起搏器植入术后患者心脏康复信息需求现状及影响因素分析

目的:探讨永久起搏器植入术后患者心脏康复信息需求现状及影响因素.方法:选取安徽省合肥市某二级甲等综合医院2020年6月至12月心血管内科住院且首次接受永久起搏器植入术的患者189例作为研究对象.通过问卷调查评估起搏器植入术后患者心脏康复信息需求现状,分析起搏器术后患者心脏康复信息需求的影响因素.结果:起搏器植入术后患者...     

永久起搏器植入术患者发生深静脉血栓的调查分析

目的通过调查了解永久起搏器植入术患者发生深静脉血栓(DVT)的原因。方法回顾性调查2009年1月—2011年12月收治于同济大学附属第十人民医院永久起搏器植入术的患者425例,分析DVT的发生情况和影响因素。结果永久起搏器植入术患者DVT的发生率为7.53%。多因素分析显示,DVT发生与患者年龄、体质指数(BMI)、吸烟史、术后制动时间、DVT病史和基础疾病有密切相关,具有统计学意义(P0.05)。结论针对永久起搏器植入术患者发生DVT的危险因素,进行早期护理干预,可降低DVT的发生率。     

1例永久起搏器植入术后患者人文关怀护理查房体会

正护理人文关怀,指护理工作中的情感表达,其核心表现为对患者精神价值的重视及对人性的根本关怀,通俗讲人文关怀就是注重人,关心人,重视人的个性,满足人的需求,尊重人的权利[1]。随着现代医学的发展,人文关怀成为患者的需要,是护理人员日常护理内容的核心之一,是优质护理的重要内涵[2]。从2015年开始,我们每月实施人文关怀护理查房,通过护理人文关怀查房模式使全院护理人员的心灵得到升华,关怀意识、责     

一例脑萎缩患者行永久起搏器植入术的护理

永久起搏器植入术是将人工心脏起搏系统(脉冲发生器和电极导线)植入到人体内的一种手术。我科于2011年11月对1例Ⅲ度房室传导阻滞合并脑萎缩及陈旧性脑梗死患者行起搏器植入术,经过护理病情好转出院,现将护理体会介绍如下。1病例简介患者男性,79岁,主因"发现心率缓慢2天"于2011年10月6日收入院。患者脑萎缩病史2年余,间断有意识障碍,发现陈旧性心肌梗塞半年。入院后拟行急诊起搏器植入术,但由于     

26例永久起搏器植入术后常见并发症的观察与护理

植入性心脏起搏器是一种植入人体内的电子治疗仪器,发放由电池提供能量的电脉冲,通过导线电极传输到心房或心室肌,造成一个人为的异位兴奋灶,以代替正常心脏起搏点引起心脏激动,达到治疗缓慢心律失常的目的[1]。我国永久性人工心脏起搏器的临床应用处于快速增长阶段。永久性人工心脏起搏     

永久起搏器植入术术中急性心包填塞患者的护理

人工心脏起搏器是利用电频脉冲刺激心肌,引起心脏兴奋和收缩的一种电子装置,安装人工心脏起搏器是治疗不可逆性心脏起搏传导功能障碍安全有效的方法,也是抢救危重患者的重要手段。急性心包填塞是由于冠脉破裂、心肌穿孔等原因造成的心包腔内积液致使心脏收缩舒张严重受阻、心排血量急剧下降导致患者休克甚至死亡的急症。     

