急性心肌梗死伴泵衰竭患者应用主动脉球囊反搏20例护理体会

急性心肌梗死（AMI）合并有泵衰竭的患者病死率较高。自1962年报道应用主动脉球囊反搏（IABP）治疗心肌梗死以来，通过机械性的循环辅助装置改善血流动力学及冠状动脉灌注使病死率显著下降。经皮冠状动脉内成形术及支架植入术能再通梗死病变的冠状动脉血流，     

左心辅助装置Impella保护经皮冠状动脉介入技术临床应用进展

正血管活性药物对循环支持具有一定局限性。随着复杂、高危并有血运重建指征的冠心病患者(complex higher-risk indicated patients,CHIP)增多,经皮机械循环支持(mechanical circulatory support,MCS)已成为CHIP诊治中进展最迅速的领域。经皮MCS可对循环系统提供有效支持,迅速纠正血流动力学紊乱状态,改善组织脏器灌注,提高经皮冠状动脉介入治疗     

主动脉气囊反搏辅助急诊冠脉介入治疗的术后护理

经皮冠状动脉介入治疗(PCI)已成为治疗急性心肌梗死(AMI)患者的首选方法.但对于存在血流动力学障碍和心律失常的患者,手术风险和死亡率会明显增加.主动脉气囊反搏术(IABP)是一种机械性辅助循环的方法,对衰竭的心脏可起到辅助和支持的作用,可以增加冠状动脉灌注,稳定血流动力学,明显改善心功能.两者联合应用,能有效提高急诊PCI患者的生存率[1].我科2009年8月～2011年6月在IABP支持下,对17例AMI患者行急诊PCI,均取得满意效果.现将护理体会报告如下.     

心肌血流储备分数在冠状动脉介入治疗中应用

冠状动脉心肌血流储备分数作为冠状动脉狭窄病变的一种功能学评价方法,在指导冠状动脉介入治疗及预后判断中有重要意义。测定心肌血流储备分数快捷、安全、重复性好,不受血流动力学变化的干扰。本文就心肌血流储备分数在冠状动脉介入治疗中的应用研究进展作一综述。     

体外肺膜氧合支持下的高危经皮冠状动脉介入治疗的初步探讨

近年来,无保护左主干（ LM）经皮冠状动脉介入治疗（ PCI）越发多见。然而,无保护的左主干病变的PCI对心血管介入医师仍然具有极大的挑战性,尤其是对血流动力学不稳定高危患者。体外肺膜氧合（ ECMO）能为心肺提供支持,在ECMO循环支持下,高危PCI更安全。我们报道2例无保护左主干病变的急性心肌梗死（ AMI ）患者,在ECMO支持下成功进行了PCI治疗。     

择期经皮冠状动脉介入治疗对心肌梗死患者左室重构的影响

目的 :应用二维超声心动图对接受经皮冠状动脉介入治疗的心肌梗死患者术前、术后 6个月各指标进行观测 ,并与未行冠状动脉介入治疗的心肌梗死组比较 ,以探讨经皮冠状动脉介入治疗对心肌梗死患者左室重构的影响。方法 :将 2 7例接受经皮冠状动脉介入治疗的心肌梗死患者作为研究组 ,另取 2 9例未行经皮冠状动脉介入治疗的心肌梗死患者作为对照组 ;经皮冠状动脉介入治疗组分别于术前、术后 6个月完成各指标的测量 ,与对照组的二维超声各指标进行分析 ,以评估经皮冠状动脉介入治疗对左室重构的影响。结果 :两组心肌梗死患者术前二维超声心动图各指标无显著差异 ,经皮冠状动脉介入治疗组术后 6个月与对照组比较左室射血分数 ,短轴缩短率有不同程度改善 ,但尚无统计学意义 ,缩末容量、舒末容量较对照组显著降低 (P<0 .0 5 )。结论 :经皮冠状动脉介入治疗术可改善缺血 ,延缓心肌梗死后的心室重构 ,促进顿抑及冬眠心肌的恢复     

