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Nursing Care of Mental Disorders Caused by Sodium Nitroprusside Used for Patients with DeBackey Ⅲ Aortic Dissection

【摘要】　目的　Ⅲ型主动脉夹层非体外循环腔内支架隔离术在围手术期应用硝普钠控制性降压易导致精神失常，总结相关护理经验。　方法　2009年7月-2010年2月确诊Ⅲ型主动脉夹层动脉瘤患者36例，围手术期应用硝普钠控制性降压，均采用非体外循环主动脉腔内隔离术治疗，排除手术、麻醉等因素所致脑损伤而产生的术后精神异常。　结果　有5例出现不同程度精神失常，经加用口服降压药，减少硝普钠泵入剂量，缩短硝普钠使用时间，经过精心治疗及护理，患者精神异常症状逐渐减轻直至消失。　结论　长期、大剂量应用硝普钠易导致精神失常，需加强护理，及时发现，及时处理。【Abstract】　Objective　To summarize the nursing experiences for mental disorders caused by sodium nitroprusside used to cure hypertension in patients receiving off-pump intervention surgery for DeBackey Ⅲ aortic dissection.　Methods　From July 2009 to February 2010, 36 patients were diagnosed to have DeBackey Ⅲ aortic dissection in our department. All patients received off-pump intervention surgery. We used sodium nitroprusside to control hypertension during the operation. Mental disorders caused by brain damage from surgery, anesthesia and other factors were ruled out.　Results　Five patients suffered from psychiatric disorders. Oral antihypertensive drugs were used, and we reduced the dose and shortened the time of using sodium nitroprusside. After intensive treatment and care, the symptoms of mental disorders alleviated and disappeared.　Conclusion　Long-term and large dose of sodium nitroprusside can easily lead to mental disorders, which requires intensive care, timely detection and treatment.

Postoperative Care of One Infective Endocarditis Patient with Isolated Kidney on the Right Side

ObjectiveTo discuss the key nursing points for patients with infective endocarditis and congenital isolated kidney after valve replacement. MethodsIn December 2012, one infective endocarditis patient with isolated kidney underwent heart valve replacement in our hospital. In addition to actively preventing postoperative infection of the heart valve, our nursing focused mainly on the isolated kidney protection and monitoring, and the related complications. ResultsThe surgery was successful, and the isolated kidney was effectively protected. The patient recovered and was discharged from the hospital. ConclusionFor patients with congenital isolated kidney with infective endocarditis, patients' urine output per hour and 24 h discrepancy quantity should be closely observed after valve replacement surgery. It is also very important to intervene early and carry out comprehensive protection of the renal function.

主动脉窦动脉瘤破裂合并妊娠前置胎盘的围手术期护理一例

自制人形保护垫在无创通气患者面部压疮预防中的应用

目的探讨自制人形保护垫在无创通气患者面部压疮预防中的应用效果。 方法2014年6月－10月，将心脏术后使用无创呼吸机辅助通气的144例患者按入院时间分为对照组72例和试验组72例，对照组采用传统方法护理面部受压皮肤，试验组在传统护理方法的基础上加用自行设计剪裁的人形保护垫贴于患者受压皮肤。 结果对照组发生面部压疮6例，其中Ⅰ期压疮4例，Ⅱ期压疮2例；试验组0例压疮发生；两组压疮发生率差异有统计学意义（P＜0.05）。 结论人形保护垫在预防无创呼吸机辅助通气患者头面部机械性压疮方面有重大意义和价值，降低了压疮发生的风险，减轻了工作人员的负担，避免了患者因面部压疮导致的痛苦和形象受损，值得临床推广。

