消融指数指导下射频消融术并发心包填塞的围手术期护理

Perioperative nursing care for radiofrequency ablation directed in ablation index with pericardial tamponade patients

心房颤动(简称“房颤”)是最常见的心律失常之一,导管射频消融治疗已成为阵发性房颤的首选治疗手段。消融指数(Ablation Index,AI)是一款能够有效预测消融损伤深度的工具,AI技术是将消融时的压力、功率及时间等参数整合在一起,用于量化消融损伤程度,它能够帮助医生在三维标测的精准定位下,根据AI指导的消融目标值进行逐点消融,从而更精准、安全地完成房颤手术,提高手术安全性和成功率。科室于2021年1月13日成功为一名阵发性房颤的患者实施AI的指导下三维高效射频消融术,这是中医系统为数不多开展此类技术的案例。文章总结了AI指导下射频消融术并发心包填塞患者的围手术期护理经验,为今后在房颤患者中开展AI指导下射频消融术提供一定的护理经验及参考。护理要点为:术前调整患者的饮食,根据中医辨证施护以保障患者的睡眠质量;完善全身相关的辅助检查以预防手术并发症,做好患者的心理建设以利于术中配合;术中需要医护多学科协作、熟练进行手术配合;有效处理手术并发症;术后科学安排休息与活动,加强皮肤护理,预防血栓栓塞及心包填塞等并发症,出院后的延续护理强调饮食、运动及预防感染的健康宣教。通过精心治疗与护理,患者最终病情好转出院。

Atrial fibrillation(abbreviated as“AF”)is one of the most common cardiac arrhythmias,and radiofrequency ablation has become the first choice for the treatment of paroxysmal atrial fibrillation.Ablation index is a tool that can effectively predict the depth of ablation damage.AI technology integrates parameters in terms of pressure,power,and time during ablation to quantify the degree of ablation damage,it can help the physician to perform point-by-point ablation according to the AI-guided ablation target value under the precise positioning of 3D mapping,so as to complete atrial fibrillation surgery more accurately and safely,improving the safety and success rate of the surgery.On January 13,2021,the department successfully performed a high-efficiency 3D mapping radiofrequency ablation under the guidance of AI for a patient with paroxysmal atrial fibrillation,this is one of the few cases in the TCM system which such a technique has been carried out.The paper summarizes the perioperative nursing experience of patients undergoing radiofrequency ablation directed in AI with pericardial tamponade,provides certain nursing experience for carrying out AI-guided radiofrequency ablation in patients with atrial fibrillation in the future.Nursing key points are as follow:before operation,it is advocated to adjust the patient’s diet,provide nursing care for the patient according to TCM syndrome differentiation to ensure the quality of sleep,complete all auxiliary examinations to prevent surgical complications,offer psychological care for patient to facilitate intraoperative cooperation;during operation,skillfully medical and nursing multidisciplinary cooperation is required,and intraoperative complication need to be effectively managed;after operation,it is advocated to scientifically arrange rest and activities,strengthen skin care,prevent complications such as thromboembolism and cardiac tamponade,and continued care after discharge emphasizes diet,exercise,and health education to prevent infection.Through careful treatment and nursing care,the patient is finally discharged from the hospital.