冠状动脉内支架植入术治疗冠心病患者的围手术期护理

目的探讨冠状动脉内支架植入术治疗冠心病患者围手术期的护理措施。方法对67例冠状动脉内支架植入术的患者进行术前、术中、术后的精心护理。结果本组67例患者手术均成功,术后出现并发症有4例,失败3病例,成功率为95.5%。结论完善、精心而系统的围手术期护理是冠状动脉支架植入术成功的关键,大大的提高了成功率,减少并发症的出现,能够促进患者早日康复。     

颅内动脉瘤支架辅助介入栓塞术围术期抗栓治疗药学监护案例总结

目的 探讨临床药师对颅内动脉瘤支架辅助介入栓塞术患者开展围术期抗栓治疗药学监护的介入点。方法 回顾某院收治的3例行颅内动脉瘤支架辅助介入栓塞术患者围术期抗栓的治疗过程。抗凝专业临床药师结合专业知识、指南共识、特异性实验室检测指标等综合判断,对3例患者围术期抗栓治疗的用药时机评估、治疗方案制订及用药监护给出相应建议。结果 医师采纳临床药师用药方案,干预后患者均好转出院。结论 抗凝专业临床药师在神经外科如何高效开展药学服务仍处于探索阶段,特别是对颅内动脉瘤或蛛网膜下腔出血的高危患者缺乏有效的风险评估。根据颅内动脉瘤围术期患者特点,精准识别药物抗凝目标群体,提供科学的决策支持、正确的血栓及药物指标解读、优质的药品不良反应监护等,可作为临床药师高效参与临床治疗的介入点及优化工作模式的探索方向。     

人工髋关节翻修术患者的围手术期护理

关节翻修术是指人工关节置换术后出现松动、移位、磨损等改变,需再次手术进行新的关节置换。随着人工髋关节置换技术的广泛开展以及人口老龄化问题的快速发展,髋关节置换术后生存期延长,需要翻修的患者逐年增加。而翻修术较置换术难度大,术后髋关节功能恢复和维护更加困难,对护理工作提出了更高的要求。2008年11月-2010年11月,我院为68例患者行人工髋关节翻修术,在围术期进行精心的护理,效果满意。现报告如下。     

全髋关节翻修术的围手术期护理

人工全髋关节置换术是重建髋关节功能的主要手段。近年来随着置换假体技术的改进及水平的提高,髋关节置换的疗效明显提高,极大地改善了患者的生活质量,但由于假体松动、人工关节脱位、骨折、假体断裂及感染等原因,必须进行翻修手术。全髋关节翻修术与首次髋关节置换术相比,手术更为复杂、困难,对护理工作的要求也更高。我科自2010年7月至2012年11月共行髋关节翻修手术45例(45髋),我们在护理中加强围手术期护理,取得了满意的效果。     

髋关节置换术围术期护理

目的：观察髋关节置换围术期护理措施在骨科临床应用的效果。方法：对21例患者进行手术前后循证护理,心理及饮食干预活动,积极预防髋关节置换术后并发症。结果：经过科学的围术期护理干预,提高了患者术后的生活质量,缩短了住院时间。结论：髋关节置换术围术期护理能有效改善患者术后。     

糖尿病患者行人工髋关节置换术的围手术期治疗

目的目前,探索糖尿病患者行人工髋关节置换术(THA)的围手术期处理。方法对糖尿病患者行THA17例(19髋),围手术期在内科医师的配合下控制血糖。结果1例出现一过性坐骨神经麻痹;2例伤口裂开;1例发生深部感染。Harris评分从术前平均58.4分提高到术后的86.2分,优良率94.7%。随访4.1年后Harris评分平均为75.4分,优良率为85.3%。结论对于没有心、肾以及周围血管并发症的糖尿病患者,经过正确的围手术期治疗,行THA疗效满意。     

高龄患者冠状动脉搭桥围术期护理

目的探讨高龄患者冠状动脉搭桥围术期的护理方法,以提高护理质量,减少手术并发症。方法对39例行冠状动脉搭桥术的高龄患者,术前制定护理计划,做好心理护理及术前准备,术后加强呼吸道护理,维持循环、血糖的稳定,以防并发症的发生。结果39例患者术后恢复快,并发症少,均痊愈出院。结论充分做好高龄患者冠状动脉搭桥围术期的护理是手术成功的保证。     

急性心肌梗塞行急诊PTCA和支架植入术的围手术期护理

<正>2009-11～2010-11笔者所在科收治的AMI行PTCA和支架植入术患者62例,现将护理体会总结如下。1临床资料1.1一般资料本组62例,男54例,女8例;平均年龄52岁。其中下壁梗塞28例,下壁+右室梗塞7例,广泛前壁梗塞18例,前间壁梗塞9例;合并心律失常9例,心源性休克1例。冠脉造影显示单支病变42例,多支病变20例。术后住院时间平均9 d,均痊愈出院。     

