Observation of Nursing Care of Patients with Acute Severe Pulmonary Embolism after General Surgery under Microscope

2021 ◽  
Vol 7 (5) ◽  
pp. 1459-1468
Author(s):  
Wenbin Liang ◽  
Jing Shen ◽  
Yuanling Zhang ◽  
Hongbing Li ◽  
Bangxing Yu
Keyword(s):  
Pulmonary Embolism ◽  
Thrombolytic Therapy ◽  
General Surgery ◽  
Acute Pulmonary Embolism ◽  
Clinical Medicine ◽  
Positive Impact ◽  
Survey Methods ◽  
Clinical Manifestations ◽  
Effective Rate ◽  
Treatment Rate

Acute pulmonary embolism (APE) is one of the common acute and critical illnesses in clinical medicine, and it is another high cause of death after heart disease, cancer and cardiovascular disease. Despite the unremitting research and exploration of many relevant experts in recent years, major progress has been made in diagnosis and treatment, but the clinical manifestations of acute pulmonary embolism are not specific, and there is a lack of effective and definite methods for diagnosis. The mortality rate of patients with acute pulmonary embolism remains high. Furthermore, the combination of multiple postoperative diseases caused by general surgery can also increase the mortality of patients. Based on this, this article uses microscope technology to study and analyze the pretreatment methods and nursing methods of patients with acute severe pulmonary embolism after general surgery to improve the condition of patients with acute pulmonary embolism and increase their recovery rate, hoping to be the domestic acute pulmonary embolism The treatment provides reference and reference. This article first summarizes the relevant theories of surgery and acute pulmonary embolism, and then uses experimental methods, data analysis methods, survey methods and comparison methods, and SPSS 22.0 statistical analysis software technology to observe the efficacy of patients after thrombolytic therapy through a microscope. It is concluded that in the sample data of 50 cases, the significant rate accounts for 58%, the effective rate accounts for 36%, and the inefficiency accounts for 6%, confirming the positive impact of early thrombolytic therapy on patients with acute pulmonary embolism. Finally, through the microscope observation and comparison of the patient’s physical signs before and after nursing, it is concluded that timely and effective nursing after surgery has a great effect on improving the treatment rate of patients.

scholarly journals The significance of C-reactive protein for the prediction of net-adverse clinical outcome in patients with acute pulmonary embolism

2020 ◽  
Vol 77 (1) ◽  
pp. 35-40
Author(s):  
Rade Milic ◽  
Boris Dzudovic ◽  
Bojana Subotic ◽  
Slobodan Obradovic ◽  
Ivan Soldatovic ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Logistic Regression ◽  
Clinical Outcome ◽  
Regression Model ◽  
Logistic Regression Model ◽  
Acute Pulmonary Embolism ◽  
Clinical Manifestations ◽  
Multivariate Logistic Regression Model ◽  
Significant Independent Predictor ◽  
End Point

Background/Aim. Acute pulmonary embolism (APE) may have different clinical manifestations. Also, its outcome can range from complete recovery to early death. Major bleeding (MB) as a due of the therapy also contributes to the overall adverse outcome. So far, it is unknown what the best predictors are for short-term mortality and MB among the several commonly used biomarkers. The aim of this study was to evaluate the significance of Creactive protein (CRP) and other biomarkers for the prediction of adverse clinical outcomes. Methods. This clinical, observational, retrospective-prospective study included 219 consecutive adult patients treated for APE. Results. Among 219 patients, 22 (10%) died within the first month after diagnosis. Twenty seven patients (12.3%) had at least one episode of MB. Composite end-point [netadverse clinical outcome (NACO)] was estimated in 47 (21.5%) of patients. The average values of all biomarkers were higher in the group of patient who died, and differences were statistically significant. Similar results were obtained for composite end-point. In terms of MB, none of biomarkers did not have significance, but CRP had a slight tendency toward significance. Results from univariate logistic regression model showed that troponin was statistically significant predictor of 30-day mortality. However, after adjusting for other variables, in multivariate logistic regression model troponin failed to be significant independent predictor of 30-day mortality. Unlike troponin, CRP and brain natriuretic peptide (BNP) were significant in all models ? uni and multivariate (they were independent predictors of 30-day mortality). Conclusion. CRP has a good predictive value for 30-day mortality and NACO, and potential for MB in patients treated for APE.

scholarly journals Prolonged Chest Compressions during Cardiopulmonary Resuscitation for In-Hospital Cardiac Arrest due to Acute Pulmonary Embolism

2015 ◽  
Vol 42 (2) ◽  
pp. 136-138 ◽  
Author(s):  
Carla Nobre ◽  
Boban Thomas ◽  
Luis Santos ◽  
João Tavares
Keyword(s):  
Pulmonary Embolism ◽  
Thrombolytic Therapy ◽  
Acute Pulmonary Embolism ◽  
Cardiopulmonary Arrest ◽  
Hemodynamic Instability ◽  
Circulatory Support ◽  
Chest Compressions ◽  
Output State ◽  
Dismal Prognosis ◽  
Systemic Thrombolytic Therapy

