气囊加压装置在永久起搏器植入术后伤口护理中的应用

目的 设计一款气囊加压装置,降低永久起搏器植入术后患者卧床时间及术后并发症的发生率,缩减伤口护理时间。方法 按随机数字表法将200例永久起搏器植入术患者分为对照组和观察组各100例;对照组伤口护理方式采用传统的沙袋压迫方法,观察组采用设计的气囊加压装置,其余常规治疗、护理操作相同。结果 观察组术后常见并发症的发生率、术后卧床时间、护士护理伤口工时均显著低于对照组,差异具有统计学意义（P<0.05）。结论 气囊加压装置可以有效降低永久起搏器植入术患者术后并发症的发生率,促进患者快速康复;减少伤口护理时间。     

永久心脏起搏器植入术后并发症的原因分析及护理对策

目的探讨永久心脏起搏器植入术后并发症及其原因,并总结护理对策。方法回顾分析2005年1月至2007年2月54例永久心脏起搏器植入术患者的临床和护理资料。结果术后发生并发症9例(11例次),发生率为20.4%(11/54),其中电极脱位5例次(45.4%),囊袋积血3例次(27.3%),起搏器感知功能障碍2例次(18.2%),起搏器综合征1例次(9.1%);所有并发症经相应处理后,患者均恢复正常。结论永久心脏起搏器植入术后并发症以电极脱位和囊袋积血为多见;熟悉永久起搏器植入术相关理论知识、术后密切观察和护理,对预防及减少术后并发症的发生有重要作用。     

1例早产儿坏死性小肠结肠炎并肠穿孔行造瘘术后的护理

目的 总结1例早产儿坏死性小肠结肠炎并肠穿孔行造瘘术后皮肤黏膜分离的护理经验。方法 该患儿系早产儿,极低出生体质量儿,感染严重,护理的重点及难点包括对患儿实施保护性隔离;控制全身感染,促进局部伤口愈合;合理喂养,改善营养状况;做好患儿家属心理护理及患儿出院后延续护理。结果 在积极控制全身感染,局部伤口配合使用藻酸盐银离子敷料、水胶体敷料及防漏贴环、造口袋,合理喂养后,术后经23 d精心护理后伤口愈合良好,顺利出院。结论 本例患儿病情危重,并发症较多,经积极治疗及实施个性化整体护理,患儿康复出院。     

32例永久起搏器植入病人的术后并发症分析及护理

[目的]分析永久起搏器植入术后引起并发症的相关因素,总结护理对策。[方法]回顾性分析总结32例心脏永久起搏器植入术后并发症的种类、原因及护理。[结果]32例永久起搏器引起囊袋出血、血肿22例,囊袋破溃感染2例,电极移位2例,起搏器综合征1例,起搏膈肌刺激症状5例。[结论]加强永久起搏器植入术后病人的观察及护理,及早发现各种并发症,早期配合医生及时处理,可提高起搏器植入手术成功率,有利于病人早日康复。     

8例伯-韦综合征患儿舌部分切除术及舌再造术的护理

目的 探讨伯-韦综合征患儿舌部分切除术及舌再造术的护理经验。方法 总结伯-韦综合征患儿8例术后的气道护理,呼吸机辅助通气、监测生命体征、气道湿化、按需吸痰等;导管护理,如固定导管、预防非计划性拔管;并发症预防护理,预防出血、感染;皮肤护理,防止压力性损伤及医用粘胶相关性皮肤损伤;营养支持。结果 8例患儿中,6例患儿留置鼻气管插管时间延长1~2 d,住院天数延长1~2 d。8例患儿经积极治疗护理后病情平稳,顺利出院。术后1个月随访,8例患儿舌体均可回纳至口内,术区恢复良好。结论 舌部分切除术及舌再造术后通过保持气道通畅、预防感染、消除术区肿胀、营养支持等积极护理,能够较好地保障患儿安全,降低治疗风险。     

