冷冻球囊导管消融治疗阵发性心房颤动病人的护理

[目的]总结冷冻球囊导管消融治疗阵发性心房颤动病人的护理。[方法]对2例阵发性心房颤动病人行冷冻球囊导管消融治疗,同时加强围术期的护理。[结果]2例病人均成功进行了肺静脉隔离,术中、术后无严重并发症发生,恢复良好。[结论]加强阵发性心房颤动病人行冷冻球囊导管消融治疗的围术期护理是手术成功的保证。     

冷冻球囊导管消融治疗阵发性房颤的护理配合

近年来,随着三维成像技术的广泛应用,射频导管消融术(Radiofrequency catheter ablation,RFCA)已成为治疗房颤的常规选择,但冷冻球囊导管消融(Cryoballoon catheter ablation,CBCA)作为一项新技术,在治疗阵发性房颤(Paroxysmal atrial fibrillation,PAF)的安全性、有效性方面越     

5例冷冻球囊导管消融治疗心房颤动患者的护理

目前经皮导管消融已经成为心房颤动（房颤）的重要治疗手段。不同于现有的常规射频消融导管,冷冻球囊导管具有标测、冷冻黏结及组织损伤程度小等优点［1］,可减少血栓形成、肺静脉狭窄、房室传导阻滞等消融并发症,且患者无明显疼痛感。近年来国外已有上百家医院应用此球囊导管消融治疗阵发性房颤,术后随访1年,约70％患者保持窦性心律［2－3］。本中心于2013年12月—2014年3月为5例房颤患者进行了冷冻消融,取得了较满意的效果,现将护理体会报告如下。     

冷冻球囊消融术治疗心房颤动的术后护理

目的总结冷冻球囊导管消融术治疗阵发心房颤动的术后护理。方法对本院2016年3~10月53例行冷冻球囊导管消融术治疗心房颤动患者,加强术中患者病情变化及主观感受的观察,加强术后生命体征及病情的监测,注意观测患者伤口情况,注意观察患者术后反应及术后并发症,给予患者术后用药指导,注意华法林钠及利伐沙班用药后的出血倾向问题,同时给予相关健康宣教。结果 53例患者均顺利完成手术,术后第3~5天康复出院,术后房颤消失。其中术后有2例复发,无术后膈神经麻痹及其他并发症发生。结论冷冻球囊导管消融术治疗心房颤动的术后护理可减少患者并发症的发生,缩短康复时间,减少患者术中及术后痛苦,减小复发率。     

75例心房颤动行二代冷冻球囊消融术患者的护理

总结75例心房颤动行二代冷冻球囊消融术患者的护理。术前充分评估患者,观察病情变化并完善术前准备,术中备好手术设备及物品,做好病情观察与指导,同时在术中、术后重视并发症的观察和预防,提高手术效果并降低并发症的发生。     

球囊导管恒速恒压子宫输卵管造影1800例围术期护理

目的:探讨球囊导管恒速恒压子宫输卵管造影患者围术期护理方法.方法:对1800例输卵管阻塞性不孕症患者加强围术期护理.结果:本组1732例(96.22%)一次造影成功,图像显示清晰,其中356例(19.78%)出现不同程度的对比刑逆流现象,未出现严重并发症;68例(3.78%)宫颈内口狭窄或松弛,导管不能插入或球囊不能嵌塞子宫颈内口,改用锥形橡胶头套管堵塞宫颈外口进行手推造影.结论:精心的围术期护理在子宫输卵管造影检查中起着重要作用.     

Fogarty球囊导管取栓术治疗急性肢体动脉栓塞的围术期护理

目的 总结急性肢体动脉栓塞的围术期的护理.方法 回顾分析26例Fogarty球囊导管取栓术治疗急性肢体动脉栓塞的围术期护理.结果 本组26例行Fogarty球囊导管取栓术治疗急性肢体动脉栓塞均取得成功.结论 Fogarty球囊导管取栓术治疗急性肢体动脉栓塞成功率高、并发症少,做好围术期护理可以为手术的成功实施提供保障.     

三维射频消融治疗心房颤动的围术期护理

目的:探讨三维射频消融治疗心房颤动的疗效及围术期护理方法。方法:49例患者行常规电生理检查后行三维射频消融术。在采用常规护理方法,三维射频消融的常识、手术方法、预后及并发症基础上采用整体围术期护理方法。结果:47例患者消融手术成功,2例因不能耐受终止手术。47例患者共消融141条肺静脉电位,135条消失,成功率为95.74%。随访1～30个月,5例复发,总复发率10.20%。共发生主要并发症13例,发生率26.53%,其中心包填塞7例,血栓栓塞5例,肺静脉狭窄1例,无死亡病例。结论:注重围手术期护理,配合医师准确无误的完成手术,可提高手术成功率,降低术后并发症的发生,提高患者生存质量。     

结肠代食管术病人的围手术期护理

围手术期是指从确定手术治疗时至此次手术有关治疗基本结束的时间。1999年7月我们收治了1例因误服硫酸致食管全程狭窄的病人,现将其围手术期的护理情况报告如下。     

Quality-of-life in patients with paroxysmal atrial fibrillation after catheter ablation: results of long-term follow-up

