全脑血管造影术并发症的分析

目的回顾性分析单纯全脑血管造影术围操作期的并发症。方法2008年7月-2009年6月在首都医科大学宣武医院介入放射诊断治疗科单中心完成单纯全脑血管造影术2460例。其中男1608例,女852例,年龄为2～84岁,平均（60±3）岁。分析其术后并发症的发生情况。结果全脑血管造影术后共31例出现并发症,发生率为1．26％,其中局部并发症19例,发生率为0．78％,分别为皮下血肿9例,动脉夹层3例,血管开口狭窄2例,导管打折2例。神经系统并发症7例,发生率为0．29％,分别为血管痉挛3例,栓塞事件1例,其他（包括心慌、血压下降、恶心、呕吐等）3例。全身并发症共5例,发生率为0．20％,分别为对比剂过敏反应2例,对比剂肾病2例,鱼精蛋白过敏1例。经合理处理后,全脑血管造影术后并发症患者均未出现严重后遗症。结论在规范操作的基础上,单纯全脑血管造影术是安全的,并发症较低。同时随着造影设备的不断改进,术前术中准备充分,操作耐心细致,可进一步减少其并发症。     

缺血性脑血管疾病的数字减影全脑血管造影分析

目的 探讨数字减影全脑血管造影在缺血性脑血管疾病诊断中的作用,寻求确诊率及敏感度较高的影像学检查方法.方法 选取2012年1月-2013年1月我院神经内科诊断为缺血性脑血管疾病患者100例作为观察对象,患者先后进行CT血管成像（CTA）及数字减影全脑血管造影检查,观察并记录两种检查方式的检查结果.结果 数字减影全脑血管造影对患者血管狭窄、血管闭塞检出率均高于CTA,差异均有统计学意义（P＜0.05）.数字减影全脑血管造影并发皮下淤血、脑血管痉挛、周围神经损伤各1例.结论 数字减影全脑血管造影在缺血性脑血管疾病诊断中具有较高的准确率,值得临床推广应用,但临床应用时应注意适应证,以积极地预防并发症.     

全脑血管造影术围检查期并发症临床分析

脑血管造影是诊断脑血管疾病的金标准,但因其是有创性检查,降低造影相关并发症的发生与处理恰当,将为获得诊断依据提供安全保证。我们将解放军第三0六医院神经内科2005年1月—2009年6月,连续实施的569例脑血管造影患者发生相关并发症的情况回顾性分析如下。     

浅谈全脑血管造影术后护理

数字减影全脑血管造影（DSA）,为一种有创性检查,存在许多操作风险及术后并发症,在术前评估、手术操作、术后观察护理等方面仍需进一步规范和完善。2007年1月至2008年9月,我院对62例患者经股动脉穿刺行DSA术,经精心护理,效果满意。现将护理体会报告如下。     

桡动脉选择性全脑血管造影的应用

目的 探讨经桡动脉入路选择性全脑血管造影的操作成功率、并发症及安全性.方法 回顾性分析83例经桡动脉入路选择性全脑血管造影的病历资料,记录操作成功率、手术相关并发症等资料.结果 83例患者中80例顺利完成操作,其中超选颈内动脉造影38次、颈外动脉造影5次、椎动脉造影49次,成功率96.4%.3例桡动脉穿刺失败.总的并发症发生率为9.6%,包括桡动脉痉挛(2例)、上肢胀痛(4例)、皮下血肿(1例)、阵发性室上性心动过速(1例)、脉搏减弱(1例)等.结论 经桡动脉入路选择性全脑血管造影成功率高、并发症少,是安全可行的.     

全脑血管造影术后皮质盲四例

全脑血管造影术作为脑血管疾病诊断的金标准，经过近20年来的飞速发展已日益普及。但一些相应的并发症则成为急需解决的问题，其中皮质盲就是较罕见的并发症之一。首都医科大学宣武医院介入放射诊断治疗科在2009年9月——2010年12月共行全脑血管造影4000例，其中出现皮质盲4例，发生率为0．1％。现将结果报道如下。     

