剖宫产术中宫腔填塞纱布止血的手术配合及护理

1997～ 2 0 0 1年 ,我院对 3 0例剖宫产术中出血患者行宫腔填塞纱布止血 ,效果良好 ,现将手术配合及护理体会介绍如下。临床资料 :3 0例患者年龄 2 3～ 3 2岁 ,平均 2 7岁 ;初次怀孕 2 2例 ,第二次怀孕 8例 ,均为初产妇 ;剖宫产术中出血量为80 0～ 2 0 0 0 ml,平均 140 0 ml,应用大剂量缩宫素、止血药效果不满意改行宫腔填塞纱布 (自制 )止血。治疗方法 :填塞纱布条均为消毒绷带 ,两侧毛边包裹在里 ,折叠为四层。应用时用卵圆钳夹住纱布一端 ,沿宫底自左向右填塞至宫腔上半部 ,不留死腔 ;取另一端自宫颈管穿至阴道 ,然后继续填塞纱布条至子…     

可抽取性纱布填塞法在成人难治性心血管外科出血中的应用

目的探讨难治性心血管外科出血的应对策略。方法我院2008年1月—2011年5月成人心外科7652例体外循环手术中,对31例常规止血难以控制的病例采用可抽取性纱布填塞局部压迫的方法进行总结分析。结果 29例患者有效地控制了出血,缩短了手术时间,3例二次开胸,没有相关感染、心包填塞等并发症发生。围术期死亡2例。结论可抽取性纱布填塞法可减少手术时间、避免二次开胸的手术风险,是一种有效应对心外科难处理大出血的方法之一。     

心脏术后出血再次剖胸止血14例分析

心脏术后出血再次剖胸止血１４例分析青岛医学院附属医院（２６６００３）荣佑宝，李贞福，高洪波，战晓春１９９２－１９９６年，我们对１４例心脏术后出血患者行再次剖胸止血，均治愈。现总结如下。１临床资料本组男１１例，女３例；年龄４－４０岁；体重１３－６７ｋｇ...     

腹膜透析在小儿心脏直视术后的应用

随着小儿心脏直视手术的广泛开展及手术适应证的日益扩大。术后急性肾功能衰竭和低心排综合征等严重并发症的发生率也随之升高。近年来有研究证实腹膜透析（PD）用于治疗小儿心脏直视术后急性肾功能衰竭和顽固性低心排综合征,疗效良好。现将PD在小儿心脏直视术后的应用情况综述如下。     

心脏直视手术后延迟关胸的护理

目的：总结1999年7－12月期间11例心脏直视手术病人术后因氏心排综合征,心律失常等原因延迟关胸的监护经验。方法：敞开胸骨的方法是在胸骨间放置不同大小的塑料注射器外套管支撑胸骨,心包及纵隔分别放置引流管,胸骨正中切口覆盖医用橡胶薄膜并与皮肤缝合密封固定,再用医用薄膜手术巾覆盖。结果：延迟关胸时间1－7天,平均2．5天,其中8例血流动力学指标逐步改善,痊愈出院,3例因重度低心排而死亡。结论：延迟关胸是重症心脏病手术后血流动力学逐步获得改善的一种有效方法,术后仔细观察血流动力学指标。心包及胸骨后引流量,切口保护膜形状及四周有无渗液,预防切口感染非常重要。     

心脏直视手术后延迟关胸的探讨

目的：本文旨在探讨延迟关胸的病理学基础、操作方法及延迟关胸的适应证,对象：我科自1999年9月－2000年10月,共有24例患者接受延迟关胸治疗,平均年龄为37．8岁,其中17例痊愈,7例死亡;延迟关胸时间为2－4．5d,平均2．8d。结论：心肌细胞,心肌细胞间质及肺间质的一过性水肿,将导致心肌收缩力减弱;胸壁等软组织在牵拉后也会出现一定程度的水肿,对于部分患者,勉强拉闭胸骨会出现“压逼综合征”,危及生命,良好地掌握延迟关胸的适应证及关胸指征可以有效地降低心脏直视手术的死亡率。     

可溶止血纱布在腭裂术中的应用

2001年3月－2005年12月,我们对45例行腭裂术患者的术后松弛切口采用可溶止血纱布处理,疗效满意。现报告如下。     

心脏直视术后急性心包填塞的诊断及处理

本文报告6例心脏直视术后发生心包填塞的原因和诊治体会,并提出5条主要预防措施。     

可吸收性止血棉在老年功能性鼻内镜术后填塞中的疗效

目的探讨可吸收性止血棉在老年功能性鼻内镜术后填塞的疗效。方法选取2012年2月至2013年2月在该院耳鼻喉科行功能性鼻内镜术治疗的老年慢性鼻窦炎、鼻息肉患者106例,随机分为可吸收性止血棉(观察组)和凡士林纱条(对照组),每组53例,对比两组患者填塞期不适感、术后24 h内鼻腔渗血情况、术后48 h出血情况。结果观察组患者出现不适感的例数明显少于对照组(P<0.01);观察患者术后24 h内鼻腔渗血量明显低于对照组(P<0.01);观察组患者术后48 h再出血率明显低于对照组(P<0.01)。结论可吸收性止血棉是一种较好的功能性鼻内镜术后止血材料,能够有效减轻老年患者术后不适感,减少术后鼻腔出血量。     

