神经内镜下导水管成形术治疗中脑导水管梗阻性脑积水的围手术期护理

目的:总结12例神经内镜下中脑导水管成形术(endoscopic aqueductoplasty,EAP)治疗中脑导水管梗阻性脑积水围手术期的护理经验。方法:术前重视观察患者病情,并给予对症护理及心理疏导,术后加强并发症的观察和护理。结果:9例患者中脑导水管成功再通,3例患者再次闭塞,后行第三脑室底造瘘术,恢复良好,随访效果满意。结论:良好的围手术期护理有助于保证患者的安全和手术疗效,对患者的康复有重要作用。     

多学科协作治疗颅底沟通性肿瘤患者围术期护理与并发症观察

目的:探讨神经外科、耳鼻喉科与颌面外科协作处理颅底沟通性肿瘤患者围手术期的护理措施,为临床治疗与护理提供依据.方法:回顾分析45例颅底沟通性肿瘤患者的临床资料.结果:45例患者经术前及术后的精心护理,无脑脊液漏、颅内感染或颅神经受损等严重并发症发生.结论:加强颅底沟通性肿瘤患者的围手术期护理,多学科密切协作能提高颅底沟通肿瘤的手术质量及治疗效果,有效减少各种并发症的发生.     

老年肺癌手术患者围手术期处理

目的：探讨老年肺癌患者围手术期的治疗经验。方法：对68例60岁以上老年肺癌患者的外科治疗进行分析。结果：68例老年肺癌患者合并高血压病19例,糖尿病11例,冠心病4例,慢性支气管炎、肺气肿10例。均行手术治疗,术后并发症19例,并发症发生率28．0％,其中心肺并发症占89．5％（17／19）。无围手术期死亡。结论：老年肺癌患者术前合并心肺血管疾病增加了手术的风险性,术前全面了解病情,加强围手术期管理,是提高手术疗效的关键;采取适当的治疗措施,老年肺癌患者也可以取得满意的治疗效果。     

椎间盘镜治疗腰椎间盘突出症的围手术期护理

目的：我科从2004年6月30日到2009年2月27日,共对2042位患者进行MED手术治疗,系统收集该2042例患者围手术期护理的情况。结论：通过腰椎间盘突出MED手术治疗及做好术前心理护理、术后常规护理,创伤小,出血少,功能恢复快,无护理并发症,优良率99%,取得满意效果。     

激光下睑眶隔脂肪释放术的围手术期护理体会

目的：探讨激光下睑眶隔脂肪释放术围手术期的护理,提高激光下睑整形的手术整体效果。方法：对本科室5年来184例激光下睑眶隔脂肪释放术患者在围手术期进行心理护理、整形外科常规护理、术区护理、遵医行为指导。结果：所有患者档案完整、手术顺利、术后无感染发生、出血少,恢复快、效果较好。结论：围手术期护理工作对于提高激光下睑眶隔脂...     

儿童嗜铬细胞瘤护理

目的:回顾总结嗜铬细胞瘤护理体会,提高其护理质量和治疗水平.方法:回顾性分析1996至2011年我院5例嗜铬细胞瘤患儿的临床表现、围手术期护理.结果:5例患儿主要临床表现有心悸、胸闷、乏力、多汗、腹痛、眩晕、高血压等;均行手术切除,术后病理检查均证实为嗜铬细胞瘤.术后随访1至13年,4例无复发,1例术后1年因肿瘤多处转移死亡.结论:儿童嗜铬细胞瘤罕见,其临床表现不典型,手术风险大,围手术期管理是保证治疗效果的重要因素.     

激光泪道成形术联合鼻泪管支架植入治疗慢性泪囊炎的护理

目的探讨激光泪道成形术联合鼻泪管支架植入治疗慢性泪囊炎的护理。方法通过对慢性泪囊炎患者82例(88只眼)行激光泪道成形术联合鼻泪管支架植入治疗,观察其疗效,总结分析术前、术后的护理措施。结果通过术前、术后的精心护理,随访3-24月,慢性泪囊炎治疗的有效率97%,无效率占3%。结论对激光泪道成形术联合鼻泪管支架植入的慢性泪囊炎患者行相应的护理措施极其重要,能最大限度地减轻患者手术的痛苦,减少手术并发症的发生,大大提高本手术治疗的成功率。     

