老年冠状动脉旁路移植术后机械通气的护理

目的探讨老年患者非体外循环下行冠状动脉旁路移植术（CABG）术后机械通气的护理干预。方法回顾17例老年患者非体外循环CABG术后机械通气的护理干预：包括保持气管插管的正确位置,足够的气道湿化,有效的吸痰,预防呼吸道感染,有计划有准备的撤机及撤机前的干预等。结果17例患者中,术后呼吸机辅助呼吸时间最短11．5h,最长铝h,无一例死亡,无一例因机械通气带来的并发症。结论老年患者非体外循环CABG术后机械通气期间,采取有效的护理干预方法可以避免因机械通气带来的并发症,达到临床满意的治疗她粟．     

高龄患者冠状动脉旁路移植术后的护理

总结对15例75岁及以上患者行冠状动脉旁路移植术的术后护理要点。包括呼吸道管理、神经系统观察、循环系统监护、保持血糖稳定、维持氧供与氧需的平衡、准确记录出入液量、保持引流管通常、保证营养、预防切口感染、患肢护理、功能锻炼和出院指导。15例患者痊愈出院,术后失访1例,其余14例随访6个月至2年,死亡1例,死亡原因为脑出血,其余患者无严重心脏事件发生。有针对性地做好高龄患者冠状动脉旁路移植术的术后护理,对提高手术成功率,减少并发症的发生,提高生存率具有重要意义。     

冠状动脉旁路移植术后并发脑梗塞患者的护理

目的 对9例冠状动脉搭桥术后并发脑梗塞患者的临床护理进行回顾性分析.方法 密切观测患者生命体征的变化,预防并发症的发生;使用血管活性药物维持适当的动脉血压;正确使用利尿、脱水剂降低颅内压;适时的抗凝治疗,强化护理干预和心理护理.结果 8例治愈,1例死亡.结论 提示科学规范的护理是冠状动脉搭桥术合并脑梗塞患者顺利度过围手术期的重要保证.     

冠状动脉旁路移植术后病人社会支持及其影响因素调查

[目的]探讨冠状动脉旁路移植（CABG）术后病人的社会支持及其影响因素.[方法]采用社会支持评定量表调查60例CABG术后病人的社会支持状况.[结果]CABG病人术后社会支持水平各维度低于国内常模（P＜0.05）;婚姻状况、家庭状况及医疗费用支付方式是影响社会支持的主要因素（P＜0.05）.[结论]CABG病人的社会支持得分呈中高等水平,且社会支持受婚姻状况、家庭状况及医疗费用支付方式等因素影响,临床护理人员应根据病人不同情况进行个性化健康教育,以利于获得更多的社会支持.     

1069例冠状动脉旁路移植术后病人的监护

总结了2000年1月至2001年12月对1069例冠状动脉旁路移植(CABG)术后病人监护的体会.本组在ICU监护期间再次开胸止血37例;59例用主动脉内气囊反搏(IABP)支持;25例有明显急性心肌缺血,其中3例即刻再次行CABG手术;36例发生室性心律失常,5例快速房颤;拔除气管插管后再次插管38例;出现神经系统并发症15例;14例因低心排综合征合并肾功能衰竭死亡.认为持续监测病人血流动力学变化,应用IABP时密切观察反搏时相,预防骨筋膜室综合征,注意保暖、复温,严密观察心率、心律变化和心肌缺血征象以及神经系统症状,加强呼吸管理,根据病人情况选择性早期拔除气管插管,定时监测血糖水平等,是提高术后监护质量的重点.     

机械通气在冠状动脉旁路移植术后的应用及护理

目的 :总结冠状动脉旁路移植术后呼吸机的应用及护理经验。方法 :回顾分析 116例冠状动脉旁路移植术后应用机械通气的效果。结果 :本组无 1例因应用机械通气而死亡 ,出现肺部并发症 8例 ,其中肺不张 3例 ,气胸 2例 ,肺部感染 3例 ,经对症治疗 ,调整呼吸机和使用抗生素后治愈。结论 :冠状动脉旁路移植术后有效地应用机械通气 ,在患者配合下 ,可使患者顺利度过围手术期 ,提高存活率     

冠状动脉搭桥术后护理体会

目的：探讨冠状动脉搭桥（CABG）术后病人护理要点。方法：回顾2007年8月～2008年11月17例搭桥术后护理情况。结果：在对病人实施循环系统、呼吸系统监护,纠正电解质紊乱,补充血容量,加强引流管、低心排及肢体护理后,除1例病人因严重心律失常、低心排死亡外,余16例病人均痊愈出院。结论：术后根据冠状动脉搭桥特点进行严密监测,采取有效护理措施,有助于准确及时防止并发症,提高病人生活质量和延长寿命。     

Recognizing depression after a coronary artery bypass graft

The purpose of this paper is to review the literature on the impact of depression on rehabilitation following coronary artery bypass graft. It describes how depression, which is often unrecognized, is one of the major factors to influence the outcome of cardiac rehabilitation programmes. The review will highlight that depression is a more important determinant of the successful outcome of a cardiac rehabilitation programme than many of the cardiac function indicators. It also describes the implications for clinical practice and presents a framework for the assessment of depression which can be used by all staff.     

