颅内动脉瘤血管栓塞术的护理体会

目的对20例颅内动脉瘤患者进行栓塞术治疗的护理探讨。方法对颅内动脉瘤患者进行术前充分准备、术中、术后严密观察与护理。结果 20个动脉瘤完全闭塞,没有发现脑血管痉挛,动脉瘤再次破裂出血,全部治愈出院,随访3～30个月无复发。结论术前、术中、术后精心的观察与护理是提高手术成功率、减少并发症的关健,降低了颅内动脉瘤患者死亡、致残率,对提高临床治疗效果有着重要的意义。     

颅内动脉瘤破裂再出血的因素与干预措施

目的:探讨如何做好颅内动脉瘤再破裂出血的干预措施。方法:对100例颅内动脉瘤患者进行术前护理及宣教,观察动脉瘤再破裂的概率。结果:提高颅内动脉瘤患者术前的干预措施后,80例患者未发生动脉瘤再次破裂出血。结论:加强颅内动脉瘤患者术前护理干预是预防颅内动脉瘤再破裂出血的关键。     

脑动脉瘤破裂并颅内血肿脑室引流术的临床护理

目的探讨颅内动脉瘤破裂并脑内血肿急诊手术患者的护理。方法回顾性分析2005年4月-2009年10月在安化县东坪镇卫生院神外科急诊手术治疗的30例破裂颅内动脉瘤并脑内血肿患者的临床资料。30例破裂颅内动脉瘤均在24 h内行急诊手术,着重术前准备,预防颅内再出血,注重术后防治脑血管痉挛和预防并发症发生的护理。结果经过积极治疗和良好护理,按GOS评分,术后恢复良好20例,轻度残废8例,重度残废1例,死亡1例。结论积极的术前准备及术前术后有效的护理干预使得颅内动脉瘤破裂并脑内血肿急诊手术效果明显,可有效降低病死率,提高恢复等级。     

电解可脱弹簧圈对颅内动脉瘤破裂早期血管内栓塞疗效分析

[目的]探讨颅内动脉瘤破裂早期电解可脱弹簧圈血管内栓塞治疗的临床效果. [方法]回顾性分析26例不同部位颅内动脉瘤患者病例资料,术前Hunt-Hess分级:I级1 Ⅱ级11例,Ⅲ级11例,Ⅳ级2例.均在发病3 d内行电解武可脱性徽弹簧圈(GDC)栓塞治疗. [结果]完全栓塞23例(88.5%),大部栓塞3例(11.5%).Glas-gow预后评分:Ⅰ级15例,Ⅱ级7例,Ⅲ-Ⅳ级2例,Ⅴ级1例,死亡1例.术后随访3～24月. [结论]早期电解可脱性弹簧圈拴塞治疗破裂的颅内动脉瘤可避免动脉瘤再次破裂出血,安全、有效、微创.     

超早期介入栓塞治疗颅内动脉瘤破裂致Ⅰ～Ⅲ级蛛网膜下腔出血疗效分析

目的目前介入栓塞已成为治疗破裂颅内动脉瘤首选方法。本研究探讨超早期介入栓塞破裂颅内动脉瘤治疗Hunt-Hess分级Ⅰ～Ⅲ级蛛网膜下腔出血的近期疗效。方法选取2010-09-10-2018-10-11湘潭市第一人民医院收治的90例Hunt-Hess分级Ⅰ～Ⅲ级动脉瘤破裂蛛网膜下腔出血患者为研究对象,均行超早期动脉瘤介入栓塞治疗,6个月后以格拉斯哥结局量表(Glasgow outcome scale,GOS)预后评分分级为指标进行疗效评估。结果 90例患者中,弹簧圈单纯致密栓塞34例,椎动脉动脉瘤行椎动脉闭塞4例,支架辅助弹簧圈栓塞52例。所有患者中,1例术中动脉瘤再次破裂出血,2例术后<1周死亡,术中脑血管痉挛5例,术后脑梗死2例。影像学随访70例,2例复发;共随访85例,完全康复77例。结论超早期介入栓塞是治疗破裂颅内动脉瘤Hunt-Hess分级Ⅰ～Ⅲ级蛛网膜下腔出血较理想的方法。     

