总结对56例行急诊PCI介入治疗患者的护理配合,使我们体会到高质量的护理配合是手术成功的基础,尤其是充分的术前准备,细心、耐心、周密、娴熟的护理技术,术中密切观察病情,及早发现心律失常并积极配合抢救是预防和减少并发症、提高手术成功率的重要保证.本组11例心率减慢,8例给予阿托品静脉注射后恢复正常心率,3例Ⅱ度二型以上房室传导阻滞患者安装临时起搏器.所发生加速性室性自主心律中有7例直接转成室性心动过速,给予静脉注射利多卡因后转复窦性心律.6例在血管再通后瞬间出现再灌注心律失常室早、室速、室颤立即非同步直流电除颤复律、静脉注射利多卡因后恢复窦性心律.

<正>周围动脉瘤是血管外科常见病,可导致危害肢体功能的严重并发症,如瘤体破裂出血、血管损伤、邻近神经组织受压等,需及早治疗。我院自2007年4月～2009年12月共收治12例周围动脉瘤患者,临床诊治效果满意,现报道如下。

目的探讨C型臂X线下针刀穴位松解治疗脊柱病的围手术期护理。方法以中医护理为主,加强术前情志护理及访视,术中配合穴位按摩减轻患者疼痛,术后进行康复指导。结果本组68例临床治愈49例,显效15例,有效3例,无效1例,总有效率98%,无并发症。结论采用中医护理为主的护理方法为患者进行围手术期护理,可提高治愈率,减少并发症,降低复发率。

Objective To study the complication nursing in catheter ablation for atrial fibrillation (AF) and its clinic effect. Method To analyze clinic effect and nursing measures in 30 AF patients undergoing catheter ablation treatment. Result All of the 30 patients were cured after ablation and no serious complications were found. Conclusion Catheter ablation can treat atrial fibrillation patients successfully with high cure rate and less complications. Well and effective nursing management is one of the important factors for successful operations

Objective To investigate the effects of percutaneous coronary intervention(PCI) on the treatment and prognosis of heart failure derived from ischemic cardiomyopathy in aged patients. Methods The subjects were divided into 2 groups: treatment group(n=55)and control group(n=56).The patients in the treatment group received PCI as well as conservative medication,while the patients in the control group underwent conservative medication only. The short-term therapeutic effects and long-term prognosis were compared between the two groups. Results In PCI treatment group, the patients had a significant amelioration of physical signs, significant elevation of LVEF, significant reduction of rehospitalization frequency in 1-and 2-year follow-up visit,and cardiac death in 4-and 8-year follow-up visit.It was significantly different compared to the control group(P0.05). Conclusion The application of PCI in treating heart failure resulting from ischemic cardiomyopathy in aged patients is feasible and fruitful if the patients can stand the procedure.Especially,the long-term prognosis is statisfactory.

介入治疗属有创技术,操作时需进行股动脉、股静脉血管穿刺,要求患者术中保持穿刺侧下肢伸直、术毕拔出鞘管后砂袋加压止血和穿刺侧肢体伸直6～8 h.

>引流管自动挤压器通过对传统引流管加装全自动机械装置以及夹闭装置,既保证了引流的有效性,极大地减轻了临床护士的工作负担,而且延长了引流管的使用寿命,现报道如下。材料与制作引流管自动挤压器由盒体、时间控制器、固

>临床上的顽固性腰背疼痛患者,尤其是中老年人中,大部分是由于骨质疏松或某些疾病引起的骨质破坏而导致的椎体压缩骨折所致,患者活动受限痛苦较大,严重影响生活质量。经皮椎体成形术(percutaneous vertebroplasty,PVP)和椎体后凸成形术(percutaneous kyphoplasty,PKP)是近年发展起来治疗椎体压缩骨折的微创技术,有显著的止痛效果和增加椎体

目的 探讨Excel电子表格在介入治疗患者的临床资料、介入导管材料管理中的应用方法,提高导管室护理管理效率和质量.方法 利用表格处理软件Excel,结合导管室工作实际情况,建立了一系列导管室资料管理工作表.结果 实现了手术资料及介入导管材料的数字化管理,提高了工作效率,临床科室及患者满意度增加,有效地防止了介入导管材料的报废流失.结论 Excel电子表格在导管室护理管理中的应用,简化、优化了导管室护理管理工作程序,提高了工作质量,促进了科学化管理.

