改良方坦手术术后危险因素分析及护理对策

Analysis of risk factor after the modified Fontan operation and nursing countermeasures

目的 判定改良Fontan手术后早期死亡的危险因素,探讨护理方案。方法 将178例改良Fontan手术的19个围手术期指标与手术结果进行统计分析,分析影响手术死亡的危险因素及护理方法。结果 术后早期死亡38例,死亡率21.3％。术前McGoon比值≤1.8,右房与右室连接、右房与肺动脉连接的手术方式,术后右房压≥20cmH2O,术后心律失常,严重低心输出量综合征,多器官功能不全是术后早期死亡的高危因素。结论 对于存在高危因素的病人,术后加强监护和护理是预防和降低术后死亡的有效措施。

Objective To analyze the risk factors causing early death after modified Fontan operation and probe into nursing measures. Methods 19 perioperative variables in 178 patients with modified Fontan operation as well as the operational effects were analyzed and treated statistically to find out the risk factors leading to death and corresponding measures for nursing. Results It was found that 38 cases died early after operation, with morbidity of 21. 3%. The high-risk factors after operation involved such factors as preoperative McGoon ratio < 1. 8, junction of atrium to right vertricle and atruum to pulmonary, postoperative right atrial pressure exceeded 20cm H2O postoperative arrhythmias i postoperative serious low cardiac output syndrome and multiorgan failure were risky for the modification. Conclusion For those of high risk, the enhancement of monitoring and nursing can prevent and lower the morbidity after operation.