心脏移植术后右心功能不全的观察及护理

Observation and nursing care for right ventricular dysfunction after heart transplantation

目的总结同种异体原位心脏移植术后右心功能不全的护理经验。方法对2007年1月至2010年12月开展的67例心脏移植手术患者的临床资料进行回顾性分析。结果58例患者临床治愈出院，死亡9例。67例受者术后早期均出现不同程度的中心静脉压（CVP）升高，右心功能不全，应用体外膜肺（EcMO）辅助治疗28例，应用连续性肾脏替代疗法（CRRT）治疗6例。治愈的58例患者出院时心功能Ⅱ级54例，Ⅲ级4例。结论通过对心脏移植术后患者早期加强监护，密切观察右心功能不全症状，提供有效的护理支持，积极防治右心衰竭，维护重要脏器功能是心脏移植成功的关键。

Objective To summarize the nursing care experience for right ventricular dysfunction after orthotopic heart transplantation. Methods Clinical data of 67 patients underwent heart transplanta- tion were retrospectively analyzed from January 2007 to December 2010. Results 58 patients were dis- charged after they were cured, 9 patients died. 67 patients were affected by different degrees of increasing central venous pressure （CVP）early postoperation and right ventricular dysfunction, 28 cases received ex- tracorporeal membrane oxygenation（ECMO） assistant, 6 cases received continuous renal replacement ther- apy（CRRT）. Among 58 discharged patients, the heart function level showed class two in 54 cases and class three in 4 cases. Conclusions After heart transplantation, followed with intensive care and close obser- vation of right heart failure symptoms ,providing effective care and support, active prevention and treatment for right heart failure, maintaining vital organs function were key to successful heart transplantation.