微创小切口应用于儿童心脏手术的配合体会

笔者报道微创小切口的手术配合体会。首先器械护士必须做到术前了解病情,参加术前讨论,熟悉手术程序。微创手术切口小,术野暴露差,给术者增加了手术难度和风险,要求器械护士快、准、稳、轻,有条不紊的递送术者所需器械,密切配合,给术者创造一个良好的手术环境。第二,巡回护士按术者要求随时调整氩气刀输出功率,防止组织灼伤,是保证微创小切口一期愈合率高的的关键。     

心脏微创小切口直视下实施二尖瓣置换术的手术配合

目的总结心脏微创小切口直视下实施二尖瓣置换术的手术配合要点。方法对45例二尖瓣置换患者实施心脏微创小切口手术,并做好手术配合。结果患者手术顺利,手术时间为140～205min,平均(163.6±17.8)min,术后未发生并发症,均痊愈出院。结论心脏微创小切口手术创伤小,出血少,术后恢复快,术前做好患者配合手术的健康指导,术中做好抗凝剂应用护理及手术配合,其是手术成功的重要措施。     

右腋下小切口心脏直视手术37例

目的；介绍右侧腋下小切口剖胸体外循环下心内直视手术经验。方法：于2002年4月-2006年6月共行右腋下小切口心内直视手术37例，其中房间隔缺损20例，室间隔缺损10例，法乐氏四联症1例。结果；36例治愈出院。1例死于肺动脉高压。结论；右腋下小切口心脏直视手术具有创伤小、恢复快、简便、安全、美容效果好等优点，值得临床推广应用。     

体外循环心脏直视手术的护理配合

体外循环下心脏直视手术风险大,操作程序复杂,需要手术医生组、麻醉组、机器组、护理组多方面配合、协作才能完成[1].各组操作内容不同,但操作质量与患者生命息息相关,配合的熟练程度与手术成功有着重要关系.所以在配合中除尽心尽职外,还要不断探索和改进配合方法,重视细小环节的操作质量,才能确保手术的成功率.现将本院手术配合体会报告如下.     

经右腋中线小切口行小儿心脏直视手术的术中配合

我院自１９９９年１２月至２０００年８月,在心内直视手术中采取右腋中线切口 ２６例,手术效果满意,现将术中配合介绍如下：１ 临床资料 本组患儿２６例,男１６例,女１０例,年龄２～１２岁,体重１０．５～２２．５ ｋｇ,其中室间隔缺损 １８例,房间隔缺损 ８例;补片修复缺损１７例,直接缝合９例。２ 术前准备 除按心脏外科手术常规准备外,还需选择细长柔软的主动脉插管,上、下腔弯头插管。准备肋骨合拢器、开胸器（２个）,长电刀头、长针持、长细镊子、可吸收缝线,术者带冷光源头灯,患儿右上肢及颈内静脉建立静脉通道。患者…     

个体化微创小切口CPB心内直视手术的临床研究

目的通过对南昌大学第二附属医院188例小切口体外循环心内直视手术的疗效观察,探讨微创个体化小切口在体外循环心内直视手术的临床研究。方法南昌大学第二附属医院2014-01—2015-07个体化小切口进行体外循环心内直视手术188例(A组)。根据体质量抽取同期南昌大学第二附属医院收治的传统正中开胸心脏病手术患者187例作为对照组。比较两组术中术后指标、治疗效果和住院费用等。结果A组在体外循环时间、主动脉阻断时间、呼吸机辅助呼吸时间等指标与B组比较差异无统计学意义(P0.05);A组术后胸腔引流血量(83.29±15.33)m L、术后输血量(98.92±19.85)m L、术后住院时间(5.85±1.47)d、住院费用(3.52±1.68)万元均明显少于B组(P0.05)。结论微创个体化小切口心脏直视手术是一种安全、有效、美观的手术方式,实用性强。     

右腋下小切口心脏直视手术的呼吸道护理

我院于 2 0 0 0年 5月～ 2 0 0 1年 12月采用右腋下小切口心内直视手术方法对心脏病患者施行手术 4 6例 ,现总结手术前后呼吸道护理体会。1　临床资料本组 4 6例中男 18例 ,女 2 8例 ,年龄 1～ 2 3岁 ,平均 9.8岁。继发孔房间隔缺损 (ASD) 2 0例 ,室间隔缺损 (VSD) 2 4例 ,ASD并发VSD 2例。患者均在全麻低温体外循环下实施右侧开胸。手术后发生肺炎、肺不张等呼吸系统并发症 10例。本组术后因其他并发症死亡 1例 ,占 2 .1%。2　术前呼吸道护理措施2 .1　呼吸训练　右腋下小切口心脏直视手术呼吸系感染是最主要的并发症之一 ,由于患者全…     

