主動脈瓣置換術后的護理

1、精選課件1主動脈瓣置換術后的護理主動脈瓣置換術后的護理The nursing of aortic valve replacement精選課件2正常的主動脈瓣有三個瓣葉：左半月瓣、右半月瓣和后半月瓣精選課件3心室舒張期心室舒張期Ventricular diastole心室收縮期心室收縮期Ventricular systole精選課件4精選課件5主動脈瓣狹窄的病因Causes of aortic stenosis先天性畸形Congenital malformations老年性主動脈瓣鈣化Senile aortic valve calcification風濕性心臟病Rheumatic heart d

2、isease主動脈瓣葉粘連、融合Aortic valve leaflets adhesion, fusion精選課件6主動脈瓣狹窄aortic stenosis主動脈瓣主動脈瓣開口面積減少開口面積減少肺靜脈高壓肺靜脈高壓 右心衰竭右心衰竭左心室射血負荷左心室射血負荷左室向心性肥厚左室向心性肥厚 左心室收縮功能左心室收縮功能室壁張力室壁張力順應性下降順應性下降室壁張力室壁張力左心衰左心衰病理生理pathophysiologyPulmonary venous hypetension精選課件7aortic stenosis順應性下降順應性下降舒張末壓力舒張末壓力心絞痛心絞痛暈厥暈厥Angina pe

3、ctorisSyncope精選課件8精選課件9急性Acute : :1.感染性心內膜炎Infective endocarditis2.主A夾層 Aortic dissection3.外傷Trauma4.4.人工瓣膜撕裂Prosthetic valve tear慢性Chronic:主動脈瓣疾病Aortic valve disease2/32/3為風心病為風心病主動脈根部擴張Aortic root dilatation主動脈瓣關閉不全的病因Causes of aortic incompetence主動脈瓣纖維化、增厚、縮短、變形精選課件10主動脈瓣關閉不全Aortic valves incompe

4、tence主動脈內血液在舒張期返流入左室主動脈內血液在舒張期返流入左室偏心性肥厚、擴大偏心性肥厚、擴大左心衰左心衰左心室容量負荷左心室容量負荷Sp 、Dp 左心室舒張末期壓力左心室舒張末期壓力CO室壁張力室壁張力心絞痛心絞痛pulmonary hypertension右心衰右心衰pathophysiology精選課件11反流面積的大小反流面積的大小 心動周期舒張期的長短心動周期舒張期的長短 AI反流量體循環(huán)血管阻力體循環(huán)血管阻力AI reverse flowReverse flow aera of the sizeBeckoning cycle diastolic lengthSystemic

5、 vascular resistance精選課件12急性主動脈瓣關閉不全左心室舒張期充盈量突然增加左心室舒張期充盈量突然增加 壓力迅速增高壓力迅速增高左房壓、肺靜脈壓迅速升高左房壓、肺靜脈壓迅速升高急性肺水腫急性肺水腫心動過速以減少反流量心動過速以減少反流量 增加增加CO二尖瓣舒張期提前關閉，緩解左房二尖瓣舒張期提前關閉，緩解左房和肺靜脈受左心室高舒張壓的影響和肺靜脈受左心室高舒張壓的影響 CO減少，低減少，低BP急性左心衰竭急性左心衰竭 急性急性AI 精選課件13v瓣膜置換術是用人工機械瓣或生物瓣進行替換人心臟瓣膜進行置換Valve replacement surgery is to use

6、 mechanical valves or biological valves to replace original human valves. 精選課件14主動脈瓣置換術精選課件15 病例介紹Case Introduction精選課件16病史medical history 羅菊梅，女，40歲,云南鎮(zhèn)雄人 Patient Jumei Luo,female,40 years old, from Zhenxiong in Yunnan province. 患者因頭昏、胸痛3年，近一年來加重，活動后心悸、氣促、乏力伴呼吸困難，休息后無明顯緩解一月余，于2014年12月10日以“非風濕性主動脈瓣狹窄

