冠状动脉介入治疗术后并发症护理进展

<正>自1977年世界上第一例经皮冠状动脉成形术(PTCA)成功之后,目前冠状动脉介入治疗(PCI)已成为常规治疗冠心病的重要手段,它具有创伤小、治疗效果好、病人康复快等特点,为越来越多的病人所接受。但该治疗方法在术后的并发症如血管路径并发症、低血压反应、心律失常、急性心包填塞、支架内血栓形成、造影剂肾病(CIN)等亦越来越受到重视。因此术     

介入治疗冠心病致血管迷走性反射的预防与护理

介入治疗可以有效治疗冠心病、心绞痛及心肌梗死，降低心脏事件的发生率，从而降低病人的死亡率。但介入治疗可导致与心脏病相关的并发症，而血管迷走性反射(即临床常称的过度迷走神经反射)是少见却极危险的并发症。由于其发生突然、进展迅速严重威胁病人生命，其次发生后有赖于快速诊断和迅速处理，系统掌握血管迷走性反射的临床特征，提高认识，注意与其它并发症相鉴别的预防护理体会报告如下。     

冠状动脉介入治疗并发症及预防

近年来,经皮冠状动脉介入治疗(PCI)已经成为冠心病治疗过程中不可缺少的有效手段。但作为有创性治疗方法,难免会出现各种并发症,包括因冠状动脉损伤或穿刺血管损伤引起的血管并发症和全身并发症,主要包括死亡、心肌梗塞、冠状动脉穿孔和心律失常、穿刺血管并发症等,高度重视其预防,及时识别和紧急处理是减少冠脉介入治疗并发症的有效手段。     

完肤止血汤在经股动脉冠状动脉介入治疗术后止血的临床观察

目的探讨完肤止血汤在经股动脉路径行冠状动脉介入治疗术后止血、预防血管并发症及提高病人舒适度等方面的临床疗效。方法将50例经股动脉穿刺后行诊断及介入治疗术后的患者随机分为完肤止血汤组(25例)与常规压迫组(25例),观察两组血管并发症等不良反应的发生率、下肢制动时间及腰痛、背痛、腹胀等不适感的程度。结果完肤止血汤组与常规压迫组比较,血管并发症明显减少(P0.05),患者卧床制动时间也明显缩短(P0.05),舒适度也明显提高(P0.05)。结论经股动脉路径行冠状动脉介入治疗术后应用完肤止血汤可明显减少股动脉穿刺后的血管并发症,缩短下肢制动时间,并明显提高患者舒适度,值得临床推广应用。     

肝移植术后胆管、血管并发症的介入治疗

目的 回顾性分析介入治疗在肝移植术后胆管及血管并发症的价值.方法 肝移植手术30例,血管、胆管并发症并经影像学证实的患者11例,3例血管病变(血栓2例,吻合口狭窄1例),溶栓并球囊扩张行支架植入;6例肝移植术后梗阻性黄疸的病人,行PTCD并球囊扩张术;2例门静脉狭窄病人行球囊扩张.结果 3例(血栓2例,吻合口狭窄1例)肝动脉狭窄,6例梗阻性黄疸,2 例门静脉狭窄病人经介入治疗后,症状均显著改善.结论 介入治疗是肝移植术后及时处理血管及胆管并发症的一种有效手段,它创伤小、操作简单、安全有效,值得临床推广应用.     

冠心病介入治疗术后并发症的护理

近年来，以冠状动脉腔内成形术和支架置入术为主的冠心病介入治疗迅速发展，成为冠心病血管重建的重要手段。但介入治疗毕竟是一种创伤性治疗措施，不可避免地会发生各种类型的并发症，甚至造成死亡。因此，在临床上应充分认识发生并发症的危险因素，消除或减轻并发症的发生。本文对并发症的类型及发生率、并发症的处理及预防、护理综述如下。     

血管内介入治疗并发症的预防

血管内介入治疗并发症的预防,关键在于一个"悟".悟通则能严格掌握好适应证.合理运用介入器材,掌握血管的解剖和变异,细致、轻柔的操作,手眼并用.安全合理的治疗方法和措施,适可而止的去治疗病人,就会减少并发症的发生,取得良好的治疗效果.     

