经导管三尖瓣缘对缘修复术患者的手术护理  

Intraoperative care of patients undergoing transcatheter edge-to-edge valve repair for tricuspid regurgitation

作　　者：王雅琳 陈丽莉[2] 钱吉利 孙新星[1] Wang Yalin;Chen Lili;Qian Jili;Sun Xinxing(Operating Room,The First Affi-liated Hospital of Zhejiang University School of Medicine,Hangzhou 311200,China)

机构地区：[1]浙江大学医学院附属第一医院手术室,浙江杭州311200 [2]温州医科大学附属第一医院护理部

出　　处：《护理学杂志》2024年第17期55-57,60,共4页Journal of Nursing Science

基　　金：浙江省科技计划项目(2023C03087);浙江省教育厅一般科研项目(自然科学类)(Y202353856)。

摘　　要：总结25例经导管三尖瓣缘对缘修复患者的手术护理经验。护理重点包括术前对高风险患者做好差异化应急准备,完善三尖瓣夹合器和手术仪器准备;术中针对三尖瓣反流疾病特征安置舒适体位,调试操作系统避免血栓及空气栓塞,警惕患者肝素化过程中的出血,积极预防术中恶性心律失常,实施目标导向性的血糖护理干预;术后转运避免夹合器脱落等。患者手术顺利,术后即刻反流由重度及以上下降至轻度13例,下降至中度10例,2例反流等级分别从5级和4级下降为3级;术后3~7 d出院。术后随访6个月,25例患者反流等级均在3级及以下,心功能和生活质量均有显著改善。A total of 25 patients underwent transcatheter edge-to-edge valve repair for tricuspid regurgitation.The experiences of caring for these patients during the operation were summarized,including making preparedness plans for emergency situations for high-risk patients;preparing surgical instruments and clips for valve repair;placing patient at comfortable position based on the characteristics of tricuspid regurgitation;adjusting the operating system to avoid thrombosis and air embolism;monitoring blee-ding complications during heparinization;preventing malignant arrhythmias;implementing goal-directed glycemic control;and preventing clamp dislodgement.Immediately after the operation,the regurgitation grade was decreased,from severe or very severe(grade≥3),to mild(grade 1)in 13 patients,to moderate(grade 2)in 10 patients,and to grade 3 in 2 patients.All patients were discharged in 3 to 7 days after the surgery,and followed-up for 6months.Regurgitation grade was≤3,cardiac function and quality of life were significantly improved.

关 键 词：三尖瓣反流 经导管三尖瓣缘对缘修复术 介入手术 应急准备 血糖管理 血栓 空气栓塞 手术室护理 

分 类 号：R472.3[医药卫生—护理学]