Patients with hemodynamic collapse due to acute pulmonary embolism have a dismal prognosis if not treated rapidly. Therapeutic options include systemic thrombolytic therapy, rheolytic thrombectomy, and surgical embolectomy. However, the efficacy of thrombolytic therapy is diminished because the low-output state hinders effective delivery of the lytic agent to the thrombus. In the absence of any form of mechanical circulatory support, such as extracorporeal membrane oxygenation or cardiac surgery on site, we think that prolonged vigorous manual compressions might be the only way to support the circulation during the initial critical state, when thrombolytic therapy has been administered. We report the results of prolonged manual chest compressions (exceeding 30 minutes) on 6 patients who received tenecteplase in treatment of acute pulmonary embolism that induced in-hospital cardiopulmonary arrest. Four of 6 patients survived and were discharged from the hospital. In an era of increasing technologic complexity for patients with hemodynamic instability, we emphasize the importance of prolonged chest compressions, which can improve systemic perfusion, counteract the prothrombotic state associated with cardiopulmonary arrest, and give the lytic agent time to act.

scholarly journals Coagulation properties of the blood coagulation system in acute pulmonary embolism and their dynamics against the background of systemic thrombolytic therapy for patients with different risk of hospital mortality

2020 ◽  
Vol 27 (1) ◽  
pp. 27-38
Author(s):  
O. A. Koval ◽  
O. M. Klygunenko ◽  
O. Yu. Muryzina
Keyword(s):  
Pulmonary Embolism ◽  
High Risk ◽  
Thrombolytic Therapy ◽  
Mortality Risk ◽  
Fibrinolytic Activity ◽  
Acute Pulmonary Embolism ◽  
Activated Partial Thromboplastin Time ◽  
Systemic Thrombolytic Therapy ◽  
Group 2 ◽  
Group 1

The aim – to evaluate the dynamics of blood coagulation changes in patients with acute pulmonary embolism before and after systemic thrombolytic therapy (TLT), by comparing high and intermediate-high risk groups. Materials and methods. 45 patients, 29 male (62 %) and 17 female (38 %), 55.6±13.6 years old admitted into an intensive care unit with the first episode of acute PE and received systemic thrombolysis, were included into prospective nonrandomized investigation. Accoding to the ESC Guideline on pulmonary embolism (2014) these patients were split into two groups: unstable high-risk pulmonary embolism patients having or hypotension or episodes of syncope (group 1, n=28, 62 %), and patients with intermediate-high mortality risk with stable hemodynamic indexes (group 2, n=17, 38 %) but with massive bilateral embolism (U1-2=2.2, p=0.33), verified by multispiral computed tomography pulmonary angiography (angio-regimen), hemodynamically overload, with signs of right and ventricular dysfunction and positive troponin tests. The 30-day mortality risk for PESI corresponds to Grade V (IV): 152 ± 19 points in group 1, 138.0±9.7 in group 2 (p1-2<0.01). Results and discussion. In both groups, a similar (p1-2>0.25) initial procoagulant status was revealed by changes in thrombin formation indexes: prothrombin time (PT) increased to 19.8 [16, 23] sec, and prothrombin index increased to 96.1 % [86, 106], reduction of activated partial thromboplastin time to 23.5 [21, 24] sec. The content of the main coagulation substrate fibrinogen increased up to 4.3 [4.1, 4.5] g/l (p1-2=0.25), and markers of thrombinemia increased as follows: soluble fibrin up to 17.0 [16, 18] mg, D-dimer up to 5214 [3605, 5643] ng/ml. The systemic fibrinolytic activity was initially suppressed: the values of spontaneous fibrinolysis were reduced to 9.5 [6.0, 12.2] %, self-retraction – to 31.9 [26.1, 36.1] %. On the 5th day after the TLT on the background of basic therapy, the following dynamics was observed: increase of (Z=5.62, p<0.00001) activated partial thromboplastin time values – up to 46.1 ± 6.0 s (p1-2=0.36) and PT – up to 22.9 (18–26) s, while fibrinogen decreased – down to 3.5 g/l. Despite favorable changes, markers of thrombinemia remained increased: although fibrin values decreased (Z=3.03, p<0.001) to 13.7 mg, but still exceeded the upper limit of the reference range in both groups (p1-2=0.21). The values of spontaneous fibrinolysis increased to 11.9 % [9.9, 12.4], and self-retraction (Z=0.64, p<0.01) to 32.0 % [27.9, 33.0], remaining significantly lower than the reference level and indicating high risk of relapse of thromboembolic events. Conclusions. For patients with acute pulmonary embolism, regardless of the presence of high or intermediate-high risk, according to the main coagulation indexes, the procoagulant state of hemostasis, inhibition of fibrinolytic activity, decrease in clot density in vitro are identical in strength and direction. On the 5th day after TLT on the basic anticoagulation therapy and despite a certain level of therapeutic anticoagulation, a rather high level of markers of thrombinemia, inhibition of fibrinolysis and retraction persists. The presence of the same coagulation changes in strength and orientation, the depletion of fibrinolytic mechanisms of hemostasis, the positive clinical impact of TLT in the intermediate-high risk group supports indications for TLT in this group of patients.

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