瓣膜置换术后并发瓣周漏再次手术患者的术后护理

The Postoperative Care of Patients Undergoing Second Operation on Parabasilar Leak Induced by Valve Replacement

回顾性总结报道2003年1月-2006年12月23例瓣膜置换术后并发瓣周漏需再次瓣膜置换术的患者术后护理监测的经验。主要是加强循环系统功能如血压、心率、中心静脉压(CVP)的监护;术中已留置Swan-Ganz导管的患者还应动态监测肺动脉压、肺毛细血管压,定时测定心排出量、外周血管阻力等,以及时了解心功能情况;加强心律失常的监护,定时复查血气分析和电解质测定,避免或及时消除导致恶性心律失常的隐患,如酸碱及电解质平衡紊乱、低氧、容量过度充盈等因素;加强纵隔及心包引流管的护理,谨防出血和心包填塞的发生;此类患者术后呼吸机辅助通气时间相对较长,加强呼吸道管理,控制肺部感染,锻炼自主呼吸以减少对呼吸机的依赖;对合并有白塞病患者严格控制输液量和速度,严防心力衰竭的发生。

In this paper, the authors reported their experience in caring 23 patients undergoing second operation on parabasilar leak in-duced by valve replacement during Jan. 2003 and Dec. 2006. The summarized care measures included： enhanced monitoring of circulation system function like blood pressure, heart rate, central venous pressure; dynamic monitoring of pulmonary arterial pressure, pulmonary capillary pressure, regular measurement of cardiac volume ejection and peripheral resistance for those carrying Swan-Ganz catheter for timely understanding of cardiac function; enhanced monitoring of arrhythmia, regular reexaminations of blood gas and detection of electrolytes to avoid arrhythmia induced by disorder of acid base electrolytes, hypoxia, volume overfilling; intensified care of interpleural space and pericardial drainage tube and prevention of hemorrhage and pericardial tamponade; intensified care of respiratory tract and control of pulmonary infection, exercises of spontaneous breathing to lower the dependence on ventilating machine because of their long-term use of breathing machine; and strict control of transfusion volume and velocity for those catching Behcet disease in order to prevent heart failure.