国内首批经导管三尖瓣环缩术治疗重度三尖瓣反流的围手术期护理

Perioperative care of first transcatheter annulus contraction for treating severe tricuspid regurgitation in China

目的总结15例重度三尖瓣反流患者接受经导管三尖瓣环缩术的围手术期护理。方法患者责任护士在术前密切观察病情、缓解心衰症状、进行呼吸功能训练和心理支持;术中与医师做好手术配合;术后进行密切的血流动力学和呼吸功能监测,及时发现和处理术后并发症,并通过早期运动促进康复。同时,通过统计手术并发症数量,记录出现术后并发症患者的处理过程和结果,并对比患者术前、术后的Barthel日常活动能力得分、六分钟步行试验距离,以此明确围手术期护理措施的实施效果。结果术后监测发现2例冠状动脉缺血、1例急性右心衰和1例右颈穿刺部位周围皮下出血,均与手术并发症相关,因而针对性地使用冠脉扩张药物,进行强心利尿治疗和严密的容量管理,并对出血部位进行持续监测。措施实施后,患者病情均得以好转,15例患者均顺利出院。患者的Barthel日常活动能力得分由术前的(35.32±6.50)分提升至出院前的(52.45±5.35)分(t=-7.88,P<0.01);出院当日六分钟步行试验距离与术前相比有明显提升[(191.30±15.21)m vs.(153.51±18.57)m,t=5.45,P<0.01]。结论密切的病情监测、全面的并发症预防和处理措施能保证接受经导管三尖瓣环缩术患者安全地渡过围手术期,顺利康复。

Objective To summarize the perioperative care of 15 patients with severe tricuspid regurgitation undergoing transcatheter tricuspid annulus contraction.Methods Preoperative care was performed with disease observation,heart failure symptom relief,respiratory training,and psychological support.Intraoperative care was mainly cooperation with the surgeon,and postoperative care was conducted with close hemodynamic and respiratory monitoring,prevention and timely management of complications such as coronary ischemia and acute right heart failure,and early exercise rehabilitation.The effect of the perioperative care was varified by counting the number of surgical complications,recording the management process and outcomes of postoperative complications,and comparing patients'preoperative and postoperative Barthel daily mobility scores and six-minute walk test distances.Results Through postoperative monitoring,2 cases of coronary ischemia,1 case of acute right heart failure,and 1 case of subcutaneous bleeding were found,which may be related to surgical complications.All 15 patients were discharged successfully,and the mean Barthel Daily Activity Score improved from 35.32±6.50 preoperatively to 52.45±5.35 before discharge(t=-7.88,P<0.01).The six-minute walking test distance on the day of discharge was(191.30±15.21)meters,which was a significant improvement compared to(153.51±18.57)meters preoperatively(t=5.45,P<0.01).Conclusion Close monitoring of the condition,comprehensive complication prevention and management measures ensure a safe perioperative period and successful recovery for patients undergoing transcatheter tricuspid valve annulus contraction.