肺动脉漂浮导管在肺动脉高压患者应用的护理

目的探讨肺动脉高压患者行肺动脉漂浮导管术的护理配合要点及经验。方法对12例经超声心动图诊断的肺动脉高压患者采用肺动脉漂浮导管测量肺动脉压,护理配合要点在于配合医生时注意无菌操作、密切观察压力曲线变化、准确准时记录肺动脉压、密切观察患者的生命体征及不适症状。结果 12例患者均顺利完成肺动脉漂浮导管术,8例患者确诊为肺动脉高压,无严重并发症出现。结论肺动脉漂浮导管术可明确诊断肺动脉高压,操作过程中严密的监测及护理配合可防止并发症的发生。     

38例肺动脉高压患者行右心导管检查围手术期护理

肺动脉高压（pulmonary arterial hypertension,PAH）是指以肺血管阻力进行性增高,并导致右心室衰竭及死亡为特征的一组疾病;依据《肺动脉高压诊断和治疗指南》[1],PAH定义标准为：静息状态下右心导管检查平均肺动脉压大于25mmHg,同时肺毛细血管嵌顿压低于15 mmHg.右心导管检查不仅可以检查右心和肺动脉的血流动力学情况,排除心内分流、异常引流和其他左心疾病,协助查找肺动脉高压的病因,可同时进行急性肺血管扩张实验,评估治疗及预后[1].现对肺动脉高压患者右心导管检查围术期护理总结如下.     

特发性肺动脉高压病人心导管检查围术期护理

正特发性肺动脉高压(IPAH)表现为不明原因的进行性发展的肺血管重建,肺血管阻力和肺动脉压力持续增高,最终导致右心衰竭。心导管检查可以评估心脏和肺动脉的血流动力学情况,排除心内分流、异常引流及左心系统疾病,协助查找IPAH的病因。心导管检查和急性肺血管反应性试验已成为国际上IPAH规范诊治的重要手段~([1-2])。IPAH病人病情重,行心导管检查术风险大,术后并发症发生率高,因此,除了熟练     

彩色多普勒超声在扩展先天性室间隔缺损合并重度肺动脉高压患者手术适应证中的研究

目的 彩色多普勒超声在扩展先天性室间隔缺损(VSD)合并重度肺动脉高压(PH)患者手术适应证中的应用价值.方法 选取先天性VSD并重度PH患者30例,肘静脉注射腺苷75 μg·kg-1·min-1,应用彩色多普勒超声心动图检测主动脉平均压、肺动脉平均压、肺动脉收缩压、肺动脉舒张压、肺循环阻力、体循环阻力、肺循环阻力/体循环阻力比值、肺动脉/主动脉收缩压比值、肺循环/体循环血流量比值,注射5分钟后肺血管阻力下降>30%和肺动脉平均压下降>10%为急性血管扩张试验阳性.结果 17例急性血管扩张试验阳性者,通过临床药物降压治疗有效后成功手术;13例药物试验阴性者继续降压治疗无效.结论 通过腺苷急性血管扩张试验,可以判断肺动脉高压的可逆性,彩色多普勒超声心动图在扩展先天性室间隔缺损合并重度肺动脉高压患者手术适应征中起到初步筛选的作用.     

超声心动图在吸入伊洛前列素急性血管反应试验中的应用价值

目的 在吸入伊洛前列素急性血管反应试验中应用超声心动图监测肺动脉高压患者血流动力学参数,探讨这一无创检查方法的临床应用价值.方法 2007年9月至2008年12月北京朝阳医院住院确诊肺动脉高压患者43例,男20例,女23例,年龄25～75岁,平均(50±14)岁,其中40例行右心导管检查,3例漂浮导管失败改为超声心动图监测.超声心动图测量指标包括:三尖瓣反流压差、肺动脉瓣舒张期最大反流压差、肺动脉瓣舒张末期反流压差、下腔静脉最大内径、下腔静脉最小内径,计算肺动脉收缩压(SPAP)、肺动脉舒张压(DPAP)、肺动脉平均压(MPAP)、右心输出量(RCO)并与右心导管作比较.结果 吸药前超声心动图测量肺动脉压力SPAP、DPAP及MPAP与右心导管测值之间有良好相关性(r分别为0.904、0.823及0.861,均P＜0.001);2种方法测得的右心输出量之间有相关性(r=0.946,P＜0.001).急性血管反应试验阳性患者7例.结论 超声心动图作为一种无创性评价肺动脉压力的检测方法应用于临床,尤其对于不能进行右心导管检查的患者,可以考虑作为替代检查,为临床医师提供诊疗依据.     

