老年先天性房间隔缺损患者的临床特点及护理

Clinical Characteristic and Nursing of Elderly Congenital Atrial Septal Defect

目的分析老年先天性房间隔缺损患者的临床特点并提出护理对策。方法对19例≥60岁先天性房间隔缺损患者(老年组)与31例<60岁的先天性房间隔缺损患者(中年组)在肺动脉压、左心室射血分数、左心室舒张功能和房颤发生率方面进行比较。结果与中年组比较,老年组患者左心室舒张功能明显减退,继发肺动脉高压和房颤的发生率明显增高,P<0.05。结论老年先天性房间隔缺损患者随增龄病情加重,其左心室舒张功能明显减退,继发肺动脉压力和房颤的比例较中年人高,因此护理时首先应评估年龄、房间隔缺损的大小、心功能改变、肺动脉高压、房颤、心电图的表现等,观察气促、胸闷、乏力、下肢水肿、发绀、心率、脉率及复发的症状及体征。加强临床观察,教会患者自我管理,做好健康教育,重视患者的生活质量。

Objective To analyze the features of left ventricular function, pulmonary artery pressure, and atrial fibrillation of elderly patients with congenital atrial septal defect and put forward nursing countermeasures. Methods Nineteen elderly patients with congenital atrial septal defect who were over 60 and 31 patients under 60 were compared in the occurrence rate of pulmonary artery hypertension and atrial fibrillation, left ventricular ejection fraction and diastolic function. Results Compared with the middle-age group, the occurrence rates of secondary pulmonary artery hypertension and atrial fibrillation increased and the diastolic function of left ventricular decreased significantly in the elderly group （P〈0.05）. Conclusion Along with aging, the pathogenetic condition of elderly patients with congenital atrial septal defect became worse. Secondary pulmonary artery hypertension, atrial fibrillation and the decrease of diastolic function of left ventricular occurred more frequently in the elderly group than the middle-aged group. Therefore, it is very necessary to evaluate primary information of the patients first, including age, diameter of atrial septal defect, cardiac function, pulmonary artery pressure and heart rhythm. It is also necessary to observe the clinical status of the patients, including ECG, chest X-ray, eehocardiology, shortness of breath, chest distress, fatigue, edema of lower extremity, cyanosis, heart rate, pulse rate, and recurrent symptoms and signs. In addition to the above, it is also important to enhance clinical observation, teach patient to manage themselves, give a good health education and emphasize their quality of life.