主动脉弓杂交术后并发脑梗死的原因分析与护理对策

Causes of cerebral infarction after hybrid repair of the aortic arch and nursing countermeasures

目的分析主动脉弓杂交术后并发脑梗死的原因,总结护理方法。方法对129例Stanford B型主动脉夹层行主动脉弓杂交术患者进行回顾性分析。结果术后5例(3.88%)并发脑梗死,其中1例并发多脏器功能衰竭家属放弃治疗,治愈出院4例,但均遗留神经系统症状,需进一步行康复治疗。结论桥血管狭窄或闭塞、主动脉弓部斑块或附壁血栓脱落造成栓塞、术后低血压、伤口血肿及小动脉瘤形成是主动脉弓杂交术后并发脑梗死的原因。对主动脉弓杂交术后患者,除严密观察生命体征、避免低血压的发生外,还要做好神经系统、伤口出血和肢体血运的观察,以预防和及早发现脑梗死并发症。

Objective To analyze causes of cerebral infarction after aortic arch hybrid repair and to summarize clinical nursing experiences.Methods We retrospectively analyzed clinical data of 129 cases with Stanford type B aortic dissection treated with aortic arch hybrid procedures.Results Of the 5 cases （3.88%） developed cerebral infarction after the surgery,1 suffering from multiple organ failure gave up treatment,and the other 4 recovered,although further rehabilitation therapy was required for neurological symp toms.Conclusion The causes of cerebral infarction after hybrid repair of the aortic arch include stent stenosis or occlusion,embolism due to dislodgment of plaque at the aortic arch or thrombus from the vessel wall,postoperative hypotension,wound hematoma,and small aneurysm formation.Besides close observation of patients＇ vital signs and avoidance of postoperative hypotension,we should provide frequent neurological checks,control wound bleeding,and assess limb blood circulation,so as to prevent and detect cerebral infarction as early as possible.