持续气道正压治疗婴幼儿心脏术后并发低氧血症的护理

【摘要】 目的 总结鼻塞式持续呼吸道正压通气治疗心脏术后婴幼儿低氧血症的效果和护理。 方法 2008年1-12月对26例心脏术后并发低氧血症的患儿使用鼻塞式持续呼吸道正压通气，吸入氧浓度60%～80%，治疗时间24～48 h。 结果 23例治疗24～48 h后临床症状完全缓解。3例患儿由于心功能差，在治疗过程中出现进行性呼吸困难，再次行气管插管机械通气，2例治愈，1例死亡（死于低心排综合征）。 结论 鼻塞式持续呼吸道正压通气是治疗患儿心脏术后低氧血症的有效方法。

Subclinical thyroid dysfunction and risk of atrial fibrillation: a meta-analysis

ObjectiveTo systematically review the relationship between subclinical thyroid dysfunction and the risk of atrial fibrillation.MethodsDatabases including PubMed, EMbase, The Cochrane Library, Web of Science, CNKI, CBM, VIP and WanFang Data were electronically searched to collect cohort studies on associations between subclinical thyroid dysfunction and atrial fibrillation from inception to June 2020. Two reviewers independently screened literature, extracted data, and evaluated risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software.ResultsA total of 11 studies involving 620 874 subjects and 19 781 cases were included. Meta-analysis showed that subclinical hypothyroidism was not associated with atrial fibrillation (adjusted RR=1.20, 95%CI 0.92 to 1.57, P=0.18) and subclinical hyperthyroidism could increase the risk of atrial fibrillation (adjusted RR=1.65, 95%CI 1.12 to 2.43, P=0.01). Subgroup analysis showed that for the community population, subclinical hypothyroidism was not associated with atrial fibrillation (adjusted RR=1.03, 95%CI 0.84 to 1.26, P=0.81); for cardiac surgery, subclinical hypothyroidism could increase the risk of atrial fibrillation (adjusted RR=2.80, 95%CI 1.51 to 5.19, P=0.001); subclinical hyperthyroidism could increase the risk of atrial fibrillation among patients with TSH≤0.1 mlU/L (adjusted RR=2.06, 95%CI 1.07 to 3.99, P=0.03) and TSH=0.1～0.44 mlU/L (adjusted RR=1.29, 95%CI 1.01 to 1.64, P=0.04). ConclusionsSubclinical hypothyroidism is not associated with atrial fibrillation and subclinical hyperthyroidism can increase the risk of atrial fibrillation. Due to limited quantity and quality of included studies, more high quality studies are needed to verify above conclusions.

Perioperative Care for Full Thoracoscopic Bipolar Radiofrequency Ablation of Simple Atrial Fibrillation

目的　探讨全胸腔镜下Box Lesion双极射频消融术治疗单纯性房颤的围手术期护理方法与要点。方法　对2011年5月－2011年9月拟行全胸腔镜下Box Lesion双极射频消融（双侧肺静脉+左心房后壁隔离）治疗的6例心房纤颤患者，术前做好心理疏通及各项手术准备；术后采取各项对症措施加强呼吸道、心律、引流、疼痛等监测与护理。 结果　6例患者均在术后即刻转复为窦性心律，无死亡，无并发症发生，术后7 d均顺利出院。出院后4周复查均为窦性心律。 结论　全胸腔镜下行Box-lesion双极射频房颤术是治疗单纯性房颤的有效手段，严密的观察及精心护理是手术顺利施行和疾患治愈的重要因素。

Risk factors for postoperative hypoxemia in patients with Stanford type A aortic dissection: A systematic review and meta-analysis

