主动脉瓣置换术后的护理

1、精选课件1主动脉瓣置换术后的护理主动脉瓣置换术后的护理The nursing of aortic valve replacement精选课件2正常的主动脉瓣有三个瓣叶：左半月瓣、右半月瓣和后半月瓣精选课件3心室舒张期心室舒张期Ventricular diastole心室收缩期心室收缩期Ventricular systole精选课件4精选课件5主动脉瓣狭窄的病因Causes of aortic stenosis先天性畸形Congenital malformations老年性主动脉瓣钙化Senile aortic valve calcification风湿性心脏病Rheumatic heart d

2、isease主动脉瓣叶粘连、融合Aortic valve leaflets adhesion, fusion精选课件6主动脉瓣狭窄aortic stenosis主动脉瓣主动脉瓣开口面积减少开口面积减少肺静脉高压肺静脉高压 右心衰竭右心衰竭左心室射血负荷左心室射血负荷左室向心性肥厚左室向心性肥厚 左心室收缩功能左心室收缩功能室壁张力室壁张力顺应性下降顺应性下降室壁张力室壁张力左心衰左心衰病理生理pathophysiologyPulmonary venous hypetension精选课件7aortic stenosis顺应性下降顺应性下降舒张末压力舒张末压力心绞痛心绞痛晕厥晕厥Angina pe

3、ctorisSyncope精选课件8精选课件9急性Acute : :1.感染性心内膜炎Infective endocarditis2.主A夹层 Aortic dissection3.外伤Trauma4.4.人工瓣膜撕裂Prosthetic valve tear慢性Chronic:主动脉瓣疾病Aortic valve disease2/32/3为风心病为风心病主动脉根部扩张Aortic root dilatation主动脉瓣关闭不全的病因Causes of aortic incompetence主动脉瓣纤维化、增厚、缩短、变形精选课件10主动脉瓣关闭不全Aortic valves incompe

4、tence主动脉内血液在舒张期返流入左室主动脉内血液在舒张期返流入左室偏心性肥厚、扩大偏心性肥厚、扩大左心衰左心衰左心室容量负荷左心室容量负荷Sp 、Dp 左心室舒张末期压力左心室舒张末期压力CO室壁张力室壁张力心绞痛心绞痛pulmonary hypertension右心衰右心衰pathophysiology精选课件11反流面积的大小反流面积的大小 心动周期舒张期的长短心动周期舒张期的长短 AI反流量体循环血管阻力体循环血管阻力AI reverse flowReverse flow aera of the sizeBeckoning cycle diastolic lengthSystemic

5、 vascular resistance精选课件12急性主动脉瓣关闭不全左心室舒张期充盈量突然增加左心室舒张期充盈量突然增加 压力迅速增高压力迅速增高左房压、肺静脉压迅速升高左房压、肺静脉压迅速升高急性肺水肿急性肺水肿心动过速以减少反流量心动过速以减少反流量 增加增加CO二尖瓣舒张期提前关闭，缓解左房二尖瓣舒张期提前关闭，缓解左房和肺静脉受左心室高舒张压的影响和肺静脉受左心室高舒张压的影响 CO减少，低减少，低BP急性左心衰竭急性左心衰竭 急性急性AI 精选课件13v瓣膜置换术是用人工机械瓣或生物瓣进行替换人心脏瓣膜进行置换Valve replacement surgery is to use

6、 mechanical valves or biological valves to replace original human valves. 精选课件14主动脉瓣置换术精选课件15 病例介绍Case Introduction精选课件16病史medical history 罗菊梅，女，40岁,云南镇雄人 Patient Jumei Luo,female,40 years old, from Zhenxiong in Yunnan province. 患者因头昏、胸痛3年，近一年来加重，活动后心悸、气促、乏力伴呼吸困难，休息后无明显缓解一月余，于2014年12月10日以“非风湿性主动脉瓣狭窄

