临时双心室同步化起搏在左心功能不全换瓣术后应用疗效及护理

Effect and nursing of temporary biventricular synchronized pace-making in left ventricular dysfunction patientsafter valve replacement surgery

目的探讨左心功能不全患者换瓣术后使用临时双心室再同步化起搏治疗的疗效及护理。方法回顾5例左心功能不全患者瓣膜置换术同期置入临时双心室起搏治疗后心输出量（CO）、桡动脉收缩压（SBP）、心电图QRS宽度、左心室射血分数（LVEF）变化,比较起搏状态和基础状态下各参数的差异,总结此类患者的护理要点。结果患者再同步化起搏治疗后较基础状态下CO提高0.5～0.6 L/min;SBP提高5～10 mm Hg;QRS时限比术前下降15～35 ms;LVEF增加6%～16%;5例患者均平稳度过围术期。结论临时双心室再同步化起搏治疗可以改善心脏外科左心功能不全患者心功能,做好双心室起搏治疗期间生命体征、心电监护、血流动力学监测及并发症预防和处理,是患者安全度过围术期的重要保证。

Objective To explore effect and nursing of temporary biventricular synchro- nized pace- making in left ventricular dysfunction patients after valve replacement surgery. Meth- ods Changes of cardiac output（CO）, radial artery systolic blood pressure （SBP）, QRS width of electrocardiogram and left ventricular ejection fraction （LVEF） were compared among 5 ventricular dysfunction patients with valve replacement. Differences between pacing mode and basic condition were analyzed retrospectively, and postoperative nursing measures for patients were summarized. Results Compared with basic condition, CO increased by 0.5～0.6 L/min, SBP increased by 5～ 10 mmHg, QRS width decreased by 15～35 ms and LVEF improved by 6 % ～16 % after accepting temporary biventricular synchronization therapy. All the patients were successful pass perioperative period. Conclusion Temporary biventricular synchronization therapy can ameliorate the cardiac function. At the same time, it is very important to focus on vital signs, monitor ECG, hemody- namic indexes, vital signs and prevent complications so as to guarantee safe perioperation.