ENSITE 3000指导下射频消融治疗室性心律失常的术中护理

目的探讨ENSITE3000标测系统指导下射频消融治疗室性心律失常的术中护理经验及护理措施。方法对45例实施ENSITE3000标测系统指导下射频消融的室性心律失常患者进行护理,包括术前准备及探访,术中严密监护,应用冷盐水灌注泵监护、消融放电监护、对术中出现心血管迷走反射、心包填塞等并发症密切配合医生及时对症治疗并采取相应护理措施。结果术中因空腹手术时间过长致低血容量性休克3例;因射频消融放电造成疼痛引起迷走神经反射2例,经对症治疗严密监护后症状消失。结论提出术前注重患者心理护理、准备完善、严密监护和观察病情是减少并发症和提高手术成功率的重要保证。     

妊娠期合并急性主动脉夹层患者的术后监护

目的:总结3例妊娠期合并急性主动脉夹层患者行大血管及产科手术后的护理经验。方法 :2010年至2012年,3例患者,年龄24～35岁,妊娠21～38w,1例为马方综合征,2例患妊娠高血压综合征,分析监护资料。结果:本组接受大血管手术患者术后顺利度过危险期,无并发症发生。结论:妊娠期合并急性主动脉夹层患者应及时手术治疗,术后严密监测生命体征、加强脊髓并发症和肾功能不全的监测、产褥期的护理、胎儿的监护及选择恰当心理护理,从而有效的保证母婴的安全。     

原位肝脏移植术后早期并发症的观察与护理

目的 总结5例肝脏移植患者术后早期并发症的观察与护理的经验，提出肝脏移植术后，严密观察病情，精心的护理，是提高肝移植术后生存率的关键。监护内容包括体温、脉博、呼吸、血压、心电图、经皮氧饱和度、中心静脉压、血糖、血常规、凝血功能、肝肾功能、血气分析、每小时出入量等。护理要点：1、严密观察病情；2、加强消毒隔离工作，防止院内感染；3、根据病情控制输液速度及量；4、心理护理。     

主动脉夹层杂交手术的护理配合

目的 总结主动脉夹层杂交手术术中配合要点,使杂交手术顺利进行.方法 对10例Stanford B型主动脉夹层患者采取术前心理护理,做好物品的准备,术中在做好防护工作和严密监测生命体征的同时与外科护士、内外科手术医生以及麻醉师之间、默契配合,术后继续严密监护生命体征和肾功能的情况.结果 10例患者均成功完成杂交手术,顺利植入支架,未出现手术意外,人工血管通畅,1例出现支架远端少许内漏,球囊扩张后内漏消失,未发生穿刺部位出血、腹膜后血肿、下肢出血等并发症.通过精心治疗,严密观察,细心护理,10例患者均痊愈出院.随访3个月到10个月,生存质量良好.结论 主动脉夹层杂交手术的积极、主动的护理配合取得良好的临床效果.     

急性主动脉夹层瘤的监护探讨

目的　探讨急性主动脉夹层的监护。方法　分别从以下六个方面 :一般情况 ;血压、心率 ;疼痛 ;休克 ;压迫症状 ;心理 ,总结 9例主动脉夹层患者的监护体会。结果　经严密细致地监护 ,及时诊治 ,5例患者痊愈 ,2例转外科 ,2例死亡。结论　应重视主动脉夹层瘤急性期的监护 ,以提高抢救成功率 ,降低死亡率     

PTCA及支架植入术的监护

本文对18例经皮冠状动脉内成形术(PTCA)及支架植入者的监护，重点介绍了术前准备、加强心理护理、指导患者进行术前训练和饮食护理，强调术后严密观察病情，预防拔管综合征、支架内血栓形成、伤口出血和皮下血肿等并发症的发生及护理措施。做好健康宣教工作，是提高患者生活质量的关键。     