晚期癌症住院患者家属需求及其影响因素分析

目的 描述晚期癌症住院患者家属的需求状况并探讨其影响因素.方法 2007年7-12月,采用自行设计的"晚期癌症住院患者家属需求调查表",对上海市15家医院的649名晚期癌症住院患者家属进行问卷调查,采用SPSS13.0统计软件进行数据处理.结果 晚期癌症住院患者家属需求的总体水平介于"一般需要"和"比较需要"之间,各纬度中以疾病知识需求得分最高,丧葬支持和临终关怀知识需求得分最低.家属需求的主要影响因素包括家属的职业、家属与患者的关系、照顾其他类似患者的经历以及患者的医疗负担情况.结论 晚期癌症住院患者家属存在一定程度的需求,各纬度中对疾病知识、患者症状控制和医护相关行为的需求较高:对患者身体舒适的关注多于心理支持;对丧葬和临终关怀知识的需求较低.家属需求受患者医疗负担、家属职业、家属的照顾经历及家属与患者关系影响,临床上护理晚期癌症患者时应综合评估家属的需求,制定有针对性的服务方案,以满足家属的有效需求,提高晚期癌症住院患者及家属的生活质量.     

ICU危重患者CRRT治疗24h内家属需求调查分析

目的了解ICU连续性肾脏替代治疗(CRRT)患者治疗24 h内家属需求,并根据不同患者家属的需求实施针对性护理。方法采用重危患者家属需求量表(CCFN1)和自制的问卷调查表对60例CRRT治疗24 h内患者家属进行调查。结果 CRRT治疗24 h内患者家属最重要的需求是病情保证的需求(3.54±0.45)分,其次为获取信息需求(3.44±0.86)分,接近患者的需求(3.28±0.83)分,获得支持的需求(2.85±0.24)分和自身舒适的需求(2.68±0.21)分。不同文化程度、年龄和有CRRT治疗的患者家属对病情保证需求及获得信息需求不同,差异有统计学意义(均P0.01)。结论 ICU护士应理解和重视CRRT治疗24 h患者家属的不同需求,针对每位家属实行个体化护理,使其更好配合患者的治疗护理,促进患者康复。     

音乐疗法床上操在永久起搏器植入术患者康复中的应用

目的探讨音乐疗法床上操在永久起搏器植入术患者康复中的应用。方法选取50例永久起搏器植入术后的患者,在患者生命体征平稳的情况下,术侧肢体局部切口砂袋压迫6h取下后,即进行音乐疗法床上操的练习。观察患者术后并发症的发生情况。结果50例患者在实施床上操前后的血压、脉搏变化差异无统计学意义（P〉0．05）,无一例出现伤口血肿、电极脱位和肩功能障碍等并发症。结论音乐疗法床上操简便易行,能改善患者的紧张、焦虑心理,减轻患者术后因长时间卧位的制动而导致的各种全身不适症状,而对患者的血压和脉搏影响不明显,故可在临床工作中广泛推广。     

颅脑损伤患者家属早期信息需求及影响因素研究

目的：研究颅脑损伤患者家属早期信息需求及影响因素。方法通过分层随机抽样,选择来自温州市三家综合医院的180名颅脑损伤患者家属,应用自制颅脑外伤患者家属信息需求量表调查家属信息需求,并分析相关影响因素。结果患者家属信息需求量表总分为(21.28±2.27)分,各维度中损伤状况得分最高为(3.56±0.31)分,医院规定得分最低为(2.61±0.48)分。患者住院时间≤3 d的家属对损伤状况、治疗措施、检查方法、家属配合及医院规定等维度的信息需求度均较住院时间>3d的家属高,差异有统计学意义(P<0.05)。重型颅脑损伤患者的家属对损伤状况、治疗措施、检查方法、医护资质、治疗费用及家属配合等维度的信息需求度均较轻中型颅脑损伤患者的家属高,差异有统计学意义(P<0.05)。初中以上文化程度的家属对治疗措施、医护资质及家属配合等维度的信息需求度均较初中及以下文化程度的家属高,差异有统计学意义(P<0.05)。颅脑损伤患者家属的信息需求满足度和其对医护工作的总体满意度呈正相关(r=0.495,P<0.01)。结论颅脑损伤患者家属早期具有很强的信息需求度。患者住院时间、患者损伤等级及家属文化程度可能会影响家属的信息需求度。满足家属的信息需求可提高其对医护工作的满意程度。     

