128例瓣膜替换术后早期的治疗和护理体会  

Postoperative Treatment and Nursing of 128 Cases of Valve Replacement Patients

作　　者：蔺兰[1] 宋继贞[1] 王晶[1] 贺淑兰 李惠君[1] 吕民[1] 王伯杰[1] 

机构地区：[1]吉林省人民医院重症监护病房,吉林省人民医院心外科

出　　处：《中国循环杂志》1996年第2期87-89,共3页Chinese Circulation Journal

摘　　要：目的：总结１２８例瓣膜替换术后的治疗和护理，其目的是找到合适的早期处理方法，以增加瓣膜替换术的成功率。方法：①注重血容量的补充，术后第１个２４小时液体的入量为０．５～１．０ｍｌ·ｋｇ￣（－１）／ｈ，出量稍大于入量，使病人处于轻度脱水状态。胶体的补充则根据引流量而定，血红蛋白达１００ｇ／Ｌ即可。②血管活性药物如硝普钠、多巴胺和多巴酚丁胺术后要尽早使用且联合应用，以支持心脏功能。③常规使用呼吸机辅助时吸。采用大潮气量（１２～１５ｍｌ／ｋｇ）和低频率（１２～１４次／分）的呼吸方式，并尽早使用呼气末持续正压通气（ＰＥＥＰ）。④术后采用高浓度补钾，以快速纠正低钾血症。结果：通过以上处理，减少了术后并发症的发生，降低了术后早期死亡率，使病人能顺利渡过术后关。结论：实践证明，本方法是实用可行的。Objective: To find better method of postoperative management to increase the successful rate of valve replacement patients. Methods: In the treatment and nursing of 128 cases of valve replacement, the followings were practised.①Maintenance of blood volume: In the first 24 hours, the fluid intake was kept at 0.5-1. 0ml·kg(-1)/h at slightly less intake than output so as to keep the patients in mild dehydration. Colloid supplementation depended on the drainage amount and hemoglobin was better kept at 100 g/L. ②Drugs administration: Dopamine, dobutamine and soium nitroprusside were timely given in combination to improve the cardiovascular function. ③Care of respiration: A respirator was routinely applied to aid respiration by using hyperpnea (12-15 ml/kg) and low frequency. PEEP was used early. ④Blood electrolytes: Hypokaliemia appeared frequently during which high concentration potassium chloride was intravenously given.Results:The managements reduced early postoperative complication and mortality rate. The patients recovered smoothly. Conclusion: The methods are pratical and effective.

关 键 词：瓣膜替换术 早期处理 护理 

分 类 号：R654.205[医药卫生—外科学] R473.6[医药卫生—临床医学]