冠状动脉造影病人的心理问题及护理

目前，冠状动脉造影已成为诊断冠心病，明确冠状动脉狭窄部位、程度的重要方法，对冠心病的诊断可达定量水平，为估计病人预后、决定药物使用及介入性治疗提供了更为确切的指标。由于介入性诊治属有创性，存在一定的风险，且术后需卧床制动，因此，绝大多数病人对该术存在担心恐惧等心理，加之术中、术后所承受的不适感觉，在很大程度上影响着该术的成功及病情变化，为减轻病人恐惧与担心，增加手术的成功率，认真做好病人的心理护理就显得尤为重要。自2000年6月我科开展冠状动脉介入性诊治护理以来，对病人心理特征不断进行观察分析，现将其总结如下。     

152例老年高血压病的诊治体会

目的:观察中西医结合治疗老年高血压的疗效。方法:将152例老年高血压患者随机分成两组,对照组76例采用西药治疗,治疗组76例除用西药治疗外辅助中药治疗。结果:治疗组显效30例,有效44例,总有效率97.4%;对照组显效24例,有效40例,总有效率为84.2%。结论:中西医结合治疗老年高血压有较好的疗效。     

男性病人冠状动脉病变与吸烟关系的研究

[目的]探讨吸烟对病人冠状动脉病变的影响。[方法]对吸烟组(5 0例)与不吸烟组(3 0例)进行冠状动脉造影,观察记录冠状动脉病变情况并进行统计学分析。[结果]两组冠状动脉病变记分、每日不同吸烟量与冠状动脉病变记分、不同的吸烟年限与冠状动脉病变记分比较均有统计学意义(P <0 .0 1)。[结论]长期吸烟可使冠状动脉病变程度加重,应加强对长期吸烟及冠状动脉介入术后病人的健康教育,有效预防和控制冠心病,提高人群的健康水平。     

Effects of tracheal extubation on coronary blood flow,myocardial metabolism and systemic haemodynamic responses

Global coronary blood flow and metabolism were measured in seven patients on the first postoperative day following coronary revascularization to test the hypothesis that tracheal extubation produces adverse haemodynamic responses akin to those observed during tracheal intubation. Regional coronary flow and metabolic measurements were made in five of the seven patients. Extubation from a continuous positive airway pressure (CPAP) of 5 cm H₂O was associated with a statistically significant rise in cardiac index from 3.44 ± 0.23 L · min^-1 · m^-2 to 3.73 ± 0.15L·min^-1 ·m^-2 related to an increase in stroke index, without significant changes in heart rate, mean arterial and pulmonary capillary wedge pressure. Consequently the changes in myocardial oxygen consumption (8.52 ± 0.55 to 8.85 ± 0.93 ml · min^-1) and coronary blood flow (172 ± 18 to 179 ± 17 ml·min^-1) were less prominent than those reported during intubation, where substantial rises in myocardial oxygen consumption and coronary flow occurred. Two patients experienced cardiac lactate production but there were no changes in systemic or coronary haemodynamics, nor were there clinical or electrocardiographic signs of ischaemia. We conclude that extubation does not appear to be associated with adverse systemic or coronary haemodynamic responses in patients following coronary bypass grafting. However, the revascularized myocardium may remain vulnerable to anaerobic metabolism in the immediate postoperative period. Pour savoir si comme ľintubation, ľextubation de la trachée provoque des perturbations hémodynamiques, on a mesuré le métabolisme et la circulation coronarienne globale chez sept patients, au lendemain ďun pontage aorto-coronarien. On a aussi calculé les valeurs régionales de ces mêmes variables pour cinq ďentre eux. Ľindex cardiaque de 3.44 ± 0.23 L · min^-1 · m^-2 sous pression positive en respiration spontanée (CPAP) de 5 cm. H₂O s’est élevé à 3.73 ± 0.15 L · min^-1 · m^-2 post-extubation avec une augmentation significative du volume ďéjection. La fréquence cardiaque et les pressions artérielles moyennes et capillaires pulmonaires n’ont pas changé. Ainsi ľaugmentation de la consommation ďoxygène du myocarde de 8.52 ± 0.55 à 8.85 ± 0.93 ml · min^-1 et celle du flot coronarien de 172 ± 18 à 179 ± 17 ml · min^-1 ont été moindres que celles, importantes, déjà observées lors de ľintubation. On a noté chez deux patients une production de lactate par le myocarde, sans changement de ľhémodynamic systémique et coronarienne non plus que de signe clinique ou électrocardiographique ďischémie. Donc, après un pontage coronarien, ľextubation ne semble pas causer ďeffet néfaste sur les circulations systémique et coronarienne, toutefois, le myocarde revascularisé peut demeurer sensible au métabolisme anaérobique.     

Survivin和Bcl-2在尖锐湿疣中的表达

目的:测定survivin和Bcl-2在尖锐湿疣(CA)组织中的表达并探讨两者表达的关系。方法:应用免疫组织化学链霉菌抗生物素蛋白过氧化物酶方法(SP法)分别检测60例CA组织及10例正常包皮组织中survivin、Bcl-2基因的表达。在镜下观察切片并计算阳性细胞百分比。结果:CA组织中survivin的表达率为86.67%,显著高于正常包皮的表达率20%(P<0.01)。其中棘层的表达率85.00%显著高于基底层的表达率70.00%和颗粒层的表达率66.67%(P<0.05),基底层与颗粒层的表达率之间无显著性差异(P>0.05)。Bcl-2在CA的表达率为66.67%,正常包皮组织中未见Bcl-2蛋白表达。survivin在CA中的表达与Bcl-2呈正相关(P<0.01)。结论:本实验检测出survivin基因在CA组织中有异常表达,提示survivin蛋白引起的细胞凋亡抑制在CA的发生中起到重要的作用。survivin与Bcl-2在CA的发生发展过程中起到协同作用。     

Use of the Arndt wire-guided endobronchial blocker via nasal for one-lung ventilation in patient with anticipated restricted mouth opening for esophagectomy.

Functional separation of the lungs may be accomplished by several methods. Patient with restricted mouth opening has limited options for one-lung ventilation. We report the use of wire-guided endobronchial blockade, a new tool for achieving one-lung ventilation in a patient with restricted mouth opening requiring nasotracheal, fiberoptic intubation for esophagectomy and reconstruction with gastric tube substitution.     

Study on hemostatic mechanism of fully soluble hemostatic fiber.

Fully soluble hemostatic fiber (FHF) is made from cotton yarn through a series of chemical reactions with NaOH and chloroacetic acid. The major component of FHF is carboxymethylcellulose. FHF is a kind of biodegradation macromolecule material that can disassociate into a low-molecular-weight compound or a simple substance by hydrolytic and enzymatic courses. The purpose of the present study is to investigate the hemostatic mechanism of FHF. The study indicated that FHF can stop bleeding by physical, chemical and physiological routes. In the physical route, expansion of carboxymethylcellulose in FHF stops bleeding by forming a mechanical clog after contacting with the blood. In the chemical route, the platelets can quickly aggregate around FHF and stimulate releasing and disaggregating reactions, after contacting with the rough surface of FHF, producing thrombus and hemostasis. In the physiological route, gluey particles with negative charges can activate intrinsic coagulation systems by activating the blood coagulation factor XII after FHF dissolution.