主动脉瓣置换术后的护理

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,主动脉瓣置换术围手术期旳护理,The nursing of aortic valve replacement,正常旳主动脉瓣有三个瓣叶：左半月瓣、右半月瓣和后半月瓣,心室舒张期,Ventricular diastole,心室收缩期,Ventricular systole,主动脉瓣狭窄旳病因Causes of aortic stenosis,先天性畸形,Congenital malformations,老年性主动脉瓣钙化,Senile aortic valve calcification,风湿性心脏病,Rheumatic heart disease,主动脉瓣叶粘连、融合,Aortic valve leaflets adhesion,fusion,主动脉瓣狭窄,aortic stenosis,主动脉瓣,开口面积降低,肺静脉高压 右心衰竭,左心室射血负荷,左室向心性肥厚,左心室收缩功能,心排血量下降,室壁张力,顺应性下降,室壁张力,左心衰,病理生理,pathophysiology,Pulmonary venous hypetension,心内膜下心肌缺血和灌注不足,aortic stenosis,脑血流灌注下降,左心室做功,心肌耗氧量,顺应性下降,舒张末压力,CO,冠状动脉平均灌注压,心绞痛,晕厥,Angina pectoris,Syncope,急性,A,cute,:,1.,感染性心内膜炎,Infective endocarditis,2.,主,A,夹层,Aortic dissection,3.,外伤,Trauma,4.,人工瓣膜撕裂,Prosthetic valve tear,慢性,Chronic,:,主动脉瓣疾病,Aortic valve disease,2/3,为风心病,主动脉根部扩张,Aortic root dilatation,主动脉瓣关闭不全旳病因,Causes of aortic,incompetence,主动脉瓣纤维化、增厚、缩短、变形,主动脉瓣关闭不全,Aortic valves incompetence,主动脉内血液在舒张期返流入左室,偏心性肥厚、扩大,左心衰,左心室容量负荷,Sp,、,Dp,左心室舒张末期压力,CO,室壁张力,心绞痛,pulmonary hypertension,右心衰,pathophysiology,反流面积旳大小,心动周期舒张期旳长短,AI,反流量,体循环血管阻力,AI reverse flow,Reverse flow aera of the size,Beckoning cycle diastolic length,Systemic vascular resistance,双击添加标题文字,急性主动脉瓣关闭不全,左心室舒张期充盈量忽然增长,压力迅速增高,左房压、肺静脉压迅速升高,急性肺水肿,心动过速以降低反流量,增长,CO,二尖瓣舒张期提前关闭，缓解左房和肺静脉受左心室高舒张压旳影响,CO,降低，低,BP,急性左心衰竭,急性,AI,What is valvereplacemengsurgery,瓣膜置换术是用人工机械瓣或生物瓣进行替代人心脏瓣膜进行置换,Valve replacement surgery is to use mechanical valves or biological valves to replace original human valves.,主动脉瓣置换术,病例简介,Case Introduction,病史,medical history,罗菊梅，女，40岁,云南镇雄人,Patient Jumei Luo,female,40 years old,from Zhenxiong in Yunnan province.,患者因头昏、胸痛3年，近一年来加重，活动后心悸、气促、乏力伴呼吸困难，休息后无明显缓解一月余，于2023年2月10日以“非风湿性主动脉瓣狭窄并关闭不全”收住,She was admitted to the hospital for Non-rheumatic aortic stenosis and incompetence on December 10th,2014.because dizziness,chest pain have last three years,heart palpitation and shortness of breath with increased activities,and exertional dyspnea lasting over a month.,Medical History,手术史Surgical operation history,2023年行“卵巢囊肿摘除术”ovarian cyst in 2004,2023年行“右上臂神经源性肿瘤切除术”,“neurogenic tumor resection of right arm”in 2011,过敏史Allergic history,双黄连,Echocardiography:,1、,Aortic valve disease:moderate aortic incompetence,moderate,aortic,stenosis,and the widening of,aortic diameter,2、,Mild mitral,incompetence,and mild tricuspid,incompetence,3、,The decreasing of left ventricular diastolic function,LVD：70mm,EF:55%,心脏彩超：,1,、主动脉瓣病变：,主动脉瓣中度关闭不全并中度狭窄，,升主动脉内径增宽。