心脏穿透伤行心脏修补术患者的急救护理

对21例心脏穿透伤患者在气管插管麻醉下急行心脏修补术治疗.结果治愈20例,死亡1例,治愈率95.24%.提出急诊科护士紧急组织抢救,手术室护士快速默契配合及相关手术器械平时处于备用状态是抢救成功的重要因素.     

放松训练对术前患者血压心率的影响

目的探讨保持患者术前血压、心率平稳的方法。方法将100例择期手术患者随机分为观察组和对照组,各50例。两组均行术前健康教育,观察组在此基础上行放松训练,即采用深吸静息式全身肌肉放松的方法进行训练。两组均于入院后及手术前1d晚临睡前(术前晚)、入手术室后麻醉前(麻醉前)分别测量其血压和心率。结果两组术前晚血压均有下降(均P<0.05),而观察组较对照组更为显著(均P<0.05);观察组心率较对照组平稳(P<0.05),两组心率麻醉前加快,对照组较观察组更为显著(P<0.05)。结论知识教育配合放松训练能使术前患者血压、心率平稳。     

结肠穿透伤行一期修补术

二战后的几十年间，对于结肠穿透伤的治疗一直以Ogilive提出的结肠外置或造口、二期行结肠缝合吻合术为标准式，它可以避免腹腔脓肿和败血症等感染并发症。然而近些年来随着围手术期条件的改进、手术技巧的提高和抗生素的发展，越来越多的外科医生倾向于选择一期修补术来处理结肠穿透伤。为了比较一期修补术与结肠造口两种术式哪种更为合理、更加安全，作者分析了文献上467例结肠穿透伤病人的治疗情况。     

心脏穿透伤修补术的麻醉处理

心脏穿透伤修补术的麻醉处理孙士道，华学光我院自１９８７年５月至１９９０年３月治疗心脏穿透伤３例，男２例，女１例，年龄１７～４６岁。３例均为尖刀锐器刺戳伤，其中左心室穿透伤２例，右心室穿透伤１例，伤后到院诊治时间为２～８ｈ。２例伤情较稳定者诱导用安定、...     

心脏穿透伤的急救体会

本文总结了我院外科自1992年以来收治的8例心脏穿透伤病人的急救体会,提出早期诊断主要依靠有前胸部2～4肋间外伤史,临床症状及体征,辅助检查往往因病情危重,有假阴性存在,应视病情而定,不应勉强检查而延误治疗抢救时机,治疗上强调出现心包压塞征及不易纠正的休克,即是手术探查指征,对少见部位的损伤应有高度重视,同时对心包压塞征有一些新认识。     

心脏大血管穿透伤患者26例急救

目的总结心脏大血管穿透伤的临床特点、早期诊断和救治经验,提高抢救成功率。方法回顾性分析2007年7月至2014年6月我院26例心脏大血管穿透伤患者的临床资料,男23例、女3例,年龄16~71(22.0±8.4)岁。其中刀刺伤25例,钢锥刺伤1例;心脏穿透伤23例,升主动脉刀刺伤2例,主肺动脉刀刺伤1例;心脏压塞型7例,失血休克型8例,心脏压塞+失血休克型2例,亚临床型9例。26例就诊后30 min至3 h急诊在全身麻醉下行开胸手术治疗,侧开胸手术20例,前正中开胸手术6例,其中2例在体外循环下手术。结果全组死亡2例,均为失血休克型,1例69岁右心室贯通伤和右冠状动脉主干损伤男性患者术中死于低心排血量综合征,1例38岁右心室前壁穿透伤男性患者术后死于纵隔感染导致的多器官功能衰竭,其余患者痊愈出院,救治成功率达92.3%。18例随访1个月至7年,无后遗症发生。结论迅速明确伤情,及时诊断,急诊开胸探查是提高心脏大血管穿透伤抢救成功率的关键。     