Thromboprophylaxis,bleeding and post-operative prosthetic joint infection in total hip and knee arthroplasty: a comprehensive literature review

Introduction: Concerns regarding risk versus benefit, that is, the possible impact of surgical-site bleeding on post-operative joint infections, have contributed to a continuing debate over recommendations for venous thromboembolism (VTE) prophylaxis in post-surgical orthopedic patients undergoing total hip and knee arthroplasty (THA/TKA).

Areas covered: A comprehensive literature search using MEDLINE covering the period 2004–2009 was conducted, and published studies that focused on THA and TKA and contained data applicable to thromboprophylaxis, post-surgical wound infection and bleeding are reviewed in this paper. The search strategy included various combinations of terms related to lower limb joint arthroplasty, anticoagulant drugs, post-operative bleeding and prosthetic joint infection (wound infection). Methodological constraints included failure in some studies to define an infection, variations among the studies in the definitions of bleeding and differences in the follow-up time for capturing infection and bleeding events. Despite this, this comprehensive review identified observational, ‘real-world' data that can contribute in important ways to the existing evidence base.

Expert opinion: There are insufficient data to either confirm or refute the hypothesis that post-operative bleeding is a mediating pathophysiologic factor linking pharmacologic VTE prophylaxis to an increased risk for wound infection. Studies specifically designed to examine the interrelationship between thromboprophylaxis, bleeding and wound infections following THA/TKA are warranted.     

氨甲环酸应用时机对髋关节置换手术患者失血量影响的研究

目的探讨不同时间使用氨甲环酸对初次行髋关节置换术患者失血量的影响。方法将90例初次行髋关节置换术的患者按随机数字表法分为：早期组（30例,氨甲环酸术前1 h使用）、晚期组（30例,氨甲环酸术中使用）和对照组（30例,不使用）。统计分析患者的显性红细胞丢失量、隐性红细胞丢失量与总红细胞丢失量。结果 （1）对照组（96.3±21.7）mL的显性失血量显著多于早期组（45.9±9.7）mL、晚期组（46.2±9.5）mL,Ps〈0.01;早期组的显性失血量与晚期组差异无统计学意义（P〉0.05）。（2）早期组（140.6±21.1）mL、晚期组（216.7±48.6）mL的隐性失血量显著少于对照组（335.1±60.3）mL,Ps〈0.01;早期组的隐性失血量明显少于晚期组（P〈0.01）。（3）早期组（236.7±42.4）mL、晚期组（344.0±51.5）mL的总红细胞丢失量显著少于对照组（492.8±65.1）mL,Ps〈0.01;早期组的总红细胞丢失量明显少于晚期组（P〈0.01）。结论氨甲环酸能够明显减少初次行髋关节置换术患者的失血量,术前1 h使用比术中使用更能明显减少隐性失血量。     

支架术后急性冠状动脉综合征患者生命质量变化及影响因素研究

目的：探讨支架术后急性冠状动脉综合征患者生命质量变化及影响因素。方法收集接受支架术急性冠状动脉综合征患者100例,应用SF-36生命质量调查表于手术前、手术后6个月对患者生命质量进行调查记录,并分析患者生命质量变化及影响因素。结果患者手术后6个月体力、心理健康、社会活动、躯体疼痛、身体功能、躯体角色、精力及身体健康评分高于手术前,差异具有统计学意义（P＜0．05）。支架术后6个月患者改善程度Logistic回归分析：女性患者、2型糖尿病、曾行经皮冠状动脉介入治疗、ST-T段抬高型心肌梗死是影响患者改善程度的重要因素（P＜0．05）。结论急性冠状动脉综合征患者支架术后6个月生命质量明显改善,女性患者、既往PCI对于患者改善具有正向影响作用,而2型糖尿病、ST-T段抬高型心肌梗死则对患者改善具有负向影响。     

