80岁以上患者行冠状动脉旁路移植术后的护理

Nursing monitoring of over 80-year-old patients undergoing coronary artery bypass grafting

目的总结80岁以上高龄冠状动脉旁路移植术后护理经验。方法对101例冠状动脉旁路移植高龄患者严密监测血液动力学变化,加强心功能维护,合理使用血管活性药物,纠正心律失常,加强呼吸道管理,做好并发症的观察和护理。结果 91例手术后恢复顺利,死亡10例。术后发生严重低心排17例,11例主动脉内球囊反搏辅助循环,心律失常20例,低氧血症21例,2次开胸探查9例,肾功能衰竭7例,床旁连续血液滤过治疗3例,呼吸机相关性肺炎4例。结论加强高龄非体外循环下冠状动脉搭桥术患者术后监护,是高龄冠状动脉搭桥手术患者顺利康复的关键因素。

Objective To summarize the experience of nursing patients over 80-year-old undergoing coronary artery bypass grafting. Methods In nursing 101 patients over 80-year-old undergoing coronary artery bypass grafting, the nursing strategies included： comprehensive monitoring bemodynamic changes, strengtbening the maintenance of cardiac function, rational use of vasoactive drugs to correct arrhythmia, enhancing respiratory management and treatments of complications. Result 91 of them were smoothly rehabilitated except 10 deaths. 17 of them contracted with low cardiac output, 20 with arrhythmia, 21 with hypoxemia, 9 with exploratory thoracotomy for a second time, 7 with renal failure, 4 with ventilator-associated pneumonia and 3 were treated with continuous hemofihration. Conclusion Strengthened postoperative care to patients over 80-year-old undergoing coronary artery bypass grafting is critical for their successful recovery.