护理干预对冠状动脉旁路移植术后康复的影响

目的 探讨护理干预对冠状动脉旁路移植术患者术后康复的影响.方法 将50例行冠状动脉旁路移植术的患者随机分为研究组和对照组各25例,对照组给予常规药物治疗和行术后一般卫生宣教,研究组在对照组的基础上,采取系统性护理干预措施(疾病知识宣教、饮食指导、运动干预和心理护理)1年.采用生活质量综合评定量表(GQOLI-74)评定2组康复情况.结果 术后1年GQOLI-74各项评分,研究组明显高于对照组(P＜0.01).结论 系统性护理干预促进了冠状动脉旁路移植术后患者的康复.     

Coronary artery bypass graft surgery: discharge planning for successful recovery

BACKGROUND: Coronary artery bypass graft (CABG) surgery is a lifesaving intervention, but the early recovery period presents a number of challenges for patients, carers and nurses. Early and adequate discharge planning based on in-depth knowledge of the postdischarge experience can help to ensure optimal recovery. AIM: This paper reports a study to examine the range of postdischarge issues, concerns and needs of patients and their family carers after discharge after CABG surgery, and explore their perceptions of unmet needs 1 year later. METHODS: A two-phase naturalistic inquiry was undertaken. Interviews were conducted with 30 patients and their carers 4-5 weeks after coronary artery bypass grafting (phase 1) and 1 year after the initial interview (phase 2). Thematic analysis was used to identify the major concerns of participants. FINDINGS: Almost half the patients experienced heart surgery as a huge personal shock. Adjusting to life afterwards was difficult, and they experienced a variety of changes, including pain. An unexpected finding was a heightened sense of body awareness and the need for postoperative physical adjustments. The financial implications of surgery were a major burden. Lifestyle adjustments were important and led to suggestions for support services, using telephone support and/or community patient networks. All participants recommended strengthening discharge planning with more accurate information about what to expect during recovery, to help them anticipate fluctuations in health and wellbeing. Carers experienced a wide range of unanticipated feelings during early recovery and had to deal with a number of personal changes. CONCLUSIONS: The findings suggest a need to improve discharge preparation and provide enhanced home support services. Further research should evaluate models of periodic follow-up and mechanisms for mutual support, and compare the experiences of cardiac patients and their carers with those of other surgical cohorts.     

非体外循环冠状动脉旁路移植手术的护理配合

[目的]总结非体外循环冠状动脉旁路移植（OPCAB）手术的护理配合.[方法]对31例病人行OPCAB手术,同时加强术前准备及术中护理配合.[结果]31例病人手术均顺利,病人均康复出院,手术效果满意.[结论]加强 OPCAB手术的护理配合是手术成功的保证.     

冠状动脉搭桥术后康复护理研究进展

文章指出了康复护理的重要性,并从饮食、运动、心理、药物、社会支持方面归纳了冠状动脉搭桥术后康复护理研究现状.在此基础上,对促进冠状动脉搭桥术后患者早期康复及早日回归家庭与社会,提高护理质量,建立完整、连续的康复体系的研究前景进行了展望.     

Incidence of postdischarge symptomatic paroxysmal atrial fibrillation in patients who underwent coronary artery bypass graft: long-term follow-up

The aim of this retrospective study was to determine the incidence of symptomatic AF of patients who had undergone coronary artery bypass grafting (CABG) during long-term follow-up. The study population included 305 post-CABG patients who were regularly followed in the outpatient clinic. Paroxysmal AF (PAF) was defined as an episode of symptomatic AF when symptoms were prolonged enough for the patient to request medical care. Perioperative AF occurred in 88 (28.9%) patients. Postdischarge symptomatic PAF occurred in 25 (8.2%) patients with an annual incidence of 2% during a mean follow-up of 48 +/- 30 months. Eighteen (20.4%) patients also experienced perioperative AF with an annual incidence of 5.1%, while only 7 (3.2%) of 217 patients, without perioperative AF, had postdischarge AF (P < 0.0003). During long-term follow-up, postdischarge AF has a low incidence and prophylactic antiarrhythmic therapy is not recommended. The method of follow-up and retrospective analysis may understate PAF and even miss some symptomatic episodes. Perioperative AF is a predictor of symptomatic late PAF recurrences, particularly in patients with reduced left ventricular function.     