腹部术后高血压监护

目的分析腹部术后高血压的特点,进一步制定并落实相应的监护措施。方法选取2014年3月~2015年3月我院收治的腹部手术患者360例的临床资料进行回顾性分析,找出腹部术后高血压患者,进一步分析腹部术后高血压的特点,并采取有效监护措施。结果术后高血压15例,发生率为4.17%。其中,行胃切除术者8例,行肝、胆、胰手术5例,行腹部动脉手术1例,行结肠手术1例。结论腹部术后高血压患者的特点突出,为了患者血压能够恢复至正常水平,有必要采取有效监护措施,对患者术后血压进行严密监测、及时采取降压处理措施、科学处理尿潴留以及实施心理护理干预等,进一步使腹部手术患者的预后效果得到有效保障。     

49例老年全肺切除术后的监护与治疗

目的总结60岁以上老年患者一侧全肺切除术后的监护与治疗经验。方法分析我院49例60岁以上老年患者一侧全肺切除术后的监护与治疗措施。结果本组术后使用呼吸机18例,术后出现肺部感染10例,急性呼吸衰竭呼吸功能不全5例,心律失常21例,急性肺水肿3例,急性肾功能衰竭2例,应激性溃疡上消化道出血1例,经积极治疗后康复48例,死亡1例。结论严密地监护措施,合理的术后治疗计划,积极防治并发症,是确保老年全肺切除患者安全度过围手术期的关键。     

肺癌患者术后监护的应用价值

目的 对52例肺癌术后患者加强生命体征、胸腔引流、呼吸功能、心功能及胸腔内活动性出血的监护.方法 采取合理体位及行早期康复锻炼;发现病情变化及时有效地处理.结果 患者术后生命体征平稳,除1例多发性脑转移患者术后第5天死亡外,余51例术后恢复良好.结论 提示全程严密监护及早期康复锻炼有利于患者康复.     

高龄重度前列腺增生患者TURP术后监护

2003-2004年，我们对32例高龄重度前列腺增生患者进行经尿道前列腺切除(TURP)术后严密监护24～48小时，收到较好效果。现将监护体会报告如下。     

Total arterial bypass operations with complete sternotomy in the awake patient

BACKGROUND: In minimally invasive coronary artery bypass surgery beating heart procedures and operations via limited incisions became more popular and are routinely performed in many centers. An additional approach to minimize general trauma is avoidance of general anesthesia endotracheal intubation. PATIENTS AND METHODS: Between March and June 2001, 14 spontaneously breathing patients underwent coronary artery bypass grafting on the beating heart without general anesthesia. Intra- and postoperative analgesia management was performed using continuous epidural infusion of local anesthetics at level Th2-Th3. Single (n = 8) as well as double (n = 5) and triple (n = 1) bypass grafting was performed with the off pump technique. Surgical access to the chest cavity was created via partial (n = 8) or complete sternotomy (n = 6). RESULTS: Twelve patients remained awake throughout the procedure; 2 patients required secondary intubation due to incomplete sensory block and pneumothorax. Operating time was 94 +/- 18 minutes. Intermediate care monitoring time amounted to 4.8 +/- 0.6 hours. No surgery-related complications or myocardial infarction occurred. Postoperative angiography reviewed good graft function in all patients. CONCLUSION: Our preliminary experience shows that complete surgical revascularization is safe and feasible without endotracheal intubation and general anesthesia. Thus, invasiveness in cardiac surgery is further reduced with less need for intensive care unit monitoring enabling faster mobilization and recovery.     

Thoracic radiology in kidney and liver transplantation

Renal transplantation accounts for more than half of all solid organ transplants performed in the U.S., and the liver is the second most commonly transplanted solid organ. Although abdominal imaging procedures are commonplace in these patients, there has been relatively little attention paid to thoracic imaging applications. Preoperative imaging is crucial to aid in the exclusion of infectious or malignant disease. In the perioperative time period, thoracic imaging focuses both on standard intensive care unit care, including monitoring devices and their complications, and on the early infections that can occur. Postoperative management is divided into three time periods, and the principles governing the occurrence of infections and malignancies are reviewed. Anatomic and pathologic aspects unique to kidney and liver transplantation patients are also discussed.     