全髋与半髋关节置换治疗老年股骨颈骨折的疗效比较

目的:比较全髋关节置换术与半髋关节置换术治疗老年股骨颈骨折(GardenⅢ-Ⅳ型)的疗效。方法:分析2009年1月—2011年1月收治的96例≥65周岁的老年股骨颈骨折并行髋关节置换术患者的临床资料。根据采取手术方式的不同,分为全髋关节置换组(46例)与半髋关节置换组(50例)。比较两组患者的手术时间、术中出血量、髋关节功能和切口感染率、假体脱位发生率和翻修率等。结果:全髋关节置换组与半髋关节置换组的手术时间、术中出血量及髋关节功能评分差异有统计学意义(P<0.05)。两组切口感染率、翻修率和假体脱位发生率均较低,差异无统计学意义(P>0.05)。结论:全髋关节置换与半髋关节置换治疗老年股骨颈骨折相比,虽然创伤较大、手术时间较长以及出血量相对较多,但髋关节功能明显优于半髋关节置换术且术后并发症少。临床上应尽量选择全髋关节置换术治疗老年股骨颈骨折(GardenⅢ-Ⅳ型),除非患者不能耐受手术或预期寿命小于5年。     

Perioperative blood loss and gastrointestinal tolerability of etoricoxib and diclofenac in total hip arthroplasty (ETO-DIC study): a single-center,prospective double-blinded randomized controlled trial

Objective:

Non-selective NSAIDs can cause serious gastrointestinal side-effects. Selective COX-2 blockers are a reasonable alternative for pain treatment. They do not seem to affect platelet function and consequently cause a lower perioperative blood loss than non-selective NSAIDs. This study compared etoricoxib and diclofenac during a perioperative (9 days) period after THA to investigate total blood loss and gastrointestinal tolerability. The hypothesis was that etoricoxib is superior to diclofenac.

Methods:

A total of 100 patients (50 in each group) were included in this trial. Etoricoxib (90?mg) was administered once and diclofenac sodium (75?mg) twice daily for 9 days. Total blood loss during and after primary cementless THA was detected. The rate of adverse events (AEs) and serious adverse events (SAEs) was analyzed to detect gastrointestinal tolerability.

Results:

The mean total blood loss (calculated) was 1548?±?SD 468?ml in the etoricoxib (ETO) group and 1649 (SD 547) ml in the diclofenac (DIC) group. The mean duration of THA was 81?min (SD 29) in the DIC and 75?min (SD 30) in the ETO group. Hence, the mean calculated total blood loss was 101?ml higher in the DIC group. This difference was not statistically significant (p?=?0.334). Fifty-six patients (28 in each group) received a cell saver retransfusion, but only one patient (ETO group) needed an additional red blood cell transfusion. The hidden blood loss was 1067?ml (SD 603) in the DIC group and 999?ml (SD 378) in the ETO group. The gastrointestinal tolerability (number of adverse and serious adverse events) was not significantly different between groups.

Conclusion:

There was no statistically significant difference in perioperative blood loss after primary THA under etoricoxib (90?mg) compared to diclofenac (75?mg). Furthermore, no gastrointestinal superiority of etoricoxib could be detected during a short period of 9 days.     

Primary total hip arthroplasty for displaced intracapsular fracture of the femoral neck: Medium-term functional and radiographic outcomes

The number of complications after primary total hip arthroplasty for displaced intracapsular fractures of the femoral neck is higher than that after operations for osteoarthritis. The aim of this study is to evaluate the number of complications and mid-term functional and radiological findings of patients after primary THA for displaced intracapsular fractures of the femoral neck. Between 1995 and 1998, we operated on a total of 89 patients for acute displaced intracapsular fractures of the femoral neck, i.e. Garden Type 3 and 4. In all the patients we evaluated intraoperative and early postoperative complications. We reviewed clinical and radiological results in 65 patients. The only intraoperative complication was abruption of the greater trochanter. Early postoperative complications occurred in 13 patients (15%). The specific complications, THA dislocation, occurred in 3 patients. Non-specific complications were recorded in 10 patients. No delayed healing of the surgical wound, neural lesion or early, delayed or late infection was recorded. Of 65 patients followed-up for an average of 78 months (range, 62–109 months), 8 patients underwent revision surgery. Of 57 patients with primary THA, very good and good clinical results according to the Harris Hip Score were recorded in 48 patients (84%) and poor results in only 2 patients (4%). Nine of 57 followed-up patients showed radiological signs of loosening (16%). The radiolucent line could be seen in 3 patients in the region of the cup, in 1 patient in the region of the femoral component and in 5 patients in both components. Clinical complaints that would result in indication for reimplantation were recorded in none of the mentioned patients. Number of complications, functional results and resumption of full self-reliance by patients after THA for an intracapsular fracture of the femoral neck are so positive that we consider the indication of THA for a displaced femoral neck fracture fully justified.     