Paroxysmal atrial fibrillation (PAF) significantly impairs patients' quality-of-life (QOL). The effect on QOL of recently developed ablation techniques with curative intention has not been studied. Thirty patients (21 men, age 54.1 +/- 9.5 years) with PAF (duration 5.6 +/- 5.2 years) who failed antiarrhythmic (3.8 +/- 1.2 trials) drug therapy underwent catheter ablation. The follow-up time was 33.9 +/- 11 months. QOL was assessed preablation, 3, 6, 9, 12, 24, and 36 months after catheter ablation. The Medical Outcomes Survey Short-Form (SF-36), scored on a 0-100 scale for each of eight domains: bodily pain, general health, mental health, physical functioning, role-emotional, role-physical, social functioning, and vitality, was used. Simultaneously, patients filled out a symptom-specific checklist (SSC) with seven clinical items scored 1-4 (1 best): dyspnea, nausea, palpitations, anxiety, syncope, presyncope, and NYHA classification. Patients with successful catheter ablation had a significant benefit in seven of eight subscales while patients with recurrence had an impact on QOL in two of eight subscales. Using SSC, a successful ablation influenced scores in all seven items while patients with recurrence had a significant change of clinical symptoms in only one item, anxiety. The subscales of the study group compared to a healthy population show higher scores after 24 months of follow-up. Patients with PAF experience a significant improvement in QOL after a successful catheter ablation. In contrast, in patients with recurrence of PAF the QOL showed improvement to a lesser extent and patients experienced ongoing symptoms.     

导管射频消融术治疗阵发性心房颤动合并快慢综合征的临床效果

目的 分析导管射频消融术治疗阵发性心房颤动合并快慢综合征的临床效果.方法 选择2015年3月至2020年3月我院收治的58例阵发性心房颤动合并快慢综合征患者作为研究对象,采用随机数字表法将其分为参照组和导管射频消融组,各29例.参照组接受常规抗心律失常药物治疗,导管射频消融组在参照组基础上接受导管射频消融术治疗.比较两...     

Termination of long-lasting persistent versus short-lasting persistent and paroxysmal atrial fibrillation by ablation

Background: Left atrial (LA) structures for the maintenance of different atrial fibrillation (AF) forms are not uniform. The incidence, electrophysiological patterns, and LA sites of sinus rhythm (SR) restoration during ablation of different AF forms were evaluated. Methods: One hundred patients with long‐lasting persistent AF were retrospectively compared to 35 patients with short‐lasting persistent AF and 59 patients with a sustained episode of paroxysmal AF. All patients underwent a first ablation using a stepwise ablation approach with the endpoint of SR restoration by ablation. Results: SR was restored in 38%, 83%, and 97% of patients with long‐lasting persistent, short‐lasting persistent, and paroxysmal AF, respectively (P <0.001 for long‐lasting persistent vs paroxysmal AF; P = 0.02 for long‐lasting persistent vs short‐lasting persistent AF). When modes and sites of SR restoration were evaluated among the patients with long‐lasting persistent, short‐lasting persistent, and paroxysmal AF, SR was restored via conversion into LA tachycardia in 79%, 52%, and 4% of patients (P <0.001 for long‐lasting persistent vs paroxysmal AF); by the pulmonary vein encircling in 8%, 24%, and 93% patients (P <0.001 for long‐lasting persistent vs paroxysmal AF); and by ablation at the LA anterior wall or inside the coronary sinus in 66%, 45%, and 2% patients (P <0.001 for long‐lasting persistent and paroxysmal AF). During the 31 ± 14 month follow‐up since the first ablation, of the 50 patients with long‐term SR maintenance (38 patients free of class I or III antiarrhythmic drugs), SR was restored by ablation in 29 (58%) patients versus nine (18%) patients out of 50 patients with unsuccessful clinical outcome (P = 0.009). Conclusion: Ablation of long‐lasting persistent AF was characterized by more frequent failure to restore SR, and predominant conversion into LA tachycardia prior to SR restoration, and SR restoration by ablation outside the LA posterior wall. SR restoration by ablation was associated with better clinical outcome in these patients.     

Major complications of cryoballoon catheter ablation for atrial fibrillation and their management

Atrial fibrillation (AF) is the most common symptomatic and sustained cardiac arrhythmia. It affects approximately 2–3 million people in the USA alone with an increased incidence and prevalence worldwide. It is associated, in addition to worsening quality of life, with increased morbidity and mortality especially in poorly controlled AF, affecting mostly those older than 65 years of age. Radiofrequency ablation was found to be a good strategy for focal isolation of pulmonary veins triggering from the vulnerable atrial substrate but is a time-consuming procedure and carries the risk of multiple complications like tamponade which could be fatal, atrioesophageal fistula and local thrombus formation at the site of ablation. Cryoballoon ablation with pulmonary vein isolation has emerged in the past few years as a breakthrough novel technology for the treatment of drug-refractory AF. It is a relatively simple alternative for point-by-point radiofrequency ablation of paroxysmal AF and is associated with fewer incidences of fatal complications such as cardiac perforation. As experience with this new tool accumulates, the field faces new challenges in the form of rare compilations including gastroparesis, phrenic nerve palsy, atrioesophageal fistula, pulmonary vein stenosis, thromboembolism pericardial effusion, and tamponade.