Postoperative assessment of the patient after transsphenoidal pituitary surgery

While most transsphenoidal pituitary surgery is accomplished without complication, monitoring is required postoperatively for a set of disorders that are specific to this surgery. Postoperative assessments are tailored to the early and later postoperative periods. In the early period, which spans the first few weeks after surgery, both monitoring of anterior and posterior pituitary function and managing neurosurgical issues are the focus of care. Potential disruption of pituitary-adrenal function is covered with perioperative glucocorticoids. Various strategies exist for ensuring the integrity of this axis, but typically this is done by measuring a morning cortisol on the 2nd or 3rd postoperative days. Patients with levels <10 μg/l should continue therapy with reassessment in the later postoperative period. Monitoring for water imbalances, which are due to deficiency or excess of ADH (DI or SIADH, respectively), is accomplished by continuous accounting of fluid intake, urine output and specific gravities coupled with daily serum electrolyte measurements. DI is characterized by excess volumes of inappropriately dilute urine, which can lead to hypernatremia. Most patients maintain adequate fluid intake and euvolemia, but desmopressin therapy is required for some. SIADH, which peaks in incidence on 7th postoperative day, presents with hyponatremia that can be severe and symptomatic. Management consists of fluid restriction. Neurosurgical monitoring is primarily for disturbances in vision or neurological function, and although uncommon, for CSF leak and infections such as meningitis. In the later postoperative period, the adrenal, thyroid and gonadal axes are assessed. New persistent hypopituitarism is rare when transsphenoidal surgery is performed by an experienced surgeon. Various strategies are available for assessing each axis and for providing replacement therapy in patients with deficiencies. Long term monitoring with assessments of visual, neurological and pituitary function coupled with pituitary imaging is necessary for all patients who have undergone surgery, irrespective of the hormone status of their tumors.     

急性心肌梗死行急诊经皮冠状动脉介入术后的早期康复护理

目的 探讨早期康复护理对急性心肌梗死（AMI）患者经皮冠状动脉介入术（PCI）后并发症及气血指标的影响.方法 选取2012年1月至2014年1月84例行急诊PCI的AMI患者,随机分为观察组和对照组,各42例.对照组患者术后行常规护理;观察组在对照组基础上行早期康复护理.干预前后采用美国M78162无创血流动力学监测仪测量两组患者血流动力学指标,观察两组患者并发症发生情况.结果 观察组术后第3天心输出量（CO）显著高于对照组同一时间段（P＜0.05）,平均脉压（MAP）显著低于对照组（P＜0.05）,而两组心率（HR）、收缩压（SBP）、舒张压（DBP）差异无统计学意义（P＞0.05）.观察组患者术后腹胀、穿刺点出血、排尿困难、腰酸背痛、烦躁失眠、坠积性肺炎发生率显著低于对照组,差异有统计学意义（P＜0.05）.观察组术后VAS疼痛评分显著低于对照组,住院时间少于对照组,而满意度评分高于对照组,差异有统计学意义（P＜0.05）.结论 早期康复护理有利于AMI患者急诊PCI术后心功能的恢复,降低术后不适感及并发症,缩短住院时间,提高患者满意度.     

Risk factors for postoperative pneumonia after cardiac surgery: a prediction model

BackgroundPostoperative pneumonia is the main infectious complication following cardiac surgery and is associated with significant increases in morbidity, mortality and health care costs. The aim of this study was to identify potential risk factors related to the occurrence of postoperative pneumonia in adult patients undergoing cardiac surgery and to develop a predictive system.MethodsAdult patients who underwent open heart surgery in our institution between 2016 and 2019 were enrolled in this study. Preoperative and intraoperative variables were collected and analyzed. A multivariate prediction model for evaluating the risk of postoperative pneumonia was established using logistic regression analysis via forward stepwise selection, and points were assigned to significant risk factors based on their regression coefficient values.ResultsPostoperative pneumonia occurred in 530 of the 5,323 patients (9.96%). Prolonged stays in the postoperative intensive care unit (ICU) and hospital, as well as higher mortality (25.66% versus 0.65%), were observed in patients with postoperative pneumonia. Multivariate analysis identified 13 independent risk factors including patient demographics, comorbidities, cardiac function, cardiopulmonary bypass (CPB) duration, and blood transfusion. The prediction model showed good discrimination (C-statistic: 0.80) and was well calibrated (Hosmer-Lemeshow χ²=7.907, P value =0.443). A 32-point risk score was generated, and then three risk intervals were defined.ConclusionsWe derived and validated a prediction model for postoperative pneumonia after cardiac surgery incorporating 13 easily discernible risk factors. The scoring system may be helpful for individualized risk estimations and clinical decision-making.     

