: Case report. SETTING: A 16-bed adult neurologic/medical intensive care unit in a university hospital. PATIENTS: A patient developed a massive pulmonary embolism the morning after elective cerebral embolization of a large unruptured cerebral arteriovenous malformation. INTERVENTION: Radial artery catheterization, arterial blood gas measurements, mechanical ventilation, vasopressors, pulmonary perfusion scan, echocardiogram, head computed tomography, heparin therapy, and systemic recombinant tissue plasminogen activator therapy. MEASUREMENT AND MAIN RESULTS: The patient required emergent mechanical ventilation and vasopressor support for respiratory and hemodynamic failure. Echocardiogram showed acute right heart failure, and pulmonary perfusion scan demonstrated massive pulmonary embolism. Despite intravenous heparin therapy, the patient had worsening hypotension and acidosis and we therefore treated with recombinant tissue plasminogen activator. Within the next day the patient was weaned from vasopressor support and extubated. Neurologic examination remained normal, and follow-up head computed tomography revealed no evidence of intracranial hemorrhage. CONCLUSION: Known arteriovenous malformations or aneurysms are considered a contraindication to thrombolysis, although the true risk of thrombolysis-precipitated intracranial hemorrhage is unknown. We believe that this risk is low in the setting of a previously unruptured arteriovenous malformation or aneurysm. The decision to use systemic thrombolysis in a patient with a known vascular malformation should be individualized.     

Comparison of troponin I and N-terminal-pro B-type natriuretic peptide for risk stratification in patients with pulmonary embolism.

OBJECTIVE: We compared the usefulness of plasma N-terminal-pro B-type natriuretic peptide and troponin I levels for risk stratification of patients with pulmonary embolism. METHODS: This was a prospective study performed in an emergency department. N-terminal-B-type natriuretic peptide assay and troponin I were performed blindly at admission in patients with pulmonary embolism confirmed by imaging tests. A complicated pulmonary embolism was defined as any of the following: death, cardiopulmonary resuscitation, requirement for mechanical ventilation, use of pressors, thrombolysis, surgical embolectomy or admission in an intensive care unit. RESULTS: Sixty patients (mean age+/-standard deviation of 72+/-15 years) were included. Seventeen (28%) patients had adverse events: all were admitted in intensive care unit, one was treated with surgical embolectomy and one with thrombolysis, and three died. The median N-terminal-pro B-type natriuretic peptide level (95% confidence interval) was higher in the group of patients with complicated pulmonary embolism, 4086 pg/ml (505-8998) versus 352 pg/ml (179-662), respectively (P<0.05). The mean value of troponin I was similar in the complicated pulmonary embolism group, 0.09+/-0.17 microg/l versus 0.08+/-0.41 microg/l, respectively (P=0.93). The best threshold value of N-terminal-pro B-type natriuretic peptide was 1000 pg/ml, and the receiver operating characteristic curve demonstrated that N-terminal-pro B-type natriuretic peptide significantly predicted the complicated pulmonary embolism with an area under the receiver operative curve of 0.72 (0.58-0.83) (P<0.05), whereas troponin I did not [area under the receiver operative curve of 0.58 (0.42-0.71)]. CONCLUSION: Unlike troponin I, N-terminal-pro B-type natriuretic peptide may be an accurate marker of in-hospital complication after pulmonary embolism.     

16层螺旋CT血管造影在肺动脉栓塞中的应用价值

目的探讨16层螺旋CT血管造影(MSCTA)对肺动脉栓塞的诊断价值。方法33例患者行16层螺旋CT血管造影检查、薄层扫描及三维重建,三维重建方法包括容积再现(VR)、多平面投影(MPR)、最大密度投影(MIP)。结果33例均能显示肺栓塞的部位、范围、局部管腔狭窄程度,25例急性肺栓塞的直接征象为"截断征","双轨征";8例慢性肺动脉栓塞主要表现为肺动脉管腔内偏心性的和附壁性的充盈缺损。结论16层螺旋CT血管造影是诊断肺动脉栓塞及其溶栓疗效评价和随访最有效的无创性方法之一。     

Thrombolysis with recombinant tissue plasminogen activator during cardiopulmonary resuscitation in fulminant pulmonary embolism. A case series.

OBJECTIVE: To describe our outcomes using thrombolysis during the cardiopulmonary resuscitation (CPR) of patients in cardiorespiratory arrest (CA) caused by fulminant pulmonary embolism (FPE). DESIGN: A case series. SETTING: Intensive care units of a district hospital and a referral centre. PATIENTS: Six patients that suffered CA secondary to an FPE. INTERVENTIONS: Administration of recombinant tissue plasminogen activator during usual CPR manoeuvres when there was a strong suspicion of FPE. Permission for the thrombolytic therapy was sought from family members in all cases. RESULTS: Four out of the six patients survived and remain symptom-free. The thrombolysis was not associated with any fatal complications. CONCLUSIONS: Early thrombolysis during CPR manoeuvres for CA apparently caused by an FPE may reduce the mortality rate among these patients.     

阿替普酶治疗急性肺栓塞高危患者29例疗效观察

目的探讨阿替普酶溶栓治疗急性肺栓塞高危患者的效果及安全性。方法 29例急性肺栓塞患者均应用阿替普酶进行溶栓治疗,溶栓后24h行CT肺动脉造影评定疗效,行超声心动图检查观察溶栓前、后右心室舒张末期前后径（anterior-posterior diameter,APD）、右心室舒张末期横径（transverse diameter,TD）、肺动脉压（pulmonary arterial pressure,PAP）、三尖瓣反流压差（tricuspid valve pressure gradient,TRPG）、右心室壁运动幅度（right ventricular wall motion amplitude,RVAWM）,检测溶栓前、后D-二聚体、B型脑钠肽（（brain natriuretic peptide,BNP）水平,记录溶栓后不良反应发生情况。结果本组有效率为93.1%;溶栓后APD、TD、PAP、TRPG较溶栓前下降,RVAWM较溶栓前增加（P〈0.05）;D-二聚体、BNP水平较治疗前下降（P〈0.05）;溶栓后出血4例,死亡1例。结论阿替普酶适用于急性肺栓塞高危患者的快速溶栓治疗。     

介入溶栓治疗胸腔镜下肺癌根治术后高危肺栓塞的经验分析

目的 探讨不同介入溶栓方式治疗胸腔镜下肺癌根治术后高危肺栓塞(PE)的价值.方法 选取2018年就诊于河南大学第一附属医院的3例胸腔镜下肺癌根治术后发生高危PE的患者作为研究对象,其中1例接受单纯静脉溶栓治疗,1例接受单纯动脉介入溶栓治疗,1例接受静脉肺动脉联合介入溶栓治疗,分析3例患者住院治疗方式、溶栓治疗效果和术后...