面横裂患儿围术期的临床护理

目的:总结27例面横裂患儿围术期临床护理的经验,以进一步提高对本病患儿的护理质量.方法:本组27例面横裂患儿,在静脉麻醉加经口气管插管下实施功能性口角成形术,其中23例同时行附耳切除整复术.围术期的护理重点有:健康宣教及喂养指导,术前访视和评估,术后严密观察病情,做好呼吸道、疼痛管理.并做好出院宣教.结果:所有患儿均取得了满意的临床治疗效果,创口均一期愈合,解剖标志复位,外貌明显改善.结论:临床护理质量的高低对于面横裂修复手术的疗效具有重要意义;规范的围术期护理,有助于提高面横裂患儿的治疗质量和病人的满意度.     

强直性脊柱炎重度后凸矫形的围手术期护理

目的探讨强直性脊柱炎重度后凸矫形的围手术期护理。方法对24例强直性脊柱炎重度后凸畸形患者,施行单纯后路蛋壳截骨后凸矫形术,术前进行心理护理、营养支持、呼吸功能训练等护理干预,术后监测生命体征、观察脊髓神经功能、防止各种并发症和加强康复训练。结果术后患者达到70%的矫形效果,肺活量明显增加,未出现严重并发症。结论有效的围手术期护理有助于降低重度脊柱后凸矫形术后并发症的发生,提高临床治疗效果。     

准分子激光前弹力层下角膜磨镶术治疗近视的护理

目的:探讨准分子激光前弹力层下角膜磨镶术(sub-bowman’s keratomileusis,SBK)治疗近视的护理措施。方法:采用回顾性分析的方法对我院准分子激光中心2010年1月至9月行SBK手术的病例共71例(133眼)进行研究,总结观察与护理的经验。结果:患者术后的反应轻,无明显疼痛,视力恢复快,屈光状态比较稳定,效果良好。结论:做好SBK围手术期护理,对其手术后的恢复有明显作用,有助于达到预期的效果。     

Detection of repolarization alternans with an implantable cardioverter defibrillator lead in a porcine model

Mechanistic links have been suggested between repolarization alternans (RPA) and the onset of ventricular tachycardia (VT) and/or fibrillation. Endocardial detection of RPA may, therefore, be an important step in future device-based treatments of arrhythmias. Here, we investigate if RPA could be detected during acute ischemia using an implantable cardioverter defibrillator (ICD) lead (tip to distal coil) located in the right ventricular apex. In 18 pigs, the right coronary (n = 10) or left anterior descending coronary (n = 8) artery was occluded for 10 min using a balloon catheter, followed by reperfusion for 30 min, and re-occlusion for 30 min. RPA magnitude, computed using the modified moving average (MMA) method, showed a sharp increase in all 18 animals, from a mean baseline level of 1.9 +/- 1.3 mV to 3.0 +/- 1.3 mV during first occlusion (p < 0.001). RPA magnitude showed a prominent increase in 10 animals during re-occlusion, from a mean baseline level of 1.7 +/- 1.0 mV to 3.3 +/- 1.5 mV (p < 0.001). The protocol was terminated during the first two stages of occlusion and reperfusion for the remaining 8 animals due to the occurrence of ventricular fibrillation (VF). These results confirm that RPA increases under ischemic conditions and that it is possible to detect and track RPA dynamics with an ICD lead that is positioned in a clinically realistic location. Such an approach may be useful in formulating improved arrhythmia detection and control algorithms.     

老年高血压合并冠心病患者的心率变异性分析

目的了解老年高血压(EH)病合并冠心病(CHD)患者心率变异性的特点及其临床意义。方法选择EH患者34例及EH合并CHD患者32例,老年健康对照组38例,青年健康对照组51例,进行24h动态血压和动态心电图检查,对两组患者心率变异性(HRV)参数及室性心律失常发生率进行对照分析。结果与对照组比较,EH组和EH合并CHD组HRV均降低(P<0.05),其中EH合并CHD组HRV降低更为显著(P<0.01);与对照组比较,EH组和EH合并CHD组室性心律失常的发生率增加(P<0.05),其中EH合并CHD组室性心律失常的发生率增加更为显著(P<0.01)。结论反映自主神经活性变化的HRV可作为高血压患者预后的重要指标之一。尤其对EH合并CHD的患者,临床上除降压治疗外,还应根据HRV的改变情况给予积极改善自主神经功能的治疗。     