电解可脱性铂金弹簧圈早期栓塞治疗颅内破裂动脉瘤临床研究

目的 探讨颅内破裂动脉瘤早期GDC栓塞治疗的效果。方法 10例颅内破裂动脉瘤，其中首次破裂8例，2次破裂2例，动脉瘤的位置：大脑前动脉l例，大脑中动脉l例，前交通动脉5例，后交通动脉2例，前交通及后交通动脉多发l例。病人分级：Hunt-Hess Ⅰ级2例，Ⅱ级4例，Ⅲ级2例，Ⅳ级l例，Ⅴ级l例，Fisher CT分级Ⅰ级2例，Ⅱ级6例，Ⅲ级2例。采用GDC早期栓塞治疗，7例于3天内治疗，3例于6天内治疗。结果 10例11个动脉瘤，100％栓塞8个，95％栓塞2个，90％栓塞1个，l例死亡，术后观察1个月。2年，7例效果良好，l例植物状态生存，l例再次发生蛛网膜下腔出血。结论 GDC早期栓塞是治疗颅内破裂动脉瘤的较好方法。     

IV、V级颅内动脉瘤破裂综合治疗的临床研究

目的：分析血管内介入结合减压和引流手术治疗Hunt-Hess分级为IV、V级动脉瘤破裂出血的疗效及比较优势。方法：回顾性分析对28例IV、V级破裂动脉瘤血管内栓塞治疗,并先后给予脑室外、腰大池引流、血肿清除治疗。结果：恢复良好、轻残者16例,占57.1%;重残、植物生存者8例,占28.6%;死亡4例占14.3%。结论：破裂动脉瘤IV、V级患者可结合介入检查、治疗和针对脑室出血、颅内血肿、脑疝等情况的外科手术进行综合处理。介入治疗创伤小、适应证广、并发症少,应作为IV、V级破裂动脉瘤首选治疗方法。早期血管内栓塞治疗可以改善动脉瘤蛛网膜下腔出血IV-V患者的预后,结合减压和引流手术可显著降低死亡率、致残率。     

颅内动脉瘤急性出血期支架辅助栓塞的治疗研究

目的:分析颅内动脉瘤急性出血期支架辅助栓塞的治疗情况。方法:选择2015年1月~2019年1月来本院接受治疗的颅内破裂宽颈动脉瘤患者52例为研究对象,对其实施支架辅助栓塞,分析结果。结果:疗效良好者(0~2分),共计46例。疗效不佳者(3~6分)共计4例,死亡共计2例,治疗良好率为88.5%。结论:针对于发生破裂的颅内动脉瘤疾病来讲,开展早期支架辅助栓塞治疗能够取得满意效果。这种方法安全性强、有效性高,有助于提升动脉瘤致密栓塞概率,减少疾病复发率。     

颅内动脉瘤破裂并脑内血肿急诊手术围手术期护理

[目的]提高颅内动脉瘤破裂并脑内血肿急诊手术患者的治愈率、生存质量,降低死亡率. [方法]回顾性分析2002年4月～2006年10月在我科急诊手术治疗的64例破裂颅内动脉瘤并脑内血肿患者的临床资料.64例破裂颅内动脉瘤均在24 h内行急诊手术,着重术前准备,预防颅内再出血,注重术后防治脑血管痉挛、预防并发症的发生. [结果]按GOS评分,术后恢复良好38例,轻度残废12例,重度残废10例,死亡4例. [结论]积极的术前准备及术前术后有效的护理干预使得颅内动脉瘤破裂并脑内血肿急诊手术效果明显,可有效降低病死率,提高恢复等级.     

颅内动脉瘤破裂出血患者的护理对策

目的探讨颅内动脉瘤破裂出血患者围手术期的护理对策。方法回顾分析2004年1月～2008年1月在我院接受手术治疗的颅内动脉瘤破裂出血患者28例。结果按Pool手术入路者2例,翼点入路6例;25例行动脉瘤颈夹闭术,其中有7例行动脉瘤包裹术,2例行单纯包裹术,1例行载瘤动脉阻断术;随访2个月～3年,良好者20例,中度残废者5例,重度残废者2例,死亡1例。结论积极的术前、术后护理及并发症的护理,能有效地提高手术疗效,减少并发症的发生。     

Hospital volume, calendar age, and short term outcomes in patients undergoing repair of abdominal aortic aneurysms: the Ontario experience, 1988-92.

