动脉硬化闭塞症为动脉因粥样硬化病变而引起的慢性动脉闭塞性疾病，主要侵犯腹主动脉下端、髂动脉、股动脉等大、中型动脉。由于动脉粥样硬化性斑块，动脉中层变性和继发血栓形成而逐渐产生管腔闭塞，使下肢发生缺血。
本病的发病年龄大多在50～70岁。男性病人比女性多见，女性病人仅占20％左右。根据疾病的发生发展可以分为四期：轻微主诉期，间歇性跛行期，静息痛期，组织坏疽期。
本病最早出现的症状为患肢发凉、麻木、间歇性跛行。随着病情的进展，患肢缺血加重，在安静状态下足趾、足部或小腿也会出现持续性的静息痛，在夜间更为剧烈，病人常抱足而坐，彻夜不眠。最总导致组织缺氧坏死。
中医古籍《内经》云：不治已病治未病。的确，防病即是治病，对于预防动脉硬化闭塞症最主要的就是预防或治疗诱发疾病，而营养与锻炼占据了重要地位：
（1）预防高血脂症。要养成良好的饮食习惯，控制动物性脂肪摄入，尽量减少食用动物内脏、奶油、蛋黄等高胆固醇食品，多食用蔬菜、水果，如发现患了高血脂症要长期服用降脂药物。
（2）预防高血压病。40岁以上的人要经常测量血压，控制体重，减轻心脏负担，自我调节神经功能，保持平稳情绪，避免情绪激动。控制盐的摄入，进行适当的体育活动，保证睡眠的时间和质量。
（3）糖尿病的预防。控制糖的摄入，不应每天过多食用甜食，经常检测血糖，发现患了糖尿病要及时治疗，治疗包括科学控制饮食量和饮食种类，食物以蔬菜、豆制品为主，面食、米饭为辅。
（4）彻底戒烟。吸烟对人体有很多危害。吸烟可以使人体外周小动脉、微动脉持续痉挛，促使动脉硬化发生，使血管内膜损伤，管腔狭窄，最终使中小动脉闭塞，产生肢体缺血症状。
（5）多参加户外活动，促进肢体血液循环。室外活动是老年人最方便的方式，但活动量要适度。不应参加过度心脏负担的剧烈活动。散步、太极拳、老龄门球、老年健身舞等都有宜于肢体血液循环，又不过度增加心脏负担，是值得提倡的体育活动。
（6）及时诊治，bureger运动。已有动脉硬化闭塞症的患者，需及时诊治，注意观察症状和体征变化，每年复查彩超检查。患肢运动练习（bｕｅｒgeｒ运动）有助于促进患肢侧支循环建立，增加患肢血供。方法是，平卧位，患肢抬高４５°，维持１～２分钟。然后坐起，患肢下垂床边2～５分钟，并作足部旋转、伸屈运动10次。最后将患肢放平休息２分钟。每次重复练习５回，每日练习数次。
动脉硬化闭塞症是中老年人的常见病和多发病，平日生活养成良好的饮食营养习惯和科学的锻炼可以有效的预防疾病的发生和发展。如出现前述症状应及时到医院就诊，以免错过最佳治疗时机。希望以上内容能够向您提供有效的帮助，对您多彩的生活有所裨益。
心律失常是心脏手术后常见的并发症之一，尤其在心内直视手术后，发生率可高达４８％－７４％。心律失常的发生，增加了手术后的危险性，而严重的心律失常，常常成为心脏手术病人术后死亡的主要原因，因此加强对心律失常的监测和护理，有着极其重要的临床意义。现将我院1998年6月2002年8月25例心脏体外循环术后心律失常患者护理体会报告如下。
\n1、临床资料
\n2、心律失常类型与常见诱因
2.1心脏术后心律失常的常见类型
2.1.1室性心律失常包括室性早搏、室性心动过速、心室颤动等，是心脏手术后最常见的并发症。
2.1.2 房性心律失常包括房早、房扑、房颤。
2.1.3房室传导阻滞临床上常见于巨大的心室间隔缺损、法乐氏四症等严重畸形纠正术后。
2.1.4非传导性心动过缓常见于体外循环中，心脏复跳后出现心肌收缩无力和心动过缓
2.2心脏手术后心律失常的常见诱因
2.2.1手术前的心功能状态术前心功能状态对术后心律失常的发生有影响。
2.2.1手术本身的打击心律失常的发生率高低与心脏病类型及手术有关，手术操作可引起心脏传导组织产生可逆性或不可逆性损伤，这些损伤可导致心脏异位激动，心动过速或房室传导阻滞。
2.2.3术后血液动力学状态的影响血压高多伴有体循环阻力的升高，
2.2.4 术后机体内环境稳定失平衡低血钾是常见心律失常诱发因素。
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男，60岁，2016年经当地医院诊断，腹主动脉瘤，前壁后壁均有斑块，前壁斑块5.4×2.7厘米，后壁5.2×1.4厘米，并伴有心梗，脑梗，高血压，糖尿病。请给予治疗建议
","barId":"1675","topicTypeId":null,"topicThemeId":"1020","readLevel":0,"files":"","clickNoLikeCount":0,"clickLikeCount":0,"clickCount":0,"score":0,"partCount":0,"replayCount":0,"publishStatus":0,"publishTime":0,"isCream":null,"canReply":0,"shareUrl":null,"foodCouponVal":0,"emailNotice":0,"permission":0,"zlyShare":0,"status":0,"sort