慢性冠状动脉供血不足致心室壁运动异常对血流动力学的影响

目的：探讨慢性冠状动脉供血不足致心室壁运动异常对血流动力学的影响。方法：对临床症状和心电图检查确认有慢性冠状动脉供血不足者44例，行超声心动图检查显示心室壁运动异常者32例，对其进行血流动力学检验。综合上述资料观察、对比、分析。结果：44例冠状动脉供血不足者，有心室壁运动异常32例，其血流动力学指标全部显示轻、中度异常。结论：慢性冠状动脉供血不足引起的心室壁运动异常者，其血流动力学全部异常。     

1例高龄患者冠脉介入术后巨大血肿的原因分析及护理

经皮冠状动脉介入治疗（PCI）是采用心导管技术疏通狭窄甚至闭塞的冠状动脉,从而改善心肌的血流灌注的方法^[1]。具有创伤小、安全、成功率高、易被患者接受等特点,近年来得到迅速发展。但其术后血管并发症仍占一定比例。     

Impella临床应用现状及进展

Impella是一种心室辅助装置,可以减轻左心室负荷,增加冠脉血流量,减少心肌耗氧,改善循环衰竭,过去常用于心源性休克及高危经皮冠状动脉介入治疗,现在心肌炎、心肌病、心力衰竭中亦有使用。Impella因其轴流泵快速运转和较大的导管直径,会引起诸多并发症,随着设备完善、研究深入,对Impella并发症的防治措施提供了一些新的思路。本文对Impella于心血管领域中的应用现状及进展做一综述。     

微循环：从心源性休克的旁观者到靶点

心源性休克是指充分纠正前负荷不足等情况下,因心输出量明显减少而致组织器官灌注不足的临床综合征。临床特点主要表现为顽固的低血压状态及组织灌注明显减低。心源性休克的主要病因是急性心肌梗死,约占心源性休克病因的80％。其他病因包括：心肌病、心肌炎、心脏瓣膜病、主动脉夹层及心脏肿瘤等［1］。早期心源性休克主要针对病因治疗,后来休克和脏器功能衰竭的关系逐渐被认识,循环功能支持成为休克治疗的核心问题,器官功能的保护也得以被重视。近年来,尽管经血管活性药物和正性肌力药物治疗、经皮冠状动脉介入治疗以及心室辅助装置等新技术应用改善大循环血流动力学,心源性休克的病死率仍高达40％～50％［2］,因此,微循环在心源性休克治疗中的作用日渐引起重视。     

CT-guided percutaneous catheter cecostomy

A patient with pseudomembranous colitis is described in whom a percutaneous cecostomy was performed using computed tomographic guidance. Several lines of evidence indicate the safety of this approach, and clinical circumstances are suggested in which the procedure may have potential therapeutic benefit.     

Carotid access for percutaneous coronary intervention

Transcarotid percutaneous coronary intervention is feasible and safe and can be considered as an ultimate alternative in cases where conventional peripheral vascular access is unavailable.     

Ultrasound-guided percutaneous nephrostomy in non-dilated pelvicaliceal system

Percutaneous placement of nephrostomy catheters in patients with non-dilated pelvicaliceal systems remains problematic. We successfully performed ultrasound-guided percutaneous nephrostomies in 5 such patients after intravenous administration of a diuretic agent. Diuresis resulted in transient dilatation of the calyces, facilitating the procedures, which were performed under real-time sonographic guidance using the Seldinger technique. No complications were encountered. © 1998 John Wiley & Sons, Inc. J Clin Ultrasound26:177–179, 1998.     

冠状动脉慢性完全闭塞病变介入治疗完美攻略

冠状动脉慢性完全闭塞病变( chronic total occlusion, CTO)被公认为是冠状动脉介入治疗（percutaneous coronary intervention, PCI）的难点,曾经是PCI的禁忌证。然而PCI医师对CTO的尝试持续超过30年,过去10余年来,得益于导丝通过技术的提高、新器械的使用以及对病理解剖理解的加深,CTO PCI领域取得了巨大进步。CTO成为冠脉介入领域全球性的热点,包括中国在内,越来越多的国家投入或涉足CTO PCI领域。本文就CTO PCI相关策略进行综述。     

