二尖瓣和主动脉瓣联合置换术22例护理配合

对22例联合瓣膜病患者行二尖瓣和主动脉瓣联合置换术.并给予密切护理配合.本组患者手术时间为210～570 min.认为充分的术前准备,熟练、严密的术中配合是手术成功的重要保证.     

泪道阻塞患者新型泪道探通硅胶管逆行植入术围术期护理

总结35例行新型泪道探通硅胶管逆行植入术治疗泪道阻塞患者的护理经验.术前根据患者及家属担忧情况做好心理护理,使患者以最好的状态接受手术;为患者泪道冲洗至达到手术要求后,准备各项手术器具;术中默契配合医生操作,保证不能自主配合的患者顺利完成手术;术后做好滴眼、引流管、拔管的护理;为患者行详细的宣教,使其在家中也能正确护理术眼.本组手术均顺利完成,无患者因术前准备不充分、麻醉不充分或术后护理不当而发生术中及术后的并发症,术后治疗效果满意.     

二尖瓣和主动脉瓣联合置换术22例护理配合

对22例联合瓣膜病患者行二尖瓣和主动脉瓣联合置换术，并给予密切护理配合。本组患者手术时间为210—570min。认为充分的术前准备，熟练、严密的术中配合是手术成功的重要保证。     

升主动脉瘤切除与同期主动脉瓣置换术的配合及护理

目的探讨升主动脉瘤切除同期主动脉瓣置换术的手术配合及护理要点。方法总结16例在体外循环下行升主动脉瘤切除同期主动脉瓣置换术患者的术中护理配合方法和措施。结果本组病例均顺利完成手术,术中器械护士及巡回护士配合达到预期效果,术后患者恢复良好,顺利出院。结论手术室护士术前充分了解病情及手术操作过程,完备物品准备和心理准备,术中积极主动与手术医师、麻醉医师、灌注医师默契配合,是手术顺利进行、成功的关键。     

微创下牛心包片行主动脉瓣成形术的手术配合

目的探讨微创牛心包片行主动脉瓣成形术的护理配合要点。方法回顾性分析24例主动脉关闭不全的患者采用微创方式行主动脉瓣成形手术的手术配合过程。结果 24例患者手术时间(201.5±46.5)min,过程顺利。术后24~48个月随访,所有患者术后心功能均在Ⅰ级。结论微创牛心包片行主动脉瓣成形手术是治疗主动脉关闭不全安全、有效、微创的方法 ,充分的术前准备,术中快速、准确的配合,认真、仔细的术中并发症护理,可有效地减少术后并发症,提高手术成功率。     

10例重度主动脉瓣狭窄介入治疗老年患者手术配合

总结10例经导管主动脉瓣植入术治疗老年主动脉瓣重度狭窄的护理配合.巡回护士需做好术前体位准备,注意保暖防止患者发生低体温;器械护士配合包括术前做好访视,做好呼吸功能、循环功能监护,临时起搏器超速抑制的护理;预防感染、术中低血压、血栓形成、对比剂肾病等并发症发生.本组1例患者术中发现Ⅲ°房室传导阻滞,立即启动临时起搏器后生命体征平稳.1例术中出现血氧饱和度低,由98%降至88%,予吸痰处理后血氧饱和度恢复正常.1例术中发生低血压,血压从150/93mmHg降到88/55mmHg,原因是手术时间长,出血量多(穿刺口渗血),即予静脉注射涧羟胺1mg,予多巴胺静脉缓注及静脉滴注万文,经处理后血压恢复正常.9例术后恢复良好出院.1例患者由于心脏功能差,左室射血分数30%,术后7d死亡.     

David及同期主动脉瓣成形手术的护理配合

总结16例David手术配合护理经验,其中13例同期行主动脉瓣成形术。手术均顺利完成。15例患者康复出院,1例术后死亡;随访(6.1±3.7)月,主动脉瓣无返流2例,轻度返流13例,中度返流1例;无患者需二次手术治疗。认为充足的术前准备、精细的术中护理配合及监测,是手术成功不可或缺的要素;深刻理解和掌握手术过程,领会手术要点是良好手术配合的核心基础。     

胶囊内镜检查22例临床护理

目的:总结胶囊内镜检查的配合经验,探讨更适宜推广应用的护理方法.方法:对22例行胶囊内镜检查的患者进行术前准备、术中配合及术后护理.结果:22例患者检查均成功,无并发症发生,未出现仪器信号中断现象.结论:精心的术前准备及良好的术中配合是胶囊内镜检查成功的关键.     

下颌阻生牙拔除术250例护理配合

对250例下颌阻生牙拔除术患者术前做好心理护理及术前准备,术中做好翻瓣、劈牙、去骨、增隙等配合,术后给予健康教育.认为做好心理护理、术前准备及术中配合,是阻生牙拔除顺利完成的关键.     

鼻内窥镜手术配合及护理体会

回顾性总结了178例患者行功能性鼻内窥镜手术的配合和护理体会.主要包括术前病人准备、器械准备,术中器械护士和巡回护士的配合以及术后麻醉恢复前的护理观察.认为良好的术前、术中、术后护理是保证手术成功的关键.     