,2,、二尖瓣轻度关闭不全,三尖瓣轻度关闭不全,3,、左心舒张功能降低,LV,：,70mm,EF:55%,DX检验,：,主动脉迂曲增宽,Aorta becomes widened and tortuous,左室增大,left ventricle becomes bigger,诊治经过,2,月,16,日前完善术,前准备,2,月,17,日,-19,日在,ICU,治疗,2,月,20,日患,者病情平稳,搬回病房。,P,reoperative,preparation,was completed before December 16th,.,The patient was stablly moved back to the ward on December 20th,病 情,2,月,17,日在全麻,CPB,下行主动脉瓣置换术，术毕于,12,：,50,分带气管插管返,ICU,，呼吸机辅助呼吸，清醒后，查血气示正常，于,22,：,30,分拔出气管插管改面罩供氧。血氧饱和度,99-100,，患者咳嗽咳痰力量稍差,On december 17th,the aortic valve replacement was completed under general anesthesia CPB,and the patient returned the icu at 12:50 with ventilator breathing.After waking,her blood check showed,normal,so pulled out endotracheal intubation and it was replace by,oxygen masks.The oxygen,saturation was respectively 99%-100,.Patients with cough and expectoration somewhat less power.,病 情,HR95-110,次,/,分，为窦性心律。,BP,由多巴胺,4.9ug/kg/min,维持在,88-122/65-84mmhg,CVP14-7,容量欠，引流液不多,总量为,500ml,尿色、尿量正常,精神饮食稍差，鼓励进食。,The heart rate of the patient and,95-110times/min.BP by dopamine 4.9ug/kg/min,maintained at 88-1,22,/65-8,4,mmhg.Central venous pressure was 9-10.Drainage of fluid was,normal,The total amount of fluid drainage is,500ml,.Urine was normal,patients spirit and diet was slightly poor.She was encouraged,to eat.,护理问题,Nursing Problem,低效性呼吸型态（Ineffective breathing pattern）,与手术及术后伤口疼痛,致咳痰,无力有关,operationand postoperativewound pain induced sputum weakness,心输出量降低,(decreased cardiac output),：,与心脏疾病、,体液,不足有关,Associated with heart disease,insufficient,b,ody,fluid,潜在并发症（,potential complication,）,抗凝不足或抗凝过分,Inadequate or excessive anticoagulation、,护理措施,nursing intervention,（一）低效性呼吸型态,1、加强呼吸道护理，听诊双肺呼吸音，定时拍背、雾化，,鼓励患者咳嗽、咳痰。,Strengthen respiratory care,auscultation of lung breath sound,timed,back patting,and atomization,and encourge,patients to cough and expectorate.,2、连续心电监护，严密观察心率、血压、呼吸、血氧饱和度,Continuous ECG monitoring,and close observation of heart rate,blood pressure,respiration,and oxygen saturation,.,（一）低效性呼吸型态,3,、定时监测血气分析成果，根据病人旳生命体征和血气情况，调整供氧方式及流量。,Regularly monitor the result of blood gas analysis and adjust the way and the flow rate of oxygen offer based on the patients vital signs and blood gas.,4,、遵医嘱合适予以止痛剂，以降低病人呼吸肌做功,Provide analgesics appropriately according to prescription to reduce the acting of patients breathing muscles.,（一）低效性呼吸型态,(,二,),心输出量降低,(decreased cardiac output),（1）严密监测心律、HR、BP、CVP及末梢情况，发觉异常要及时报告医生,Keep close monitoring in the change of rhythm,HR,BP,CVP and Peripheral situation,and report to the doctor promptly when abnormal situa