7、并關閉不全”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.精選課件17Medical Hist

8、ory手術史Surgical operation history2004年行“ 卵巢囊腫摘除術” ovarian cyst in 2004,2011年行“右上臂神經源性腫瘤切除術”“neurogenic tumor resection of right arm” in 2011過敏史Allergic history 雙黃連精選課件18 Echocardiography:1、Aortic valve disease: moderate aortic incompetence, moderate aortic stenosis, and the widening of aortic diamete

9、r 2、Mild mitral incompetence, and mild tricuspid incompetence3、The decreasing of left ventricular diastolic function , LVD：70mm,EF:55%精選課件19心臟彩超：1、主動脈瓣病變： 主動脈瓣中度關閉不全并中度狹窄， 升主動脈內徑增寬。2、二尖瓣輕度關閉不全 三尖瓣輕度關閉不全3、左心舒張功能降低 LV：70mm,EF:55%精選課件20DX檢查：主動脈迂曲增寬 Aorta becomes widened and tortuous左室增大left ventricle b

10、ecomes bigger精選課件21診治經過診治經過12月16日前完善術前準備12月17日-19日在ICU治療12月20日患者病情平穩(wěn)搬回病房。Preoperative preparation was completed before December 16th.The patient was stablly moved back to the ward on December 20th精選課件22病 情 12月17日在全麻CPB下行主動脈瓣置換術，術畢于12：50分帶氣管插管返ICU，呼吸機輔助呼吸，清醒后，查血氣示正常，于22：30分拔出氣管插管改面罩供氧。血氧飽和度99-100，患者咳

11、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 sa

12、turation was respectively 99%-100. Patients with cough and expectoration somewhat less power.精選課件23病 情 HR95-110次/分，為竇性心律。BP由多巴胺4.9ug/kg/min, 維持在88-122/65-84mmhg,CVP14-7,容量欠，引流液不多, 總量為500ml,尿色、尿量正常,精神飲食稍差，鼓勵進食。The heart rate of the patient and 95-110times/min. BP by dopamine 4.9ug/kg/min, maintained

13、at 88-122/65-84mmhg. 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 .精選課件24 護理問題 Nursing Problem低效性呼吸型態(tài)（Ineffective breathing pattern） 與手術及術后傷口疼痛致咳痰無力

14、有關operation and postoperative wound pain induced sputum weakness 心輸出量減少(decreased cardiac output)： 與心臟疾病、體液不足有關Associated with heart disease, insufficient body fluid潛在并發(fā)癥（ potential complication ） 抗凝不足或抗凝過度Inadequate or excessive anticoagulation、精選課件25護理措施nursing interventionnursing intervention（一）低

15、效性呼吸型態(tài) 1、加強呼吸道護理，聽診雙肺呼吸音，定時拍背、霧化， 鼓勵患者咳嗽、咳痰。 Strengthen respiratory care, auscultation of lung breath sound, timed back patting ,and atomization ,and encourge patients to cough and expectorate.精選課件26 2、持續(xù)心電監(jiān)護，嚴密觀察心率、血壓、呼吸、血氧飽和度 Continuous ECG monitoring, and close observation of heart rate, blood pr

16、essure, respiration, and oxygen saturation.（一）低效性呼吸型態(tài)精選課件27 3、定時監(jiān)測血氣分析結果，根據病人的生命體征和血氣情況，調整供氧方式及流量。 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、遵醫(yī)囑適當予以止痛劑，以減少病人呼吸肌做功 Provide analgesics appro

17、priately according to prescription to reduce the acting of patients breathing muscles. （一）低效性呼吸型態(tài)精選課件28(二)心輸出量減少(decreased cardiac output)（1）嚴密監(jiān)測心律、HR、BP、CVP及末梢情況，發(fā)現異常要及時報告醫(yī)生 Keep close monitoring in the change of rhythm, HR, BP, CVP and Peripheral situation, and report to the doctor promptly when a