超声心动图诊断先天性主动脉瓣畸形及其指导临床治疗的现状探讨

先天性主动脉瓣畸形系胚胎期瓣膜发育障碍所致,是一种常见的瓣膜畸形。随着超声仪器性能的不断提高及新技术的出现,主动脉瓣畸形的诊断率明显提高,但在实际工作中仍有部分病例被误漏诊。本文就超声心动图对主动脉瓣畸形的诊断、指导临床治疗及漏误诊原因的分析做一综述。     

Association between bicuspid aortic valve morphotype and regional dilatation of the aortic root and trunk

Thoracic aortic disease, including thoracic aortic aneurysm (TAA), is frequently seen in patients with bicuspid aortic valve (BAV). We hypothesized that BAV morphotype would be associated with aortic aneurysm phenotypes but that other patient variables would significantly modify this relationship. 829 patients between 18 and 90 years with BAV and available raw imaging of the aortic valve and the ascending aorta to its mid-portion prior to aortic valve and aortic surgery were examined. The sinuses of Valsalva and proximal ascending aorta were measured from 2-dimensional co-planar echocardiographic images. We observed strong associations between patient habitus and raw and normalized dimensions of the aortic root and ascending aorta. Patients with R–L morphotype presented at an older age with larger aortic root but similar ascending aortic dimensions. After accounting for patient morphometric characteristics and severity of aortic valve disease, patients with R–L valve morphotype were marginally more likely to have an aortic root aneurysm (86% vs. 78%; P?=?0.043), defined as aortic root dimension Z score ≥3. We observed only small differences in aortic dimensions between BAV morphotypes, that are eclipsed by variation in patient habitus. We interpret these findings to mean that BAV patients will not likely benefit from therapies based on aortic valve morphotype. Rather, we propose that all BAV patients should undergo longitudinal follow-up, independent of valve morphotype. Guidelines for aortic surgery based upon dimensions alone may be improved by considering patient characteristics such as age, body size and other characteristics.     

超声心动图评价二瓣化主动脉瓣瓣膜功能

目的 探讨超声心动图在二瓣化主动脉瓣病理生理进展评价中的应用,分析二瓣化主动脉瓣各年龄瓣膜病变的程度.方法 回顾性分析135例二瓣化主动脉瓣患者超声资料及病例资料,结合临床资料分析患者病程进展中瓣膜功能的变化.结果 二瓣化主动脉瓣关闭不全最常见,本组资料中为68例(50%),单纯狭窄仅19例(14%).狭窄并关闭不全者29例(22%),瓣膜功能正常者19例(14%).各年龄组内主动脉瓣病变均以关闭不全多见.病程晚期的手术患者各年龄组内主动脉病变亦均以关闭不全为主.结论 超声心动图能对主动脉瓣的病变作出早期诊断.二瓣化主动脉瓣最常见的瓣膜病变是主动脉瓣关闭不全.     

Semont方法治疗后半规管发作性位置性眩晕的配合及护理

时间护理是探讨“择时护理”的学说。根据时间护理理论，护理人员可结合患者的生物周期和疾病的节律变化特点来展开护理。这是维持和恢复人体正常生理节律，有效促进疾病早期康复的重要手段，也是以人为本护理理念的体现。由于人体生物节律的作用，脑梗死疾病的发生发展具有一定的时间节律性，但根据该节律性对脑梗死患者进行相应时间护理的研究却鲜有报道。本研究从时间护理的角度．提出脑梗死患者的护理措施，以提高护理质量，现报道如下。     

超声心动图评价二瓣化主动脉瓣瓣膜功能

目的 探讨超声心动图在二瓣化主动脉瓣病理生理进展评价中的应用,分析二瓣化主动脉瓣各年龄瓣膜病变的程度.方法 回顾性分析135例二瓣化主动脉瓣患者超声资料及病例资料,结合临床资料分析患者病程进展中瓣膜功能的变化.结果 二瓣化主动脉瓣关闭不全最常见,本组资料中为68例(50%),单纯狭窄仅19例(14%).狭窄并关闭不全者29例(22%),瓣膜功能正常者19例(14%).各年龄组内主动脉瓣病变均以关闭不全多见.病程晚期的手术患者各年龄组内主动脉病变亦均以关闭不全为主.结论 超声心动图能对主动脉瓣的病变作出早期诊断.二瓣化主动脉瓣最常见的瓣膜病变是主动脉瓣关闭不全.     