冠心病介入治疗并发症的护理

血管介入治疗是心血管疾病治疗史上的一次革命,冠心病介入治疗极大地改善了冠心病病人的治疗效果.经皮经腔冠状动脉成型术(PTCA)是心脏病学领域最基础,应用最广泛的技术.目前以成为冠心病血运重建治疗的重要手段.近年来新技术如冠状动脉支架,球囊旋磨技术,旋切技术是冠状动脉呢激光的应用.使介入治疗适应症不断扩大,疗效日益提高.作为有一定危险的侵人性诊断和治疗手段,不可避免地会发生各种类型的并发症,正确认识并及时处理这些并发症是术后护理的重要内容.现时我院622例冠心病介入诊断和治疗病人的术后护理进行总结,探讨最佳的护理措施,提高治疗水平.     

后腹腔镜肾切取、离体肾动脉瘤切除及自体肾移植术的手术配合

肾动脉瘤是一种罕见的内脏动脉瘤，其治疗包括手术治疗和介入治疗。手术方法包括动脉瘤切除原位修复或补片血管成形、自体大隐静脉或人造血管旁路术等多种方式。原位手术治疗肾动脉瘤的难度大、并发症多，失败后多切除肾脏。     

选择性无保护左主干冠脉内支架术

在缺血性心脏病、充血性心力衰竭或心源性休克等心脏导管介入检查中 ,左主干病变约占 3% (5 % ,长期以来 ,由于左主干血管支配整个左心系统 ,一旦血流被阻断 ,将易出现严重的心肌缺血并发症 ,如室颤、心脏骤停或心源性休克 ,因此无保护左主干狭窄 (ＵＬＭＣＡ)病人的治疗一直为人们所关注[1] 。冠脉搭桥术以其显著改善病人的生存率而成为ＵＬＭＣＡ病人的首选治疗手段[2 ] 。经皮冠脉腔内球囊成形术 (ＰＴＣＡ)治疗ＵＬＭ ＣＡ的早期研究表明由于手术风险、难度及严重并发症均较高而未得到认可[3 ] 。随着支架技术在冠心病介入治疗中的应用…     

Value of D-Dimers in patients with acute aortic dissection

Objective: To evaluatel the value of D-dimers in patients with acute aortic dissection (AAD). Methods: This study consisted of 16 patients with AAD and 27 non-AAD patients. Serum D-dimets were measured by Sta-Liatest D-DI immunoturbidimetric assay. Results: D-dimer level was higher (P ＜ 0.001) in patients with AAD(7.91 ± 5.52 μg/ml) than that in non- AAD group(1.57±1.24 μg/ml). D-dimer was positive (＞0.4 μg/ml) in all patients with AAD and in 10 control group patients (37%). Among patients with acute AAD, D-dimers tended to be higher in Stanford A than in Stanford B (8.67 ± 4.31 μg/ml vs. 3.24±1.27 μg/ml, P ＜0.01). D-dimer values tended to be higher in more extended disease(3.84 ± 1.65 μg/ml, 8.57 ± 3.58 μg/ml and 11.87 ± 5.69 μg/ml in thoracic aorta, thoracic and abdominal aorta, thoracic and abdominal aorta and iliacal arteries, respectively, P ＜ 0.05 for both 8.57 ± 3.58 and 11.87 ± 5.69 vs. 3.84 ± 1.65 ). Including the control group into the analysis, we found a sensitivity of 100%, a negative predictive value of 100%, and a specificity of 66% and a positive predictive value of 64% for D-dimer in diagnosis of AAD in our patients with suspected AAD. Conclusion: D-dimer was elevated in patients with AAD. A negative D-dimer test result could be useful in excluding AAD.     

Research of combined liver-kidney transplantation model in rats

Objective： To set up a simple and reliable rat model of combined liver-kidney transplantation. Methods： SD rats served as both donors and recipients. 4℃ sodium lactate Ringer＇s was infused from portal veins to donated livers,and from abdominal aorta to donated kidneys, respectively. Anastomosis of the portal vein and the inferior vena cava （IVC） inferior to the right kidney between the graft and the recipient was performed by a double cuff method, then the superior hepatic vena cava with suture. A patch of donated renal artery was anastomosed to the recipient abdominal aorta. The urethra and bile duct were reconstructed with a simple inside bracket. Results： Among 65 cases of combined liver-kidney transplantation, the success rate in the late 40 cases was 77.5%. The function of the grafted liver and kidney remained normal. Conclusion： This rat model of combined liver-kidney transplantation can be established in common laboratory conditions with high success rate and meet the needs of renal transplantation experiment.     