人文关怀式健康教育对永久性起搏器植入患者的影响

目的探讨人文关怀式健康教育对永久性起搏器植入患者的教育效果。方法将104例永久性起搏器植入患者按随机数字表法分为观察组与对照组,每组52例。对照组患者给予常规健康教育,观察组患者在常规健康教育的基础上实施人文关怀式健康教育。在两组患者入院时及起搏器植入术前,采用焦虑自评量表（self-rating anxiety scal,SAS）对两组患者进行焦虑评分并比较,同时观察并比较两组患者术后并发症的发生情况。结果两组患者入院时SAS评分差异无统计学意义（P〉0.05）;经健康教育后,两组患者手术前SAS评分较入院时均显著降低（P〈0.01）,观察组评分较对照组下降更为明显（P〈0.01）;术后观察组发生并发症的例数少于对照组（P〈0.05）。结论人文关怀式健康教育能减轻永久性起搏器植入患者的焦虑情绪,减少术后并发症的发生,提高患者的自护能力,从而提高患者的生活质量。     

Permanent Pacemaker Implantation Using the Femoral Vein: A Preliminary Report

A permanent pacemaker was implanted through the femoral vein in 23 patients using the percutaneous puncture technique. The pulse generator was placed in the lower abdominal wall. The method is simple and reduces the time necessary to accomplish implantation. Catheter extrusion in one patient was easily corrected. Another patient had late thrombophlebitis, possibly unrelated to the procedure. Catheter dislodgement occurred in four (4) patients and penetration of the right atrial appendage and right ventricular apex each occurred once. We believe these problems can be circumvented with more experience and expect the femoral approach to be a simple and practical method permanent pacemaker implantation.     

永久性心脏起搏器安置术后并发症的护理

随着我国心律失常介入治疗的迅速开展,心脏起搏器的临床应用日益广泛,安置心脏起搏器是治疗不可逆性心脏传导功能障碍的安全有效的方法,特别是治疗因“窦房结病变”和“心脏传导系统病变”引起的重症缓慢心律失常。2009年1—12月,我院心内科安置永久性心脏起搏器患者141例,     

Incidence and Predictors of Permanent Pacemaker Requirement after Transcatheter Aortic Valve Implantation with a Self‐Expanding Bioprosthesis

Background: Previous reports have suggested the occurrence of cardiac conduction disorders and permanent pacemaker (PPM) requirement after transcatheter aortic valve implantation (TAVI). Based on a single‐center experience, we aim to assess the incidence of postprocedural conduction disorders, need for PPM, and its determinants after TAVI with a self‐expanding bioprosthesis. Methods: From August 2007 to October 2009, 32 consecutive patients underwent TAVI with the Medtronic CoreValve (MCV) System (Medtronic Inc., Minneapolis, MN, USA). Three patients paced at baseline and two cases of procedure‐related mortality were excluded. We analyzed the 12‐lead electrocardiogram at baseline, immediately after procedure and at discharge. Requirements for PPM were documented and potential clinical, electrophysiological, echocardiographic, and procedural predictors of PPM requirement were studied. Results: After TAVI, eight patients (29.6%) required PPM implantation due to high‐grade atrioventricular (AV) block. The prevalence of left bundle branch block increased from 13.8% to 57.7% directly after implantation (P = 0.001). Need for PPM was correlated to the depth of prosthesis implantation (r = 0.590; P = 0.001). At a cutoff point of 10.1 mm, the likelihood of pacemaker could be predicted with 87.5% sensitivity and 74% specificity and a receiver operator characteristic curve area of 0.86 ± 0.07 (P = 0.003). Of the seven patients with preexisting right bundle branch block (RBBB), four (57.1%) required PPM implantation after TAVI. Conclusions: High‐grade AV block requiring PPM implantation is a common complication following TAVI and could be predicted by a deeper implantation of the prosthesis. Patients with preexisting RBBB also seem to be at risk for the development of high‐grade AV block and subsequent pacemaker implantation. (PACE 2010; 1364–1372)     

Permanent Pacemaker Implantation Following Cardiac Surgery: Indications and Long-Term Follow-Up