Myocardial perfusion after aortic implantation for anomalous origin of the left coronary artery from the pulmonary artery

Postoperative myocardial perfusion and function were evaluated using thallium-201 myocardial imaging and technetium-99m cardiac pool imaging in five patients with an anomalous left coronary artery arising from the pulmonary artery. The patients underwent reimplantation of the left coronary artery at an age ranging from 10 months to 13 years. Postoperative electrocardiographic and radionuclide studies were performed both at rest and during stress 1 to 4 years after the operation. Electrocardiograms which were abnormal preoperatively returned to normal after surgery except that the T wave in lead aVL remained negative. Postoperatively, left ventricular ejection fraction measured by technetium-99m cardiac pool imaging was normal in all patients. Postoperative thallium-201 myocardial imaging, however, showed a perfusion defect with incomplete redistribution at the high-lateral or antero-lateral segment in all patients after a stress test. These data suggest that although myocardial ischaemic change decreases and global cardiac function improves after establishment of a dual coronary artery system, severe myocardial damage remains at the high-lateral or antero-lateral segment.     

Intracranial pressure monitoring and treatment: a contemporary view

ICP monitoring and recording provide another important parameter in the intensive care management of many critically ill patients and have been shown to augment the clinical neurologic examination, particularly in comatose patients suffering from severe head trauma, toxic and metabolic encephalopathies, massive cerebral infarctions, and many other central nervous system insults. Once considered an experimental tool restricted exclusively to sophisticated specialty neurosurgical and neuroanesthesia intensive care units, this straightforward and rapidly evolving technology is readily available and relatively easy to apply as a bedside intensive care procedure for selected patients. Many indications of particular interest to emergency physicians are indicated. The precise role of ICP monitoring in the prehospital management of patients has not been established. At this time, the conventional treatments for presumed ICP elevations, as outlined, are the mainstays of prehospital care. ICP monitoring may have a role in more extended or lengthy interinstitutional transfers of some critically ill patients.     

两种护理模式对新生儿Ⅲ型先天性食管闭锁围手术期影响的对比研究

目的探讨新生儿Ⅲ型先天性食管闭锁围手术期的护理措施及效果,以为临床护理工作提供借鉴。 方法回顾性分析新疆维吾尔自治区人民医院小儿外科,自2008年7月至2016年7月收治的56例Ⅲ型先天性食管闭锁新生患儿的病案资料,对比分析常规外科护理(对照组)及专科围手术期护理(观察组)方法的效果。 结果56例患儿手术均成功,观察组术后并发症发生率低于对照组;观察组的住院时间12～21 d(14.26±3.27),体重增加量为15～24 g(18.00±8.23),与对照组比较差异有统计学意义(均P<0.01)。 结论在常规儿外科护理干预基础上应用专科针对性的围术期护理取得理想的效果,值得在临床推广应用。     

Die Überwachung der Leberfunktionen in der Intensivmedizin

The relevance of liver dysfunction in the management of critically ill patients is increasingly being recognized. It has been found to affect mortality of patients with septic organ failure in several studies. The increasing prevalence of chronic liver disease among intensive care patients adds importance to the issue of monitoring the various aspects of liver function. An array of liver function tests as part of blood biochemistry testing has long been established. In the context of critical care and chronic liver disease, however, they must be interpreted cautiously. In addition, several dynamic tests of liver function have been developed. Relatively best explored are tests based on the hepatic elimination of indocyanine-green (ICG). Commercially available systems analyzing the plasma disappearance rate of ICG (ICG-PDR) are being marketed but these parameters also are difficult to interpret in the intensive care setting and especially in patients with chronic liver disease. ICG-PDR correlates with mortality in patients with septic organ dysfunction but studies investigating the outcome-oriented results of therapeutic interventions directed by these parameters have not been published. The possible relevance to intensive care management of several other dynamic tests of liver function, as well as interventional and ultrasonografic methods to address liver perfusion, are discussed in the article. As yet, there is no single method to monitor the various aspects of liver function and no method whose clinical value has been proved. Clinicians therefore have to mostly rely on clinical judgement aided by a reasonable selection among existing monitoring tools.