235例肠套叠患儿手术前后的护理

目的 总结235例肠套叠患儿手术前后的护理经验。方法 本组235例患儿全麻下行肠套叠手法复位术或肠切除吻合术,护理要点包括:手术前给予补液治疗纠正脱水及电解质、酸碱平衡紊乱,脓毒性休克的护理,通过胃肠减压降低肠道压力减轻腹胀,完善手术前各项检查,做好手术区皮肤的准备;手术后加强腹部观察,腹部手术切口的护理,观察排气排便情况,指导合理饮食,做好出院宣教。结果 本组235例行肠套叠手法复位术175例,肠切除吻合术60例。1例并发脓毒性休克予积极液体复苏治疗后完成手术,2例术后切口感染经抗感染、切口换药、半导体激光照射后,切口愈合良好。1例术后并发肠瘘,再次行肠造瘘术。235例经手术治疗后,在住院期间给予补液、抗感染治疗后,均顺利出院。结论 对肠套叠行手术治疗患儿,根据患儿年龄小、配合度较差、发病速度快、晚期并发症多等特点,做好手术前后护理极其重要。     

永久心脏起搏器术后并发症的观察和护理

86例行心脏起搏器植入术患者术后发生电极移位3例、电极折断1例,囊袋内积血和血肿2例、起搏器综合征4例、感知障碍3例、感染2例。通过细致地护理,并发症均及时得到处理。按时对永久起搏器术后患者进行随诊,减少并发症的发生。     

12例蓝色橡皮大疱痣样综合征患者的护理

目的 总结12例蓝色橡皮大疱痣样综合征患者在手术切除及内镜下硬化剂联合手术切除围术期的护理经验,改善蓝色橡皮大疱痣样综合征患者术后护理效果。方法 术前做好心理护理;术前术后观察患者消化道出血、感染、肠套叠、吻合口瘘、面瘫等并发症并采取相应措施,术后观察患者腹部症状、体征以及大便情况,警惕延迟性出血的可能等病情监测。结果 本组12例患者住院7~28 d均好转出院,治疗效果显著,随访6~37个月,症状均得到改善。结论 做好心理护理、密切观察患者病情变化并做到预见性护理及做好并发症护理,可以改善蓝色橡皮大疱痣样综合征患者的预后。     

6例高位小肠坏死早产儿Bishop-Koop肠造口术后护理

目的 总结6例高位小肠坏死早产儿采用Bishop-Koop肠造口术的护理经验。方法 对诊断小肠坏死的早产儿行剖腹探查术,术中发现高位小肠坏死者采用Bishop-Koop肠造口术式,术后护理人员严密观察腹部体征;保持引流管及减压管通畅;保持患儿内环境稳定;加强输液管理;积极喂养;促进恢复。结果 本组6例患儿,2例提前行Ⅱ期造口还纳术,3例恢复良好封堵造口出院,择期行造口还纳术,1例放弃治疗后死亡。结论 高位小肠坏死患儿救治难度大,Bishop-Koop肠造口术可尽量保留患儿较多肠管,术后加强精细化护理及并发症观察,可提高患儿生存率。     

综合护理对中耳炎患者术后的影响

目的 探讨综合护理对鼓室探查联合人工听骨植入术对慢性中耳炎患者的影响。 方法 选取我院2016年1月-2017年2月收治的56例慢性中耳炎患者为研究对象,将其分为对照组和观察组,每组28例,均进行鼓室探查联合人工听骨植入术的治疗。术后对照组进行常规护理,观察组进行综合护理。比较2组患者焦虑情绪、生活自理能力、纯音测听值及并发症发生情况。 结果 护理后,观察组焦虑评分低于对照组(t=2.094,P=0.041),日常生活能力量表评分显著高于对照组(t=3.841,P＜0.001),纯音测听评分显著低于对照组(t=12.124,P＜0.001),并发症例数少于对照组(χ²=4.308,P=0.038)。 结论 综合护理能有效改善鼓室探查联合人工听骨植入术治疗中耳炎患者的焦虑情况,提高患者生活自理能力,促进患者早日康复。     