冠状动脉搭桥术后患者社会支持、应对方式与生存质量的相关性研究

目的探讨冠状动脉搭桥术（coronary artery bypass graft,GABG）后患者社会支持、应对方式与生存质量的相关性。方法应用社会支持评定量表、简易医学应对问卷、SF-36生存质量量表对42例冠状动脉搭桥术后患者进行调查。结果冠状动脉搭桥术后患者社会支持总分高于国内常模（P〈0．01）。应对方式中采用面对应对方式的得分高于常模（P〈0．05）;回避应对方式的得分与常模相似（P〉0．05）;屈服应对方式得分低于常模（P〈0．05）。面对应对方式与SF-36总分及躯体功能、机体疼痛、总体健康、活力、情感角色和心理健康均呈正相关（均P〈0．05）。回避应对方式与总健康及情感角色呈负相关（P〈0．05）;屈服应对方式与社会功能及心理健康呈负相关（P〈0．01）。社会支持总分与躯体功能、总体健康感觉、活力、情感功能及心理健康维度均呈正相关（均P〈0．05）;主观支持与SF-36总分及其活力、心理健康维度呈正相关（均P〈0．05）;社会支持利用度与活力、社会功能、情感角色、心理健康及SF-36总分均呈正相关（均P〈0．05）。结论CABG患者所获得的社会支持、采取的应对方式在一定程度上影响术后患者的生活质量。护理人员应认识良好的社会支持与积极的应对方式对CABG术后患者康复的重要性。并及时、及早评估CABG患者的社会支持系统及其所采取的应对方式对生活质量的影响．制订综合性护理干预方案,以提高患者的生活质量。     

冠状动脉搭桥术患者的围术期护理

目的探讨冠状动脉搭桥术患者的围术期护理。方法总结行冠状动脉搭桥术的154例患者的临床护理资料,重点关注患者的术前护理、术后病情观察、并发症的观察和护理、康复护理。结果 154例行冠状动脉搭桥术的患者中,153例手术后经治疗护理顺利康复出院,1例死亡。结论冠状动脉搭桥术的围术期护理十分重要。精心的围术期护理可以帮助患者顺利度过危险期,减少和预防并发症的发生,促进患者全面康复。     

冠状动脉搭桥患者围术期血浆15-F2t-isoprostane含量变化及临床意义

目的　分析常温心脏手术中血浆游离 15 F2 t isoprostane浓度变化及其与术后早期心功能的关系。方法　选择 30例在常温体外循环 (CPB)下行冠状动脉搭桥术患者 ,根据术后有 (组 )、无 (组 )应用正性肌力药物分为两组。 CPB中采用间断温血灌注 ,分别于麻醉诱导后、阻升主动脉后 30 min以及开放升主动脉后 10、30和 12 0 min抽取中心静脉血样 ,采用有高度特异性的兔血清抗体用酶标放射免疫法测量血浆中游离 15 F2 t isoprostane含量。术中至术后 6 h进行连续心排量测量。结果　 15 F2 t isoprostane血浆含量于阻升主动脉后 30 m in、开放升主动脉后 10 min显著升高 ,开放升主动脉 30 m in以后开始下降。组 患者血浆 15F2 t isoprostane含量的升高呈递减趋势 ,至开放升主动脉后 30 min恢复正常 ;相反 ,术后需两种以上正性肌力药物支持以维持心脏指数 (CI) >2 .2 L· m in- 1· m- 2的患者 (组 )血浆 15 F2 t isoprostane含量至开放升主动脉后 30 m in均显著高于正常。术后 CI与开放升主动脉后 10和 30 min时血浆游离 15 F2 t isoprostane含量呈良好的负相关性 (r=- 0 .95 ,P<0 .0 1)。结论　术中 15 F2 t isoprostane血浆含量与术后心功能的恢复密切相关。     

Reoperative off-pump coronary artery bypass grafting: current outcomes,concerns and controversies

Increasing numbers of patients have undergone coronary artery bypass grafting in the last four decades. As a result, the incidence of reoperative coronary artery bypass grafting is rising. Reoperative procedures pose several technical difficulties and are associated with increased operative risks, which exceed those of the initial revascularization. As the incidence of reoperative procedures is increasing so is the experience of reoperative coronary artery bypass grafting, with the resultant evolution of several alternative strategies to lower the operative risks. These strategies include alternative techniques for re-entry, strict avoidance of graft manipulation to minimize the risk of graft atheroembolism, and modification of the method of myocardial protection, depending on the status of the native coronary circulation and the patency of venous or arterial grafts. Off-pump coronary artery bypass grafting is one such technique that, through the avoidance of inherent risks of cardiopulmonary bypass, has the potential to reduce the morbidity associated with reoperative coronary artery bypass grafting. This article evaluates the current outcomes of reoperative off-pump coronary artery bypass grafting, and highlights the concerns and controversies associated with this strategy.     

