单中心前100例经导管主动脉瓣置换术围手术期护理(1)
摘 要 目的：探讨经导管主动脉瓣置换术治疗主动脉瓣狭窄患者围手术期的护理要点。方法：回顾性分析前100例经导管主动脉瓣膜置换术的围手术期护理，包括术前完备各项护理准备；术中安全护理、手术体位、麻醉配合、监测生命体征、传递耗材、手术配合、术中并发症护理；术后麻醉复苏及转运交接、血管并发症护理、血流动力学护理、呼吸道管理、用药护理、术后并发症护理。结果：前100例实施经导管主动脉瓣膜置换术成功率为97%，出现瓣膜移位脱落转入外科2例，术中抢救无效死亡1例。术后30 d死亡率为2%，包括1例术中死亡、1例住院期间因主动脉夹层，术后第5天抢救无效死亡，其余患者治疗后均康复出院。结论：充分了解患者基础状况、掌握瓣膜支架的特点和具体手术过程，在围手术期内评估可能出现的并发症并进行有效护理干预是利于患者术后康复的关键。
关键词 主动脉瓣狭窄 经导管主动脉瓣置换术 围手术期 护理
中图分类号：R473.6； R542.52 文献标志码：C 文章编号：1006-1533(2019)07-0056-06
Perioperative nursing care of the first 100 cases with transcatheter aortic valve replacement in single center*
ZHU Li1**， LING Huaxing1， GE Junbo1***， ZHOU Daxing1， PAN Wenzhi1， ZHANG Xiaochun1， QIN Wei2， ZHANG Yuxia2， CHEN Haifeng1， KONG Leyi2(1. Department of Internal Medicine-Cardiovascular， 2. Department of Nursing， Zhongshan Hospital， Fudan University， Shanghai 200032， China)
ABSTRACT Objective： To explore the perioperative nursing points of transcatheter aortic valve replacement in patients with aortic stenosis. Methods： The data from perioperative nursing of the first 100 patients undergoing transcatheter aortic valve replacement were retrospectively analyzed， including preoperative nursing preparation， intraoperative safety nursing， operative position， anesthesia cooperation， monitoring vital signs， transmitting consumables， operative cooperation， intraoperative complications nursing， post-operative anesthesia resuscitation and transfer， vascular complications nursing， hemodynamic nursing， respiratory tract management， nursing of medication and complications after operation. Results： The success rate of transcatheter aortic valve replacement in the first 100 cases was 97%. Two cases of valve displacement occurred and were transferred to surgery. The mortality was 2% in postoperative 30-days， including one case died of ineffective rescue during operation and another case died of aortic dissection during hospitalization. On the fifth day after operation， all the other patients recovered and discharged. Conclusion： Fully understanding the basic condition of patients， mastering the characteristics of valve stent and the specific operation process， evaluating the possible complications during the perioperative period and undergoing effective nursing intervention are the keys to be of benefit to the postoperative recovery of patients.
KEY WORDS aortic stenosis； transcatheter aortic valve replacement； perioperation； nursing care
主動脉瓣狭窄(aortic valve stenosis， AVS)是影响老年人群健康的主要心血管疾病[1-3]，经导管主动脉瓣置换术(transcatheter aortic valve replacement， TAVR)[4-5]是治疗主动脉瓣狭窄患者的一种主要微创介入方法[6]。它是一种通过股动脉、锁骨下动脉、心尖等路径建立输送通道，将新的主动脉瓣替代原有主动脉瓣，实现瓣膜的正常生理功能的方法[7]。我国TAVR开展尚在起步阶段，复旦大学附属中山医院葛均波院士团队于2010年开展国内第一例TAVR术[8]。Lauck等[9]及《经导管主动脉瓣置换团队建设及运行规范中国专家建议》[10]特别提到了护理在TAVR团队协作中的地位，然而国内针对TAVR围手术期护理方面的总结相对欠缺。因此，本研究针对TAVR术前、术中、术后临床资料进行护理总结，得出护理管理的方案和要点，为进一步优化TAVR的护理发展奠定基础。现对我中心前130例TAVR的围手术期护理病例进行总结。, 百拇医药(朱丽 凌华兴 葛均波 周达新 潘文志 张晓春 秦薇 张玉侠 陈海奉 孔乐怡)
关键词 主动脉瓣狭窄 经导管主动脉瓣置换术 围手术期 护理
中图分类号：R473.6； R542.52 文献标志码：C 文章编号：1006-1533(2019)07-0056-06
Perioperative nursing care of the first 100 cases with transcatheter aortic valve replacement in single center*
ZHU Li1**， LING Huaxing1， GE Junbo1***， ZHOU Daxing1， PAN Wenzhi1， ZHANG Xiaochun1， QIN Wei2， ZHANG Yuxia2， CHEN Haifeng1， KONG Leyi2(1. Department of Internal Medicine-Cardiovascular， 2. Department of Nursing， Zhongshan Hospital， Fudan University， Shanghai 200032， China)
ABSTRACT Objective： To explore the perioperative nursing points of transcatheter aortic valve replacement in patients with aortic stenosis. Methods： The data from perioperative nursing of the first 100 patients undergoing transcatheter aortic valve replacement were retrospectively analyzed， including preoperative nursing preparation， intraoperative safety nursing， operative position， anesthesia cooperation， monitoring vital signs， transmitting consumables， operative cooperation， intraoperative complications nursing， post-operative anesthesia resuscitation and transfer， vascular complications nursing， hemodynamic nursing， respiratory tract management， nursing of medication and complications after operation. Results： The success rate of transcatheter aortic valve replacement in the first 100 cases was 97%. Two cases of valve displacement occurred and were transferred to surgery. The mortality was 2% in postoperative 30-days， including one case died of ineffective rescue during operation and another case died of aortic dissection during hospitalization. On the fifth day after operation， all the other patients recovered and discharged. Conclusion： Fully understanding the basic condition of patients， mastering the characteristics of valve stent and the specific operation process， evaluating the possible complications during the perioperative period and undergoing effective nursing intervention are the keys to be of benefit to the postoperative recovery of patients.
KEY WORDS aortic stenosis； transcatheter aortic valve replacement； perioperation； nursing care
主動脉瓣狭窄(aortic valve stenosis， AVS)是影响老年人群健康的主要心血管疾病[1-3]，经导管主动脉瓣置换术(transcatheter aortic valve replacement， TAVR)[4-5]是治疗主动脉瓣狭窄患者的一种主要微创介入方法[6]。它是一种通过股动脉、锁骨下动脉、心尖等路径建立输送通道，将新的主动脉瓣替代原有主动脉瓣，实现瓣膜的正常生理功能的方法[7]。我国TAVR开展尚在起步阶段，复旦大学附属中山医院葛均波院士团队于2010年开展国内第一例TAVR术[8]。Lauck等[9]及《经导管主动脉瓣置换团队建设及运行规范中国专家建议》[10]特别提到了护理在TAVR团队协作中的地位，然而国内针对TAVR围手术期护理方面的总结相对欠缺。因此，本研究针对TAVR术前、术中、术后临床资料进行护理总结，得出护理管理的方案和要点，为进一步优化TAVR的护理发展奠定基础。现对我中心前130例TAVR的围手术期护理病例进行总结。, 百拇医药(朱丽 凌华兴 葛均波 周达新 潘文志 张晓春 秦薇 张玉侠 陈海奉 孔乐怡)