三尖瓣下移畸形合并预激综合征患者的术后加强护理

Postoperative Intensive Care of Ebstein Syndrome in Patients with Wolf-Parkinson-White Syndrome

目的 报告三尖瓣下移畸形(Ebstein畸形)合并预激综合征(W-P-W)患者手术治疗后的护理经验。方法 对13例Ebstein畸形合并预激综合征患者进行外科治疗,手术切割房室附加旁道并行三尖瓣成形或置换术。术后加强护理:(1)心律失常的监护;(2)低心排综合征的防治;(3)呼吸功能的维护;(4)抗凝治疗的观察。结果 全组13例患者未发生术后并发症,均痊愈出院。术后随访9个月～7年,无晚期死亡,无预激综合征复发,心功能Ⅰ级11例,Ⅱ级2例。结论 手术治疗Ebstein畸形合并预激综合征,可同时纠正三尖瓣功能障碍和预激综合征,获得良好的效果。对此类患者术后施行加强护理,可提高手术成功率和患者生存质量。

Objective To sum up the experience of postoperative intensive care of Ebstein syndrome in patients with Wolf-Parkinson-White (W-P-W) syndrome. Methods All 13 patients with Ebstein syndrome with Wolf-Parkinson-White (W-P-W) syndrome received surgical treatment, in whom accessory conduction pathways were successfully ablated. 10 patients had tricuspid valvuloplasty and 3 patients had tricuspid replacement. The postoperative intensive care methods included monitoring of arrhythmia, treatment of low cardiac output syndrome, management of the airway and prevention of thromboembolism. Results There were no postoperative complications. Follow-up ranged from 9 months to 7 years. 11 patients were in NYHA class I and 2 in class II . Conclusion The combined approach of tricuspid valve repair or replacement and surgical ablation of accessory atrioventricular connections was an effective treatment for Ebstein syndrome with Wolf-Parkinson-White syndrome. Postoperative intensive care can improve the success rate of operation and life quality.