妊娠和产褥期合并主动脉夹层患者行孙氏手术的围术期护理

Perioperative nursing of Sun's procedure for patients with aortic dissection during pregnancy and early postpartum

目的:总结妊娠和产褥期合并主动脉夹层患者行孙氏手术的围术期护理效果及经验。方法:2010年6月至2016年2月间,共12例妊娠和产褥期合并主动脉夹层患者接受孙氏手术治疗,年龄(30.5±3.9)岁。其中,Stanford A型夹层10例(83.3%);Stanford B型夹层2例(16.7%),均合并主动脉根部瘤。结果:1例早期妊娠发病后继续妊娠至孕7周行引产术,术后患者存活;4例中期妊娠患者中3例存活,1例因术后多器官衰竭死亡,1例胎儿存活;3例晚期妊娠患者母体、新生儿均存活,其中1例新生儿剖宫产术后3个月院外死亡;4例产褥期患者中3例存活,1例术前合并合并肾功能不全患者因术后肾衰竭死亡。患者术后二次开胸探查1例,肾衰竭1例,呼吸功能不全2例,低氧血症1例。结论:提高护士对该疾病的认识,加强围术期病情观察,做好并发症预防和护理以及心理护理,可改善孙氏手术治疗妊娠和产褥期合并主动脉夹层孕产妇的母婴预后。

Objective：To summarize the perioperative nursing outcome and experience of Sun＇s procedure for patients with aortic dissection （AD） during pregnancy and early postpartum.Methods：From June 2010 to February 2016,12 AD patients in pregnancy and early postpartum underwent Sun＆#39;s procedure in our center.The mean age was （30.5 ＆#177;3.9） years.10 patients （83.33%） were Stanford type A dissection,2 （16.67%） were Stanford type B aortic dissection and aortic root aneurysm.Results：1 patient in first trimester suffered AD and continued pregnancy until aborted by induced labor at 7 gestation weeks,survived after aortic surgery;3 of 4 patients in second trimester survived after surgery,another one died of multiorgan failure,but only 1 fetus was alive;3 patients in third trimester with both maternal and neonatal survival after surgery,but 1 baby dead at 3 months after cesarean delivery;3 of 4 patients in early postpartum survived after surgery,another one died of renal failure.Of them,reoperation was performed in 1,and postoperative respiratory dysfunction was found in 2,hypoxemia in 1,renal failure in 1.Conclusion：The prognosis of maternal and fetal for patients with AD in pregnancy and early postpartum underwent Sun＆#39;s procedure can be improved by increasing the nurses＆#39; awareness of the disease,strengthening the perioperative clinical observation,and paying close attention to postoperative complication and mental nursing.