成人Ebstein8例畸形行矫治术的护理

Postoperative Nursing of Correction in 8 Adult Patients with Ebstein's Anomaly

目的报告成人Ebstein畸形(三尖瓣下移畸形)患者手术治疗前后的护理经验。方法对8例成人Ebstein畸形患者在全麻低温体外循环下施行矫治术,术前充分做好患者准备,其其心理、生理达到最佳状态,术后护理要点:①加强呼吸道管理,维持良好的呼吸功能;②积极预防并处理心律失常;③维护右心功能,预防低心排综合征的发生;④密切观察尿量,维护肾功能。结果 2例患者术后出现频发室性早搏,合理使用利多卡因静脉给药后心律均恢复正常,其余患者未发生任何术后并发症,患者均痊愈出院。结论成人Ebstein畸形患者瓣叶畸形的程度一般较儿童为重,因此,行矫治术的难度大,风险高,对此类患者加强手术前后护理,可提高手术成功率。

[Objectives]To report the experience of preoperative and postoperative nursing of Ebstein＇s anomaly in adult patients.[Methods]8 patients with Ebstein＇s anomaly were given correction surgery with hypothermic cardiopulmonary bypass under general anesthesia. Before operation, a sufficient preparation in patients was performed, in order to make their mental and physical condition achieve the best state. Main points of postoperative nursing included the following： ①To enhance respiratory management, maintain good function of respiratory. ②To take active measures, prevent and treat the arrhythmia. ③To maintain right ventricular function, prevent low cardiac output syndrome. ④To observe urine output, maintain function of renal.[Results]The frequent ventricular premature beat occurred in 2 patients after operation, and the heart rate returned to normal after intravenous administration of lidocaine. No postoperative complication occurred among the other patients. All patients were cured and discharged.[Conclusion]Because the deformity degree of valve leaflets in adult patients with Ebstein＇s anomaly is more serious than that in children generally, the correction surgery has the characteristics of great difficulty and high risk. The sufficient preoperative and postoperative nursing can improve the success rate of operation.