腔内带膜支架置入治疗DeBaKeyⅢ型主动脉夹层围术期护理.DOCVIP

临床医学论文-腔内带膜支架置入治疗DeBaKeyⅢ型主动脉夹层围术期护理 ???????????????????? 作者：池月英　姚美霞　曾庆红??? 【关键词】? 支架 　　摘要：目的：总结腔内带膜支架置入治疗DeBakeyⅢ型主动脉夹层这项新技术围术期的护理特点。方法：通过对8例该项技术的病人进行术前有针对性的心理护理，严密观察疼痛及监测血压，术后监测血压，观察有无截瘫、器官缺血、出血，血栓，感染等并发症的发生，同时在实施健康教育中向患者说明本病的特点及坚持药物控制血压的重要性。结果：8例病人全部治愈出院，随访6～18个月，达到预期目的。结论：合理的围术期护理是保证手术顺利完成和效果的关键，健康教育是该项技术保证长期疗效的有力保障。 　　关键词：腔内带膜支架；主动脉夹层；围术期护理 　　Perioperative Nursing of Endovascular Stent-graft Implantation for DeBaKey type Ⅲ Aorta Dissection 　　　Abstract：Objective:To summarize perioperative nursing characteristics of a new technique of endovascular stent-graft implantation for DeBaKey type Ⅲ aorta dissection.Method: Special psychological nursing,pain observing and blood pressure monitoring were offered to the patients before operation.In the postoperative period,the blood pressure was monitored,the complications such as paraplegia,organ ischemia,bleeding,thrombus and infection were observed.Meanwhile,the disease characteristics and importance of sticking to drug-controlled blood pressure were explained to the patients during the health education.Result:Eight patients were cured.The patients were followed up for 6 to 18 months.The expected goals were attained.Conclusion:Rational perioperative nursing was the key to ensure smoothly operations and ideal curative effect.Health education was the forceful guarantee for long term curative effect of the endovascular stent-graft implantation. 　　Key words：Endovascular stent-graft;Aortic dissection;Perioperative nursing??????????????????????????????????????????????????????????????????????????????????????????? 　　主动脉夹层为各种原因造成的主动脉壁内膜破裂，由于血液流体力学的压力沿内膜与中外层之间层面纵行剥离而形成的壁内血肿，又称为主动脉夹层动脉瘤成主动脉剥离症。主动脉夹层DeBakeyⅢ型是内膜破口位于左锁骨下动脉远端，累及降主动脉甚至腹主动脉者，如果瘤体继续扩大，会引起破裂大出血，一旦破裂，抢救非常困难，死亡率极高。我院自2002年1月开展腔内带膜支架置入治疗主动脉夹层DeBakeyⅢ型以来，弥补了以往开胸手术或者药物保守治疗的不足，具有创伤小、恢复快等优点，取得良好效果，现将围术期护理报告如下： 　　1 资料与方法 　　2002年1月至2004年6月，我院共行腔内带膜支架置入（EVSGP）治疗DeBakeyⅢ型主动脉夹层8例，其中男性6例，女性2例，年龄 48～83岁，平均年龄 63± 15岁，全部患者高血压病，2例有冠心病，3例有糖尿病，1例呼吸功能不全，心功能Ⅰ级7例，Ⅱ级1例，急性夹层2例，慢性夹层6例。累及腹主动脉4例，