Endocardial pacemaker implantation in infants weighing < or = 10 kilograms

Epicardial pacemaker implantation is the most common approach for small children requiring pacemaker implantation, though it is not free from complications. This article reviews the experience with endocardial pacemaker implantation, as an alternative approach, in children < or =10 kg at two centers. Thirty-nine children, median age 3.8 months (2 days-35 months), weight 4.6 kg (2.3-10 kg) underwent endocardial permanent pacing (VVI/R in 38, DDDR in 1). Indications for pacing were complete heart block (CHB) in 34 (congenital in 21, postsurgical in 12, congenitally corrected transposition of the great arteries 1), long QT syndrome in 3, and sinus bradycardia in 2 children. Two children with postsurgical CHB died 7 days and 3 weeks after implantation, respectively, due to heart failure and septicemia, despite appropriate pacemaker therapy. Over a median follow-up of 4.3 years (9 months-15.3 years), 12 patients underwent 18 generator replacements. Five patients were upgraded to physiological pacing. Ten patients underwent 12 ventricular lead advancements. Ventricular lead extraction was attempted 11 times in nine patients and succeeded 10 times. Two patients were converted to epicardial dual chamber systems. Two prepectorally placed generators required resiting due to threatened skin necrosis. Infective endocarditis on the lead, 9 months postimplant required removal of the system in one patient. The subclavian vein was found to be asymptomatically thrombosed in four patients. Endocardial permanent pacing is feasible and effective in children < or = 10 kg and an acceptable alternative to epicardial pacing.     

永久性心脏起搏器置入术后囊袋感染原因分析及护理

目的探讨永久性心脏起搏器置入术后发生囊袋感染的相关因素及预防对策。方法对本院2例永久性心脏起搏器置人术后患者囊袋感染原因进行分析,并给予针对性的治疗护理。结果2例患者分别于6个月、9个月起搏器切开处皮肤干性坏死,给予囊袋清除术和重新置人起搏器。结论永久性心脏起搏器置入术后囊袋感染的发生与囊袋大小是否合适、术中操作及患者个体差异有关,应针对原因进行积极治疗和护理,指导患者预防感染。     

Complications Related to Permanent Pacemaker Therapy

This study evaluates complications related to permanent endocardial pacing in the era of modern pacemaker therapy. There is only limited information available about the complications related to modern cardiac pacing. Most of the existing data are based on the 1970s and are no longer valid for current practice. The recent reports on pacemaker complications are focused on some specific complication or are restricted to early complications. Thus, there are no reports available providing a comprehensive view of complications related to modern cardiac pacing. Four hundred forty-six patients, who received permanent endocardial pacemakers between January 1990 and December 1995 at Kuopio University Hospital, were reviewed retrospectively using patient records. Attention was paid to the occurrence of any complication during the implantation or follow-up. An early complication was detected in 6.7%, and 4.9% of patients were treated invasively due to the early complication. Late complication developed in 7.2% and reoperation was required in 6.3% of the patients. Complications related to the implantation procedure occurred in 3.1%. Inadequate capture or sensing was observed in 7.4% of the patients. Pacemaker infection was detected in 1.8% and erosion in 0.9% of the patients. An AV block developed in 3.6% (1.6%/year) patients who received an AAI(R)-pacemaker due to sick sinus syndrome. There was no mortality attributable to pacemaker therapy. A great majority (68%) of the complications occurred within the first 3 months after the implantation. Complications associated to modern permanent endocardial pacemaker therapy are not infrequent. Eleven percent of patients needed an invasive procedure due to an early or late complication.     

主动电极导线植入在患儿右室间隔部起搏中的应用及护理

目的 探讨主动电极导线的植入在患儿右室间隔部起搏中的应用方法及护理经验.方法 对20例Ⅲ度房室传导阻滞患儿采用Medtronic起搏器植入心室主动电极导线,并做好术前准备,术后严密观察病情,及时发现和处理并发症等护理.结果 主动电极导线成功植入右室间隔18例;另2例电极定位间隔部失败,改行常规心尖部起博.6例出现并发症...     

