20例射频导管消融术的护理

经导管射频消融术(radiofrequency catheter ablation，RFCA)1987年应用于临床，我国1991年引进RFCA。十多年来这一技术在国内快速发展，使快速性心律失常的治疗发生了根本变化，被推选为某些快速心律失常的首选治疗方法。2001年10月～2002年8月，我院心血管介入治疗中心用RFCA治疗快速性心律失常患者20例，取得了良好的效果，现将护理体会报道如下。     

11例射频导管消融术患者的护理体会

射频导管消融术(radiofrequency catheter ablation,RFCA)是近年来用于临床的治疗各种快速心律失常的介入性治疗技术。由于此术系以心导管术为基础的创伤性治疗方法,术中及术后都可能发生严重并发症,故护理质量好坏直接影响治疗效果。本文通过11例病人的护理,认为除做好基础护理外,术前应加强心理护理,术中与医技人员密切配合;术后进行监护,防止并发症是RFCA护理的关键。本组11例患者全部手术成功,术中、术后无任何并发症。现将护理体会报告如下:     

快速心律失常患者射频消融术后的护理

目的探讨快速心律失常患者射频消融术后的护理方法。方法回顾性分析2009年10月至2010年4月120例快速心律失常行射频消融术患者的临床资料与术后护理要点。结果本组患者均成功完成了射频消融术。术后发生并发症6例,其中一过性Ⅲ度房室传导阻滞1例、穿刺部位出血1例、迷走神经反射1例、胸痛3例,经积极的治疗与护理,均好转出院。结论术后加强观察和护理可有效减少各种并发症的发生,提高手术成功率,有利于患者的术后康复。     

经皮导管射频消融术治疗心动过速的并发症及其原因分析

射频消融术(RFCA)是九十年代迅速发展起来的治疗心律失常的新技术,目前被公认为是根治心动过速安全的有效的手段,至今全世界已有数万人接受了RFCA。我国于1991年后在较多地区开展了此项工作,至今已有近百家医院为上万人实施了RFCA术,较大的医疗中心已做了千余例。与任何介入治疗方法一样,RFCA可以产生严重并发症,甚至导致死亡。本文分析了我院1996年以来120例RFCA术后的并发症,总结经验教训,供同道     

房颤患者行射频消融术的护理

目的总结房颤患者射频消融治疗的护理经验。方法对我院27例房颤患者进行射频消融治疗,术前加强心理护理,做好手术准备工作,术中、术后密切观察,及时处理并发症。结果成功12例,有效9例,失败或需要二次手术6例。患者术前对治疗方法和相关准备有充分的了解,均能以良好的心态对待手术。结论有效的护理可减轻病人术前、术后的心理压力,同时应密切观察术中、术后并发症的发生,最大限度地减轻并发症的危害。     

经导管射频消融术并发心包填塞的观察与护理

经导管射频消融术是目前治疗快速性心律失常的主要方法之一，但在治疗过程中会出现一些并发症，心包填塞是其主要的并发症之一，可危及生命，本文总结5例病人的观察经验；既要注意术中发生急性心包填塞，又要警惕术后发生迟发性心包填塞，一旦发生心包填塞，快速输液，输血，配合心包穿刺等护理措施是抢救成功的关键。     

射频导管消融术的观察与护理

射频消融术是近10多年来应用于临床治疗快速性心律失常的一种安全和有效的方法。高质量的护理对安全有效地开展射频消融术的意义重大。现将射频导管消融术的观察与护理报道如下。     

房颤患者射频消融术中术后并发症护理

回顾分析14例房颤行射频消融术治疗患者在术中、术后出现并发症的观察和护理.本组出现急性心包填塞3例,麻痹性肠梗阻l例,肺静脉狭窄5例,严重皮下血肿并出血性休克1例,急性左心衰1例,心包及胸腔积液3例,除肺静脉狭窄无症状未做治疗外,其余患者经及时治疗护理均康复出院.认为在术中、术后,应严密病情观察及生命体征监测,如血压、心率、心律、呼吸变化;时刻询问患者自觉症状,是否有头晕、胸闷、胸痛、气促等.术前配血,准备心包穿刺物品、升压药、止血药等急救药品,术中一旦出现心包填塞,立即予快速补液、升压、输血、止血,严密观察病情变化,做好穿刺引流和抢救准备,观察出血是否增加等;术后出现麻痹性肠梗阻时.予禁食、胃肠减压等;术后询问患者有无胸闷、气促、咳嗽等症状,及时发现肺静脉狭窄或闭塞的发生;做好心理护理,解除患者思想顾虑.     

