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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

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.

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。

瓣膜置换加双极射频消融术后心房颤动复发患者电复律的护理

目的　总结经胸体外直流电复律治疗心脏瓣膜置换加双极射频消融术后复发心房颤动患者的临床护理经验。 方法　回顾性分析2009年7月－2011年1月行心脏瓣膜置换加双极射频消融术，出院后复发心房颤动的26例患者其体外直流电复律治疗的护理措施。 结果　通过严密监测和有效护理26例患者均安全出院，其中24例复律成功转为窦性心律，2例复律失败。 结论　做好电复律前的护理准备工作，严密观察电复律对心房颤动患者的治疗效果并实施有效的护理措施，既能促使电复律达到满意的效果又能保障患者安全。

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.

Fiberoptic Bronchoscopy for the Patients with Mechanical Ventilation after Cardiopulmonary Bypass Operation

目的探讨纤维支气管镜（纤支镜）在体外循环术后机械通气患者中的应用。 方法回顾性分析2014年1～12月行纤支镜检查76例体外循环术后机械通气患者的临床资料，男45例、女31例，年龄21～71（42.8±6.3）岁。其中行二尖瓣置换术35例，主动脉瓣置换术11例，二尖瓣置换术+主动脉瓣置换术17例，冠状动脉旁路移植术5例，升主动脉+主动脉全弓或半弓人工血管置换术8例。术前心功能Ⅱ级25例、Ⅲ级39例、Ⅳ级12例。术前合并中、重度肺动脉高压13例，感染性心内膜炎5例。 结果76例患者中气道大量分泌物59例，气道严重充血、水肿明显9例，痰痂阻塞气管导管3例，血痂阻塞气管导管2例，导管部分闭塞2例，气道轻微渗血1例。59例经纤支镜检查吸出气道分泌物后，肺部湿啰音较检查前明显减轻，呼吸状态明显好转；其余17例也经纤支镜检查进行准确诊断和有效处理。本组患者在纤支镜检查中顺利完成痰液标本采集共31例，未发生缺氧、心律失常和出血等操作并发症。 结论体外循环术后机械通气患者行纤支镜检查，在维持呼吸道通畅、正确指导抗生素应用、辅助诊断治疗中有积极作用。

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。

基于电子病历管理的ICU医护共同查房模式对临时医嘱执行效率的影响

目的　探讨基于电子病历（EMR）系统的重症医学科胸外ICU医护共同查房模式对临时医嘱执行效率的影响。 方法　随机选取2010年4月－2011年11月入住ICU且实行EMR管理的200例患者及30名管床护士、10名一线医生为调查对象，回顾比较基于EMR模式下医护分离查房和医护共同查房两种方式对临时医嘱执行的效果及满意度。 结果　采取医护共同查房模式后，患者及管床护士对临时医嘱执行的满意度提高（P＜0.05），临时医嘱平均执行时间较以前增快（P＜0.000 01），护理差错率减少（P=0.04）。 结论　医护共同查房模式可行，对ICU临时医嘱的执行效率有良好的促进作用，值得推广。