| 胡岳秀,苏云艳.妊娠期体外循环下行瓣膜置换术围术期护理[J].上海护理,2020,20(10): |
| 妊娠期体外循环下行瓣膜置换术围术期护理 |
| Perioperative nursing care for patients with valve replacement in pregnancy/XIONG jian qiu,HU yue xiu ,JIN hua |
| DOI： |
| 中文关键词: ［］妊娠期 瓣膜置换术 围术期护理 |
| 英文关键词: |
| 基金项目:国家临床重点专科建设项目（2011872） |
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| 中文摘要: |
| 目的 总结了2例妊娠合并心脏瓣膜病的患者,在全麻、浅低温体外循环下行瓣膜置换术的围术期护理措施。方法 对在我科妊娠期行心脏瓣膜置换术患者的资料进行分析,总结该类手术患者的围术期护理措施。术前注意调整心功能,严密监测胎儿情况,预防早产、胎死宫内。本组1例患者,为妊娠合并感染性心内膜炎,并有二尖瓣赘生物形成,要严密观察病情变化,预防猝死和栓塞并发症；术中体外循环期间,为保证母儿的血供,需维持较高的灌注流量和平均动脉压(MAP)。术后加强心功能的维护、呼吸道管理、神经系统监测和肾功能的维护。同时加强多学科合作,请产科医师和药剂科医师会诊,协助监测胎儿情况,指导临床用药。结果 本组患者均顺利脱机拔管,术后监护室治疗3天。其中1例患者,回监护室后出现频繁宫缩,经硫酸镁和消炎痛栓治疗后缓解,未出现早产,顺利康复,并在足月期顺利分娩。结论 妊娠期行瓣膜置换术手术复杂,技术难度大,严密的围术期专科护理是此类手术成功并保证孕妇及胎儿安全的重要保证,同时加强多学科协作是保证母婴安全的重要保障。 |
| 英文摘要: |
| Objective We present our experience of perioperative nursing care for two cases who were recept cardiopulmonary bypass surgery for cardiac valve replacement during pregancy without any maternal or fetal mortality. Methods Data of patients who got cardiopulmonary bypass surgery for cardiac valve replacement during pregancy in the ward during 2015 were collected and analysed,mothers" vital signs,cardiac function,vaginal bleeding and symptoms of preterm labor were monitored. Medical therapy were taken to reduce the symptoms of heart failure. High level of perfusion flow and MAP were maintained. Core temperature were 33.0-36.7℃.All patients recieved circulation support, airway management. nervous system function were monitored and renal function were supported. Results All patients were extubated successfully.ICU time were 3-4 days.One patients came across recurrent uterine contractions but didn"t suffered premature labour after been treated with Magnesium sulfate and indomethacin suppositories. This patients discharged successfully and delivered at term. Conclusion Cardiopulmonary bypass surgery for cardiac valve replacement during pregancy is still a challenging problem. With rigorous perioperation specific nursing, we can give a better clinical outcome for both mothers and fetus. Otherwise, a multispecial clinical team consists of cardiac surgery, ICU doctor, anesthetist, obstetrician, pharmacist and special nurses is a necessary guarantee for patients. |
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