Objective To systematically evaluate the risk factors for hypoxemia after Stanford type A aortic dissection (TAAD) surgery. Methods Electronic databases including PubMed, EMbase, The Cochrane Library, Web of Science, CNKI, Wanfang Data, VIP and CBM were searched by computer to collect studies about risk factors for hypoxemia after TAAD published from inception to November 2021. Two authors independently assessed the studies' quality, and a meta-analysis was performed by RevMan 5.3 software. ResultsA total of 19 case-control studies involving 2 686 patients and among them 1 085 patients suffered hypoxemia, included 21 predictive risk factors. The score of Newcastle-Ottawa scale≥7 points in 16 studies. Meta-analysis showed that: age (OR=1.10, 95%CI 1.06 to 1.14, P＜0.000 01), body mass index (OR=1.87, 95%CI 1.49 to 2.34, P＜0.000 01), preoperative partial pressure of oxygen in arterial blood/fractional concentration of inspiratory oxygen (PaO2/FiO2)≤300 mm Hg (OR=7.13, 95%CI 3.48 to 14.61, P＜0.000 01), preoperative white blood cell count (OR=1.34, 95%CI 1.18 to 1.53, P＜0.000 1), deep hypothermic circulatory arrest time (OR=1.33, 95%CI 1.14 to 1.57, P=0.000 4), perioperative blood transfusion (OR=1.89, 95%CI 1.49 to 2.41, P＜0.000 01), cardiopulmonary bypass time (OR=1.02, 95%CI 1.00 to 1.03, P=0.02) were independent risk factors for hypoxemia after TAAD surgery. Preoperative serum creatinine, preoperative myoglobin, preoperative alanine aminotransferase were not associated with postoperative hypoxemia. Conclusion Current evidence shows that age, body mass index, preoperative PaO2/FiO2≤300 mm Hg, preoperative white blood cell count, deep hypothermic circulatory arrest time, perioperative blood transfusion, cardiopulmonary bypass time are risk factors for hypoxemia after TAAD surgery. These factors can be used to identify high-risk patients, and provide guidance for medical staff to develop perioperative preventive strategy to reduce the incidence of hypoxemia. The results should be validated by higher quality researches.

Research Progress of Delirium after Cardiac Surgery

Delirium is an acute, transient, usually reversible, fluctuating disturbance in consciousness, attention, cognition, and perception. Delirium after cardiac operations is associated with increased morbidity, reduced cognitive functioning, increased short-term and long-term mortality, longer hospitalization and higher hospitalization cost. The diagnosis, prevention and treatment of delirium are of great importance for perioperative care of patients undergoing cardiac surgery. Effective delirium screening tools are very helpful for the recognition and monitoring of delirium after cardiac surgery. In recent years, there has been many new strategies for the treatment, nursing care and prevention of delirium after cardiac surgery. This review focuses on the incidence, risk factors, diagnostic methods, treatment and preventive strategies of delirium after cardiac surgery.

脉波轮廓温度稀释连续心排量测量技术在心脏直视术后的临床监测及应用

目的探讨脉波轮廓温度稀释连续心排量测量技术（PICCO）在心脏直视术后患者血流动力学参数监测中的应用及效果。 方法2011年1月－2012年6月采用PICCO监测20例术后危重患者的心功能指数（CI），全心舒张末期容积指数（GEDI），血管外肺血指数（ELWI），对监测结果为CI＜3 L/（min·m2）、GEDI＜700 mL/m2、ELWI＞10 mL/kg的患者，治疗上慎重增加容量，同时增加儿茶酚胺类药物剂量的对策；对CI＜3 L/（min·m2）、GEDI＞700 mL/m2、ELWI＞10 mL/kg的患者，治疗上予以增加儿茶酚胺类药物剂量同时严格控制容量，每日严格泵入液体量及管喂量的处置方式；对CI＞3 L/（min·m2）、GEDI＜700 mL/m2、ELWI＞10 mL/kg、SVRI＜900 kPa·s/（min·m2）的患者，则采取容量增加慎重同时增加儿茶酚胺类药物剂量，调节去甲肾上腺素用量的方式。 结果经PICCO严密监测以及药物和容量调整，19例患者循环逐渐稳定，均拔除气管插管后转出重症监护室（ICU）回病房继续治疗，1例因全心功能衰竭，抢救无效死亡。 结论通过应用PICCO对心脏直视术后患者血流动力学参数进行监测，能更直观有效、及时精确的找准血流动力学不稳定因素，对症下药，改善患者心功能情况，减少ICU住院天数，提高患者治愈率。