胸部小切口心脏直视手术

目的：介绍几种体外循环下胸部小切口心脏直视手术的经验。方法：161例心脏疾病患者采用右腋下、右前外侧胸、胸骨右侧旁及胸骨下段小切口,在体外循环下施行心脏直视手术。病种包括房间隔缺损、室间隔缺损、法乐四联症、二尖瓣狭窄或／并关闭不全、二尖瓣狭窄并三尖瓣关闭不全及其他畸形,包括肺动脉口狭窄、动脉导管未闭及永存左上腔静脉等。结果：术后161例患者中2例（1．2％）分别死于消化道溃疡出血及重型肺炎。1例并发胸骨后出血、Ⅲ度房室传导阻滞、室间隔缺损修补术后残余分流;1例右侧胸腔积液,经处理后均康复出院。结论：以上各小切口开胸行心脏直视刘安全、有效的。术野显露好,病变矫正满意,创伤小,并发症少,痛苦轻,恢复好,美观效果亦好。临床 可根据具体情况选择应用。     

新生儿心脏直视手术的巡回配合

[目的]总结新生儿心脏直视手术的巡回配合。[方法]回顾性分析2006年7月—2014年6月21例新生儿进行心脏直视手术的临床资料及巡回配合情况。[结果]1例患儿因体外循环后循环无法维持抢救无效死亡,20例患儿术后安全返回心脏重症监护室监护,手术时间2.3h~13.5h,均未出现压疮、电灼伤等不良事件。[结论]巡回护士细心的护理配合是新生儿心脏直视手术顺利进行的保证。     

122例右胸前外侧小切口微创心脏手术的体外循环应用

目的探讨微创心脏手术中体外循环管理策略,总结新型手术中体外循环的初步经验。方法 2010年1月-2012年8月122例病人实施微创心脏手术,其中男性54例,女性68例,年龄14-65（36.7±14.5）岁,体质量31-76（57.3±10.6）kg。61例采用常温非停跳心内直视手术（非停跳组）,其余病例于浅或中低温体外循环停跳下行心内直视术（停跳组）。术式包括房间隔缺损修补术,室间隔缺损修补术,主动脉瓣置换术,二尖瓣置换/成形术,三尖瓣成形术,部分型肺静脉异位引流矫治术,左房黏液瘤摘除术。小切口主动脉瓣置换术的病例采用股动脉插管、二级股静脉插管建立循环回路,必要时加用上腔静脉插管引流。其余病例均采取股动脉插管、同侧股静脉插管及上腔静脉插管建立体外循环回路。停跳组阻断升主动脉后,顺行灌注4∶1冷血停搏液,行浅或中低温高流量灌注。必要时配合超滤。结果体外循环时间20-161（72.4±27.9）min,最低鼻温27.7-35.4（33.0±1.9）℃,最低肛温31-35.7（34.1±1.3）℃。停跳组61例病例中,升主动脉阻断时间17-107（49.9±21.0）min,其中36例病人心脏自动复跳,自动复跳率为58.9%。转中常规超滤3例,超滤液量1 500-3 000ml;平衡超滤8例,超滤液量2 000-7 000ml;常规超滤±平衡超滤6例,超滤液量3 800-6 500ml。122例患者均安返监护室,术后呼吸机辅助时间为4-18（6.5±2.5）h。监护室停留时间为13-37（19.0±4.8）h,术后胸腔引流量50-420（150±203）ml。术后住院时间为6-21（7.2±2.0）天。治愈出院121例,死亡1例,死亡率为0.8%。结论综合而全面的进行体外循环管理对微创心脏手术是有效而必要的,同时还应注重与术者及麻醉师等相关手术人员的有效配合与沟通。     

应用微创技术治疗乳磨牙龋病的护理配合

通过对25例乳磨牙牙本质龋的分组治疗,探讨微创技术在龋病治疗过程中的护理配合.术前安抚、术中细致默契的配合及术后健康教育是护理的3个重要环节.正确熟练的护理配合不仅可以消除儿童的恐惧感,提高合作程度,而且可以降低医生及患儿的疲惫感,提高治疗质量和效率.     