短暂性脑缺血发作120例患者全脑血管造影结果分析

目的探讨短暂性脑缺血发作(TIA)全脑血管造影的临床意义。方法选择120例TIA患者行全脑血管造影检查,比较脑动脉颅内段、颅外段病变分布情况。结果 120例患者全脑血管造影检查阴性13例(10.83%),动脉硬化性改变24例(20%),血管狭窄或闭塞78例(65%),非动脉硬化性改变5例(4.17%),其中烟雾病3例,动脉夹层2例。颈内动脉系统的TIA以颅内段血管狭窄或闭塞为主,椎-基底动脉系统的TIA以颅外段血管狭窄或闭塞为主。结论颅内段血管狭窄是颈内动脉系统TIA的主要病因,颅外段血管狭窄是椎-基底动脉系统TIA的主要病因,建议TIA患者早期行脑血管造影检查,指导临床治疗。     

全脑血管造影术及支架植入术的护理

目的探讨全脑血管造影术（DSA）及支架植入术的术前、术中、术后的护理。方法对40例行全脑血管造影或支架置入术的脑血管病患者进行术前心理疏导，做好各项术前准备，加强术中、术后监测和护理，及时处理各种并发症。结果1例支架置入术患者由于血管扭曲支架无法到位而手术终止，其余病例均获手术成功。2例支架置入术患者术中、术后出现了心率缓慢、血压下降，给予提高心率、升血压等措施，1周后症状消失；2例术后穿刺部位出现了假性动脉瘤，经加强局部压迫止血而治愈；1例出现肺部感染，经加强抗感染及护理后治愈。结论术前充分准备，术中密切监护，术后加强护理对手术成功意义重大。     

65例颅脑CT与脑血管造影的对照研究

报道65例颅脑CT与脑血管造影(含颈动脉系统造影、股动脉插管选择性椎动脉造影及数字减影)对照分析,发现两项检查对颅内疾病的定位定性诊断均有一定的漏、误诊率,若结合使用,可以互补,为鉴别诊断提供更有价值的依据。     

36例全脑血管造影术的并发症分析及防治

目的 观察全脑血管造影术(DSA)中出现并发症的情况,并提出预防和治疗DSA并发症的方法.方法 回顾性分析我院36例DSA检查出现的并发症,并对处理进行研究总结,对采用新型动脉压迫止血器的效果进行了研究.结果 DSA并发症最常见的依次是穿刺处血肿和皮肤淤斑,术后急性尿潴留,低血糖表现,颅内动脉痉挛,感染;经积极处理,患者并发症均治愈,未留下明显后遗症;采用新型动脉压迫止血器防止瘀斑和皮下血肿效果较好,与常规弹力绷带压迫止血差异有统计学意义(x2=3.848 2,P＜0.000 1).结论 DSA检查总体还是比较安全,严重并发症发生少,轻的并发症给予预防措施和正确处理能减少发生甚至避免,可推广采用动脉压迫止血器止血.     

60例高原地区高血压病人的护理体会

目的探讨高原地区高血压病人有效护理方法,提高患者生活质量。方法选取我院2013年1月至2013年10月收治的高血压患者共60例,随机分为对照组和观察组,对照组采取常规护理,观察组采取护理干预,对两组患者临床效果进行对比分析。结果观察组总有效率为96.67%,患者满意率为100%;对照组显效总有效率为83.33%,患者满意率为83.33%。两组患者总有效率、满意率明显高于对照组,差异有统计学意义,P0.05。结论对高原地区高血压患者采取健康教育、心理护理、饮食指导、用药指导等综合护理干预能有效的提高治疗有效率及患者满意度,可进一步推广应用。     

The importance of peripheral angiography in elderly patients undergoing coronary angiography

Objectives Early and accurate diagnosis of peripheral atherosclerosis is of paramount importance for global management of patients with known coronary artery disease (CAD), especially in the elderly. We sought to evaluate the prevalence and clinical relevance of significant abdominal vessel stenosis or aneurysm (AVA ) in patients undergoing coronary angiography. Methods Medical records of consecutive > 75-year old patients who underwent coronary angiography at two public institutions over a 12-month period were evaluated. Angiographic results of patients who underwent coincident diagnostic abdominal aorta angiography to evaluate abdominal vessels on the basis of clinical and angiographic criteria were analyzed. Results During the study period, AVA was found in 90 (35.7%) of 252 consecutive patients (185 males, mean age 79±5.8 years) , renal artery stenosis in 13.1% of cases (33 patients) , aort-oiliac artery disease in 13.7 % (35 patients), and aortic aneurismal disease in 8.9% (22 patients). Logistic regression analyses revealed >3-vessel CAD (odds ratio [OR] :9.917, P = 0.002), and > 3 risk factors (OR: 2.8, P = 0.048) as independent predictors of AVA . Conclusions Aged patients with multivessel CAD frequently have a high risk profile and multiple vascular atherosclerotic distributions, suggesting the usefulness of a more global and comprehensive cardiovascular approach in aged patients. (J Geriatr Cardiol 2005;2(1) :42-45).     

