113例冠状动脉血管病变患者行胸腔镜辅助冠状动脉旁路移植术的护理

Nursing of Patients with Coronary Artery Disease Undergoing Coronary Artery Bypass Grafting with Video-assisted Thoracoscopy:A 113-case Study

目的总结胸腔镜辅助下小切口冠状动脉旁路移植术的护理经验。方法对113例冠状动脉血管病变患者行胸腔镜辅助下小切口冠状动脉旁路移植术,护理要点包括:做好术中被动保暖及主动加温方式维持正常体温,预防术中发生低体温;借助负压吸引及二氧化碳混合生理盐水喷洒保持术野清晰;精密器械的使用及管理;预防恶性心律失常事件的发生。结果113例患者术中转为胸骨正中开胸建立体外循环6例,余均在胸腔镜辅助下顺利完成小切口冠状动脉旁路移植术,术后死亡2例,其余康复出院。结论手术室护理人员熟练掌握冠状动脉血管病变患者行胸腔镜辅助下小切口冠状动脉旁路移植术护理配合要点,维持手术患者正常体温,保持术野干净,正确管理及使用精密器械,有效应对心跳骤停等紧急事件是手术顺利的重要保障。

Objective To summarize the nursing experience of patients with coronary artery disease(CAD)undergoing coronary artery bypass grafting(CABG)with video-assisted thoracoscopy(VATS).Methods The nursing points for 113 CAD patients undergoing CABG with VATS included maintenance of normal temperature via passive and active heating during the operation;maintenance of clear operation field with the help of vacuum suction and spray of CO2 mixed with normal saline;application and management of surgical instruments and the prevention of malignant arrhythmia.Results Totally 113 patients in the study completed CABG with VATS but the rest 6 with extracorporeal circulation.All the patients recovered except 2 postoperative death.Conclusion Nursing points of CABG with VATS are maintenance of normal temperature,maintenance of clear operation field,application and management of surgical instruments and the prevention of malignant arrhythmia.