盐水冰袋预防体外循环术后反跳性高热效果观察

目的 探讨盐水冰袋降温预防体外循环术后反跳性高热的效果,以确保手术成功.方法 将100例先天性心脏病体外循环术后患者随机分为观察组和对照组各50例,术后两组均进行持续肛温监测,观察组同时进行皮肤温度监测,当肛温达37.0℃或每30秒上升≥0.5℃、且四肢皮肤温暖(36.0℃)时,采取自制5%～10%盐水冰袋行预防性头部物理降温;肛温＞37.5℃时,头部、大动脉处置盐水冰袋.对照组肛温≥38.0℃时采用传统冰袋降温.结果 观察组反跳性高热发生率显著低于对照组(P＜0.01),观察组术后4、8、12、24 h肛温与对照组比较,差异有显著性意义(均P＜0.01).结论 早期使用盐水冰袋降温可有效减少体外循环术后反跳性高热的发生,使用盐水冰袋降温方法简单,且安全、方便、经济,可操作性强.     

麦杰克冰袋用于物理降温效果观察

目的 观察麦杰克冰袋用于高热患者物理降温的效果。方法 将100例高热患者采取随机抽样的方法分为两组，观察组50例使用麦杰克冰袋降温；对照组50例使用橡胶冰袋降温，比较两组降温效果、患者满意度及护士操作时间。结 果两组降温效果、患者满意度及护士操作时间比较，差异有显著性意义（P〈0．05，P〈0．01））。结论 麦杰克冰袋用于高热患者物理降温效果好，节省操作时间，患者容易接受，满意度高。     

麦杰克冰袋用于物理降温效果观察

目的 观察麦杰克冰袋用于高热患者物理降温的效果.方法 将100例高熟患者采取随机抽样的方法分为两组,观察组50例使用麦杰克冰袋降温;对照组50例使用橡胶冰袋降温,比较两组降温效果、患者满意度及护士操作时间.结果 两组降温效果、患者满意度及护士操作时间比较,差异有显著性意义(P＜0.05,P＜0.01)).结论 麦杰克冰袋用于高热患者物理降温效果好,节省操作时间,患者容易接受,满意度高.     

APTT监测体外循环后肝素中和与反跳

目的：评价激活部分凝血活酸疼时间（ＡＰＴＴ）用于监测体外循环后肝素中和与反跳。方法：择期风心病瓣膜替换术病人２０例，ＣＰＢ后于不同时点测定激活部分凝血活酶时间〖ＡＰＴＴ）和激活全血凝固时间（ＡＣＴ）。结果：鱼精蛋白／肝素为０．５：、和１：１拮抗后ＡＰＴＴ值依次缩短（Ｐ〈０．０５），ＡＣＴ值无明显改变；０．５：１和０．７：１拮据的血浆经体外滴定后，ＡＰ化：１拮抗后３小时和５小时有２例ＡＰＴＴ值明显延     

不同介质冰袋冰敷对颅脑损伤高热患者降温效果的观察

目的比较不同冰敷介质冰袋、生物冰袋对颅脑损伤高热患者降温的效果。方法将神经外科重症监护室的100例颅脑损伤高热需使用物理降温的患者随机分为5组,每组20例。各组分别用清水、10%盐水、25%乙醇、10%芒硝、生物冰袋冷敷,护士采用标准化的降温程序为患者降温。记录冷敷不同时间点各组患者的腋温及冰袋更换例次数。结果时间因素对各组体温变化有显著影响(P0.05)。降温过程中,生物冰袋组更换例数最多,25%乙醇组更换例数最少(P0.05)。结论 5种介质冰袋冰敷对颅脑损伤高热患者均能达到持续降温的效果。25%乙醇冰袋用冷180 min时降温幅度高于其他组,更换次数少,建议冷疗患者优先使用。     

自制简易降温垫应用于小儿体外循环术后高热

小儿体外循环术后,由于术中机器转流、血液降温与复温、全麻等导致体温调节中枢功能紊乱[1],极易发生高热。以往常用冰袋置于患儿头部、双腋下及腹股沟处行物理降温,但传统冰袋存在诸多不足,如冰块有尖锐棱角,极易刺破冰袋;冰块大小不一,放置不均匀,不能与体表充分接触,影响降温     

外周神经阻滞后反跳痛的研究进展

外周神经阻滞后反跳痛是指阻滞效果消退后出现的中至重度疼痛,在临床患者中发生率很高且易被忽视,容易导致阿片类药物消耗量增加、恢复延迟等不良后果。目前临床上尚缺乏统一的诊断标准,其机制及防治策略尚未完全明确。因此,本文就外周神经阻滞后反跳痛的定义、病理机制、相关危险因素及防治措施的研究现状进行综述,旨在为临床解决此类问题提供参考。     

小儿体外循环术后肺部护理体会

体外循环手术后，护理的关键是清除呼吸道分泌物，保持呼吸道通畅，防止分泌物坠积发生肺不张、肺炎。小儿心脏病体外循环术后因其年龄小，不配合，咳痰效果差，护理难度大，笔根据多年的临床经验总结出一些护理体会，报告如下：     