18、bnormal situation is found.nursing intervention精選課件29(二)心輸出量減少(decreased cardiac output)（2）運用血管活性藥物，根據患者的生命體征進行調整 Use vasoactive drugs, and adjust according to the patients vital signs精選課件30(二)心輸出量減少(decreased cardiac output) （3）引流管的監(jiān)測 The drainage tube monitoring： 定時擠壓引流管保持引流管的通暢 Squeeze drainage t

19、ube regularly to keep its patency. 觀察引流液量及性質， Observe the drainage amount and nature. 觀察傷口有無滲血 Observe whether there is bleeding or not in wound.精選課件31(二)心輸出量減少(decreased cardiac output) (4)準確記錄出入量，注意水電解質平衡 Record intake and output accurately, and pay attention to the balance of water electrolyte.（5

20、）鼓勵患者進食 Encourage patients to eat精選課件32nursing interventionnursing intervention（三）潛在并發(fā)癥的預防和護理 1、抗凝不足與抗凝過度 Inadequate anticoagulation and excessive anticoagulation (1)、為避免血栓形成，機械瓣置換術后，需終身抗凝治療，生物瓣術后抗凝3-6個月。要定時定量口服 Explain to patients the importance of taking warfarin orally, Take anticoagulant medicin

21、e regularly and quantitatively The dose is 2.5-5 milligram（2）、服藥期間監(jiān)測INR，使之維持在2.03.0. Monitor INR during the medication to maintain it at 2.0 to 3.0精選課件33（3）加強患者的監(jiān)測，如有無皮膚青紫瘀斑、牙齦出血等Strengthen the monitoring of patients, such as the skin bruising , and bleeding gums, etc.（4)、注意飲食對抗凝藥物的影響 Pay attention

22、to the infuence of diet on anticoagulants.精選課件34 Health EducationPrevention of infectionDietPeriodic reviewMedication guideActivity and restSelf-test精選課件35用藥指導Medication guide 華法林只在體內抗凝，通過華法林只在體內抗凝，通過拮抗維生素拮抗維生素K K而產生藥理作用。而產生藥理作用。常用常用INR(INR(國際標準化比值國際標準化比值) )評價評價 Warfarin anticoagulation only in the

23、body, vitamin K antagonism generated by pharmacological effects. Common INR (international normalized ratio) evaluation記住服藥時間要固定哦！記住服藥時間要固定哦！精選課件36DietvIt is best for you to have more nourishing food and easily- digested food, including high-protein,high-vitamins, and so on.At the same time,you shou

24、ld have more meals with less food for each meal,develop good living habits.v Avoid cigarettes, alcohol, coffee and spicy food. vPatients with poor cardiac function should limit sodium intake . Patients should observe the changes in body weight. 保持飲食結構的相對平衡保持飲食結構的相對平衡 應進食富含營養(yǎng)，易于消應進食富含營養(yǎng)，易于消化的食物，報告高蛋白、化的食物，報告高蛋白、高維生素等，同時，應少高維生素等，同時，應少食多餐，養(yǎng)成良好飲食習食多餐，養(yǎng)成良好飲食習慣。慣。 禁忌煙酒、咖啡及刺激性禁忌煙酒、咖啡及刺激性食物。食物。 心功能較差的病人要限制鈉心功能較差的病人要限制鈉鹽的攝入；應用利尿劑的鹽的攝入；應用利尿劑的病人，注意觀察尿量及體病人，注意觀察尿量及體重的變化。重的變化。精選課件37 富含維生素富含維生素K的食物會降低華法林抗凝作用，的食物會降低華法林抗凝作用， 不易長期單調食用某種含維生素不易長期單調食用某種含維生素K多的綠色青菜多的綠色青菜精選課件3