BLOOD PRESSURE CHANGE WITH AGE IN SALT-SENSITIVE TEENAGERS

Objective To observe blood pressure change with age in salt-sensitive teenagers whose salt sensitivity were determined by repeated testing.Methods Salt sensitivity was determined through intravenous infusion of normal saline combined with volume-depletion by oral diuretic furosemide in 55 teenagers. After five years, salt sensitivity was re-examined and subject blood pressure was followed up. Blood pressure changes in salt-sensitive teenagers were compared to that of non-salt sensitive teenagers over five years.Results After 5 years, the repetition rate of salt sensitivity determined by intravenous saline loading is 92.7%. In teenagers with salt sensitivity on the baseline, both the systolic blood pressure increments and increment rates were much higher than non-salt sensitive teenagers (12.7±12.1 mmHg vs. 2.8±5.2 mmHg, P＜ 0.01; 12.2%± 12.0% vs. 2.5% ±4.4%, P＜ 0.001,respectively). There was a similar trend for diastolic blood pressure (8.4 ± 6.4 mmHg vs. 3.7 ± 6.4 mmHg, P = 0.052; 13.2% ±10.6 % vs. 6.8%± 10.1%, P = 0.053, respectively).Conclusions Salt sensitivity determined by intravenous saline loading showed good reproducibility. Blood pressure increments with age were much higher in salt-sensitive teenagers than non-salt sensitive teenagers, especially in terms of systolic blood pressure.     

安心颗粒对急诊经皮冠状动脉介入术后生活质量影响的研究

目的：评价使用安心颗粒对急诊经皮冠状动脉介入术（PPCI）术后生活质量的影响.方法：将160例接受PPCI的急性ST段抬高型心肌梗死患者随机分为安心颗粒组（术前顿服安心颗粒8.8g,术后安心颗粒4.4 g/次,每日2次）和对照组（仅接受基础药物治疗）.所有患者均服用阿司匹林、氯吡格雷和阿托伐他汀.分别在入院时、出院前1d、出院后180 d时,应用心肌梗死多维度量表（MIDAS）、中文版SF-36评价量表对患者生活质量评分.并观察术后30 d以内的出血并发症、血小板减少症发生情况.结果：入院时和出院前1d,两组患者的心肌梗死MIDAS、SF-36量表评分比较无差异（P＞0.05）;出院后180 d时,与对照组比较,安心颗粒组MIDAS、SF-36评分明显减低（P＜0.05）;组内与入院时比较,两组出院前1d、出院后180 d时,MIDAS、SF-36评分均降低（P＜0.05）.两组患者在随访期间均无大量出血、少量出血、重度和极重度血小板减少症发生,安心颗粒组有4例、对照组有7例发生不明显出血（P＞0.05）.两组发生轻度血小板减少症的患者数比较无差异（P＞0.05）.结论：PPCI使用安心颗粒,能改善急性ST段抬高型心肌梗死患者的生活质量,且不增加出血风险.     

The comparative studies of the influences of Urapidil and Nicardipine on sino-atrial node function, atrio-ventricular node function and hemodynamics

Objective:To investigate the influences of urapidil and nicardipine on rabbit sinus function,atrio-ventricular node function and hemodynamics.Methods:Thirty-two Angora's rabbits were selected and randomly divided into four groups.U1 group:urapidil 0.25 mg/kg;U2 group:urapidil 0.5 mg/kg;N1 group:nicardipine 10 μg/kg;N2 group:nicardipine 20 μg/kg.All these medicine were administrated within 30 seconds.Measurements were taken before and after the administration of urapidil or nicardipine for the following data:mean blood pressure(MAP),heart rate(HR),sino-atrial conduction time(SACT),maximal sinoatrial recovery time(SNRTmax)corrected sinus node recovery time(CSNRT),index of sinus node recovery time(SNRTI),Wenckebach A-V conduction frequency (WB),and P-R interval.Results:Significant MAP and HR changes were identified in all of the four groups before and after administration of both urapidil and nicardipine.No significant changes could be found in the rest of the parameters.Intergroup analysis showed that SACT and CSNRT of N1 and N2 groups were shorter than those of the U2 group(P＜0.01);the MAP decreased(P＜0.01)and the HR increased drastically(P＜0.01).Conclusions:Neither urapidil(0.25 mg/kg,0.5 mg/kg)nor nicardipine(10μg/kg,20μg/kg)has any significant influence on rabbit sinus function or rabbit atrio-ventricular node function.Nicardipine could be a better choice than urapidil for parafunctional sinus node patients.     