再次冠状动脉旁路移植术25例总结

目的总结再次冠状动脉旁路移植术(Re-CABG)治疗冠心病的临床经验及手术效果。方法1997年3月~2007年5月共完成Re-CABG手术25例,男22例,女3例;年龄50~72岁,平均(62.5±8.1)岁;2次手术时间间隔3~109个月,平均(48.7±35.2)个月。体外循环Re-CABG手术17例,不停跳非体外循环Re-CABG手术8例。结果全组25例患者恢复顺利,无手术死亡,无心肌梗死,心绞痛症状消失。术后随访8~90个月,平均(38.7±30.6)个月,无心绞痛复发,无冠心病相关事件发生。失访4例。结论正确掌握手术指征和时机,合理应用各种技术和方法及良好围手术期管理,Re-CABG可以取得满意的临床疗效。     

Psychometric evaluation of the Telenursing Interaction and Satisfaction Scale

Aims and Objectives

Interaction between caller and telenurse in telenursing is important for caller satisfaction and subsequent compliance. Despite this, satisfaction measures with focus on interaction in telenursing are scarce and rarely anchored in nursing theory. The aim was to evaluate the psychometric properties of the Telenursing Interaction and Satisfaction Scale (TISS) with focus on data quality, factor structure, convergent validity, and reliability.

Methodological Design and Justification

This psychometric study was based on cross-sectional data.

Research Methods, Instruments, and/or Interventions

Callers to the National Medical Advisory Service in Sweden (n = 616) completed the 60-item Telenursing Interaction and Satisfaction Questionnaire based on Cox's Interaction Model of Client Health Behavior. Twenty-five of these items were selected to form the TISS in four subscales according to the model. Data quality was evaluated in terms of missing data patterns and score distributions. The factor structure was evaluated with confirmatory factor analysis for ordinal data, convergent validity with Spearman correlations, internal consistency with ordinal alpha, scale reliability with composite reliability coefficients, and test–retest reliability with intraclass correlations.

Results

The amount of missing data was acceptable and equally distributed. Data deviated significantly from a normal distribution. All response options were endorsed. The factor analysis confirmed the hypothesised four-factor structure; factor loadings ranged from 0.56 to 0.97 and factor correlations were high (0.88–0.96). Internal consistency (ordinal alpha = 0.82–0.97), scale reliability (0.88–0.99), and test–retest reliability (ICC = 0.77–0.86) were satisfactory for all scales.

Study Limitations

The study design did not allow drop-out analysis.

Conclusions

The TISS showed satisfactory psychometric properties in the study sample. It provides a measure that enables quantitative measurement of caller satisfaction with interaction in telenursing.     

冠状动脉旁路术中不同旁路材料的应用体会

目的 :总结冠状动脉旁路移植术中目前几种常用旁路材料的临床应用。方法 :2 0 0 0年 1月～ 2 0 0 2年 3月连续 5 6例行冠状动脉旁路移植术 ,旁路材料包括左乳内动脉 (5 6根 )、游离右乳内动脉 (2 1根 )、桡动脉 (3 2根 )和大隐静脉(4 3根 )。回顾分析不同旁路材料的手术结果。结果 :桡动脉移植后旁路血管“线样征”1例 ;无胸骨、前臂并发症 ;下肢切口感染 2例 ,均为糖尿病、大体重患者 ,治疗后痊愈 ;死亡 3例 ,与旁路材料无关 (非体外循环手术因循环状态不稳死亡 1例 ,鱼精蛋白过敏 1例 ,顽固性心律失常 1例 )。结论 :注意旁路材料的取制技巧 ,针对不同病变冠脉血管选取应用不同旁路血管 ,以及术后及时监护处理是保证良好手术结果的关键     

网络医疗健康管理对冠状动脉搭桥术后患者自我管理行为的影响

目的探讨网络医疗健康管理对冠状动脉搭桥术患者自我管理行为的影响。方法将首次行冠状动脉搭桥术的122例患者分为对照组和试验组,对照组仅采用常规术后指导及出院后常规复诊,试验组在对照组的基础上,实施网络医疗健康管理,干预6个月后比较两组自我管理行为的改善效果。结果试验组患者在自我效能、自我管理行为、生存质量和机体功能方面均优于对照组(P0.01)。结论健康管理能提高冠状动脉搭桥术患者的自我管理行为,对改善和提高冠状动脉搭桥患者术后生活质量有积极作用。     

康复治疗对重症冠状动脉搭桥术后患者血浆脑钠肽水平的影响

目的：观察康复治疗对冠状动脉搭桥术后患者血浆脑钠肽水平的影响。方法：随机对照研究将46例拟行冠状动脉搭桥的住院患者分为康复组（n=25）和对照组(n=21),康复组给予逐渐递增的康复运动治疗。对血浆脑钠肽、左室射血分数、6min步行距离和术后平均住院时间进行观察。结果：与对照组相比,康复组患者的脑钠肽水平明显下降（P＜0.05）,左室射血分数改善（P＜0.05）。而且,康复组患者6min步行距离明显长于对照组（P＜0.01）,康复组患者术后平均住院时间也明显缩短（P＜0.01）。康复组患者的上述观察指标相关性分析显示脑钠肽分别与左室射血分数(r=-0.66,P＜0.01）和6min步行距离(r=-0.52,P＜0.01）成负相关。结论：康复治疗可以提高冠脉搭桥术后患者的运动能力,加速脑钠肽水平的降低,促进心脏功能的恢复。