膀胱功能训练仪对降低尿潴留的疗效观察

目的观察膀胱功能训练仪对降低留置尿管患者拔除尿管后发生尿潴留的疗效。方法选择2009年1月～2011年1月本科室留置尿管〉7d的患者80例,按入院的先后顺序分为实验组和对照组,每组各40例。对照组采用常规方法持续开放尿管引流尿液,并在拔管前1～2d间断夹闭尿管;实验组在留置尿管期间应用膀胱功能训练仪控制尿管的夹闭与开放,比较两组患者拔除尿管后第1次排尿时间以及排尿的有效率。结果实验组排尿总有效率高于对照组,拔除尿管后第1次排尿时间短于对照组（均P〈0.05）。结论在留置尿管期间应用膀胱功能训练仪控制尿管的夹闭与开放,维持膀胱的功能,能有效预防患者拔除尿管后发生尿潴留。     

心房颤动导管消融的地位和进展

心房颤动(房颤)是临床常见的心律失常之一,最大风险是血栓栓塞,常见是脑卒中。随着人口的老龄化,房颤人数持续增加,治疗问题也逐渐成为人们关注重点。房颤导管消融是其重要治疗方法之一,可明显改善房颤患者预后。且随着技术发展,消融方法也日趋成熟,故导管消融术治疗房颤地位正在逐步提升。但消融方法尚无固定术式,发生机制尚未完全明确,尤其对于持续房颤。因此房颤消融术仍存在一些问题有待进一步探索。     

射频消融术后心肌肌钙蛋白的变化

目的　观察射频消融术患者术前、术后血清心肌肌钙蛋白I(cTnI)、肌酸磷酸激酶同工酶 (CK MB)及心功能的变化 ,评价cTnI、CK MB在诊断心肌微小损伤中的灵敏性 ,探讨心肌损伤程度与消融因素的相关性。方法　选择行射频消融术 (RFCA)的阵发性室上性心动过速 (PSVT)患者 80例。每例患者均于术前及术后测定血清cTnI、CK MB水平及超声心动图。结果　术后 4～ 2 4小时cTnI及CK MB较术前明显增高 ,cTnI及CK MB升高倍数与消融能量无线性关系 (r =0 .2 0 ,P >0 .0 5 ;r =0 .2 6 ,P >0 .0 5 ) ,与消融时间、消融次数呈正相关 (r =0 .5 6 ,r =0 .4 2,P均 <0 .0 5 ;r =0 .37,r =0 .4 8,P均 <0 .0 5 )。心室侧消融术后 4～ 2 4小时cTnI的升高倍数和术后 4～ 2 4小时数值均显著高于心房侧消融 (P <0 .0 5 )。旁道组术后cTnI和CK MB升高倍数高于双径路组。RFCA术后左室射血分数 (LVEF)、左室短轴缩短率 (LVFS)、二尖瓣舒张早期最大流速 (E)及二尖瓣舒张晚期最大流速 (A)的比值 (E/A)与术前比较差异无统计学意义 (P >0 .0 5 )。结论　RFCA所造成的心肌损伤为小范围的损伤 ,不影响心脏的整体功能。检测这种微小损伤 ,cTnI的灵敏度较CK MB高。这种损伤与放电时间、放电次数、消融部位有关 ,而与放电能量无关。     

缓慢心室率心房扑动患者射频消融术后发生房室传导阻滞分析

目的探讨心房扑动射频消融术后出现房室传导阻滞的原因及对策。方法回顾性分析35例心房扑动患者,存在房室传导比率≥5:1,均采用消融下腔静脉至三尖瓣峡部,终点达到双向阻滞。29例于房扑下消融,6例是转窦性心律后消融,分析术后发生房室传导阻滞的原因。结果 9例患者术后发生I°至高度房室传导阻滞,其中4例患者恢复,5例患者未恢复。结论心房扑动行射频消融术有造成房室传导阻滞可能,但发生率低。缓慢心室率的心房扑动术前可能合并房室传导阻滞,转窦性心律后消融对增加手术安全性及是否存在并发症的判定有帮助。     

The results of radiofrequency catheter ablation of supraventricular tachycardia in children