Objective To investigate the characteristics and mechanism of atypical electrocardiogram (ECG) in isthmus-dependent atrial flutter (AFL). Methods Fifty-five patients with isthmus-dependent AFL underwent electrophysiological studies, patterns and activation times of coronary sinus (CS) and their relationship with the FL wave in the surface ECG were analyzed. Results According to FL wave morphology in inferior leads(Ⅱ,Ⅲ,aVF),four groups of counterclockwise conduction AFL (CCW AFL) were observed: group 1 had purely negative FL wave in inferior leads; group 2 had small positive terminal portion with proximal-to-distal (PD) pattern. The CS activation direction of group 1 and 2 both were PD, and the activation time were (33.41± 13.43) ms and (35.23 ± 15. 56) ms respectively. Group 3 had broad positive terminal portion or purely positive FL wave with a distal-to-proximal pattern (DP) or fused pattern (FL), the activation time was (-21.3 ±11.41)ms. Group 4 had almost flat-line recording with PD pattern. Three groups of clockwise conduction AFL (CW AFL)were observed: group 1 had positive or notched positive F wave inferiorly with a PD or FL pattern in CS, the activation time was (5.43 ±17. 59)ms. Group 2 had negative FL wave with PD pattern, the activation time was (42.43 ± 14. 41) ms. Group 3 had almost fiat-line recording with fused pattern. Conclusions FL wave morphology in inferior leads of isthmus-dependent AFL is determined by the left atrium activation sequence, which is determined by the interatrial connections. The activation blockage or delay of the interatrial connections may change the FL wave morphology and induce atypical ECG appearance in isthmus-dependent AFL.

Objective To explore the allocation ratio of clinic nursing personnel to patients and the number of nursing personnel needed in reality, so as to offer academic evidence to collocate the nursing personnel resources reasonably.Me-thods Six typical clinics including neurology, cardiology, gynaecology and obstetrics, pediatrics, dermatology and orthopedics were chosen to test the work hours of nursing procedures and the allocation of clinic nursing personnel resources was analyzed by means of literature reviewing, experts consulting, work hours testing and contrasting.Results Direct nursing hours accounted for 58.65% of the total nursing hours. In dermatology department the direct nursing time of each case every day was significantly longer than that in other departments (P0.05 for all). There was no significant difference in the direct nursing time between department of cardiology and departments of neurology, orthopedics, as well as that between department of gynaecology and obstetrics and department of orthopedics (P0.05 for all). There was no significant difference in indirect nursing time between different departments (P0.05). Work hours of five performances including TPR measuring, maintaining visit order, clinic patient registration, preparation before work and cooperation between doctor and nurse accounted for 53.82% of the total performance time. The reasonable ratio of patient to nurse was 100∶3, so there was still deficiency of nursing personnel in the tested hospital, number of which was 11.Conclusion There is still shortage of clinic nursing personnel. To improve efficiency and quality of clinic nursing service, allocation of nursing personnel should be increased according to different conditions in each department, especially in the department that requires many treatments, such as department of dermatology, department of gynaecology and obstetrics and department of orthopedics.

Objective To investigate the value of DSA, CTA in diagnosis of lower extremity arterial stenosis or occlusion. Methods 21 confirmed patients of lower extremity arterial stenosis or occlusion were received DSA and CTA examinations. The two methods were compared in the definition, grade of arterial lumen stenosis, sensitivity, specificity, accuracy and bypass circulation. Results CTA was better than DSA in definition of artery, but with no significant difference(P≥0.05). CTA was not conformed to DSA in 2 cases of iliac artery, 4 cases of popliteal-femoral artery and 4 cases of tibial-fibular artery. Compared with DSA, CTA over-estimated the degree of stenosis so as with more false positive rate. The sensitivity, characteristics and accuracy of CTA decreased with the degree increase of arterial stenosis, but with no significant difference(P≥0.05)compared with DSA. CTA had the worse image of bypass circulation with the degree increase of arterial stenosis. It would increase the positive rate of bypass circulation and distal artery of occlusion by increasing contrast dosage and exposure time in DSA. Conclusion CTA is used increasely in primarily detecting lower extremity arterial stenosis or occlusion, but DSA is still the first choice of diagnosis.

1993年4月～2006年9月,我院对556例阵发性室上行心动过(PSVT)患者行射频消融术(RFCA),其中36例发生不良反应,包括心脏反应8例,血管反应10例,穿刺反应4例,痛疼反应14例.