基层医院心脏穿透伤的急救经验

1998年1月至2007年12月我们收治了11例急诊心脏穿透伤患者,取得了一定的临床效果。现探讨基层医院对心脏穿透伤的急救流程,总结救治经验。     

胸部穿透伤患者的护理

<正>胸部穿透伤是一种极为严重的损伤性疾病,可造成胸腔内器官和血管的损伤,导致血胸、气胸,甚至损伤心脏、膈肌、脾脏。伤情复杂、凶险、变化快。患者稍微移动可能造成二次创伤。严重者可危及生命,甚至死于呼吸衰竭和循环衰竭。1病历摘要患者,男,57岁,建筑工人。工作时从高空跌落致螺纹钢筋由右胸背部穿入左胸部贯穿胸腔。外伤后胸痛、胸闷1 h来我院就诊。体格检查:血压142/95 mm Hg(1 mm Hg=0.133 kPa),被动俯卧位,极度痛苦面容。右胸背部可见一约1.5 m长螺纹钢     

心脏术后患者并发精神异常的护理

随着人工心肺机装置。灌注技术及心内直视操作的不断改进，尤其在术中使用微泡氧合器和在体外循环管道中装配微孔过滤器排除心腔残留气体后，心脏术后脑损害的发病率显著下降。但由于ICU的特殊环境，疼痛、失眠等影响可并发精神障碍。1990年我院行心内直视手术322例，发生精神障碍4例，占1．24％。通过分析其发生的原因，加强预防护理，1996年1～6月行心内直视手术220例，仅发生1例精神异常，发生率降至0．45％。现将护理措施介绍如下。1临床资料322例心内直视手术患者并发精神障碍4例，均为男性，平均年龄42．5岁。换双瓣3例，左室室壁瘤…     

放松训练联合减痛护理对混合痔患者术后疼痛和心理状态的影响

目的:探究放松训练联合减痛护理对混合痔患者术后疼痛和心理状态的影响。方法:将2020年3月至2022年12月于我院进行治疗的90例混合痔患者作为研究参与者,将其随机分为对照组和联合组,每组45例。对照组患者行常规术后护理干预,联合组在对照组基础上给予患者放松训练联合减痛护理,均持续干预至患者出院。比较2组患者不同时点的疼痛程度、心理状态和术后并发症发生情况。结果:干预前,2组患者疼痛评分比较差异无统计学意义(P>0.05);干预24 h、48 h联合组患者疼痛评分均低于对照组(P<0.05)。干预前,2组患者的焦虑自评量表(SAS)、抑郁自评量表(SDS)评分比较差异无统计学意义(P>0.05);干预后,联合组患者SAS、SDS评分均低于对照组(P<0.05)。2组患者术后并发症发生率比较差异无统计学意义(P>0.05)。结论:放松训练联合减痛护理可以有效缓解混合痔患者的术后疼痛,改善心理状态,值得临床推广应用。     

耳穴贴压法对围术期患者焦虑及心率、血压的影响

目的寻找减轻或改善围术期患者焦虑、保证患者生命体征稳定的方法。方法将200例住院择期手术患者随机分为常规护理组（A组）和耳穴贴压护理组（B组）。两组均予常规围术期护理；B组在此基础上加用耳穴贴压法，即在耳穴板上将带有王不留行籽的小方块胶布贴于耳穴位，使用时间为术前3d至术后3d；采用焦虑自评量表（SAS）和心电监护仪对患者焦虑程度和心率、血压进行评定与监测。结果两组术前1d、术后3d焦虑程度变化比较，差异有显著性意义（P〈0．01）；入手术室后20rainA组心率、收缩压较术前1d显著增加（均P〈0．01），B组差异无显著性意义（均P〉0．05）；两组入手术室后20min心率、收缩压比较，差异有显著性意义（均P〈0．01）。结论围术期行耳穴贴压法配合常规护理可缓解患者焦虑情绪，稳定心率和血压，利于手术的顺利进行。     

耳穴贴压法对围术期患者焦虑及心率、血压的影响

目的 寻找减轻或改善围术期患者焦虑、保证患者生命体征稳定的方法.方法 将200例住院择期手术患者随机分为常规护理组(A组)和耳穴贴压护理组(B组).两组均予常规围术期护理;B组在此基础上加用耳穴贴压法,即在耳穴板上将带有王不留行籽的小方块胶布贴于耳穴位,使用时间为术前3 d至术后3 d;采用焦虑自评量表(SAS)和心电监护仪对患者焦虑程度和心率、血压进行评定与监测.结果 两组术前1 d、术后3 d焦虑程度变化比较,差异有显著性意义(P＜0.01);入手术室后20 minA组心率、收缩压较术前1 d显著增加(均P＜0.01),B组差异无显著性意义(均P＞0.05);两组入手术室后20 min心率、收缩压比较,差异有显著性意义(均P＜0.01).结论 围术期行耳穴贴压法配合常规护理可缓解患者焦虑情绪,稳定心率和血压,利于手术的顺利进行.     