高龄起搏器植入患者并发症的观察及护理

目的 探讨高龄人工心脏起搏器(起搏器)植入患者的护理。 方法 将208例70岁及以上安置起搏器的患者分为2组,将患1种基础心脏疾病患者作为单种慢性疾病组(98例),将存在2种及以上慢性疾病的患者作为多种慢性疾病组(110例)。 结果 单种慢性疾病患者发生并发症2例,多种慢性疾病组患者发生并发症16例,单种慢性疾病组并发症发生率明显低于多种慢性疾病组。术后3年内单种慢性疾病组死亡1例,多种慢性疾病组死亡12例,多种慢性疾病组死亡率明显高于单种慢性疾病组。 结论 针对高龄起搏器植入患者多种慢性疾病并存、风险性高的临床特点,加强相应护理,以减少和避免并发症的发生,提高手术成功率、患者生存率及护理质量。     

A shorter hospital stay after cardiac pacemaker implantation

In an effort to shorten the hospital stay after implantation of a permanent cardiac pacemaker, some physicians have begun performing pacemaker implantation on an ambulatory basis. To assess the potential safety of shortening the duration of hospitalization after pacemaker implantation, we reviewed the complications that occurred in 100 consecutive patients after pacemaker implantation and noted the time after the implantation when the complications occurred. In our study group, all complications that necessitated invasive intervention occurred within 24 hours after the pacemaker implantation. Complications that necessitated noninvasive programming occurred as long as 72 hours after implantation, and all could have been safely corrected at the time of follow-up had the patient been dismissed at the 24-hour period. Although we do not believe that ambulatory pacemaker implantation should be routinely implemented at this time, the practice of dismissing patients at 24 hours after pacemaker implantation and scheduling subsequent outpatient follow-up seems to be safe and effective.     

Cardiac pacing in children

Advances in pacemaker technology over the last 25 years have made cardiac pacing in infants and children a safe and practical therapy. Some of the technical challenges encountered with the first permanent pacemaker implantation in children during the early 1960s have been solved with miniaturized generators, lithium batteries, noninvasive programmability, and improved placement techniques. This chapter reports common causes of bradydysrhythmias in children, reviews the indications for permanent pacemaker implantation in children, describes current pacing systems appropriate for children, and identifies nursing implications and potential pacemaker complications unique to children.     

Transvenous Pacing in Children Weighing Less than 10 Kilograms

Pacemakers are used in small children with increasing frequency for the treatment of life-threatening bradyarrhythmias. The epicardial approach is generally preferred in these patients, to avoid the risks of vessel thrombosis. We examined the feasibility and safety of transvenous pacemaker implantation in children weighing <10 kg, via subclavian puncture, using a 4 Fr sheath introduced after a venogram was performed to evaluate the vein diameter. Progressive dilation with 5, 6, and 7 Fr sheaths preceded the insertion and placement of the endocardial lead. A subaponeurotic pocket was created in the abdominal or pectoral regions, depending upon the patient's size. Between 2001 and 2007, we treated 12 patients (median age = 16 months; range 1–32; median weight = 7.9 kg; range 2.3–10.0; 7 males), of whom four weighed <5 kg. Indications for permanent pacing included postsurgical complete atrioventricular block (n = 8), sinus node dysfunction (n = 2), congenital atrioventricular block (n = 1), and long QT syndrome (n = 1). Single-chamber pacemakers were implanted in 10, and dual-chamber pacemakers in two patients. The patients were evaluated at 48 hours, 10 days, and at 3 and 6 months. The mean follow-up was 31.8 ± 23.5 months. There were no procedural complications. Lead dislodgment occurred in one patient and required replacement of the ventricular lead. One patient died from septicemia. Endocardial pacemaker implantation was feasible and safe in children weighing <10 kg. This procedure is less invasive than the standard epicardial approach.     

Endocardial Pacing in Infants and Children 15 Kg or Less in Weight: Medium-term Follow-Up

Twenty-four children 15 kg or less in weight (range 2.8–15 kg) underwent implantation of a permanent pacemaker using the transvenous technique of lead placement. During a follow-up period of 2 months to 6 years 1 month (median 3 years 6 months) eight children suffered complications, six of which necessitated reoperation. These included: lead fracture in two, infection in two, transient myocardml dysfunction in one, generator migration in one, premature battery depletion in one, and threshold rise in one. A loop of redundant ventricular lead positioned in the atrium at the time of implant is successfully unravelling in all children. One child died during the follow-up period of a pneumonia unrelated to her pacemaker. The other children are growing and developing normally and the cosmetic appearance has proved acceptable in all cases.