危重心脏瓣膜置换术38例围术期护理体会

Experience of perioperative nursing care of 38 patients with critical valvular disease treated with valve replacement

目的：探讨危重心脏瓣膜病瓣膜置换术围术期护理方法。方法：对38例危重瓣膜病瓣膜置换患者术前充分准备，术中加强心肌保护，术后严密监测心功能，预防低心排综合征（LOS）和心律失常，加强呼吸系统管理，严密观察瓣膜功能和凝血功能，积极救活多器官功能衰竭（MODS），加强营养支持和基础护理。结果：本组早期发生并发症28例，死亡2例，其余均康复出院，随访6个月-1年，心功能均迭Ⅱ级以上。结论：完善术前准备，选择适当手术时机，术后加强循环系统监护，完善呼吸系统管理，积极预防与治疗各种并发症是保证手术成功的关键。

Objective： To explore preoperative nursing methods in the treatment of valvular disease by valve replacement. Methods： Full preparation was made for all 38 patients before operation, protection of cardiac muscle was enhanced and careful monitoring of heart function was taken postoperatively in order to prevent LOS and arrhythmia. MODS was treated positively through strengthening care of respiratory system, supportive nutrition and essential nursing care, close observation on function of valve and blood coagulation. Results ： In 28 cases of complications, 2 died and the rest were all cured by 6 months to one year follow - up. The function of heart of all the discharged reached or were above Level Ⅱ. Conclusion： Preferable preoperative preparation, proper choice of operation, careful monitoring of circulation system and respiratory system and prevention of complications are the keys to ensure the success of operation.