7、并关闭不全”收住 She was admitted to the hospital for Non-rheumatic aortic stenosis and incompetence on December 10th,2014.because dizziness, chest pain have last three years, heart palpitation and shortness of breath with increased activities , and exertional dyspnea lasting over a month.精选课件17Medical Hist

8、ory手术史Surgical operation history2004年行“ 卵巢囊肿摘除术” ovarian cyst in 2004,2011年行“右上臂神经源性肿瘤切除术”“neurogenic tumor resection of right arm” in 2011过敏史Allergic history 双黄连精选课件18 Echocardiography:1、Aortic valve disease: moderate aortic incompetence, moderate aortic stenosis, and the widening of aortic diamete

9、r 2、Mild mitral incompetence, and mild tricuspid incompetence3、The decreasing of left ventricular diastolic function , LVD：70mm,EF:55%精选课件19心脏彩超：1、主动脉瓣病变： 主动脉瓣中度关闭不全并中度狭窄， 升主动脉内径增宽。2、二尖瓣轻度关闭不全 三尖瓣轻度关闭不全3、左心舒张功能降低 LV：70mm,EF:55%精选课件20DX检查：主动脉迂曲增宽 Aorta becomes widened and tortuous左室增大left ventricle b

10、ecomes bigger精选课件21诊治经过诊治经过12月16日前完善术前准备12月17日-19日在ICU治疗12月20日患者病情平稳搬回病房。Preoperative preparation was completed before December 16th.The patient was stablly moved back to the ward on December 20th精选课件22病 情 12月17日在全麻CPB下行主动脉瓣置换术，术毕于12：50分带气管插管返ICU，呼吸机辅助呼吸，清醒后，查血气示正常，于22：30分拔出气管插管改面罩供氧。血氧饱和度99-100，患者咳

11、嗽咳痰力量稍差 On december 17th, the aortic valve replacement was completed under general anesthesia CPB ,and the patient returned the icu at 12:50 with ventilator breathing. After waking, her blood check showed normal, so pulled out endotracheal intubation and it was replace by oxygen masks. The oxygen sa

12、turation was respectively 99%-100. Patients with cough and expectoration somewhat less power.精选课件23病 情 HR95-110次/分，为窦性心律。BP由多巴胺4.9ug/kg/min, 维持在88-122/65-84mmhg,CVP14-7,容量欠，引流液不多, 总量为500ml,尿色、尿量正常,精神饮食稍差，鼓励进食。The heart rate of the patient and 95-110times/min. BP by dopamine 4.9ug/kg/min, maintained

13、at 88-122/65-84mmhg. Central venous pressure was 9-10. Drainage of fluid was normal, The total amount of fluid drainage is 500ml. Urine was normal, patients spirit and diet was slightly poor. She was encouraged to eat .精选课件24 护理问题 Nursing Problem低效性呼吸型态（Ineffective breathing pattern） 与手术及术后伤口疼痛致咳痰无力

14、有关operation and postoperative wound pain induced sputum weakness 心输出量减少(decreased cardiac output)： 与心脏疾病、体液不足有关Associated with heart disease, insufficient body fluid潜在并发症（ potential complication ） 抗凝不足或抗凝过度Inadequate or excessive anticoagulation、精选课件25护理措施nursing interventionnursing intervention（一）低

15、效性呼吸型态 1、加强呼吸道护理，听诊双肺呼吸音，定时拍背、雾化， 鼓励患者咳嗽、咳痰。 Strengthen respiratory care, auscultation of lung breath sound, timed back patting ,and atomization ,and encourge patients to cough and expectorate.精选课件26 2、持续心电监护，严密观察心率、血压、呼吸、血氧饱和度 Continuous ECG monitoring, and close observation of heart rate, blood pr

16、essure, respiration, and oxygen saturation.（一）低效性呼吸型态精选课件27 3、定时监测血气分析结果，根据病人的生命体征和血气情况，调整供氧方式及流量。 Regularly monitor the result of blood gas analysis and adjust the way and the flow rate of oxygen offer based on the patients vital signs and blood gas. 4、遵医嘱适当予以止痛剂，以减少病人呼吸肌做功 Provide analgesics appro