BACKGROUNDS: Radiofrequency (RF) catheter ablation represents a major advance in the management of children with cardiac arrhythmias and has rapidly become the standard of care for the first-ling therapy of supraventricular tachycardias (SVTs). The purpose of this study was to investigate the results of the RF catheter ablation of SVTs in pediatric patients. METHODS: From December 1989 to August 2005, a total of 228 pediatric patients (age: 9 +/- 7 years, range: 5-18 years; male:female = 117:111) with clinically documented SVT underwent an electrophysiologic study and RF catheter ablation at our institution. RESULTS: The arrhythmias included atrioventricular reentrant tachycardia (AVRT; n = 140, 61%), atrioventricular nodal reentrant tachycardia (AVNRT; n = 66, 29%), atrial tachycardia (AT; n = 11, 5%), and atrial flutter (AFL; n = 11, 5%). The success rate of the RF catheter ablation was 92% for AVRT, 97% for AVNRT, 82% for AT, and 91% for AFL, respectively. Procedure-related complications were infrequent (8.7%; major complications: high grade AV block (2/231, 0.9%); minor complications: first degree AV block (6/231, 2.6%), reversible brachial plexus injury (2/231, 0.9%), and local hematomas or bruises (10/231, 4.3%)). The recurrence rate was 4.7% (10/212) during a follow-up period of 86 +/- 38 months (0.5-185 months). CONCLUSIONS: The RF catheter ablation was a safe and effective method to manage children with paroxysmal and incessant tachycardia. The substrates of the arrhythmias differed between the pediatric and adult patients. However, the success rate of the ablation, complications, and recurrence during childhood were similar to those of adults.     

Electrophysiologic characteristics and radiofrequency catheter ablation in children with Wolff-Parkinson-White syndrome

BACKGROUND: The majority of cardiac arrhythmias in children are supraventricular tachycardia, which is mainly related to an accessory pathway (AP)-mediated reentry mechanism. The investigation for Wolff-Parkinson-White (WPW) syndrome in adults is numerous, but there is only limited information for children. This study was designed to evaluate the specific electrophysiologic characteristics and the outcome of radiofrequency (RF) catheter ablation in children with WPW syndrome. METHODS: From December 1989 to August 2005, a total of 142 children and 1,219 adults with atrioventricular reentrant tachycardia (AVRT) who underwent ablation at our institution were included. We compared the clinical and electrophysiologic characteristics between children and adults with WPW syndrome. RESULTS: The incidence of intermittent WPW syndrome was higher in children (7% vs 3%, P=0.025). There was a higher occurrence of rapid atrial pacing needed to induce tachycardia in children (67% vs 53%, P=0.02). However, atrial fibrillation (AF) occurred more commonly in adult patients (28% vs 16%, P=0.003). The pediatric patients had a higher incidence of multiple pathways (5% vs 1%, P<0.001).Both the onset and duration of symptoms were significantly shorter in the pediatric patients. The antegrade 1:1 AP conduction pacing cycle length (CL) and antegrade AP effective refractory period (ERP) in children were much shorter than those in adults with manifest WPW syndrome. Furthermore, the retrograde 1:1 AP conduction pacing CL and retrograde AP ERP in children were also shorter than those in adults. The antegrade 1:1 atrioventricular (AV) node conduction pacing CL, AV nodal ERP, and the CL of the tachycardia were all shorter in the pediatric patients. CONCLUSION: This study demonstrated the difference in the electrophysiologic characteristics of APs and the AV node between pediatric and adult patients. RF catheter ablation was a safe and effective method to manage children with WPW syndrome.     

肛肠病术后尿潴留的护理进展

分析肛肠病术后产生尿潴留的原因,阐述了术后尿潴留的应对措施,为临床护理提供依据。     

肛肠病术后尿潴留的护理进展

分析肛肠病术后产生尿潴留的原因,阐述了术后尿潴留的应对措施,为临床护理提供依据。     

导管射频消融治疗右室流出道室性早搏的护理

目的探讨导管射频消融治疗右室流出道室性早搏的护理方法。方法对52例右室流出道室性早搏患者,采用射频消融治疗,并给予心理护理和基础护理。结果52例均完成了射频消融治疗。随访2~60个月,根治率92.3%(48/52),有效率98.1%(51/52)。结论合理、细致的护理可消除患者的恐惧心理,提高手术耐受性,且能及早发现和防治并发症,增加手术的安全性。     

使用射频自凝刀治疗子宫肌瘤的护理配合

2003年4月-2004年3月选择自愿接受射频自凝刀治疗并经B超检查发现孤立的直径≤5cm的子宫肌瘤患者104例,在B超引导下经阴道、宫颈将射频自凝刀插入肌瘤进行治疗,笔者主要报道术前、术中及术后护理配合要点:由于是新开展项目,术前向患者及其家属介绍本方法的优点,使患者以良好的心态配合治疗;术中密切观察患者面色、呼吸、心率、血压的变化及有无腹痛,及时清除自凝刀头上粘连的气化组织,保证治疗效果;术后注意观察腹痛、阴道流血水样分泌物的情况,及有无发热。