中西医结合治疗贲门癌术后反流性食管炎

目的 探讨贲门癌切除术后反流性食管炎的治疗方法和疗效。方法 应用单纯西药和中西医结合方法，分别治疗贲门癌切除术后胃食管反流的患者各45例。并根据临床表现、X线食管钡剂造影检查、纤维胃镜检查对疗效进行判断。结果 中西医结合组症状有效率、食管钡剂造影检查好转率、纤维胃镜检查好转率分别为93．3％、60．6％、72．5％，单纯西药治疗组为75．6％、25．8％、48．7％，两组间差异有显著性(P＜0．05)。结论 取半卧位睡眠、服用奥美拉吐、西沙必利能较为有效地控制胃食管反流，结合中医治疗更能提高治疗效果。     

预见性护理在预防腹部术后粘连性肠梗阻的效果

目的 探讨预见性护理预防腹部术后粘连性肠梗阻的效果.方法 随机将接受腹部手术的64例患者分为2组,每组32例.对照组行常规护理,观察组在常规护理的基础上联合预见性护理.比较2组患者术后离床活动时间、胃肠功能恢复时间和粘连性肠梗阻发生率.出院时发放自制护理工作满意度反馈表调查患者对护理工作的满意度.结果 观察组患者术后离...     

Pulsatile Augmentation Device for Extracorporeal Circulation

Abstract: A device has been designed, constructed, and tested to provide pulsatile pressure/flow to a standard extracorporeal bypass circuit. The pulsatile augmentation device is pneumatically driven similar to an artificial heart ventricle except that there are no valves. It is constructed of polyurethane by vacuum forming and high frequency welding. Drivers used are a modified Arrow-Kontron in-traaortic balloon pump or the Utah artificial heart driver. In vitro testing with fresh bovine blood demonstrated acceptable blood compatibility and hemodynamic function. In vivo testing for 4 h in a right and left heart extracorporeal bypass circuit showed good pulse augmentation in pulmonary and systemic bypass circuits. The device shows promise for adding pulse to standard cardiopulmonary bypass and to extracorporeal right heart circulatory assist circuits.     

Clinical Experience with Nikkiso Centrifugal Pumps for Extracorporeal Circulation

Abstract: A comparative study of a newly developed impeller–type centrifugal pump, Nikkiso HMS–15, was made to assess the effects on hemolysis, platelet function, and renal function for extracorporeal circulation (ECC) during open heart surgery. The Bio–pump (cone–type, Medtronic) and the roller pump were used as controls. The increase of serum hemoglobin level in the Nikkdiso pump was significantly lower than that in the other pumps. The decrease of platelet counts was recognized after the initiation of ECC in the three pumps whereas the levels of platelet factor 4 and β–thromboglobulin in the Nikkiso pump group increased by far less than in the other two groups. Moreover, renal function was better maintained in the Nikkiso pump group; in particular, a significantly higher urine output was recorded during ECC and for 1 h after the termination of ECC. The results of our clinical studies suggest that the Nikkiso centrifugal pump is suitable for ECC during open heart surgery.     

Renal Complications Following Heart Surgery with Extracorporeal Circulation

Renal complications were recorded in altogether 59 of 423 patients following operation with extracor-poreal circulation between December, 1959, and July, 1966, at the Department of Thoracic Surgery in Stockholm; these postoperative renal complications were slight in 46 and severe in 13 cases. The terms slight and severe renal complication are defined. The slight renal complication was of no clinical significance, while the severe renal complication were of utmost importance and carried a high mortality rate—only one of the thirteen patients in the group survived. The results at the start of the period, when the perfusion was done with whole blood, are compared with those recorded in the later part of the period when haemodilution was used and modifications were made in the machine. A striking reduction in haemolysis and a decrease in the incidence of renal complication were noted in the later part of the period. The causes of the severe renal complications are discussed. It would seem that low arterial pressure during perfusion and high haemolysis combined with whole blood perfusion and a low peroperative urinary secretion were factors of particular importance. Possible means of further reducing the incidence of renal complications and diminishing the mortality carried by severe postoperative kidney damage are discussed.     

A Technique for Apex Cannulation without Extracorporeal Circulation

A simple, fast, and highly reliable technique for apex cannulation without extracorporeal circulation is presented as a result of more than 30 left ventricle assist device implants performed in calves in the last 4 years at the Cleveland Clinic Foundation. Minimal bleeding and reduced risk of ventricular fibrillation, air emboli, muscle flap, and trauma to the heart have made this technique very unique and highly applicable to any investigative laboratory, as no special tools or expensive apparatus are required. The practicality of the technique is immediately applicable to the clinical level to avoid potential complications with cannula insertion.     

急症体外循环

目的：回顾最近2年急诊体外循环病例,分析其特点并总结经验。方法：收集1998－1999年间共97例急诊体外循环心血管手术临床资料,其中动脉瘤20例,冠状动脉旁路移植术15例,粘液瘤17例,心瓣膜置换术16例,先天性心脏病急性缺氧发作18例,大血管破裂出血6例,心室辅助3例,主动脉窦瘤破裂2例,涉及多种体外循环方法的应用。结果：早期主要并发症为低心排血量、出血、短时间的神经系统功能障碍,共20例,占20．6％,死亡8例,占8．2％,其余患者顺利出院,目前正接受长期随访。结论：急诊体外循环在心血管急诊手术中非常重要,快速建立体外循环,针对不同病情采取相应措施是手术成功和减少并发症的关键。