子宫动脉栓塞术治疗子宫肌瘤的早期血流动力学变化

目的探讨子宫肌瘤子宫动脉栓塞(UAE)后的血流动力学变化。方法选择30例子宫肌瘤经腹部彩色多普勒和MR诊断的患者予双侧子宫动脉栓塞(UAE),分别于栓塞前1周内和栓塞后7天、1个月予彩色多普勒超声检查,测量双侧子宫动脉血流量(BFV),搏动指数(PI)、阻力指数(RI)和平均流速(Vm),并用能量图(CDE)观察血流情况。结果2组病例栓塞前与栓塞后7天、1个月比较,BFV、PI、RI、Vm均明显减少,P＜0.01;栓塞后7天和1个月子宫肌层和肌瘤周边血流明显减少或未见显示。结论UAE治疗在早期对病灶血流的阻断是持续存在的,从而保证了栓塞治疗的疗效。     

Characteristic Sonographic Findings of Early Restenosis After Carotid Endarterectomy

Objective. Restenosis of the carotid artery after carotid endarterectomy (CEA) is a major complication. The frequency, time of occurrence, and tissue characteristics of carotid restenosis were assessed with sonography. Methods. Two hundred sixteen patients who had CEA for carotid stenosis were studied; follow‐up sonography and magnetic resonance angiography were done 2 weeks, 3 months, and then every year after CEA. On sonography, restenosis was defined as an internal carotid artery (ICA) with a peak systolic velocity of 170 cm/s or greater or a maximum area of stenosis of 90% or greater. Results. During 605 artery‐years of follow‐up, 18 patients (7.5%) were found to have restenosis on sonography: 4 at 3 months, 11 at 1 year, and 3 at 2 years after CEA. At the time that restenosis was detected, in all 18 ICAs the peak systolic velocity exceeded 200 cm/s and had more than doubled since the last measurement (mean ± SD, 103 ± 27 to 321 ±107 cm/s), whereas the area of stenosis exceeded 90% in 6 patients, and magnetic resonance angiography revealed stenosis of 60% or greater in 8 patients. On sonography, all of the restenotic plaques were isoechoic and concentric. The restenosis was asymptomatic in 17 patients. Vascular risk factors or the severity of initial carotid stenosis before CEA were not associated with development of restenosis. Eleven patients had successful endovascular therapy, and the others received medical treatment. Conclusions. A marked increase in the flow velocity through an operated ICA is a good indication of restenosis. The isoechogenicity and concentricity of the restenotic plaques suggest that the restenosis is primarily the result of intimal hyperplasia.     

Inspiratory Muscle Strength as a Determinant of Functional Capacity Early After Coronary Artery Bypass Graft Surgery

Stein R, Maia CP, Silveira AD, Chiappa GR, Myers J, Ribeiro JP. Inspiratory muscle strength as a determinant of functional capacity early after coronary artery bypass graft surgery.

Objective

To evaluate the effects of a 6-day postoperative in-hospital cardiopulmonary rehabilitation program on inspiratory muscle strength and its potential association with improved functional capacity after coronary artery bypass graft (CABG) surgery.

Design

Prospective, randomized controlled trial.

Setting

Tertiary public hospital in Brazil.

Participants

Men (N=20) after CABG were randomized to cardiopulmonary rehabilitation (n=10; age, 64±8y) or to usual care (n=10; age, 63±7y).

Interventions

Ten subjects underwent a 6-day postoperative in-hospital program, which included the use of expiratory positive airway pressure mask and bronchial hygiene techniques, coupled with progressive distance walking and calisthenics as well as cardiopulmonary training. Ten controls were followed by their own physicians and received routine nursing assistance but were not exposed to any specific respiratory or motor physical intervention.

Main Outcome Measures

Maximal inspiratory and expiratory pressure were measured by a pressure transducer, and the highest pressure obtained in 6 measurements was used for analysis (before surgery, and 7 and 30d after surgery). The six-minute walk test (6MWT) was performed 7 days after surgery, and maximal cardiopulmonary exercise testing was performed 30 days after CABG.