Arrhythmia discrimination in implantable cardioverter defibrillators using support vector machines applied to a new representation of electrograms

Arrhythmia classification remains a major challenge for appropriate therapy delivery in implantable cardioverter defibrillators (ICDs). The purpose of this paper is to present a new algorithm for arrhythmia discrimination based on a statistical classification by support vector machines of a novel 2-D representation of electrograms (EGMs) named spatial projection of tachycardia (SPOT) EGMs. SPOT-based discrimination algorithm provided sensitivity and specificity of 98.8% and 91.3%, respectively, on a test database. A simplified version of the algorithm is also presented, which can be directly implemented in the ICD.     

Detection of atrial activity from high-voltage leads of implantableventricular defibrillators using a cancellation technique

The inability to detect atrial activity limits implantable ventricular cardioverter defibrillators (ICD) in discriminating tachycardias and can result in inappropriate therapy. This study attempted to detect atrial activity on the wide-spaced bipole signals formed by the high-voltage (HV) leads of the ICD during device implantation and to develop an algorithm for the detection of atrial fibrillation (AFib) from these signals. The authors used a method that cancelled ventricular and correlated atrial activity from the HV lead signals and measured frequency and amplitude distribution information to discriminate sinus rhythm (SR) and AFib segments. The authors analyzed 186 data segments from 21 patients (six AFib, 14 SR, one AFib and SR). For individual segments in this data set, the sensitivity of the algorithm was 78%, specificity 92.65%, positive and negative predictive values 79.59 and 91.97%, respectively. These results demonstrate that atrial activity is present in the HV lead signals, and AFib detection can be achieved in many, but not all cases, using information currently available to ICDs. Prior work from surface electrocardiograms suggests that this algorithm can function during ventricular tachycardias. However, specificity of the algorithm is not high enough for clinical use     

Multisensor fusion for atrial and ventricular activity detection incoronary care monitoring

Information management for critical care monitoring is still a very difficult task. Medical staff is often overwhelmed by the amount of data provided by the increased number of specific monitoring devices and instrumentation, and the lack of an effective automated system. Specifically, a basic task such as arrhythmia detection still produce an important amount of undesirable alarms, due in part to the mechanistic approach of current monitoring systems. In this work, multisensor and multisource data fusion schemes to improve atrial and ventricular activity detection in critical care environments are presented. Applications of these schemes are quantitatively evaluated and compared with current methods, showing the potential advantages of data fusion techniques for event detection in noise corrupted signals.     

Four Birds with One Stone: A Multifunctional Polypeptide Nanocomposite to Unify Ferroptosis,Nitric Oxide,and Photothermia for Amplifying Antitumor Immunity

Tumor metastasis and relapse mainly results in therapy failure and becomes a big challenge in oncology. Immunogenic cell death (ICD) of tumors mediated immunotherapy (IT) is attracting widely for solving that problem although achieving sufficient ICD and strong immune response is challenging for nanoparticles-based cancer IT. Herein, a multifunctional polypeptide coordinate nanocomposite that possesses near infrared photothermia (PT) and responsive releases of nitric oxide (NO) and iron ions is constructed, which synergistically kills cancer cells and highly prohibits metastatic 4T1 cells invasion and migration by PT-boosted NO release and ferroptosis (FT). Remarkably, triple FT-NO-PT treatment amplifies the ICD effects and outperforms combo/monotherapy FT-PT and FT in cancer cells and tumors, which further activates dendritic cells maturation, and primed CD4⁺T and CD8⁺T cells immune responses and memory effects, playing four birds with one stone (i.e., FT-NO-PT-IT). The PCSFG-based FT-NO-PT not only fully eradicates 4T1 primary tumors, but also induces strong ICD, immune priming, and memory effects to reject rechallenged 4T1 tumors and inhibit malignant tumor metastasis, demonstrating synergistic amplified ICD effects with strong cell immunities and memory effects by a unified FT-NO-PT-IT.     

