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演讲人:日期:心脏手术英文目录OverviewofcardiacsurgeryTypeofcardiacsurgeryCardiacsurgerystepsComplicationsofcardiacsurgeryPostcardiovascularsurgerycareRiskandpreventionofcardiacsurgery01OverviewofcardiacsurgeryDefinitionCardiacsurgeryisanysurgicalprocedureperformedontheheartoritsmajorbloodvesselsPurposeThemainpurposeofcardiacsurgeryistorepairorreplacedamagedordiseasedpartsoftheheart,restorebloodflow,andimprovetheheart'sfunctionDefinitionandPurposeSurgicalindicationsCoronaryartdiseaseBlockagesinthecoronaryartsthatsupplybloodtotheheartmusclemayrequiresurgerytorestorebloodflowHeartvalvediseaseDamagedordiseasedheartvalvesmayneedtoberepairedorreplacedtoensureproperbloodflowthroughtheheartCongenitalheartdefectsSomeCongenitalheartdefects,suchasVenturalSeptaldefectsorAtrialSeptaldefects,mayrequiresurgicalcorrectionHeartfailureInsomecases,surgerymaybenecessarytotreatheartfailurebyimplementingdevicessuchaspacemakersordefibrillatorsSeverelungdiseasePatientswithseverelungdiseasemaynotbeabletotollthestressofcardiovascularsurgeryPoorgeneralhealthPatientswithpoorgeneralhealthormultiplecomorbiditiesmaybeatincreasedriskforapplicationsduringandaftersurgeryBleedingdisordersPatientswithbleedingdisordersorwhoaretakingantibioticsmayneedtoundergoadditionaltestingandpreparationbeforesurgeryUntreatableinfectionsActiveinfections,specificallythoseinvolvingtheheartoritssurroundingstructures,mayneedtobetreatedbeforesurgerycanbeperformedContainmentstosurgeryMedicalhistoryandphysicalexaminationAdetailedmedicalhistoryandphysicalexaminationareessentialtoassessthepatient'soverallhealthandidentifyanypotentialrisksDiagnostictestingDiagnostictestssuchaselectrocardiograms(ECGs),echocardiograms,andcardiaccatalysismaybeperformedtoevaluatethepatient'sheartfunctionandanalysisPreoperationalevaluationPreoperativecounselingPatientsshouldreceivecounselingabouttherisksandbenefitsofsurgery,aswellasinstructionsonhowtoprepareforsurgeryandwhattoexpectduringrecoveryMedicalreviewandadjustmentPatientsmayneedtostoptakingcentralmedicinebeforesurgeryandstarttakingotherstoreducetheriskofcomplicationsPreoperationalevaluation02TypeofcardiacsurgeryCoronaryartbypasssurgeryIndicationsCoronaryartdiseasewithsignificantstenosis,typicallycausinganginaorheartattackGraftoptionsInternalsummaryart(IMA),saphenousvein,orradialartcanbeusedasgradesProcedureCreatinganewpathforbloodflowtotheheartmusclebygraftingahealthybloodvesselaroundtheblockedcoreartPostoperationalcareClosemonitoringofheartfunction,gradepatience,andmanagementofanyapplicationsIndicationsValvularheartdiseasesuchasstenosis(narrowing)orregression(leakage)ofthevalvesValverepairorvalvereplacement,dependingontheseverityandnatureofthevalveissueMechanicalvalves(dualbutrequirelifetimeanticoagulation)orbiologicalvalves(lessdualbutdonotrequireanticoagulation)Closemonitoringofheartfunction,valvefunction,andmanagementofanyapplicationsProceduretypesValveoptionsPostoperationalcareHeartvalvesurgeryStructuralheartdefectspresentatbirth,suchaspartialdefects,valveabnormalities,orcomplexcongenitalheartdefectsIndicationsSurgicalcorrectionofthestructuraldefect,ofteninvolvingrepairorreplacementofaffectedheartstructuresProcedureOpenheartsurgeryorminimallyinvasivetechniques,dependingonthecomplexityofthedefectandthepatient'sconditionSurgicalapproachesClosemonitoringofheartfunction,surgicalsite,andmanagementofanyapplicationsPostoperationalcareCongenitalheartdiseasesurgeryIndicationsEndstageheartfailurereferraltomedicaltherapyandothersurgicaloptionsDonorselectionRigorousscreeningprocesstoensuredonorheartissuitablefortransportationPostoperationalcareIntensivecareunit(ICU)monitoring,immunosuppressiontherapytopreventrejectionofthedonorheart,andclosefollow-upforlongtermmanagementProcedureRemovalofthediseasedheartandreplacementwithahealthydonorheartHearttransplantsurgery03CardiacsurgerystepsGeneralAnesthesiaisadministeredtoensurethatthepatientisunconsciousandunabletofeelpaidduringtheprocedureAnesthesiaThepatientispositionedontheoperatingtableinawaythatprovidesthelargewithoptimalaccesstotheheartThiscommonlyinvolveslyingonthebackwiththearmsextendedouttothesidesPositionAnesthesiaandPostureDecisionAsurgicaldecisionismadethroughtheskinandintothechemicalactivityThelocationandsizeoftheinvestmentdependonthetypeofsurgerybeingperformedExposureTheribsarespreadaroundandthesternum(breakbone)maybedividedtoprovideaccesstotheheartRetractorsareusedtoholdtheribsandsternuminpositionduringthesurgeryDecisionandexposureBypasssurgeryIncoronaryartbypassgrafting(CABG),ahealthybloodvesselistakenfromanotherpartofthebodyandattachedtotheblockedcoronaryarttoreroutebloodflowtotheheartmuscleValvesurgeDamagedordiseasedheartvalvesmayberepairedorreplacedwithartisticvalvesduringheartvalvesurgeOtherproceduresOthersurgicalproceduresmayincluderepairingcongenitalheartdefects,treatingarrhythmias,orimplementingdevicessuchaspacemakersordefibrillatorsSurgicalprocedureVSBleedingiscontrolledusingvarioustechniquessuchasapplyingpressure,usinghomeostaticagents,orcausetizingbloodvesselswithheatorelectricitySuturingThedecisionisclosedusingsutures(sticks)thatareplacedintheskinandunderlyingissuesThesuturesaretypicallyremovedafterthesoundhasheatedupefficientlyHemastasisHemostasisandsuturing04ComplicationsofcardiacsurgeryPostoperativebleedingisacommonapplicationofcardiacsurgery,whichmayrequireadditionalsurgicalinterventionorbloodtransferBleedingSurgicalsiteinfections,pneumonia,andotherinfectionscanoccuraftercardiacsurgery,necessitatingantibioticsandothertreatmentsInfectionBleedingandinfectionAtrialfiltrationThisisthemostcommonarrhythmiaaftercardiacsurgery,characterizedbyirregularandsoftrapidheartbeatVentriculararrhythmiasThesecanbemoreseriousandmayrequiremedicine,defibrillation,orpacemakerinsertionRhythmiasHeartfailurePaidfunctionoftheleftvehicle,themainpumpingchamberoftheheart,canleadtoheartfailureLeftvehiculardysfunctionPaidfunctionoftherightvehiclecanalsooccur,specificallyaftercomplexsurgeriesinvolvingtherepairorreplacementofheartvalvesRightvehiculardysfunction01ClotsorEmbolicandisruptduringsurgeryandtraveltothebrain,causingastrokeStroke02PaidkidneyfunctioncanoccurduetoreducedbloodflowordamagecausedbycontrastdieusedduringtheprocedureRenalfailure03DifficultlybreakingcanoccurduetofluidaccumulationinthelungsordamagetotherespiratorymusclesduringsurgeryRespiratoryfailure04Nausea,invoicing,andconsistencyarecommonaftercardiacsurgeryandcanbemanagedwithmedicalanddietarychangesGastrointestinalcompositesOtherapplications05PostcardiovascularsurgerycareNursingintheintensivecareunitNursesaretrainedtoidentifyandrespondquicklytoanysignsofapplicationssuchasblending,infection,orarrhythmiasPreventionofapplicationsHeartrate,bloodpressure,respiratoryrate,andtemperaturearecontinuouslymonitoredtoensuretheyremainwithinsafelimitsClosemonitoringofvitalsignsPatientsaregivenpaintreatmentasneededtokeepthemcomfortableandfacilityrecoveryManagementofpainanddiscomfort03UseofrespiratoryaidsInsomecases,patientsmayrequiretheuseofhospitalsorotherrespiratoryaidstosupporttheirbreathing01RespiratorymonitoringPatients'respiratorystatusiscloselymonitored,includingoxygensaturationlevelsandlungsounds02AssistancewithbreakingexercisesPatientsareresourcedtoperformdeepbreakingandcoachingexercisestocleartheirlungsandpreventpneumoniaRespiratorycareManagementofChesttubesChesttubesareinsertedaftersurgerytodrainfluidfromtheChestcavityThesetubesarecarefullymonitoredandmanagedtoensureproperdrainageCareoftheinsertionsiteTheareaaroundthechemicaltubeinsertionsiteiscleanedanddressedregularlytopreventinfectionMonitoringofdrainageTheamountandcoloroffluiddrainedfromthechemicaltubesarecloselymonitoredtoassessthepatient'srecoveryprogressDrainagetubecareDietaryrecommendations01Patientsareprovidedwithdietaryguidelinestoensuretheyreceivethenutrientstheyneedforrecoverywhileavoi
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