":0,"highlight":0,"highlightEffectTime":0,"digest":0,"digestEffectTime":0,"top":0,"topEffectTime":0,"closed":0,"stamp":0,"icon":0,"bgcolor":null,"fontcolor":null,"favtimes":0,"isAdopt":0,"adoptId":null,"sortDate":0,"metaSearch":null,"rn":2},{"id":"2046","isDel":0,"createAt":0,"createBy":null,"createName":null,"updateAt":0,"updateBy":null,"updateName":null,"userId":null,"title":"升主动脉瘤62mm能做手术吗？风险大吗","content":"男61岁一月前发现前胸闷后背疼痛 气喘咳嗽 在十堰市太和医院做胸部ct 彩超 心电图 医生确诊升主动脉瘤62mm
\n请问这个能做手术吗？风险大吗
","barId":"1675","topicTypeId":null,"topicThemeId":"1019","readLevel":0,"files":"","clickNoLikeCount":0,"clickLikeCount":0,"clickCount":0,"score":0,"partCount":0,"replayCount":0,"publishStatus":0,"publishTime":0,"isCream":null,"canReply":0,"shareUrl":null,"foodCouponVal":0,"emailNotice":0,"permission":0,"zlyShare":0,"status":0,"sort":0,"highlight":0,"highlightEffectTime":0,"digest":0,"digestEffectTime":0,"top":0,"topEffectTime":0,"closed":0,"stamp":0,"icon":0,"bgcolor":null,"fontcolor":null,"favtimes":0,"isAdopt":0,"adoptId":null,"sortDate":0,"metaSearch":null,"rn":2},{"id":"1714","isDel":0,"createAt":0,"createBy":null,"createName":null,"updateAt":0,"updateBy":null,"updateName":null,"userId":null,"title":"穿透性心脏损伤表现","content":"心脏穿透伤的病理和临床表现，一方面取决于受伤机制，即穿透物的性质、大小和速度。例如，火器伤所致者80％以上现场死亡，而刀刺伤约半数仍可到达医院。另一方面，主要取决于损伤的部位、伤口的大小以及心包裂口的情况。心包裂口足够大时，心脏的出血可通畅流出体外或流入胸腔、纵隔或腹腔，心包内积血（血心包）量不多，临床上主要表现为失血性休克，甚至迅速死亡。心包裂口小、或被周围组织（如心包外脂肪、肺等）或血块所堵塞，心脏出血可引起急性心包填塞，使心脏舒张受限，腔静脉回心血流受阻和心排出量减少。枪弹伤引起的心包裂口较大，主要表现为失血性休克，而刀刺伤的心包裂口容易被堵塞，80％～90％发生心包填塞。心包填塞有利于减少心脏出血，病人生存机会反而较有出血但无心包填塞者为多，然而，如不及时解除，则很快导致循环衰竭。当心脏伤口很小时可自行闭合而停止出血。左心室壁伤口容易自行封闭，心包填塞的发生率较右心室为低（42．9％对92．7％）。偶有伤后数天或数周发生迟发性心包填塞的可能性。心房壁较薄，伤口不易自然止血，可能比心室损伤更为严重。
","barId":"1675","topicTypeId":null,"topicThemeId":"1016","readLevel":0,"files":"","clickNoLikeCount":0,"clickLikeCount":0,"clickCount":0,"score":0,"partCount":0,"replayCount":0,"publishStatus":0,"publishTime":0,"isCream":null,"canReply":0,"shareUrl":null,"foodCouponVal":0,"emailNotice":0,"permission":0,"zlyShare":0,"status":0,"sort":0,"highlight":0,"highlightEffectTime":0,"digest":0,"digestEffectTime":0,"top":0,"topEffectTime":0,"closed":0,"stamp":0,"icon":0,"bgcolor":null,"fontcolor":null,"favtimes":0,"isAdopt":0,"adoptId":null,"sortDate":0,"metaSearch":null,"rn":2},{"id":"1943","isDel":0,"createAt":0,"createBy":null,"createName":null,"updateAt":0,"updateBy":null,"updateName":null,"userId":null,"title":"损害心脏的行为","content":"哪些行为会导致心脏损伤呢？