16例房颤患者左心耳封堵术的围手术期护理及随访

Perioperative nursing and follow-up of 16 cases patients with atrial fibrillation treated by percutaneous left atrial appendage occlusion

目的总结经皮左心耳介入封堵术预防脑血管事件围手术期的护理经验。方法回顾性分析2014年5月—2015年3月间在杭州师范大学附属医院心内科行经皮左心耳封堵术治疗的16例心房颤动患者围术期的护理情况,包括:术前准备、术中生命体征及ACT的观察、生命体征及患者综合管理、抗凝药物及抗生素管理、可能发生的并发症护理等护理内容。总结经皮左心耳封堵术预防脑血管事件的围手术期护理经验。结果 13例房颤患者均顺利完成经皮左心耳封堵术,2例患者部分收回封堵伞后重新定位释放;1例患者TEE下封堵伞周围存在2 mm沟隙,仅有少量血流通过,无收回指证。通过严密监护和有效护理,16例房颤患者术后恢复良好。术后2h、24 h及3 d行经胸超声心动图检查,确认无心包积液或封堵器脱落等情况。术后随访3个月,未出现死亡(心源性或非心源性)、致死性或非致死性恶性心律失常、急性心包填塞、脑血管意外和其他需要紧急住院治疗的植入器械相关事件的MACE事件。结论在经皮左心耳封堵术围手术期,严密观察和有效护理有助于心房颤动患者术后的恢复,为降低术后并发症和提高手术成功率提供支持。

Objective To summarize the perioperative nursing experience of percutaneous left atrial appendage occlusion in prevention of cerebral vascular events. Methods Perioperative nursing of 16 cases of patients with atrial fibrillation treated by percutaneous left atrial appendage occlusion from May 2014 to March 2015 in Cardiology department of the affiliated hospital of Hangzhou normal university were respectively analyzed, including nursing of preoperative preparation, intraoperative vital signs and ACT, general management of patient vital signs, management of anticoagulant drugs and antibiotics, and nursing of complications. And the perioperative nursing experience of percutaneous left atrial appendage occlusion in prevention of cerebral vascular events was summarized. Results Thirteen cases of patients with atrial fibrillation were successfully completed pereutaneous left atrial appendage occlusion,2 patients were repositioning released after partially recovered occluder, 1 patient preseneed 2 mm fissure around TEE occluder with small amount of blood flow and no testify. Through close guardianship and effective nursing, 16 cases of patients treated by percutaneous left atrial appendage occlusion recovered well. There were no happening of perieardial effusion and oceluder off, confirmed by transthoracic echocardiography postoperative 2 h ,24 h and 3 d. All patients were followed up for three months,there were no MACE events of death （eardiogenic and non cardiogenic）, fatal or non-fatal malignant arrhythmia, acute cardiac tamponade, cerebral vascular accident and implanted device-related requiring emergency hospitalization. Conclusion During perioperative period of percutaneous left atrial appendage occlusion, close guardianship and effective nursing are helpful for postoperative recovery of atrial fibrillation patients ,and can provide support on reducing complications and improving success rate.