CT angiography after coronary artery bypass graft surgery

CT angiography is an emerging technique for the noninvasive assessment of coronary artery disease. The diagnostic performance of different generation CT scanners has been investigated for the detection of significant stenosis (≥ 50% lumen diameter reduction) in patients after coronary artery bypass surgery (CABG). The temporal and spatial resolution of CT scanners are important determinants for reliable evaluation of bypass grafts and native coronary arteries. Important drawbacks of 64-slice CT angiography remain the evaluation of severely calcified native coronary segments and distal graft anastomosis site. Future developments in the latest CT scanners head toward the use of wider detectors and improved coverage, which may be relevant in post-CABG patients. Despite technical advances, the role of CT angiography in the follow-up of patients after bypass surgery has not yet been established.     

冠状动脉旁路移植术围手术期心肌梗死的诊断进展

冠状动脉旁路移植术(coronary artery bypass grafting，CABG)是治疗心肌缺血性疾病的主要手段。我国每年约2万例患接受CABG。一方面，通过搭桥恢复和改善缺血区心肌的血液供应．另一方面．手术本身会造成心肌的损害，严重时可造成围手术期心肌梗死(perioperative myocardic infarction,PMI)。PMI是CABG围手术期的主要并发症，其后果非常严重．因此PMI越来越受到重视。     

Patient-related outcomes five years after coronary artery bypass graft surgery

For five years, we prospectively studied 353 consecutive patients undergoing first-time coronary artery bypass graft surgery (CABG) for stable angina in the North of England. Angina was present before surgery in nearly all patients, in 20% 3 months after surgery, and in 48% after 60 months. The Nottingham Health Profile, showed a significant improvement in perceived health status (PHS) 12 and 60 months after surgery compared with preoperation. However, PHS at 60 months was worse than at 12 months in the dimensions 'pain' and 'physical mobility' in part 1, and in 'looking after the home' and 'taking holidays' in part 2. Employment rates were 36%, 34% and 21%, before, and 12 and 60 months after surgery, respectively. Working at 12 and 60 months was associated with age below retirement age, work preoperation and absence of angina, and at 12 months also with male gender and waiting time < 6 months. This study describes everyday clinical practice. The significant improvement in angina symptoms and PHS after CABG persists for at least 5 years. However, only one third of patients in this geographical area return to work, and this is not solely dependent on clinical symptoms.     

Caring for a patient after coronary artery bypass graft surgery

Follow this system-by-system approach to keeping your patient stable and steering clear of complications.     

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.     

Gender-specific predictors of early mortality after coronary artery bypass graft surgery

Background

Female gender is a risk factor for early mortality after coronary artery bypass graft surgery (CABG). Yet, the causes for this excess mortality in women have not been fully explained.

Objectives

To analyse gender differences in early mortality (30?days post surgery) after CABG and to identify variables explaining the association between female gender and excess mortality, taking into account preoperative clinical and psychosocial, surgical and postoperative risk factors.

Methods

A total of 1,559 consecutive patients admitted to the German Heart Institute Berlin (2005–2008) for CABG were included in this prospective study. A comprehensive set of prespecified preoperative, surgical and postoperative risk factors were examined for their ability to explain the gender difference in early mortality.

Results

Early mortality after CABG was higher in women than in men (6.9 vs. 2.4?%, HR 2.91, 95?% CI 1.70–4.96, P?P?P?P?=?0.01), respiratory insufficiency (9.4 vs. 5.3?%, P?=?0.006) and resuscitation (5.2 vs. 1.8?%, P?=?0.001). The combination of these factors explained 71?% of the gender difference in early mortality; age and physical functioning alone accounted for 61?%. Adjusting for these variables, HR for female gender was 1.36 (95?% CI 0.77–2.41, P?=?0.29).

Conclusions

Age, physical function and postoperative complications are key mediators of the overmortality of women after aortocoronary bypass surgery. Self-assessed physical functioning should be more seriously considered in preoperative risk assessment particularly in women.