Results

After randomization, clinical and functional characteristics were similar in the 2 groups. Rehabilitation resulted in maintenance of maximal inspiratory pressure (PImax) measured at 7 and 30 days postoperatively, respectively (from 68±19% at baseline to 58±22% and to 61±22% predicted), while it was significantly reduced in the control group. 6MWT distance was longer 7 days after CABG in rehabilitation subjects (416±78m) than controls (323±67m). Peak oxygen uptake (Vo₂peak) at day 30 was also higher (28%) in the rehabilitation group and was correlated with PImax (r=.90).

Conclusions

A 6-day rehabilitation program attenuated the postoperative reduction in respiratory muscle strength and also improved the recovery of functional capacity after CABG. The correlation between PImax and Vo₂peak during the late postoperative period suggests that inspiratory muscle strength is an important determinant of functional capacity after CABG.     

循证护理指导脑血管病介入术后护理的研究

目的探讨运用循证护理思维指导经皮股动脉穿刺脑血管介入治疗术后患者的护理效果。方法回顾性分析病例120例,58例作为对照组,给予常规护理。观察组62例,采用循证护理方案,提出护理问题,针对问题查阅相关资料和文献的直接和间接实证,并进行分析、归纳、结合临床实践,制定出护理方案并实施。结果观察组24 h腰背酸痛、腹胀、入睡困难、尿潴留发生率显著低于对照组(P<0.01),两组均未发生并发症。结论运用循证护理可提高脑血管介入治疗术后患者的舒适度,预防并发症,提高护理质量。     

脑外伤及颅脑手术后急性脑血管病的早期诊断和治疗

急性脑血管病在正常情况下发作时较易作出诊断,但是,在脑外伤或颅脑手术后发作,则由于脑血管病的临床表现和头部ＣＴ等检查的某些特点常被脑外伤或脑手术损伤所掩盖,尤其是伤前或术前无症状者,加之伤后或术后病情的限制常舍弃了脑血管造影等检查,因此,极易被漏诊和误诊,延误治疗。１９９４～１９９８年,作者等诊治此类患者３９例,效果满意。现就其早期诊断和治疗问题总结如下。１　临床资料１．１　一般资料　本组３９例,男性２４例,女性１５例,平均年龄５２（２～７６）岁。其中脑挫裂伤或伴硬膜下小血肿１９例,硬膜下血肿清…     

脑卒中认知功能损害的早期康复护理

目的 探讨脑卒中患者认知功能损害的早期康复护理。方法将68例脑卒中患者随机分为康复护理组36例和常规护理组32例,采用中文版智力状态检查表（MMSE）作为评价标准。康复护理组进行以认知功能训练为主的康复护理训练。结果对患者进行认知功能训练能明显改善患者的智能,优于治疗前和对照组（P〈0．05）。结论认知功能训练能改善脑卒中患者的智能,减少脑卒中患者痴呆的发生率,提高患者的生命质量。     

早期成人破伤风首诊误诊原因分析

目的分析成人破伤风的早期临床表现,总结破伤风误诊原因,以提高首诊准确率。方法回顾性分析我院12例首诊误诊的成人破伤风的临床资料。结果 12例均有不同程度张口困难及面肌痉挛表现,首诊时均未提供明确外伤史和慢性感染窦道史,分别于我院普外科、感染科、急诊科、神经内科、骨科及口腔科首诊,诊断抽搐原因待查4例,误诊为颈椎病2例,腰椎病、多颅神经炎、药物锥体外系反应、面神经炎、脑梗死及颞下颌关节炎各1例。12例均结合病史及临床表现确诊为破伤风,予相应治疗皆痊愈。随访1年无明显后遗症。结论首诊时无明确外伤史及典型破伤风表现的早期成人破伤风患者容易漏误诊。临床遇到面肌痉挛及张口困难表现者,尤其是1978年前出生未接种过百白破疫苗者,应高度警惕破伤风。     

