经导管三尖瓣环成形系统治疗重度三尖瓣关闭不全患者的围术期护理

Perioperative nursing for patients with severe tricuspid incompetence treated with transcatheter tricuspid valve ring forming system

目的 探索重度三尖瓣关闭不全患者经导管三尖瓣环成形系统(K-ClipTM)进行三尖瓣环成形术的围术期护理。方法 2021年7至12月东南大学附属中大医院应用K-ClipTM治疗重度三尖瓣关闭不全患者3例,通过围术期护理,包括术前改善心力衰竭症状,重视心理护理,完善术前准备及制定并落实应急预案;术中密切配合手术和病情观察;术后强调体位、细化饮食管理,倾听患者主诉,监测血流动力学变化,做好并发症风险管理,实施早期康复护理,重视出院指导。结果 3例患者术后均未发生严重并发症,心力衰竭症状明显改善,心功能分级提高,TR程度减轻,B型利钠肽质量浓度下降,6分钟步行试验距离增加,KCCQ评分增高。结论 K-ClipTM治疗重度三尖瓣关闭不全患者的围术期护理值得在临床上推广应用。

ObjectiveTo discuss the perioperative nursing for patients with severe tricuspid incompetence treated with tricuspid annuloplasty by using transcatheter tricuspid valve ring forming system(K-ClipTM).MethodsDuring the period from July 2021 to December 2021 at the Affiliated Zhongda Hospital of Southeast University of China,three patients with severe tricuspid incompetence received tricuspid annuloplasty by using K-ClipTM.Perioperative care included preoperative improvement of heart failure symptoms,close attention to psychological care,improvement of preoperative preparation and formulation of emergency plans.During the operation,the nurses should closely cooperate with the operator.After the operation,the nursing care should be concentrated on the patient’s position,diet management,patient’s complain,monitoring hemodynamics,managing the risk of complications,implement of early rehabilitation nursing,and carrying out discharge guidance.ResultsNo serious complications occurred in all the three patients.The symptoms of heart failure and the cardiac function classification were significantly improved.The degree of tricuspid regurgitation was reduced.The concentration of B-type natriuretic peptide was decreased.The distance of 6-minute walk test and the KCCQ score were increased.ConclusionThe perioperative nursing for patients with severe tricuspid incompetence treated with tricuspid annuloplasty by using K-ClipTMis clinically valuable.Therefore,this nursing mode is worth popularizing in clinical practice.