17、priately according to prescription to reduce the acting of patients breathing muscles. （一）低效性呼吸型态精选课件28(二)心输出量减少(decreased cardiac output)（1）严密监测心律、HR、BP、CVP及末梢情况，发现异常要及时报告医生 Keep close monitoring in the change of rhythm, HR, BP, CVP and Peripheral situation, and report to the doctor promptly when a

18、bnormal situation is found.nursing intervention精选课件29(二)心输出量减少(decreased cardiac output)（2）运用血管活性药物，根据患者的生命体征进行调整 Use vasoactive drugs, and adjust according to the patients vital signs精选课件30(二)心输出量减少(decreased cardiac output) （3）引流管的监测 The drainage tube monitoring： 定时挤压引流管保持引流管的通畅 Squeeze drainage t

19、ube regularly to keep its patency. 观察引流液量及性质， Observe the drainage amount and nature. 观察伤口有无渗血 Observe whether there is bleeding or not in wound.精选课件31(二)心输出量减少(decreased cardiac output) (4)准确记录出入量，注意水电解质平衡 Record intake and output accurately, and pay attention to the balance of water electrolyte.（5

20、）鼓励患者进食 Encourage patients to eat精选课件32nursing interventionnursing intervention（三）潜在并发症的预防和护理 1、抗凝不足与抗凝过度 Inadequate anticoagulation and excessive anticoagulation (1)、为避免血栓形成，机械瓣置换术后，需终身抗凝治疗，生物瓣术后抗凝3-6个月。要定时定量口服 Explain to patients the importance of taking warfarin orally, Take anticoagulant medicin

21、e regularly and quantitatively The dose is 2.5-5 milligram（2）、服药期间监测INR，使之维持在2.03.0. Monitor INR during the medication to maintain it at 2.0 to 3.0精选课件33（3）加强患者的监测，如有无皮肤青紫瘀斑、牙龈出血等Strengthen the monitoring of patients, such as the skin bruising , and bleeding gums, etc.（4)、注意饮食对抗凝药物的影响 Pay attention

22、to the infuence of diet on anticoagulants.精选课件34 Health EducationPrevention of infectionDietPeriodic reviewMedication guideActivity and restSelf-test精选课件35用药指导Medication guide 华法林只在体内抗凝，通过华法林只在体内抗凝，通过拮抗维生素拮抗维生素K K而产生药理作用。而产生药理作用。常用常用INR(INR(国际标准化比值国际标准化比值) )评价评价 Warfarin anticoagulation only in the

23、body, vitamin K antagonism generated by pharmacological effects. Common INR (international normalized ratio) evaluation记住服药时间要固定哦！记住服药时间要固定哦！精选课件36DietvIt is best for you to have more nourishing food and easily- digested food, including high-protein,high-vitamins, and so on.At the same time,you shou

24、ld have more meals with less food for each meal,develop good living habits.v Avoid cigarettes, alcohol, coffee and spicy food. vPatients with poor cardiac function should limit sodium intake . Patients should observe the changes in body weight. 保持饮食结构的相对平衡保持饮食结构的相对平衡 应进食富含营养，易于消应进食富含营养，易于消化的食物，报告高蛋白、化的食物，报告高蛋白、高维生素等，同时，应少高维生素等，同时，应少食多餐，养成良好饮食习食多餐，养成良好饮食习惯。惯。 禁忌烟酒、咖啡及刺激性禁忌烟酒、咖啡及刺激性食物。食物。 心功能较差的病人要限制钠心功能较差的病人要限制钠盐的摄入；应用利尿剂的盐的摄入；应用利尿剂的病人，注意观察尿量及体病人，注意观察尿量及体重的变化。重的变化。精选课件37 富含维生素富含维生素K的食物会降低华法林抗凝作用，的食物会降低华法林抗凝作用， 不易长期单调食用某种含维生素不易长期单调食用某种含维生素K多的绿色青菜多的绿色青菜精选课件3