老年患者胸腔镜手术后早期活动的临床意义及可行性研究

目的探讨老年患者胸腔镜手术后早期活动的可行性及有效性。方法将53例老年胸腔镜患者按不同病区分为实验组及对照组,实验组患者麻醉清醒后即指导其活动,对照组患者术后常规护理。比较两组患者的呼吸、心率、血压、脉氧饱和度以及有效咳痰量、胸腔引流管留置时间和对干预措施的依从性。结果实验组患者术后早期护理干预后呼吸、心率、血压、脉氧饱和度及对干预措施的依从性无显著差异,但有效咳痰率、胸腔引流管留置时间差别显著,有统计学意义。结论老年患者胸腔镜手术后早期自理活动可减少胸腔引流管留置时间,提高有效咳痰率,且对呼吸、心率、血压、脉氧饱和度无明显影响,对于老年患者胸腔镜手术后是一项安全有效的护理措施。     

脑出血患者早期锻炼及功能恢复

观察早期康复治疗对脑出血患者肢体运动功能恢复效果。方法：选择急性脑出血患者93例随机分成两组,对照组按常规护理及14d后开始肢体功能锻炼,观察组入院后开始作肢体功能锻炼,30d后进行肌力比较。结果：观察组肌力改善明显高于对照组（P〈0.01）。结论：脑出血急性期早期康复干预能明显提高肢体运动功能。     

经颅多普勒超声屏气试验评价重度颈动脉狭窄脑血管储备功能

目的:应用经颅多普勒超声(TCD)屏气试验评价重度颈动脉狭窄患者脑血管储备(CVR)功能。方法:选取30例健康对照者(正常对照组)、26例单侧重度颈动脉狭窄患者(颈动脉狭窄组),其中无症状性颈动脉狭窄14例(无症状亚组)、症状性颈动脉狭窄12例(症状亚组)。症状亚组中9例行颈动脉支架置入(CAS)术。比较各组患者的屏气指数(BHI),评估CVR功能。结果:与正常对照组比较,颈动脉狭窄组狭窄侧的BHI明显降低(P=0.000);与无症状亚组狭窄侧相比,症状亚组狭窄侧BHI明显降低(P=0.000);颈动脉狭窄组症状亚组患者CAS术后狭窄侧BHI与术前比较升高(P=0.021),术后狭窄侧的BHI低于健侧(P=0.019)。结论:重度颈动脉狭窄患者狭窄侧CVR功能降低,症状性颈动脉狭窄患者较无症状性颈动脉狭窄患者降低更明显,CAS可以改善症状性颈动脉狭窄患者CVR功能。     

人工膝关节置换术病人围手术期功能康复锻炼

随着人口的老龄化及人们对高质量生活的需求 ,因骨性关节病而实行全膝关节置换术的病人越来越多。为了减轻病人的痛苦 ,减少术后并发症的发生 ,尽早恢复关节功能 ,提高病人术后生活质量 ,我科在人工膝关节置换术病人的护理和康复过程中形成了一套较系统的方法 ,现总结如下。1　临床资料　　 1995年 1月— 2 0 0 0年 10月共行人工膝关节置换术 38例( 4 7个膝 ) ,其中左膝 2 4个 ,右膝 2 3个。男性 7例 ,女性 31例 ,年龄 2 6岁～ 75岁 ,平均年龄 5 6 .5 9岁。骨性关节病 2 8例 ( 36个膝 ) ,滑膜炎 2例 ,翻修术 2例 ,类风湿性关节炎 3例 ( 4个…     

CA1-03: Cognitive Impairment in Patients Hospitalized for Acute Coronary Syndromes: Preliminary Findings from TRACE-CORE