Berry综合征的影像学诊断

目的探讨多种影像技术对Berry综合征的诊断价值。 方法选取2005年3月至2014年12月武汉亚洲心脏病医院收治的12例Berry综合征患者,对其超声心动图及CT图像、导管检查结果进行分析。 结果12例患者均行超声心动图及CT检查,超声心动图检查10例诊断为Berry综合征,超声显像可见Ⅱ型主-肺动脉间隔缺损,均合并右肺动脉起源于主动脉,且可见A型主动脉弓离断合并粗大动脉导管未闭,CT检查12例患者均诊断为Berry综合征。5例患者行导管检查,3例考虑为阻力型肺动脉高压,放弃手术治疗。 结论超声心动图结合CT检查是诊断Berry综合征的可靠手段,手术指征的判断需结合心导管检查、心血管造影,肺动脉压力及阻力是影响手术时机与预后的关键因素。     

呼吸系统相关性肺高血压40例超声及右心导管检查分析

目的探讨呼吸系统相关性肺高血压患者的彩色多普勒超声与右心导管检查结果之间的关系。方法对40例临床诊断为呼吸系统相关性高血压患者的彩色多普勒超声及右心导管检查资料进行分析。结果彩色多普勒超声测出肺动脉收缩压为（62±12.1）mmHg;右心导管检查肺动脉收缩压为（67±22.3）mmHg,肺动脉平均压为（40.8±13.2）mmHg。结论彩色多普勒可用于早期发现及筛查肺动脉高压（PAH）。     

肺动脉高压早期诊断及其临床意义的研究

作者于1995年1月至1998年7月通过对36例COPD患者同步进行右心导管直接测定肺动脉压和动脉血气分析检查,对肺动脉高压的早期诊断及其临床意义进行初步研究。材料和方法1.病例选择　选择呼吸内科住院病人36例,其中男31例,女5例,年龄38～67岁。所有患者按有关标准确诊为COPD,其中6例合并慢性肺源性心脏病。2.肺动脉压的直接测定　自右贵要静脉插入微型心导管(4F,125cm)。将微导管通过PTM-6型压力传感器与PTM-6型生理压力测试仪连接测压,再连接HB-3COG三笔心输出量机作压力曲线,肺阻抗血流图或微分图和心电图的同步描记。以BJ-2型心电…     

雾化吸入伊洛前列环素治疗肺动脉高压的疗效观察与护理

目的:观察雾化吸入伊洛前列环素在治疗肺动脉高压患者中的作用,并实施相应的护理措施。方法:对20例肺动脉高压患者分别给予20μg的伊洛前列环素实施雾化吸入,吸入15min后,通过右心导管接压力连接管测量各部位压力,观察患者肺动脉收缩压、肺动脉平均压、肺动脉舒张压、肺小动脉嵌顿压、心率的变化。结果:经吸入伊洛前列环素雾化治疗后,20例患者肺动脉压力均有下降。患者、血压、心率无明显变化。结论:雾化吸入伊洛前列环素,配合精心的护理,能有效、安全的降低肺动脉压力,达到理想的治疗效果。     

重度肺动脉高压患者全身麻醉下行肺叶切除术的护理

总结了1例重度肺动脉高压患者在全身麻醉下行肺叶切除术的护理经验.对患者进行严密的围术期护理,留王肺动脉导管监测肺血流动力学,应用伊洛前列素等肺血管扩张剂预防肺动脉高压危象的发生,对已发生的肺动脉高压危象进行积极处理,患者恢复,顺利出院.     

Doppler echocardiographic evaluation of pressure in the pulmonary artery in children with congenital heart defects

In children with congenital heart disease serial noninvasive assessment of the pulmonary vascular bed is desirable in order to determine the appropriate timing of cardiac catheterization and corrective surgery. To assess the value of pulmonary Doppler echocardiography for the estimation of pulmonary arterial pressure we correlated the rightsided systolic time intervals (preejection period, acceleration period, ejection period) derived from pulmonary artery Doppler traces with catheterization data (systolic, mean and diastolic pulmonary arterial pressure, total and vascular pulmonary resistances). 62 children aged from 1 month to 15 years suffering from congenital heart disease (n = 52), from rheumatic heart disease (n = 4), from cardiomyopathy (n = 5) or from primary pulmonary hypertension (n = 1) were investigated. The major finding was a highly significant correlation between the acceleration period and the systolic pulmonary arterial pressure (r = 0.79; p less than or equal to 0.0001). However the acceleration period could not be used for prediction of pulmonary arterial pressure in children with poor myocardial contractility.     