Expression of OPGmRNA and ODFmRNA in the patients of hip fracture due to osteoporosis

Objective：To investigate the gene expression of osteoprotegerin（OPG） and osteoclast differentiation factor（ODF） in the bone tissue of patients with hip fracture due to osteoporosis. Methods：OPGmRNA and ODFmRNA in the bone tissue in 50 cases of osteoporosis sufferers（over 50 years old） with hip fracture（Observer Group） and 30 cases of hip facture sufferers with no osteoporosis（Control group） were analyzed with the Semi-Quantitative RT-PCR method. Results：The mRNA expressed of ODF, OPG were both high in the patients with hip fracture. In the control group, the expression of OPG mRNA was observed, while the expression of ODF mRNA was very slight. Conclusion：Aged patients contained all signals including OPG, ODF that are essential for inducing osteoclastogenesis and promoting bone resorption.     

The clinicopathological and immuohistochemical analysis of solid-pseudopapillary tumor of the pancreas： report of 9 cases

Objective：To investigate the clinical features, pathological characteristics and immunophenotype of solid-pseudopapillary tumor of the pancreas（SPTP）. Methods：Nine surgically treated cases of SPTP were retrospectively reviewed. Hematoxylin and Eosin（HE） staining and immunohistochemical staining were used to analyze all cases, and the general clinical data was collected. Results：Six patients were asymptomatic except for a palpable mass. Two patients complained of vague-epigastric pain. One patient appeared jaundice. The tumor was encapsulated and solid tissues alternately with cystic tissues. Histologically, the histological structure of solid portion was pseudopapillary with a fibrovascular core. Tumor cells were uniform and medium-sized which were arranged in sheets ets or nests or pseudopapillary patterns. Immunohistochemical studies demonstrated that SPTP proved positive in vimentin（9/9 cases）, AAT（9/9 cases）, NSE（9/9 cases）, ACT（7/9 cases）, CK20（2/9 cases）, CgA（1/9 cases）, S-100（3/gcases）, PR（4/gcases）, Syn（3/9 cases） and CD56（5/9cases）, negative in CEA and ER. Conclusion：SPTP is a tumor predominantly occurring in young women frequently without special symptoms. This tumor has various characteristical histological patterns with different immunophenotype.     

Dynamic Changes in Serum Estradiol and Progesterone levels in Patients of Premenstrual Syndrome with Adverse Flow of Liver-qi

Objective:To probe into the influence of changes of ovarian hormones on the pathogenesis of the specific sub-type premenstrual syndrome(PMS)and reveal partial microcosmic mechanisms of adverse flow of liver-qi.Methods:Estradiol(E2)and progesterone(P)levels in serum were determined at different phases of menstrual cycle by radioimmunoassay.Results:In the group of PMS with adverse flow of liver-qi.the secretive peak value Of E2 and P at the follicular phase significantly decreased,and the secretive peak value at the luteal phase did not come into being.Conclusions:Low E2 and P secretive peak at the follicular phase and absence of secretive peak at the luteal phase is one of the microcosmic mechanisms of PMS with adverse flow of liver-qi.One of the pathophysiologic mechanisms of specific sub-type PMS is probably the continuous low level of E2and P.     

Real-time Three-dimensional Echocardiography in Assessment of Left Ventricular and Right Ventricular Volumes

Real-time three-dimensional echocardiography (RT3DE)is a new ultrasound technique that enables dynamic threedimensional visualization and quantification of the heart in real time. Investigation of feasibility and methodology of RT3DE in determining left ventricular (LV) and right ventricular (RV) volumes, RT3DE was performed in 35 normal adults using Philips SONOS 7500 system with a 2-4 MHz matrix array transducer. The 60°×60° "pyramid" volume database was obtained and analyzed on a TomTec echo workstation. Both LV and RV volumes were calculated with four 3DE methods (i.e. apical 2, 4, 8, and 16-plane) through manually tracing ventricular endocardial borders in end diastole and end systole. Stroke volumes were then calculated. LV volume was also measured by 2DE Simpson's rule using GE VIVID 7 ultrasound machine.     

SCREENING FOR A 21-CHROMOSOME ABNORMALITY IN PREIMPLANTED EMBRYOS OF ELDERLY WOMEN

Increasing maternal age is the only etiological factor unequivocally linked to Down's syndrome in humans. The occurrence rate of newborns with Down's syndrome is about 1/220 in women over 35 years old. However, the occurrence rate in embryos fertilized in vitro, of the elder woman is unclear. Using FISH we screened the number of chromosome 21 in preimplanted embryos of 5 elderly women (average age, 38.4 years) to study the feasibility and necessity of screening trisomy 21 in embryos in patients over 35 years old at the in vitro fertilization (IVF) center.