异丙酚对血压、心率及内皮依赖性血管调节的影响

目的;观察异丙酚麻醉诱导对血压,心率及内皮依赖性血管调节的影响。方法：心肺功能正常的择期非心脏手术病人１８例,用异丙酚２．０ｍｇ／ｋｇ,芬太尼４μｇ／ｋｇ,潘库溴铵０．０８ｍｇ／ｋｇ和琥珀胆碱１．５ｍｇ／ｋｇ麻醉诱导。记录诱导前,插管前和插管后１,３和５分钟时ＳＢＰ,ＤＢＰ,ＭＡＰ和ＨＲ,同时测定血浆内皮素－１,前列环素和血栓素２变化。结果：插管前ＳＢＰ,ＤＢＰ和ＭＡＰ均较诱导前明显降低,降幅分别     

Blood Pressure and Heart Rate Variability in Patients on Conventional or Sodium-Profiling Hemodialysis

Background. Autonomic nervous system dysfunction and dialysate sodium (Na) concentration are believed to play a role in the pathogenesis of hemodialysis-related hypertension. The present study was undertaken to determine whether increases in blood pressure in hemodialysis patients are associated with changes in heart rate variability (HRV), a measure of the autonomic nervous system function, and long-term exposure to increased dialysate Na concentration. Methods. Baseline clinical, biochemical data and HRV of patients undergoing increased Na profiling dialysis (High-Na, n?=?9) and on conventional treatment (Control, n?=?11) were compared with those obtained after one year of study. Results. After one year, the mean predialysis systolic blood pressure (SBP) increased in seven patients of the High-Na and in five of the Control group, and decreased or remained unchanged in the remaining subjects. Initial HRV was significantly higher in patients with increased SBP, and it increased further in these patients after one year. At the end of the study, post-dialysis plasma Na, osmolality, and weight gains were significantly higher in the High-Na group. No significant correlation, however, was found between individual changes in intradialytic sodium elimination and the alterations in blood pressure. Conclusion. These data suggest that the dialysate sodium concentration, a most important determinant of interdialytic weight gain and fluid balance, is only partly correlated with long-term changes in blood pressure. An increased blood pressure over time may develop in a subset of hemodialysis patients with higher HRV, suggestive of increased sympathetic activity.     

Twenty-Four-Hour Ambulatory Blood Pressure and Heart Rate Monitoring in Combat-Related Posttraumatic Stress Disorder

This study examined the cardiovascular correlates of posttraumatic stress disorder (PTSD) in Vietnam combat veterans using 24-hr ambulatory blood pressure and heart rate monitoring. Veterans with PTSD (n = 11) exhibited significantly higher heart rate and diastolic blood pressure across the 24 hr than veterans without PTSD (n = 7) (80.8 vs. 71.9 bpm, and 80.1 vs. 71.5 mm Hg, respectively). Heart rate during sleep was also significantly higher among veterans with PTSD, compared to veterans without PTSD (71.0 vs. 62.7 bpm). These results, based on a more naturalistic measurement methodology used outside the laboratory, support an association between PTSD and increased chronic cardiovascular arousal.     

Heart Rate, Blood Pressure, and Oxygen Consumption during Orthopaedic Rehabilitation Exercise

The cardiovascular response to orthopaedic rehabilitation may carry clinical significance, particularly for individuals who are deconditioned, elderly, or have underlying heart disease. We examined heart rate, blood pressure, and oxygen consumption responses in individuals performing commonly used orthopaedic rehabilitation protocols. The rate pressure product during these rehabilitation protocols was approximately 80% of that achieved during maximum cycle ergometry tests. Maximum systolic blood pressures in both men and women were higher during orthopaedic rehabilitation protocols than maximum cycle ergometry. Patients undergoing velocity spectrum orthopaedic ~ehabilitations hould be monitored for their heart rate and blood pressure. Caution should be observed in cardiac and elderly individuals undergoing these rehabilitation protocols. J Orthop Sports Phys Ther 1987;8(7):346-350.     