回顾性分析876例心血管病介入术后患者的监护方法、处理措施和预后。结果106例心血管介入术后发生不良反应(术后24 h内出现的各种异常情况),其中68例经简单对症处理后恢复,38例并发严重心脏并发症而需行再次冠脉造影、冠脉介入治疗及心包穿刺、冠脉搭桥术等治疗。心血管介入术后高危患者的判断标准:并发低血容量、心衰、心包积液或急性冠脉综合征。处理措施:怀疑有急性冠脉综合征且溶栓无效者立即行再次冠脉造影;造影发现冠脉内有血栓、闭塞、夹层者立即行冠脉内溶栓、PTCA及支架植入术;发现有心脏压塞时立即行心包穿刺抽血减压;再次介入治疗无效者立即行冠状动脉搭桥术。

目的 探讨Carto标测系统指导下射频消融治疗房颤的术中配合经验及护理措施.方法 对13例实施Carto标测系统指导下射频消融的房颤患者进行手术,配合要点包括术前探访,进入导管室后的心理干预,特殊设备仪器的连接使用,术中及时提供专用器械,全过程严密监护,根据手术进程密切配合医生操作及时提供有效信息,对发生的异常情况进行分析并迅速采取护理措施.结果 13例患者手术成功率100%,术中发生并发症3例,其中呼吸、心脏骤停1例,因疼痛致迷走神经反射出现血压降低、心率减慢、恶心呕吐2例,经积极治疗护理后均转危为安.结论 术中注重患者心理护理,准备完善,熟练配合,严密监护和观察是手术顺利进行,减少并发症和提高手术成功率的重要保证.

射频消融(RFCA)是目前根治阵发性室上性心动过速(PSVT)、特发性室速(IVT)和心房扑动(AF)的有效方法[1].1993年4月-2005年11月,在我院行RFCA 517例,其中496例获成功,成功率达95%以上[2].此手术简单,创伤性小,安全系数大,并发症仅为1%[3].但近年来有关RFCA术中引起的并发症屡见报道[4-6],因此我院对RFCA过程中发生的不良反应进行及时的观察识别与处理,以避免并发症的发生,现报道如下.

冠状动脉造影是诊断冠心病的主要手段,也是指导治疗和确定治疗方案的可靠方法.但冠状动脉造影时导管刺激心脏和造影剂的影响,常会引起心律失常、心肌缺血等并发症.我们观察了384例患者冠状动脉造影术中并发症的发生情况,并探讨相关对策,旨在为临床提供参考.

Objective: To approach the short and long period results of high speed rotational atherectomy (HSRA) adjunt ballon angio-plasty or coronary stenting in calcified coronary stenosis of elderly patients with coronary artery disease. Methods: HSRA adjunct percutaneous transluminal coronary angioplasty(PTCA) or coronary stenting was performed in 31 calcified lesions identified coronary arigiog-raphy ,short or long period results and complications was observed. Results:The mean diameter stenosis before angioplasty was (83.6±5.6)% ,residual stenosis following intervention was (7. 0±9. 4)% , so the success rate of coronary angiography and operation was 100% and 96.7%. There was no death,Q-wave MI or CABG ocurred and non-Q-wave MI happened in one case during acute period. Angina (1 case) , cardiogenic death (1 case) and revascularization (2 cases) were recurrent in fllow-up period. No CABG was seen. Conclusion: HSRA adjunct PTCA or coronary stenting is an effective, safe and feasible method to treat calcified coronary stenosis of elderly patients according to short or long period results.

To investigate radiofrequency current ablation(RFCA) and cautions of atrioventricular nodal reentry tachycardia(AVNRT) in patients with small imaging Koch triangle. The small imaging Koch triangle was defined as that the distance between the site of the largest His potential and coronary sinus ostia(CSo) was not for more than three 8-French big-tip electrodes under X ray fluoroscopy of right anteoblique 30 degree, and the slow pathway were ablated referring to the routine ablating method in 16 AVNRT patients with small imaging Koch triangle. Results: Of 16 patients with small imaging Koch triangle, successful ablating site was located below CSo level in 12 patients, at the same level in 3 and above in 1. The leaping of atrioventricular conduction disappeared in 14 patients, only leaping but no both atrial echo and isoprenaline-induced AVNRT in 2. Among the 12 patients , there was transient atrioventricular block(AVB) during RFCA and type 2 of second degree AVB happened in 1 patient post-procedure 24 hours, which did not improve after 3 months' follow up, thus the patient received cardiac pacemaker. There were no both AVB and AVNRT recurrence in other 15 patients following 3.5±1.2(0.5～5)years. Conclusions: Mapping and ablating of slow pathway could not follow the routine ablating method, mostly, the slow pathway should be mapped and ablated in the ante-inferior field of CS ostia for the patients with small imaging Koch triangle. Meanwhile, it was necessary to regulate ablating parameter instantly according to responses of slow pathway to radiofrequency current.