全肺切除术后心律失常的护理干预

目的:探讨全肺切除术后并发心律失常的临床护理特点。方法:对我院从2004年至2006年实施了全肺切除手术32例病人的临床资料进行回顾性分析。结果:术后并发心律失常9例(占28.1%),均发生在3d内,全部患者痊愈出院。结论:加强病人的健康教育,积极治疗合并症,从心理、生理上提高病人对手术的耐受性,加强心肺功能的监测,保持气管位置居中,控制输液速度及总量,维持电解质的平衡,有效止痛,保持呼吸道通畅,及时正确的使用抗心律失常的药物,可有效地控制术后心律失常的发生。     

From Holter monitors to automatic defibrillators: developments in ambulatory arrhythmia monitoring

In 1961, Holter reported a design of a tape recorder that acquired and stored electrocardiographic (ECG) signals from ambulatory patients. This made long-term monitoring of patients in their day-to-day environments possible. The next generation of devices employ microcomputer circuits for automatic interpretation of cardiac arrhythmias. Implantable pacemaker also show some arrhythmia interpretation capability. A special case is the automatic implantable defibrillator which recognizes the ventricular fibrillation signal. We present here the details of the original Holter recorder, the microcomputer-based arrhythmia monitor, and the automatic implantable defibrillator. In conjunction with the historic account of these developments, we present the current techniques of ambulatory ECG signal acquisition, processing, arrhythmia detection, and performance evaluation of automated arrhythmia detectors.     

Statistical accuracy of a moving equivalent dipole method to identify sites of origin of cardiac electrical activation

While radio frequency (RF) catheter ablation (RCA) procedures for treating ventricular arrhythmias have evolved significantly over the past several years, the use of RCA has been limited to treating slow ventricular tachycardias (VTs). In this paper, we present preliminary results from computer and animal studies to evaluate the accuracy of an algorithm that uses the single equivalent moving dipole (SEMD) model in an infinite homogeneous volume conductor to guide the RF catheter to the site of origin of the arrhythmia. Our method involves measuring body surface electrocardiographic (ECG) signals generated by arrhythmic activity and by bipolar current pulses emanating from a catheter tip, and representing each of them by a SEMD model source at each instant of the cardiac cycle, thus enabling rapid repositioning of the catheter tip requiring only a few cycles of the arrhythmia. We found that the SEMD model accurately reproduced body surface ECG signals with a correlation coefficients > 0.95. We used a variety of methods to estimate the uncertainty of the SEMD parameters due to measurement noise and found that at the time when the arrhythmia is mostly localized during the cardiac cycle, the estimates of the uncertainty of the spatial SEMD parameters (from ECG signals) are between 1 and 3 mm. We used pacing data from spatially separated epicardial sites in a swine model as surrogates for focal ventricular arrhythmic sources and found that the spatial SEMD estimates of the two pacing sites agreed with both their physical separation and orientation with respect to each other. In conclusion, our algorithm to estimate the SEMD parameters from body surface ECG can potentially be a useful method for rapidly positioning the catheter tip to the arrhythmic focus during an RCA procedure.     

A low-complexity intracardiac electrogram compression algorithm

Implantable cardioverter defibrillators (ICD's) detect, diagnose and treat the potentially fatal heart arrhythmias known as bradycardia, ventricular tachycardia (VT), and ventricular fibrillation (VF) in cases where these arrhythmias are resistant to surgical and drug-based treatments by direct sensing and electrical stimulation of the heart muscle. Since the ICD is implanted, power consumption, reliability, and size are severe design constraints. This paper targets the problems associated with increasing the signal recording capabilities of an ICD. A data-compression algorithm is described which has been optimized for low power consumption and high reliability implementation. Reliance on a patient's morphology or that of a population of patients is avoided by adapting to the intracardiac electrogram (ICEG) amplitude and phase variations and by using adaptive scalar quantization. The algorithm is compared to alternative compression algorithms which are also patient independent using a subset of VT arrhythmias from a data base of 146 patients. At low distortion the algorithm is closest to the Shannon lower bound achieving an average of 3.5 b/sample at 5% root mean square distortion for a 250-Hz sample rate. At higher distortion vector quantization and Karhunen-Loeve Transform approaches are superior but at the cost of considerable additional computational complexity