Effects of Precurarization on the Blood Pressure and Heart Rate Changes Induced by Suxamethonium Facilitated Laryngoscopy and Intubation

The effects of precurarization on blood pressure and heart rate increases during laryngoscopy and intubation were studied in 60 surgical patients, who were randomly allocated to four groups, receiving as a pretreatment d-tubocurarine (0.05 mg/kg), alcuronium (0.03 mg/kg), pancuronium (0.008 mg/kg) or saline in a double-blind fashion. d-Tubocurarine and alcuronium pretreatments seemed to attenuate the blood pressure increase during laryngoscopy and intubation under suxamethonium. Moreover, d-tubocurarine pretreatment protected effectively against high blood-pressure increases. Heart-rate increases were of the same magnitude in all the pretrealed groups. d-Tubocurarine pretreat ment abolished suxamethonium-induced fasciculations completely, whereas alcuronium pretreatment gave protection in 93% and pancuronium pretreatment in 43% of patients.     

The Impact of Posttraumatic Stress Disorder on Blood Pressure and Heart Rate in a Veteran Population

Hyperarousal is a hallmark of posttraumatic stress disorder (PTSD). PTSD has been associated with increased blood pressure (BP) and heart rate (HR) in veteran populations. We retrospectively identified male patients consulted to outpatient psychiatry at the Iowa City Veterans Affairs Healthcare System. Patients were divided into PTSD (n = 88) and non‐PTSD (n = 98) groups. All PTSD patients and a subset of non‐PTSD patients had documented blast exposure during service. The study investigated whether patients with PTSD had higher systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) than patients without PTSD. The effect of trauma exposure on BP was also examined. Mean SBP (133.8 vs. 122.3 mm Hg; p < .001), DBP (87.6 vs. 78.6 mm Hg; p < .001), and HR (78.9 vs. 73.1 bpm; p < .001) were all significantly higher in the PTSD group. Trauma‐exposed patients without PTSD had significantly higher BP than nonexposed patients. The prevalence of hypertension (HTN) was 34.1% (diagnosed and undiagnosed) among PTSD patients. Patients with PTSD had higher BP and HR compared to patients without PTSD. Trauma exposure may increase BP in this population. These findings will increase awareness about the cardiovascular implications of PTSD.     

Dopamine and Noradrenaline Are Unrelated to Renalase,Heart Rate,and Blood Pressure in Heart Transplant Recipients

Introduction

Renalase may degrade catecholamines and regulate sympathetic tone and blood pressure. The aim of this study was to assess dopamine, norepinephrine, and renalase in 80 heart transplant recipients and 22 healthy volunteers and their correlations with heart rate, blood pressure control, type of hypotensive therapy, and renal function.

Patients and Methods

Renalase, dopamine, and norepinephrine were studied by using commercially available assays.

Results

Renalase levels were higher in heart transplant recipients compared with healthy volunteers, and noradrenaline levels were lower in the studied cohort patients than in the healthy volunteers. Noradrenaline was correlated with white blood cell count (r = −0.21, P < .05), copeptin (r = 0.41, P < .01), and left ventricular diameter (r = −0.29, P < .05), whereas dopamine was correlated in univariate analysis with white blood cell count (r = −0.22, P < .05), posterior wall of left ventricular diameter (r = 0.58, P < .01), and left atrium diameter (r = −0.31, P < .05). Neither noradrenaline nor dopamine was correlated with heart rate, blood pressure, kidney function, or New York Heart Association class. Noradrenaline was significantly higher in patients with elevated diastolic blood pressure (>90 mm Hg) compared with those with normal diastolic blood pressure (P < .05). Renalase was related to kidney function but was unrelated to catecholamines.

Conclusions

Elevated renalase levels in heart transplant patients were related to kidney function but not linked to the sympathetic nervous system activity in this study population. In heart transplant recipients, these findings might suggest that sympathetic denervation and the modulation of β-receptors persist.