心导管介入治疗先天性心脏病复合畸形的护理

随着介入治疗技术的日渐成熟和新型封堵器械的不断出现,经导管介入治疗某些单纯型先天性心脏病已成为替代外科手术的一种有效治疗方法。我院2004年8月～2009年8月对128例先天性心脏病复合畸形经心导管同期进行介入治疗,取得了满意的效果,现将护理报告如下。     

Pulse oximetry during cardiac catheterization in children with congenital heart disease

One hundred and five children with congenital heart disease were monitored by pulse oximetry during cardiac catheterization. Excellent correlation (r = 0.95) was found between oxygen saturation values obtained with pulse oximetry and those obtained from arterial blood in 133 data pairs. This correlation was described by the regression equation y = 0.91 x + 8.1. The correlation was also excellent in 47 data pairs with saturation values of less than 90% (r = 0.94, y = 0.93x + 6.0) from 36 cyanotic children. The clinical usefulness of pulse oximetry in the early recognition of decreased pulmonary blood flow or partial airway obstruction was demonstrated. Early diagnosis of changes in oxygenation was especially helpful in children with cyanotic congenital heart disease, in whom small changes in arterial oxygen tension may cause large changes in oxygen saturation.     

Pulmonary Hypertension: Evaluation and Management

Pulmonary hypertension (PH) is a hemodynamic state characterized by elevation in the mean pulmonary arterial pressure and pulmonary vascular resistance leading to right ventricular failure and premature death. PH can be the result of a variety of diseases of different etiologies. Pulmonary arterial hypertension (PAH) should be distinctly differentiated from pulmonary venous hypertension (PVH) as a result of left heart disease. PAH is commonly caused by or associated with an underlying pulmonary, cardiac, or systemic disease (APAH). In the absence of an identifiable etiology or associated underlying disease, PAH is referred to as idiopathic (IPAH). IPAH, formerly known as primary pulmonary hypertension (PPH), is a rare disease most commonly seen in women of childbearing age. Presenting symptoms and signs are nonspecific and include dyspnea on exertion, fatigue, and a loud pulmonary component of the second heart sound. Transthoracic Doppler echocardiography is an excellent noninvasive test to detect the presence of pulmonary hypertension, although every patient should receive a right heart catheterization to confirm the diagnosis. A detailed work up, including laboratory tests and imaging studies, is also indicated to rule out known causes of pulmonary hypertension. Several targeted treatment options have become available in recent years and include parenteral and inhaled prostanoids, oral endothelin receptor antagonists, and oral phosphodiesterase type-5 inhibitors. As a result of their complex care, patients should be referred to centers with expertise in pulmonary hypertension.     

多普勒超声心动图估测全肺阻力的研究

目的　探索应用多普勒超声技术估测全肺阻力（ＴＰＲ）的新方法。方法　对６０ 例左向右分流的先天性心脏病患儿,应用多普勒超声技术,根据改良肺动脉／ 主动脉血流时间间期比法（ＦＰＡ／ＦＡＯ） 和容积血流测量技术估测肺动脉收缩压（ＰＡＳＰ） 、平均压（ＰＡＭＰ） 及肺血流量（ＱＰ） ,按Ｐｏｉｓｅｕｉｌｌｅ 公式计算ＴＰＲ,并与心导管实测值对比。结果　多普勒超声技术估测的ＰＡＳＰ、ＰＡＭＰ、ＱＰ、ＴＰＲ与心导管实测值高度相关（ｒ＝ ０．８６、０ ．８６ 、０．７１、０ ．７５ ,Ｐ＜ ０．００１）。结论　多普勒超声技术可准确地估测ＴＰＲ。     

一例先天性巨大冠状动脉右室瘘患者介入治疗的护理体会

冠状动脉瘘（Coronary arterial fistula,CAF）是一种罕见的先天性心脏病,其发病率极低。目前认为CAF是由于心脏胚胎发育过程中心肌窦状间隙未能退化而持续存在所形成的冠状动脉主干或其分支与心脏或血管间的异常通道。     