OBJECTIVE: To determine, for abdominal aortic aneurysm surgery, whether a previously reported relationship between hospital case volume and mortality rate was observed in Ontario hospitals and to assess the potential impact of age on the mortality rate for elective surgery. DESIGN: Population based observational study using administrative data. SETTING: All Ontario hospitals where repair of abdominal aortic aneurysm as a primary procedure was performed during 1988-92. PATIENTS: These comprised 5492 patients with unruptured abdominal aortic aneurysms and 1203 patients with ruptured abdominal aortic aneurysms admitted to hospital between 1988-92 for repair of abdominal aortic aneurysm as a primary procedure. MAIN OUTCOMES: In-hospital death and length of in-hospital stay. RESULTS: The case fatality rate was 3.8% for unruptured abdominal aortic aneurysms and 40.0% for ruptured abdominal aortic aneurysms. For unruptured cases, after adjustment for patient and hospital covariates, each 10 case per year increase in hospital volume was related to a 6% reduction in relative odds of death (odds ratio (OR) 0.94, 95% confidence intervals 0.88, 0.99) and 0.29 days reduction (95% CI -0.22, -0.35) in postoperative in-hospital stay. Female sex (OR 1.53, 95% CI 1.08, 2.18) and transfer from another acute care hospital (OR 4.37, 95% CI 2.62, 7.29) were associated with increased case fatality rates among patients in the unruptured category. For ruptured cases, neither the case fatality rate nor postoperative in-hospital stay were significantly related to hospital volume. The case fatality rates increased linearly and substantially with advancing age both for unruptured and ruptured aneurysms, and the excess risk of postoperative death in ruptured as compared to unruptured aneurysms was substantially higher in older patients. CONCLUSION: The relationship between hospital volume and mortality or morbidity was very modest and observed only for elective surgery. Case fatality rates in patients with ruptured abdominal aortic aneurysms remained 10 times higher than for patients with unruptured abdominal aortic aneurysms, despite improvements in overall mortality in comparison to previously published data. More effective detection of aneurysms, including elective repair for those once considered "high risk" older patients, might further reduce the toll from ruptured aortic aneurysms.     

40例手助腹腔镜结直肠癌根治术术前及术后的护理

目的:总结手助腹腔镜结直肠癌根治术的护理.方法:分析40例手助腹腔镜结直肠癌根治术患者的临床资料.结果:40例患者均成功实施手助腹腔镜结直肠癌根治术,术前加强心理护理、营养支持、肠道准备、肠造口腹部定位及皮肤准备;术后注意生命体征监测、饮食活动指导、疼痛、引流管及造口护理;及时发现并处理肠梗阻、肺部感染、切口感染等并发症,患者均痊愈出院.结论:加强术前及术后护理,早期发现及时处理并发症,有利于患者早日康复.     

Successfully operated ruptured gastroduodenal artery pseudoaneurysm

INTRODUCTION: Visceral real and pseudoaneurysms are the rarest aneurysms of the arterial system. The aneurysms of the duodeno-pancreatic arcade constitute only 2-3% of all aneurysms. Their frequency after pancreatitis can reach 10%. AIM/PURPOSE: On the basis of an individual case the authors summarize their experiences with this rare, but varied disease, and they review the literature data. CASE REPORT: Their female patient of 62 with alcoholic antecedent was hospitalized with haematemesis, melaena, anaemia, icterus repeated several times, while abdominal CT scan verified the pseudoaneurysm of the gastroduodenal artery. The night before the elective operation a hypovolaemic shock arose with strong abdominal pain. Subsequent to the treatment of shock the authors performed the gastroduodenal artery ligation and Kehr-drainage. After an uneventful postoperative care she was discharged. CONCLUSION: Splanchnic aneurysms are rare, they are difficult to diagnose. Their importance lies in the fact that the risk of their rupture is 50% with a high mortality rate. Considering the patient's antecedent and concomitant diseases (alcoholism and pancreatitis) their occurrence shall be considered as a risk factor, so that the diagnosis could be established as soon as possible.     

食道癌病人的术前术后护理及健康指导

随着医学模式的转变，护理工作也从单一的疾病护理转变为对病人的整体护理，加强对食道癌患者的术前术后全方位的护理对病人的早日康复至关重要。本文通过对36例食道癌手术患者术前术后有效的护理及科学的健康指导，不仅减少了术后的并发症，而且提高了患者的生活质量，使病人早日康复出院。     

Long-term outcome of unruptured cerebral aneurysms

BACKGROUND: The frequency at which unruptured cerebral aneurysms are detected has increased due to advances in low- or non-invasive diagnostic techniques. Despite the recent improvements in surgical and medical management of aneurysmal subarachnoid hemorrhages, however, the overall case-fatality rate of this disease is still high. To reduce it, the natural history of unruptured cerebral aneurysms should be better understood. METHODS: The subjects consisted of 156 patients with unruptured cerebral aneurysms who had been admitted to the Department of Surgical Neurology, Jichi Medical School Hospital or Jichi Medical School Ohmiya Medical Center, Japan, between January 1989 and December 1998. All of the patients were classified according to the process by which aneurysms had been detected. The expected number of deaths was calculated by using age- and sex-specific mortality rates obtained from the vital statistics. A standardized mortality ratio and 95% confidence interval were calculated by using the expected and observed numbers of deaths. RESULTS: The standardized mortality ratios differed among the groups according to the process of detecting aneurysms. The incidence rate of rupture of unruptured cerebral aneurysms was 1.3 per 100 person-years. The annual rupture rate of unruptured cerebral aneurysms was higher than previously reported. The survival rate of the group that underwent surgical treatment for unruptured cerebral aneurysms was higher than that of the untreated group. CONCLUSIONS: The annual rupture rate of unruptured cerebral aneurysms may be higher than previously reported.     