超声引导下PTGD在低位恶性梗阻性黄疸疾病中的应用

目的讨论超声引导下经皮经肝穿刺胆囊置管引流术(PTGD)在低位恶性梗阻性黄疸疾病中的应用价值。方法对2006年3月—2007年3月在我院超声科所施行的8例PTGD术进行回顾性分析。结果8例PTGD术均获得成功。术中超声均能较清晰地显示穿刺针穿入胆囊床的位置、导丝进入胆囊的深度,导管在胆囊中的位置。并发症主要有:疼痛、发热、渗血、引流管阻塞等。结论在低位恶性梗阻性黄疸疾病的诊治中,超声引导下PTGD具有实时、准确,置管快捷、方便等优点,提高患者的生活质量,延长了患者的生存时间,同时为外科手术提供了必要的准备和条件,但也存在携带不便等缺点。     

Hepatobronchial fistula with percutaneous pyogenic abscess drainage of the liver

Percutaneous abscess drainage has been successfully used in the treatment of hepatic abscesses. We present a case of a posttraumatic pyogenic liver abscess treated by CT-guided percutaneous catheter drainage with an unusual complication of a hepatobronchial fistula. Patient management and the subtle roentgenographic features of this case are presented. Early signs of hepatobronchial fistula including paroxysms of coughing and a peculiar metallic taste during the performance of an abscessogram are reported.     

Splenic abscess: Sonographic diagnosis and percutaneous drainage or aspiration

During a recent 5-year period, 12 patients with splenic abscesses were evaluated by abdominal ultrasound (US) examination. Multifocal abscesses were noted in seven patients, three of them were secondary to infectious endocarditis, three were in immunosuppressed state, and one was caused by tuberculosis. The latter four patients had developed splenic microabscesses with a diameter of <1.5 cm. The larger abscesses showed an irregular wall, weak or no internal echoes, ovoid or round in shape, and accompanied by mild to moderate distal acoustic enhancement. Wedge-shaped abscesses were typically noted in patients with infectious endocarditis and septic embolism. US-guided percutaneous drainage was done in five patients (abscesses > 4 cm). Simple aspiration in conjunction with antibiotic administration was done for seven smaller abscesses (diameter <3.5 cm) in five patients. A second drainage, either for a dislodged catheter or a recurrent abscess, was performed in two cases. All patients had uneventful clinical course following this therapeutic approach.     

Fatal liver necrosis following percutaneous ethanol injection for hepatocellular carcinoma

A 76-year-old man underwent an injection of 5 ml of ethanol for the treatment of a hepatocellular carcinoma 3 cm in diameter. Shortly after the procedure, he had an attack of abdominal pain. His condition soon deteriorated and he died 5 days later. Massive hepatic necroses distant from the injection site and a myocardial infarction were found at autopsy. To our knowledge, this is the first fatality associated with percutaneous ethanol injection therapy.     

Ultrasonically guided percutaneous transhepatic transcholecystocholangiography in the nondilated biliary tree

Five patients with CT or ultrasoundproven nondilated intrahepatic biliary radicles underwent ultrasound-guided percutaneous transhepatic transcholecystocholangiography (PTHTCC) for visualization of the biliary tree following failed endoscopic retrograde cholangiography. In no instance were more than 2 passes of a 22-gauge needle necessary to enter the gallbladder. Visualization of the biliary tree was excellent in all cases, and there were no complications. Therefore, PTHTCC is a safe and reliable method of visualizing the nondilated biliary tree.     

超声引导下胆囊穿刺取石术1例

患者女,90岁,主因"反复中上腹胀痛20年,加重1天"入院.查体见中上腹局部隆起,脐上2 cm可扪及肿大的胆囊,压痛.腹部B超:胆囊大小约3.8 cm×10.5 cm,胆囊壁连续完整,厚约0.3 cm,腔内可见大小约2.8 cm×3.5 cm的强光团,伴声影.肝内外胆管不扩张.超声诊断:胆囊结石,胆囊积液.因患者心肺功能不全,行胆囊切除术风险极大,综合考虑后决定行超声引导下胆囊穿刺取石术(percutaneous cholecystolithotomy, PCCL).