婴幼儿先天性心脏病行深低温体外循环术后肺动脉高压使用一氧化氮的临床效果评价

目的评估吸入一氧化氮治疗先天性心脏病体外循环术后肺动脉高压的效果。方法20例先天性心脏病术后有肺动脉高压或肺高压危象临床表现患者,用吸入一氧化氮法治疗,比较治疗前后中心静脉压和血氧分压的变化。结果20例患者在其他治疗不变的前提下,经过吸入一氧化氮治疗后,中心静脉压比治疗前明显下降,血氧分压比治疗前明显增高,差异有显著意义[（58．24±16．8）kPaVS．（46．0±13．9）kPa,P〈0．05;（13．2±4．70）mmHgVS．（24．3±4．4）mmHg,P〈0．05]（1mmHg=0．133kPa）。结论吸入一氧化氮治疗先天性心脏病体外循环术后肺动脉高压有良好的临床效果。     

Right atrial emptying fraction non-invasively predicts mortality in pulmonary hypertension

Right-sided heart failure is the most common cause of death in pulmonary hypertension (PH). Echocardiographic measurements of right atrial (RA) size are associated with worse outcome in PH, however the association between RA function and death in PH has not been well-described. 160 PH patients (World Health Organization groups 1–5) underwent cardiac magnetic resonance imaging (cMRI) and right heart catheterization (RHC) within 6 weeks of each other at a tertiary care academic medical center in the United States. We measured cMRI RA maximum and minimum volumes indexed to body surface area and calculated RA emptying fraction (RAEF). We evaluated the relationship between RAEF and clinical variables with death using Cox proportional hazard models. 57 deaths occurred during a median follow-up of 3.5 years (36?% died overall, 10?% per year). RAEF was directly correlated in univariate analyses with right ventricular (RV) ejection fraction, left ventricular (LV) ejection fraction, LV size, cardiac index, absence of tricuspid and pulmonic regurgitation, absence of pericardial effusion, estimated glomerular filtration rate, 6-minute walk distance, and pulmonary arterial oxygen saturation, whereas it was inversely correlated with death, BNP, heart rate, mean RA pressure, mean PA pressure, pulmonary and systemic vascular resistance, RV size, and RA size. Using multivariate analyses, RAEF had a robust inverse association with death after adjusting for measured risk factors (HR per 5?% change in RAEF: 0.83 [95?% CI 0.73–0.94], p?=?0.003). In PH patients, decreased RAEF by cMRI is independently associated with worse survival after adjustment for other risk factors.     

超敏C-反应蛋白与心脑血管疾病的研究进展

Along with the increased incidence of cardiac-cerebral vascular disease and the development of medicine,more study focus on cardiovascular and cerebrovascular diseases. In recent years, reseasher pay more and more attention to the role of serum high sensitive C-reactive protein （hs-CRP） in cardiac-cerebral disease. Serum hs-CRP is an independent risk factor of cardiac-cerebral vascular disease. It is closely related to the occurrence,de- velopment and predictability of hypertension,coronary heart disease as well as stroke. Soft can be used as the index of disease diagnosis and condition monitoring, with value of clinical popularization. Research progressions of hs- CRP and cardiac-cerebral vascular disease will be briefly described in the article.     

The effects of music intervention on anxiety in the patient waiting for cardiac catheterization.

BACKGROUND: Hospitalization causes anxiety for many patients. It increases when patients anticipate their turn for cardiac catheterization. Music therapy reduces the psychophysiologic effects of anxiety and stress through the relaxation response. AIM: To determine the effects of music therapy an anxiety, heart rate and arterial blood pressure in patients waiting for their scheduled cardiac catheterization. METHODS: In a quasi-experimental, pretest-posttest design, 101 subjects were randomly assigned to either the test group: those who listened to 20 minutes of preselected music, or the control group: those who received treatment as usual. Subject anxiety levels and physiological values were measured while waiting their turn for cardiac catheterization and just prior to departure to the cardiac lab. RESULTS: 63 males and 38 females participated in the study. There was a statistically significant reduction in anxiety in the test group alone (P = 0.003) and in comparing the test to the control group (P = 0.004). In comparing the initial and departure physiologic values, it was noted that both heart rate and systolic blood pressure dropped in the test group, but increased in the control group. Within gender groups, there were no statistically significant differences in hemodynamics or STAI scores, but between gender groups there were significantly higher diastolic blood pressure in males and STAI initial and departure scores for females. DISCUSSION: Patients waiting for their cardiac catheterization benefit from music therapy. Anxiety and the heightened physiological values elicited by the stress response are reduced. Results also suggest that women waiting for cardiac catheterization experience a higher level of anxiety than males.