Background: Conduction disturbances requiring permanent pacemaker implantation after heart surgery occur in about 1.5% of patients. Early pacemaker implantation may reduce morbidity and postoperative hospital stay. We reviewed our experience with patients undergoing surgery to try and identify predictors for pacemaker requirements and patients who will remain pacemaker dependent.
Methods: We performed a retrospective review of 4,999 patients undergoing surgery between the years 1993 and 2005. Patient age was 64 ± 12 years, and 71% were males. Coronary bypass was performed in 4,071 (81%), aortic valve replacement in 675 (14%), and mitral valve replacement in 968 (18%) patients.
Results: Seventy-two patients (1.4%) required implantation of a permanent pacemaker after surgery. Indications for pacemaker implantation included complete atrioventricular block in 59, symptomatic bradycardia/slow atrial fibrillation in nine, second-degree atrioventricular block in two, and other conduction disturbances in two patients. Predictors for pacemaker requirement by multivariate analysis were left bundle branch block and aortic valve replacement (P < 0.001). Late follow-up was available in 58 patients, at 72 ± 32 months. Thirty-seven (63%) were pacemaker dependent. Predictors for late pacemaker dependency were third-degree atrioventricular block after surgery and preoperative left bundle branch block (P < 0.001).
Conclusions: Patients at high risk for pacemaker implantation after heart surgery include those with preexisting conduction disturbances, and those undergoing aortic valve replacement. Of those receiving a pacemaker, about one-third will recover at late follow-up. For patients in the high-risk group who are pacemaker dependent after surgery, we recommend implanting a permanent pacemaker at 5 days after surgery, thus enabling early mobilization and early discharge.     

渐进性肌肉放松训练改善永久起搏器植入术患者的身心症状

目的探讨渐进性肌肉放松训练（progressive muscle relaxation,PMR）改善行永久起搏器植入术患者术后身心症状的作用。方法将113例行永久起搏器植入术的患者随机分为两组,对照组56例采用常规护理,试验组57例在常规护理的基础上进行PMR,2次／d。结果（1）干预前,两组患者的SAS、SDS评分比较,差异无统计学意义（P〉0．05）;试验组患者接受渐进性肌肉放松训练后,其术前晚及术后8h的SAS、SDS评分,与干预前及同期对照组比较,差异均有统计学意义（P〈0．01）。（2）试验组患者接受PMR后,其术后腰背疼痛、伤口疼痛程度和尿潴留发生率明显降低,睡眠质量改善,与对照组比较,差异均有统计学意义（P〈0．05或P〈0．01）。结论PMR可明显改善永久起博器植入术患者术后的焦虑和抑郁状态,提高患者的舒适度和生活质量。     

Transiliac Vein Approach to a Permanent Pacemaker Implantation After Aortic Valve Reoperation

This article describes the case of a 71 -year-old woman in whom a permanent pacemaker implantation was performed through an iliac vein because of superior vena cava obstruction after aortic valve reoperation. During a 6-month follow-up, the patient did well and the pacemaker performance was satisfactory.     

A Technique Utilizing a Steerable Hydrophilic Guidewire for Permanent Pacemaker Implantation

We report the use of a steerable hydrophilic guidewire for permanent pacemaker implantation. This wire, previously used for peripheral vascular and cardiac angiography, is able to be steered and passed in many situations when a standard guidewire cannot be used. We report three cases where the standard J-tipped guidewire could not be passed by either the cephalic or subclavian route and the hydrophilic guidewire allowed for successful atraumatic placement of a sheath and pacemaker lead.     

Permanent Pacemaker Implantation in a Pregnant Woman with the Guidance of ECG and Two-Dimensional Echocardiography

A 30-year-old pregnant woman was admitted to the Cardiology Research Center with syncope, dizziness, and fatigue on exertion. On ECG complete atrioventricular block was diagnosed. Permanent pacemaker implantation was performed with the guidance of ECG and two-dimensional echocardiography and without the use of fluoroscopy.