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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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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5年前做过右下肢静脉手术，溃疡一直未完全愈合，现在溃疡面扩大，有疼痛感，右下肢深静脉瓣膜有问题，怎么治疗，是否需要手术
","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":3},{"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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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
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