自体心包补片修补主动脉瓣环辅助主动脉瓣置换

背景：在主动脉置换过程中常遇到瓣环钙化、瓣周囊肿等特殊情况,这时一般应用特殊技术辅助主动脉瓣置换。目的：观察自体心包补片修补主动脉瓣环辅助主动脉瓣置换治疗钙化性主动脉瓣狭窄并瓣环钙化的临床可行性。方法：回顾性分析2009年1月至2012年1月郑州大学第一附属医院42例钙化性主动脉瓣狭窄并瓣环钙化患者的临床资料,并通过统计学软件处理自体心包补片修补主动脉瓣环技术辅助主动脉瓣置换前后的主动脉瓣有效瓣口面积指数、最大跨瓣压差、血流峰值速度、左室射血分数等数据,分析自体心包补片修补主动脉瓣环技术辅助主动脉瓣置换的应用效果。结果与结论：无置换中死亡病例,置换中主动脉阻断时间为52-88（63.0±18.1）min,体外循环时间为78-122（102.6±25.1）min,置换后1例患者出现急性肾功能衰竭,经床旁血透治疗后治愈。余患者无严重置换并发症。置换后住院天数为7-20（13.6±5.5）d。置换后多普勒超声心动图示：瓣膜功能良好,均未发现主动脉瓣周漏。置换后6个月的主动脉瓣有效瓣口面积指数、最大跨瓣压差、血流峰值速度、左室射血分数均有显著改善,与置换前比较差异均有显著性意义（P〈0.05）。证实对置换适应证合适的特殊换瓣患者,自体心包补片修补主动脉瓣环辅助主动脉瓣置换可取得满意的外科治疗效果,且操作安全简单,是一项可行的技术。     

Emergency aortic valve replacement for critical aortic stenosis

Objective: To demonstrate that emergency aortic valve replacement can be successfully performed in patients with critical aortic stenosis and reduced left ventricular function even in cardiogenic shock with associated severe multiple organ failure. Design: Retrospective, consecutive case series. Setting: Multidisciplinary intensive care unit of a tertiary care university hospital. Patients: Five patients admitted to the intensive care unit with critical aortic stenosis (aortic valve area 0.56 ± 0.13 cm²) and greatly reduced left ventricular ejection fraction (20 ± 3 %) in prolonged cardiogenic shock and associated multiple organ failure (Multiple organ failure score 6.8 ± 0.5; Acute Physiology, Age, and Chronic Health Evaluation III score 91 ± 27). Intervention: Emergency aortic valve replacement. Results: All patients survived with full recovery of organ function. At follow-up (18 ± 10 months) all patients were in New York Heart Association functional class I or II with improvement of left ventricular ejection fraction to 48 ± 25 %. Conclusions: This excellent outcome suggests that emergency aortic valve replacement should be strongly considered in patients with critical aortic stenosis even in cardiogenic shock and multiple organ failure.     

Feasibility of sheathless transfemoral aortic valve implantation in patients with small access vessel diameters

Objectives

We intended to show feasibility of sheathless transfemoral aortic valve implantation in patients with small access vessel diameters.

Background

Transcatheter aortic valve implantation (TAVI) has emerged as a valid treatment option in patients with aortic valve stenosis who are poor candidates for surgical aortic valve replacement. Few patients, who cannot undergo transfemoral or transsubclavian aortic valve implantation due to small access vessel diameters, are not suitable for transapical or direct aortic valve implantation, either.

Methods

In more than 700 transcatheter aortic valve implantations since 2008 we identified 17 patients who had to be excluded from transfemoral valve implantation due to vessel diameters <6 mm and who were no candidates for transapical or direct aortic implantation. We performed CoreValve? implantations in these patients without the required 18F sheath to cross the vessels despite their small size (4.6–5.9 mm).

Results

Sixteen sheathless implantations were successful. In all 17 patients, bleeding during the procedure due to the smaller delivery catheter was minimal. Sixteen patients had a successful access site closure at the end of the procedure.

Conclusions

Sheathless implantation of a self-expanding aortic valve can be safely considered in selected patients with access vessel diameters below 6 mm, if transapical or direct aortic implantation is not suitable.     

同种异体人心脏主动脉与肺动脉瓣膜的生物力学比较

背景:目前同种心脏瓣膜已成熟应用于瓣膜替换手术及复杂先天性心脏病矫治手术中,但人心脏肺动脉瓣膜与主动脉瓣膜生物力学特性的对比研究报道较少.目的:对比分析深低温液氮保存人心脏主动脉瓣膜和肺动脉瓣膜的生物力学特性.方法:对比观察试验于2004-03/07在中国医学科学院心血管病研究所先天性心脏病研究室完成.取深低温液氮保存的健康成年男性脑死亡6 h内志愿捐献者的人心脏主动脉瓣膜和肺动脉瓣膜各6例,符合医学伦理学要求.应用HD-10型厚度仪测定瓣膜组织的厚度,应用Instron拉伸机测定周向瓣膜组织的生物力学参数:瓣膜组织的断裂强度、应力应变曲线的斜率及伸长比.结果与结论:与人主动脉瓣膜相比,人肺动脉瓣膜组织厚度明显变薄;但二者的乍物力学参数瓣膜组织的断裂强度、应力应变曲线的斜率及伸长比差异均无显著性意义(P>0.05).结果提示,人主动脉瓣膜与肺动脉瓣膜的生物力学特性基本相似,从瓣膜水平上分析,人肺动脉瓣膜可满足主动脉瓣位生物力学的需要.