Adiponectin and mortality in patients undergoing coronary angiography

CONTEXT: The adipokine adiponectin has been suggested to protect against coronary artery disease (CAD). However, studies addressing the association between adiponectin and mortality are sparse. OBJECTIVE: The objective of the study was to elucidate the relationship between adiponectin and mortality. DESIGN, SETTING, AND PARTICIPANTS: Adiponectin was determined in 2473 persons with and 673 persons without angiographic CAD. During a mean follow-up period of 5.45 yr, 427 persons with CAD and 55 persons without CAD died. MAIN OUTCOME MEASURE: Hazard ratios for mortality according to adiponectin levels were measured. RESULTS: Adiponectin was positively related to female gender, age, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, homocysteine, and N-terminal pro-B-type natriuretic peptide. It was inversely related to glomerular filtration rate, body mass index, and triglycerides and was low in diabetes mellitus and CAD. An increase of 1 sd in adiponectin was associated with unadjusted and fully adjusted hazard ratios for death from any cause of 1.31 [95% confidence interval (CI) 1.20-1.42] and 1.22 (95% CI 1.12-1.34), and for death from cardiovascular causes of 1.32 (95% CI 1.19-1.45) and 1.23 (95% CI 1.11-1.37), respectively. In angiographic CAD, stable CAD, and unstable CAD, the predictive value of adiponectin was similar to that in the entire cohort, but it did not attain statistical significance in persons without angiographic CAD. Adiponectin was also positively related to the risk of death from noncardiovascular causes. CONCLUSIONS: Despite the common view about adiponectin as a protective molecule in cardiovascular disease, high adiponectin independently predicts all-cause, cardiovascular, and noncardiovascular mortality in individuals with CAD.     

Contrast-media induced nephropathy in patients undergoing coronary angiography

Contrast-medium induced nephropathy (CIN) in patients undergoing cardiac catheterization has an extremely variable incidence, which is very elevated in high-risk subgroups. Despite its benign course in most cases, it is associated with a longer hospital stay, and elevated in-hospital and late mortality rates. This paper reviews the physiopathogenesis of CIN, as well as the clinical manifestations and preventive measures currently available.     

Effects of video information in patients undergoing coronary angiography

BACKGROUND: informed consent is a fundamental and legal obligation for each interventional cardiologist. The effect of consent form describing risks of invasive procedure on anxiety is controversial. This trial was aimed to assess the added value of video information to the standard informed consent process. METHODS: 200 consecutive patients undergoing coronary angiography were enrolled. The first one hundred were assigned to conventional education conducted by the physician (no video group) and the second one hundred had consent obtained in the conventional manner assisted by video information (video group). The outcome variables for this comparison consisted of a standard anxiety score (Spielberger Statement Anxiety Inventory questionnary) plus hemodynamics measurements of heart rate, systolic and diastolic blood pressure obtained at baseline and immediately after written informed consent In addition, before discharge, patients graded the tolerability and satisfaction on a 4-point scale. RESULTS: The groups were similar with regard to their baseline characteristics and anxity score (37+23 vs 37+23). Patients who had not had prior experience of catheterization had higher baseline anxiety than those who had prior angiography (45 + 22 vs 31 + 20; p = 0.027). Patients who watched the video were significantly less anxious after informed consent (28 + 21 vs 34 + 22; p = 0.048) and had a significantly lower heart rate (65 + 10 vs 71 + 12; p = 0.03). The benefits of video information were especially prominent in those with higher anxiety scores at baseline (score after 45 + 24 vs 57 + 26; p = 0.046). Tolerability were higher in the video group compared with no video group (98% vs 86%; p = 0.003). Finally, satisfaction of information for informed consent process was higher in video group than in no video group (99% vs 76%; p = 0.001). CONCLUSION: a video information decreased anxiety level after written informed consent and improved tolerability and satisfaction scales in patients undergoing coronary angiography. The most likely to benefit from video information are patients with higher anxiety level at baseline. Beneficial effect on informed refusal should be investigated in larger population.     

