一例大血管术后合并消化道出血引发脑部缺血性脑卒中的术后个案护理

目的:总结一例大血管合并脑部缺血术后的临床资料和护理经验,为今后此类患者护理提供临床经验。方法:回顾性分析2024年2月29日我科收治的一例stanford A型患者的治疗和护理过程。针对患者现存主要护理问题:疼痛、血容量不足、活动无耐力,消化道出血,压力性损伤、潜在并发症等,术后采取全面心电监护、维持内环境稳定、维持水电解质及酸碱平衡、对症支持治疗、神经系统观察、镇痛镇静、积极抗炎症反应、营养支持、积极处理皮肤问题、密切关注术后并发症、尽早行心脏康复以及心理支持等个性化的治疗及护理。结果:本例患者经积极治疗和护理后患者于术后转出我科继续治疗,生活完全自理,顺利康复出院。结论:术后有针对性的一例大血管术后合并消化道出血引发脑部缺血性的术后个案护理,有临床借鉴积极意义。Objective: To summarize the clinical data and nursing experience of a Stanford A type patient who underwent major vascular surgery and suffered from cerebral ischemic stroke after gastrointestinal hemorrhage, in order to provide clinical experience for future nursing care of similar patients. Methods: The clinical course and nursing care of a Stanford A type patient admitted to our department on February 29, 2024 were retrospectively analyzed. Based on the main nursing problems of the patient, such as pain, insufficient blood volume, lack of activity tolerance, gastrointestinal hemorrhage, pressure ulcers, potential complications, etc., postoperative comprehensive electrocardiogram monitoring, maintenance of the internal environment, maintenance of water, electrolyte, and acid-base balance, symptomatic supportive therapy, neurological observation, analgesia and sedation, active anti-inflammatory response, nutritional support, active management of skin problems, close monitoring of postoperative complications, early cardiac rehabilitation, and psychological support were provided with individualized treatment and nursing. Results: After active treatment and nursing, the patient was transferred out of our department for further treatment and was able to live independently, recovering smoothly and discharged from the hospital. Conclusion: The case of postoperative hemorrhage due to cerebral ischemia caused by a large vessel operation with targeted care has clinical reference value.

“烟囱”技术在胸主动脉夹层腔内修复术中的应用分析

目的 探讨“烟囱”支架技术在近端锚定区长度不足的胸主动脉夹层的主动脉腔内修复术治疗中的应用.方法 回顾性观察2012年8月至2013年9月广东省人民医院17例近端锚定区长度不足的胸主动脉夹层患者使用“烟囱”技术进行主动脉腔内修复术治疗的临床资料.结果 男16例,女1例,Stanford B型主动脉夹层16例,Stanford B型主动脉夹层合并腹主动脉瘤1例.手术成功率为100％,支架释放后即时血管造影显示破口封堵完全,“烟囱”支架血流正常.随访3-16个月,中位时间12个月,无术后死亡患者.随访期间,患者出现左足乏力1例、头晕1例、胸闷痛2例、Ⅰ型内漏2例.无严重神经系统及脏器缺血并发症发生.术后主动脉计算机断层扫描血管造影（CTA）未见移位、明显内漏及“烟囱支架”闭塞等异常.结论 对于近端锚定区长度不足的胸主动脉夹层的患者,使用“烟囱支架技术”进行主动脉腔内修复是安全、有效的治疗方法.

长象鼻支架与急性A型主动脉夹层术后脊髓损伤风险的单中心回顾性队列研究

目的探讨长象鼻支架是否增加急性A型主动脉夹层患者术后脊髓损伤的风险。方法纳入2018—2019年广东省人民医院心脏大血管外科收治的急性A型主动脉夹层患者172例,根据术中采用象鼻支架的长度将患者分为两组:支架长度100 mm的为短支架组,长度150 mm的为长支架组。短支架组124例,男108例(87.1%)、女16例(12.9%),年龄(51.8±7.9)岁;长支架组48例,男44例(91.7%)、女4例(8.3%),年龄(50.6±9.7)岁。总结并分析两组患者的临床资料及预后。结果对于术中支架远端锚定区,长支架组平均锚定于第(8.5±0.7)胸椎水平,短支架组平均锚定于第(6.8±0.6)胸椎水平(P=0.001)。术后两组共16例患者死亡[短支架组13例(10.5%)vs.长支架组3例(6.2%),P=0.561]。术后两组共7例脊髓损伤[短支架组6例(4.8%)vs.长支架组1例(2.2%),P=0.675]。再次开胸止血、内漏等并发症两组间差异亦无统计学意义。术后平均随访16.7(1~30)个月,长支架组随访期间2例死亡,短支架组随访期间5例死亡。出院后无新发脊髓截瘫或轻瘫,无远端再次手术干预。结论长象鼻支架不增加急性A型主动脉夹层患者术后脊髓损伤风险。