Effect of carbamazepine initiation and discontinuation on antithrombotic control in a patient receiving warfarin: case report and review of the literature

A 72-year-old Caucasian woman with paroxysmal atrial fibrillation had been taking warfarin therapy for 5 years with a stable international normalized ratio (INR). Her dentist then prescribed carbamazepine 200 mg/day to control facial nerve pain. At her next physician visit about 2 weeks after the start of the carbamazepine, the patient's INR had dropped from 3.3 to 1.3; she reported no contributing changes in her diet or warfarin dosage, nor had she taken other interacting drugs. Her warfarin dosage was increased, and the INR returned to the target range of 2.0-3.0 approximately 2 months later. The patient's INR remained stable for approximately 6 more months, until she had facial surgery. During that time, her warfarin was discontinued for 5 days, and the patient had stopped taking the carbamazepine because she had no pain. One month later, her INR increased from 2.2 to 3.6. She did not experience any thrombotic or hemorrhagic episodes. Warfarin undergoes hepatic metabolism through cytochrome P450 2C9, and carbamazepine induces this isoenzyme. Inducing warfarin metabolism necessitates an increase in the warfarin dosage to maintain the INR in the therapeutic target range. To our knowledge, this is the first report documenting the effect of the carbamazepine initiation and discontinuation in a patient receiving anticoagulation therapy with warfarin. In patients taking warfarin, clinicians should monitor the INR closely when carbamazepine is started or discontinued, or when either dosage is changed.     

Posaconazole as salvage therapy in a patient with disseminated zygomycosis: case report and review of the literature

Zygomycosis refers to any fungal infection originating from the class Zygomycetes and the order Mucorales. In immunocompromised patients, these fungi produce a relatively rapid, violently destructive, and highly fatal infection. Treatment approaches include both aggressive antifungal pharmacotherapy and surgical intervention. Unfortunately, even with optimal therapy, morbidity and mortality rates remain relatively high. As failure rates are elevated with commercial antifungals, new treatment options are needed. Posaconazole is an orally available, extended-spectrum triazole antifungal being investigated in phase III clinical trials for the treatment and prevention of invasive fungal infections, including zygomycosis. We report the case of a 26-year-old Vietnamese man with a medical history of acute lymphocytic leukemia who had undergone consolidation chemotherapy and had neutropenic fever when he came to the emergency department. The patient was admitted to the hospital and treated with broad-spectrum antibiotics and caspofungin. Two weeks into his admission, however, abscesses in the pelvis, prostate, and musculature surrounding the hip were detected radiographically; these abscesses eventually cultured for Mucor sp. Disseminated zygomycosis was diagnosed. Caspofungin was immediately discontinued, and high-dose liposomal amphotericin B 10 mg/kg/day was begun. Over the next month, infection spread to the right lung, left kidney, middle thoracic spine, and epidural space. As a result, oral posaconazole 200 mg 4 times/day was added to the liposomal amphotericin B. Significant clinical, hematologic, mycologic, and radiologic improvements were demonstrated as early as 10 days after start of posaconazole therapy and continued through 41 days of inpatient treatment. Liposomal amphotericin B was discontinued after 3 weeks of posaconazole, and the patient was discharged on hospital day 92 receiving oral posaconazole, with no major adverse events reported. Five months after discharge, the patient had no evidence of fungal disease recurrence or progression. Posaconazole appears to be a well-tolerated and effective salvage treatment for zygomycosis, including disseminated disease.     

益气活血法对全髋关节置换术后下肢深静脉血栓形成的临床干预

目的探讨益气活血法对全髋关节置换术后下肢深静脉血栓形成的影响。方法回顾分析益气活血法在全髋关节置换术36例中的应用效果并加以分析。结果 36例患者全髋关节置换术后未发生下肢深静脉血栓。未发生肺部感染与尿路感染。术后住院时间为15～42d。结论益气活血法在围手术期的应用是预防全髋关节置换术后并发下肢深静脉血栓形成的有效方法 。     

Delayed-onset grade 4 neutropenia associated with rituximab therapy in a patient with lymphoma: case report and literature review

A 53-year-old man developed delayed-onset neutropenia 6 weeks after completing first-line therapy with rituximab, cyclophosphamide, mitoxantrone, vincristine, and prednisone for high-grade B-cell lymphoma. Bone marrow biopsy demonstrated hypercellular marrow with normal maturation. He also developed interstitial pneumonitis, an adverse event associated with rituximab use. Infiltrates of T cells were found in the patient's lungs. For the next 6 months, the patient required subcutaneous granulocyte colony-stimulating factor 300 mug twice/week to maintain a granulocyte count above 1000 cells/mm3. He also received oral antibiotics for mouth sores and thrush. Based on the existing evidence, monitoring blood counts for as long as 8 weeks after rituximab therapy may be advisable, although the literature reports that neutropenia can develop up to 1 year after treatment. The development of a registry and uniform testing may help uncover the cause of this delayed-onset neutropenia.