Contrast nephropathy in azotemic diabetic patients undergoing coronary angiography

PURPOSE: To evaluate the incidence of, risk factors for, and outcome of contrast nephropathy in azotemic diabetic patients undergoing coronary angiography. PATIENTS AND METHODS: Fifty-nine insulin-dependent diabetics with a mean serum creatinine level of 522 mumol/L (5.9 mg/dL) underwent coronary angiography as part of a pretransplant evaluation. Twenty-four azotemic diabetics undergoing inpatient evaluation not including angiography for transplantation formed the control group. Serum creatinine measurements obtained at baseline and after radiocontrast exposure were compared in patients and control subjects. Risk factors for contrast nephropathy were evaluated in patients with a 25% or greater increase in serum creatinine. RESULTS: Serum creatinine was significantly elevated 24 hours after radiocontrast exposure in patients (557 +/- 141 mumol/L versus 522 +/- 141 mumol/L, mean +/- SD; p less than 0.001) but not in controls. Seven patients required dialysis within 6 days of coronary angiography and two additional patients required dialysis within 14 days. Contrast nephropathy, defined as a serum creatinine increase of greater than 25% when measured 48 hours after radiocontrast exposure, occurred in 50% of patients and no controls. Univariate analysis of risk factors for contrast nephropathy revealed a significant association with dye quantity (p = 0.002), mean arterial pressure less than 100 mm Hg (p = 0.02), and ejection fraction less than 50% (p = 0.04). Stepwise logistic regression verified the independence of dye quantity and low mean arterial pressure but not low ejection fraction as risk factors for contrast nephropathy. Follow-up serum creatinine values were not significantly different in patients and control subjects. CONCLUSIONS: Azotemic patients with diabetes are at high risk of developing contrast nephropathy even when less than 100 mL of radiocontrast agent is used. The acute renal failure is reversible but precipitates the need for short-term dialysis in some patients. Radiocontrast quantity is an important risk factor not previously noted. The incidence of contrast nephropathy can be minimized by using less than 30 mL of radiocontrast agent.     

Glucometabolic state in Chinese patients undergoing elective coronary angiography

Aim

The aim of this study is to characterize the glucometabolic state of patients undergoing elective coronary angiography (CA) in a subpopulation in China.

Methods and results

This study recruited 896 patients undergoing elective CA for the evaluation of suspected coronary artery disease (CAD). Oral glucose tolerance tests (OGTTs) performed in patients without previously known diabetes revealed that 173 (19.2%) had newly diagnosed diabetes and 281 (31.5%) had impaired glucose regulation. The prevalence of abnormal glucose metabolism (AGM) was significant difference among three groups of CA diagnosis, including normal coronary, nonsignificant stenosis and CAD. Overall, the proportion of patients with type 2 diabetes increased from 22.0% at baseline to 41.2% post-OGTT analysis. In total, 270 (59.5%) patients with AGM would have remained undetected if OGTTs had not been performed. Patients with CAD, hypertension, dyslipidemia, obesity and high C-reactive protein levels were at high risk of AGM.

Conclusions

AGM is common and underestimated by FPG testing alone in patients undergoing elective CA. OGTTs should be routinely performed to assess the glucometabolic state of patients undergoing elective CA, especially in patients with high risks of AGM. Detecting the state of AGM in CA individuals may provide strategies to reduce the progression of AGM and associated complications.     

62例咯血患者的护理体会

咯血是呼吸内科常见的症状之一,支气管扩张、支气管肺癌、肺结核等疾病均可引起咯血的发生。咯血有时来势凶猛,如不及时抢救常会引起窒息及失血性休克,造成患者的死亡。对咯血患者进行有效的护理和抢救可使窒息的发生率有效降低,也对疾病的治疗和预防有着重要的作用。为探讨咯血患者的临床护理方法,特收集我院呼吸内科2007年1月至2011年9月收治的62例咯血患者的病历、护理计划、护理交接班记录等加以整理分析,现报告如下。     

晚期血吸虫病患者的护理体会

通过一般护理、心理护理及针对并发症的护理,64例晚期血吸虫病患者中有27例达临床治愈,3例病情好转,34例病情稳定。