心脏损伤疾病在我们日常生活中会越来越常见，我们无比在日常生活中的各种小事中注意到保护自己的心脏，我们应该如何在日常生活中保护心脏呢，以下是关于常见的会损害心脏的行为。
\n跷二郎腿 跷二郎腿的坐姿容易导致血管收缩压和舒张压分别上升7%和2%，经常跷二郎腿还会增加髋关节压力，导致腿部静脉压迫，甚至会增加血栓危险。建议大家跷二郎腿的姿势别超过10-15分钟，每坐半小时左右就应该起身走动一会儿。
\n长时间堵车 拥堵的交通很容易让人紧张、焦虑，引发血压升高。驾车时高度紧张也会促使心跳加快、心肌疲劳，容易诱发冠心病。此外，如果堵车时打开窗户，脏空气就会携带着 大量污染物迎面扑来，不仅伤害心脏，也会殃及到肺。所以研究者建议，一旦遇上交通拥堵，最好不要开窗透气，使用车内循环系统为宜。
\n常用抗菌皂 美国2013年的一项最新研究显示，三氯生是抗菌药皂和牙膏中含有的有效化学物质，它与甲状腺疾病有关，还会形成难以杀灭的、对抗生素产生抗药性的细菌，从而对心脏和肌肉组织造成损害。其实，用普通肥皂和清水洗手的效果和抗菌性药皂一样好。
\n在闹市骑车 虽然骑车是一项很好的运动，但穿行在污染严重的马路上，弊大于利。比利时哈塞尔特大学研究人员发现，无论开车、骑车或步行上班，只要经过车辆密集的路段， 都会增加心脏病发作危险，主要原因是尾气污染，其中骑车上班者危险最大。因此，建议心血管病高危人群在交通拥挤的高峰期不要选择骑车出行。
\n爱吃罐装食品 罐 装食品中含有双酚A，它是一种强效的激素干扰物，还会增加心脏病危险，即使是小剂量的双酚A(通常接触量)也会导致危险的心律失常和造成心脏性猝死的不规 则心跳。因此，除了限制罐装食品的摄入量，多吃新鲜食品或冷冻食品外，还要减少接触超市小票，因为很多小票和收据的涂层中也含有双酚A，很容易被皮肤吸 收。
\n雾霾笼罩 很多人都知道，雾霾天气对呼吸道疾病影响很大，殊不知，雾霾天气更\"伤心\"。阴霾天中的颗粒污染物不仅会引发心肌梗死，还会造成心肌缺血或损伤。
\n哪些行为会导致心脏损伤。以上是容易损伤心脏，导致疾病的一些常见行为习惯，我们大家一定要避免，需要好好保护自己的心脏，爱护自己的心脏，实现自身的健康。
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速尿又名呋塞米（furosemide），是强效髓袢利尿剂。他减低肾脏氧耗，促进利尿并保护肾脏功能。但同时也扩张血管，降低前负荷，利尿的同时易产生低血容量和低钾血症，大量利尿剂不利于体外循环心脏手术病人后期的循环稳定。
\n在体外循环中，由于预充大量液体，包括平衡液、明胶或羟乙基淀粉溶液等，血液稀释往往使hct降低至17％～18％（少数低至15％）。为了排除过量的液体负荷，使hct在停机前后达21％～24％，一些灌注医师简便的处理办法就是给速尿10～20mg，结果使病人大量利尿，体外循环后麻醉医师不得不快速输血输液和补钾，出现了“大脱大补”的忙乱局面，使病人循环处于不稳定状态。曾有1名54kg的女性病人，行双瓣替换术，术前hct为34％，体外循环开始hct降至17％，给速尿15mg后，转中尿量达1#600ml，转后hct为23％，术后达27％，但术后4小时尿量高达2#300ml。
\n我们多年的经验表明，体外循环中一般不要用速尿来强制病人排出体内过多的液体，除非病人尿量少于1ml·kg－1.h－1。因为血液稀释本身可以使病人抗利尿激素分泌减少，肾血流量增加。只要血压回升，病人很快就会来尿。如果病人实在没尿，近期又未接受过速尿者，或换瓣病人术前肝大有明显水潴留者，成人开始可以给予2.5～5.0mg，小儿0.5～1mg／kg，不可一开始就用较大剂量速尿。除非病人正在使用利尿剂才可能将起始量增至10～20mg，否则会使病人发生容量治疗问题和电解质失衡。
\n对血液过度稀释的预防与处理可应用下列方法：（1）麻醉医师在体外循环前不要过多输液，只要循环稳定输液量5～10ml·kg－1.h－1即可；（2）灌注医师按体重大小采用适当的氧合器，预充量要适当，小儿更应做到氧合器和管道小型化，目的是尽量减少预充的液体量和稀释度；（3）当体外循环中hct＜18％时，可采用人工超滤装置，减少速尿的用量，以免打乱病人自身的调节机制。
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