进行心脏手术的手术前危急疾病患者的表现和结果
Thomas S Metkus1, Carlos L Alviar2, Vivian M Baird-Zars3
1Divisions of Cardiology and Cardiac Surgery, Departments of Medicine and Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
JACC. Advances
|February 15, 2024
概括
大约8.6%的心脏重症监护室 (CICU) 患者接受心脏手术. 尽管疾病严重程度很高,但这些患者的死亡率与一般ICU人口相比相当.
科学领域:
- 心脏病学 心脏病学
- 密集护理医学 密集护理医学
- 心脏外科手术 心脏外科手术
背景情况:
- 关于心脏重症监护室 (CICU) 治疗方法在心脏手术转诊患者中的患病率和结果的数据有限.
- 了解这些因素对于优化护理途径至关重要.
研究的目的:
- 调查心脏手术所转诊的CICU患者的临床特征和结果.
- 为了确定影响这种高急性群体死亡率的因素.
主要方法:
- 从2017年至2020年期间,对29个中心的10321例中急症监护室入院病例进行了回顾性分析.
- 检查了患者的特征,手术前的CICU疗法和住院死亡率.
- 使用多变量分析进行调整以考虑混因素.
主要成果:
- 8.6%的重症监护室入院者 (887名患者) 接受了心脏手术,包括CABG,移植,VAD和门手术.
- 集中护理的常见症状是休克 (33.5%) 和呼吸不全 (24.9%).
- 术前治疗包括血管活性剂 (52.2%),机械循环支持 (35.9%) 和机械通风 (35.7%). 外科手术患者的住院死亡率为9.1%,整体为11.7%. 手术前的机械循环支持和脏替代疗法与死亡率有关.
结论:
- 几乎每12名ICU患者中就有1人接受心脏手术,往往具有显著的手术前敏度.
- 尽管疾病严重程度很高,但接受心脏手术的ICU患者的死亡率与整体ICU患者的死亡率相当.
- 这表明在高急性心脏手术护理中有效选择患者和术后管理.
更多相关视频
相关概念视频
01:28Cardiac Catheterization I: Pre-Procedure Overview
Cardiac catheterization is an invasive diagnostic technique used to identify and evaluate structural and functional diseases of the heart and major blood vessels. This technique diagnoses congenital heart disease, coronary artery disease, valvular heart disease, and coronary spasms and assesses ventricular function. It helps guide treatment decisions, including the need for revascularization procedures like percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) and...
01:26Cardiac Catheterization IV: Nursing Management
Nursing responsibilities before cardiac catheterization include:Assess for allergies and establish baseline health status.Before cardiac catheterization, assess the patient for allergies to contrast dye. Perform a comprehensive baseline assessment, including vital signs, heart and breath sounds, and a neurovascular assessment of the extremities, noting distal pulses, skin color, and temperature. Instruct the patient to fast for 8-12 hours before the procedure. Evaluate baseline laboratory...
01:28Acute Coronary Syndrome IV: Interprofessional Care
IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
Patients with hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract (LVOT) obstruction who remain symptomatic despite optimal medical therapy may undergo a septal myectomy (Morrow procedure). This procedure involves excising a portion of the hypertrophied septum below the aortic valve using a heart-lung machine to improve blood flow through the LVOT. Effective preoperative and postoperative nursing management ensures successful patient outcomes, minimizes complications, and...
01:23Peripheral Artery Disease V: Postoperative Nursing Management
During the postoperative period, it is crucial to focus on maintaining circulation, identifying and managing potential complications, and planning for discharge.Nursing AssessmentVital signs monitoring: Regularly monitor vital signs, including blood pressure, heart rate, respiratory rate, and temperature, to detect early signs of complications such as bleeding and infection.Circulation assessment: Monitor pulses, perform Doppler assessments, and check capillary refill, color, temperature, and...
01:22Aneurysm IV: Nursing Management
Vigilant monitoring for aneurysm rupture is essential for patients undergoing aortic surgery.Preoperative Nursing ManagementContinuously monitor the patient for manifestations of aneurysm rupture, such as pallor, weakness, tachycardia, hypotension, abdominal, back, groin, or periumbilical pain, changes in consciousness, and a pulsating abdominal mass. Regularly assess the patient's peripheral pulses.Instruct the patient to consume a clear liquid diet the day before surgery and administer...