机器人微创心脏手术的护理管理

目的观察机器人微创心脏手术的临床应用,总结其护理管理方案。方法回顾分析431例使用“达芬奇S”全机器人手术系统完成微创心脏手术患者的术前准备、手术配合过程及术后机器的管理方法。结果经过完善的术前准备、术中配合和术后管理,成功完成了431例全机器人心脏手术,无术中中转开胸,术前准备时间和手术时间明显缩短。结论充分的术前准备、默契的手术配合及熟练的机器操作是机器人手术顺利进行的前提条件。     

电视胸腔镜下胸外科手术的护理配合

目的:探讨胸腔镜下胸外科手术的术中护理配合。方法:总结92例胸外科疾病患者电视胸腔镜手术治疗的护理配合,包括充分的术前准备,科学、熟练的术中配合。结果:手术过程顺利,未出现严重并发症,手术及护理效果均满意。结论:充分的术前准备及熟练的术中护理配合对胸腔镜手术顺利实施至关重要。     

微创小切口冠状动脉搭桥的手术配合

总结68例微创小切口冠状动脉搭桥术的手术配合。熟悉手术方案、要点,及时冷静的应对术中可能出现的情况,充足的物品准备,熟练配合医生操作使手术衔接紧密,缩短手术时间是保证手术顺利完成的关键之一。     

Towards pain free cardiac surgery - high thoracic epidural analgesia

Epidural analgesia is a well-established analgesic technique, providing complete or near complete perioperative analgesia for major surgery. Epidural analgesia may also confer additional benefits during the perioperative period, including attenuation of the stress response, reduction in procoagulation tendency, and reduction in myocardial ischaemia and infective complications. These additional benefits are an advantage in patients with ischaemic heart disease. We discuss the use of high thoracic epidural anaesthesia in cardiac surgery, outlining potential benefits and risks. Our experience with epidural analgesia in over 300 patients undergoing cardiac surgery is briefly described.     

Congenital cardiac surgery in the less privileged regions of the world

Pediatric cardiac surgery has been available for several decades. With advances in recent years, the majority of children born with congenital heart disease, if repaired in time, are expected to lead normal productive lives. This privilege of early diagnosis and timely management is restricted to children in developed countries only. The majority of children born with congenital heart disease in developing countries do not get the necessary care, leading to high morbidity and mortality. Several reasons exist for this state of affairs. Most centers for congenital cardiac surgery are located in developed countries, whereas most children requiring cardiac surgery do not live in these countries. In less privileged regions of the world, the high cost of cardiac surgery makes it unaffordable for the families of these children. Furthermore, issues such as late presentation of cases, associated comorbid conditions, understaffing of units and limited resources contribute to suboptimal outcome in those who undergo surgery. This review discusses the current status of pediatric cardiac surgery in developing countries and the reasons for it. Some of the strategies for improvement, in the wake of limited resources, are suggested. Often, the resources are not only limited but improperly utilized.     

Curative surgery for atrial fibrillation: current status and minimally invasive approaches

Atrial fibrillation (AF) is the most common disorder of heart rhythm. Affecting 2.2 million Americans and millions more worldwide, AF is a dangerous and costly epidemic. AF is associated with an increased risk of stroke, premature death and billions of dollars in healthcare expenditures. Traditional treatments of AF, which include medications aimed at rate or rhythm control have been disappointing, leaving most patients in AF and failing to eliminate the risk of stroke. In contrast, advances in surgical and catheter-based therapies offer the chance to cure AF. With more than a decade of experience, surgical treatment of AF is the most effective means of curing this arrhythmia. The classic Maze procedure eliminates AF in more than 90% of patients. A complex but safe operation, the Maze procedure is applied by relatively few surgeons. Recently, however, there has been a resurgence of interest in surgical treatment of AF. Advances in the understanding of the pathogenesis of AF and development of new ablation technologies enable surgeons to perform pulmonary vein ablation and create linear left atrial lesions rapidly and safely. Such procedures, which are generally applied to patients with AF and valvular heart disease, add 15 minutes to operative time and cure AF in approximately 80% of patients. New ablation technologies have been adapted to enable thoracoscopic and minimally invasive surgical AF ablation in patients with isolated AF, extending the possibility of cure to large numbers of patients.     

Four years' experience with the minimally invasive surgical approach in cochlear implant surgery

This is a prospective study on 808 profoundly or totally deaf patients who underwent either unilateral or bilateral cochlear implantation, involving a minimally invasive surgical approach, at the Medical University of Hannover's Department of Otolaryngology between May 2001 and May 2005. Advanced Bionics, Cochlear and MED‐EL devices were used, the latter having been in use at our department since the beginning of 2003.

The aim of our investigation was to determine the optimal surgical technique, evaluate safety aspects and gauge patient satisfaction with this minimally invasive surgical approach during cochlear implantation. Surgical technique is analysed. Complications such as skin flap problems did not occur. The use of this minimally invasive surgical technique did not increase the surgical risk. This procedure proved both cosmetically and psychologically beneficial for patients, especially for children and their parents.