延迟关胸技术在小儿开胸心脏术后的应用

目的介绍延迟关胸技术在先天性心脏病手术中的应用。方法研究阜外医院心外科2001年1月～2002年12月期间小儿开胸心脏手术的临床资料,其中有8例成功延迟关胸,并痊愈出院。结果延迟关胸的原因1例为出血,其他7例为血液动力学不稳定。胸骨敞开时间平均为3.1d(2～5d)。延迟关胸后,血管活性药物剂量明显下降,血液动力学稳定,其中平均动脉压上升15.4mmHg(1～24.6mmHg)。结论对于小儿开胸心脏手术后出现的血液动力学不稳定、低心排、出血,延迟关胸是一种安全而有效的解决方法。     

心脏直视术后胸骨裂开的处理

目的探讨心脏直视术后胸骨裂开的原因、诊断和治疗。方法回顾分析2007年5月至2012年6月我院心脏直视术后并发胸骨裂开的26例病例,探讨其病因、早期诊断及治疗。结果26例患者均在全麻下二次开胸行胸骨固定术,同时积极治疗伴发病,加强支持治疗,患者全部治愈,伤口愈合平均时间（15．09±4．41）d。结论伤口局部的症状、体征,术后异常引流液和x线胸片检查对心脏直视手术后胸骨裂开的诊断和治疗有着重要意义;及早发现与正确的术中和术后处理是治疗胸骨裂开的关键。     

Delayed sternal closure as a safe adjunct to support biventricular failure after open heart surgery

Over a four-year period, 22 patients of 2495 undergoing open heart surgery sustained severe biventricular failure (BVF) and would not tolerate primary sternal closure. Reasons for BVF included intraoperative injury, perioperative infarction, global dysfunction, cardiopulmonary edema, and intractable arrhythmia. Mechanical assist devices were required in nine patients. Average cardiac index fell to 1.1 L/min/m2 with attempts to close the chest, then stabilized at 1.9 with the sternum open and only soft tissue closed. After 3 to 11 days, cardiac index rose to 2.5 when assist devices were removed, inotropic agents decreased, and the sternum closed. Three early deaths (5-12 days) were caused by progressive biventricular failure. Five later deaths (19-64 days) were associated with renal and respiratory failure, superinfection, and sepsis. All of these required tracheostomy. Survival of 14 patients was not related to early low cardiac output, preoperative status, timing of sternal closure, or age, but was associated with early recovery of respiratory function without need for tracheostomy, avoidance of renal failure, and satisfactory alimentation. Sternal infection occurred in three patients, resulting in one death. The hospital stay ranged from 12 to 230 days. There was one death resulting from respiratory failure 14 months postoperatively. Our findings show that delayed sternal closure lessens early cardiac instability during BVF, helps allow recovery, and does not produce long-term disability.     

Use of sternal zipper in open heart surgery]

A sternal zipper was used in 50 patients with an unstable haemodynamic condition after open heart surgery. The patients were 19 women and 31 men (average age 51.6 years, range 7 to 67 years). The indications for surgery were aortocoronary bypass in 25 cases, replacement of the ascending aorta in 7 cases, valve replacement in 16 cases and correction of congenital heart disease in 2 cases. Twenty eight patients required circulatory assistance. The sternal zipper was used for 4 to 72 hours (average 29.5 hours) and mediastinal toilet was performed at least every 24 hours. At each opening of the zipper, 3 bacteriological swabs were taken from 3 different sites in the mediastinum and sent for culture. Global mortality was 36% (N = 18). The cause of death was a low output syndrome in 12 cases, hepatic and renal failure in 2 cases, resistant arrhythmia in 1 case, neurological complication in 1 case and septicaemia in 2 cases. There was one late death 3 months after hospital discharge which was attributed to a cardiac arrhythmia. The sternal zipper would seem to be a valuable option when the operative conditions are difficult, allowing the chest to remain open, so preventing cardiac compression during a critical period.     

Upper gastrointestinal bleeding following open heart surgery

We reviewed our experience with endoscopically evaluated severe upper gastrointestinal hemorrhage following open heart surgery. Of 4892 patients undergoing open heart surgery, 18 (0.4%) sustained upper gastrointestinal hemorrhage requiring endoscopic evaluation. Endoscopy identified the source of bleeding in all cases. No significant complications of endoscopy were observed. Duodenal ulcers (DUs) were found in 16 (89%) of cases and were felt to be the source of bleeding in 15 (83%). Aggressive features, such as multiplicity, large size, or distal location were associated with 13 (81%) of the DU cases. Complications necessitated endoscopic or surgical therapy in eight (44%) patients with DUs. We conclude that aggressive DU disease accounts for the majority of severe upper gastrointestinal bleeding following open heart surgery.     

Proton pump inhibitors may increase the risk of delayed bleeding complications after open heart surgery if used concomitantly with warfarin

OBJECTIVES: The American Food and Drug Administration has suggested that proton pump inhibitors increase the international normalized ratio (INR) when used concomitantly with warfarin, by being metabolized by cytochrome P450 2C19. We therefore reviewed patients taking warfarin. METHODS AND RESULTS: Two hundred and forty patients who took warfarin after surgery were divided into two groups: Group I (n = 114) had rabeprazole (10 mg/day) and Group II (n = 126) had lansoprazole (15 mg/day). The initial dose of warfarin was 3 mg and INR was initially assessed on postoperative day 4. Initial INR was significantly lower in Group I (1.66 +/- 0.87) than in Group II (2.06 +/- 1.03, P = 0.0011). Delayed cardiac tamponade and hemothorax occurred as complications in 6 and 1 patients, respectively, in Group II from 5 days to 3 months postoperatively. At the time of the occurrence of complications, the average INR increased to 3.95 (range from 3.11 to 5.86). There were no patients with delayed bleeding in Group I ( P = 0.015). CONCLUSIONS: These results suggest that lansoprazole emphasizes the effects of warfarin. Rabeprazole could be safely used concomitantly with warfarin.