Background/Aims Cognitive impairment (CI) among hospitalized patients is associated with lack of functional recovery, rehospitalization, and death but limited data exists on CI in patients hospitalized for acute coronary syndromes (ACS). We examine the prevalence of, and factors associated with, CI among patients with an ACS. Methods Adults (n = 623 to date) in central MA or Macon, GA without dementia or delirium were interviewed during hospitalization for an ACS as part of an ongoing study within the Transitions, Risk, and Actions in Coronary Events: Center for Outcomes Research and Education (TRACE-CORE). CI was indicated by a score =30 on the Telephone Interview of Cognitive Status (TICS; range = 0-41) Patients reported demographic and psychosocial factors: anxiety (GAD8; >4=high anxiety), depression (PHQ9; >4= high depressive symptoms), stress (PSS4; range 0-20), medication adherence (Morisky Scale), and health-related quality of life (SF-36). Patient characteristics were compared by CI status using chi-squared and t-tests. Results Participants were 65% (405 of 623) male, 77% (479 of 623) non-Hispanic white and 14% (87 of 623) African-American, and aged 61.3±11.0 years. Thirty percent of patients hospitalized for ACS were cognitively impaired (187 of 623). In general, patients with CI were only mildly impaired (mean TICS = 28.4). Compared to patients who were cognitively intact, patients with CI were less educated (post high school: 69% vs. 85%) and were more likely to have high levels of depressive symptoms and anxiety (p's<0.05). Impaired patients had higher mean stress levels (5.8 vs. 4.7) and significantly lower average quality of life in both the physical (38.7 vs. 42.0) and mental (43.5 vs. 47.3, all p's<0.001) health domains of the SF-36. Patients with CI were more likely to report caregiving support (19% (118 of 623) vs. 11% (68 of 623), p=0.02). Age, sex, race/ethnicity, and self-reported medication adherence did not differ by CI. Discussion CI is highly prevalent among patients hospitalized for ACS. Screening for CI would identify patients who may require tailored transitional care or closer post-discharge monitoring. Future work in this study will examine the trajectory of cognitive function after discharge, comparing factors associated with persistent versus transient CI.     

早期肠内营养在胃肠道肿瘤术后患者中的应用

目的：探讨早期肠内营养支持在胃肠道恶性肿瘤术后患者中应用的临床效果。方法：54例胃肠道恶性肿瘤行根治手术的患者,随机分为对照组和研究组,分别接受肠外营养支持（PN）和肠内营养支持（EN）。比较两组治疗前后的血清白蛋白、前白蛋白和转铁蛋白水平,肝肾功能指标,胃肠功能恢复时间以及并发症的发生率。结果：经过术后7d的营养支持治疗,EN组术后血清前白蛋白、转铁蛋白水平升高程度明显大于PN组,胃肠功能较PN组更快恢复。在术后并发症的发生率和肝肾功能指标方面两组没有显著性差异。结论：早期肠内营养支持能够安全有效地促进胃肠道肿瘤术后患者的恢复。     

妇产科腹部手术后患者早进食的护理

为缩短妇产科腹部手术后患者肛门排气时间，减轻腹胀，对４１例（Ａ组）患者给予术后早进食及早期床上活动的指导，即术后６ｈ开始进食。Ｂ组（４１例）按护理常规待肛门排气后进食。经观察，Ａ组患者肛门排气时间平均为１９．９ｈ，Ｂ组为５８．３ｈ。说明妇产科腹部手术后患者早期进食及早期床上活动是可行的。     

肺减容手术治疗肺气肿病人的护理

肺减容术是通过切除被破坏的肺组织 ,减少生理无效腔和肺动静脉分流 ,减少肺残气量 ,减轻肺阻力 ,改善肺通气和血流 ,增加肺的弹性回缩力 ,从而增加气体流动和减少肺过度膨胀[1] ,以改善临床症状 ,提高生活质量。肺气肿是慢性阻塞性肺疾病(ＣＯＰＤ)晚期最常见、最严重的?..