颈动脉支架成形术围手术期并发症的护理

目的本研究结合我院脑血管病中心近年来颈动脉支架围手术期护理经验,探讨颈动脉狭窄血管内支架成形术围术期的护理方案。方法通过回顾性分析我科59例行颈动脉支架成形术患者围手术期出现的并发症,总结护理经验,提出合理的护理方案。结果 59例患者共置入颈内动脉支架64枚,颈动脉支架64枚全部放置成功,技术成功率100%,但有4例发生手术相关并发症(占6.2%)。1例患者出现术后血压低,心率过慢,给予持续静滴阿托品及多巴胺1 w后恢复正常;1例患者术后肢体乏力加重,复查头颅MR见多发脑梗,考虑小栓子脱落;1例患者术中支架内急性血栓形成,给予尿激酶溶栓后完全恢复正常;1例患者出现术后颅内出血,脑疝死亡。结论对颈动脉狭窄接受经皮血管内支架成形术治疗的患者在围术期进行精心护理,是提高治疗效果的重要保证。术前心理护理、充分准备是手术成功的基础,术中密切观察患者生命体征变化及心理护理安慰和医护配合是支架成功的保证,术后生命体征和神经系统功能的监测以及对患者及其家属的术后防止出现并发症的指导是预防并发症的关键。     

宫外孕失血性休克65例的术前抢救配合及术后护理

目的：观察分析宫外孕失血性休克的术前抢救配合及术后护理的方法。方法：回顾性分析65例宫外孕破裂失血性休克患者的资料及术前抢救和术后护理的方法。结果：65例患者抢救全部成功,无一例在抢救及手术过程中死亡。休克得到良好纠正,所有患者的切口均甲级愈合,无1例患者出现切口感染及其他并发症。结论：抢救前的准备工作应到位,抢救中的循环改善工作应重点落实,手术中的生命体征检测应密切,术后的切口护理和心理护理应全面不仅能够有效的提高患者生命挽救的成功率,对于改善其预后也有者较为显著的影响。     

经皮肾镜手术治疗复杂性肾结石围手术期的护理体会

目的：探讨如何更好地护理经皮肾镜碎石取石微创手术的患者。方法：对50例经皮肾镜碎石取石微创手术后患者进行术前、术后护理,做好术前准备、术后密切观察生命体征变化及并发症,做好导尿管、肾造瘘管、双J管的护理。结果：本组术后复查,结石总清除率94％,无护理并发症发生。结论：专业的护理能提高手术的成功率,有效地预防并发症,提高患者对疾病的认识及自我保健意识,使患者达到最好的康复     

老年性白内障围手术期的心理护理及饮食护理研究

目的 研究心理护理和饮食护理在老年性白内障患者围手术期中的作用.方法 选择在我院接受手术治疗的老年性白内障患者,随机分为常规护理对照组和心理及饮食护理观察组,进行SAS评分、测量各项生命体征、观察术后并发症发生情况.结果 观察组患者术前30 min SAS评分41.74±5.03,明显低于对照组患者;观察组术中的血压和心率与术前30 min时无明显变化,而对照组术中血压和心率明显高于术前30 min;观察组发生各类并发症的例教均明显低于对照组.结论 在围手术期给予心理护理和饮食护理,能够有效控制患者术前焦虑情绪,使术中生命体征更加平稳,减少术后并发症的发生.     

人文关怀护理在大容量肺灌洗中的应用

目的：探讨大容量全肺灌洗（WLL）术前、术中、术后的心理护理体会。方法：130例患者WLL术前进行心理护理、完善检查;术中密切配合、准确记录灌洗出入量、预防并发症;术后予以吸氧、半卧位、保持呼吸道通畅、监测生命体征变化、预防并发症发生。结果：130例患者全部康复出院。结论：而术前严格选择适应证,做好心理护理;术中规范操作,密切配合;术后密切监护是降低WLL并发症的关键。术中灌洗护理工作中人文关怀尤为重要,可保障大容量全肺灌洗术顺利进行。