经导管主动脉瓣膜置换术复杂高危患者围手术期护理管理策略  

Perioperative Nursing Management Strategies for Patients With Complex and High-risk Transcranial Aortic Valve Replacement

作　　者：张春[1] 蔡闵敏 王海霞[1] 石夏兰 马蔓娟[1] 冯英[1] 宋婷婷[1] 张延龙 ZHANG Chun;CAI Minmin;WANG Haixia;SHI Xialan;MA Manjuan;FENG Ying;SONG Tingting;ZHANG Yanlong(Department of Cardiology,The Second Hospital of Lanzhou University,Lanzhou Gansu 730030,China)

机构地区：[1]兰州大学第二医院心血管内科,甘肃兰州730030

出　　处：《中国继续医学教育》2021年第9期182-185,共4页China Continuing Medical Education

摘　　要：经导管主动脉瓣膜置换术(TAVR),因其创伤小、全因死亡率及术后并发症低等优点,已逐步成为外科手术高风险AS患者的替代治疗方法,有学者对重度AS行TAVR的患者进行了近6年追踪,证实了其安全及有效性。文章报告医院2018年10月—2019年12月经导管主动脉瓣植入术(TAVR)治疗重度主动脉瓣狭窄患者围手术期的护理管理策略,总结复杂高危TAVR围手术期的护理工作对保障患者安全和保证治疗效果尤为重要,为今后此类手术护理工作提供帮助。护理要点:术前积极完善相关检查,并多学科协同评估患者,拟定治疗方案,使用有效方法改善心肾功能,制定个体化的护理计划。术中护士需熟悉手术进程及每一项操作的配合方法及潜在风险,做好患者的病情观察。术后严密监测生命体征,加强呼吸支持,血流动力学监测,维持循环稳定;积极观察各项指标,预防出血、急性肾损伤、瓣周漏等手术并发症的发生。10例患者术后主动脉狭窄解除,血流动力学明显改善,NYHA恢复至Ⅱ级,均未出现严重心血管恶性事件,治愈出院。Transcatheter aortic valve replacement(TAVR),because of the advantages of this procedure with less trauma,lower all-cause mortality and postoperative complications,has gradually become an alternative treatment for patients with high-risk aortic stenosis who have undergone surgical procedures,there was a research has followed patients with severe as for nearly 6 years and confirmed its safety and efficacy.To report the perioperative nursing management strategy of patients with severe aortic stenosis treated by transcatheter aortic valve implantation(TAVR)in our hospital from October 2018 to December 2019,it is particularly important to summarize the nursing care efforts in the perioperative period of complex high-risk TAVR to safeguard patient safety and guarantee the therapeutic effects,and to provide theoretical support for future nursing efforts.Key points of nursing care:preoperative active improvement of relevant examinations,multidisciplinary and synergistic assessment of patients,formulation of treatment options,use of effective methods to improve cardiac and renal function,and development of an individualized plan of care.Intraoperative nurses need to be familiar with the surgical process and the cooperation method and potential risks of each operation,and make a good observation of the patient's condition.After the operation,closely monitor vital signs,strengthen respiratory support,hemodynamic monitoring,maintain circulation stable;observe each index actively to prevent the occurrence of bleeding,acute kidney injury,paravalvular leak and other surgical complications.Results:the aortic stenosis resolved after surgery in 10 patients,their hemodynamics improved significantly,and NYHA recovered to classⅡ,none of whom experienced a serious cardiovascular malignant event and they were all cured and discharged.

关 键 词：经导管 主动脉瓣狭窄 危重症 围手术期 计划 并发症 

分 类 号：R542[医药卫生—心血管疾病]