146例全胸腔镜下心脏手术围手术期护理.pdfVIP

‘1U／q、。／、PV__L__Ll )．北京：民族出席 ．疗恐惧及影响因 患 病 儿童 心理 惺 146例全胸腔镜下心脏手术围手术期护理 殷秋阳 马增山* 冯福云 薛桂华 王乐信* 泰山医学院聊城临床学院心外科 摘要 目的:探索全胸腔镜下心脏手术围手术期护理策略。方法：146例先心病 患者，在全麻体外循环下行全胸腔镜下心脏手术，术前排除肺部疾病，指导患者进行呼 吸功能的锻炼。术中不同程度的膨胀右肺，术后呼吸机辅助通气常规加PEEP，吸痰后 及时简易呼吸气囊膨肺，胸部物理治疗，雾化吸入，手术中、手术后常规静脉应用利尿 剂及甲强龙，保持胸腔闭式引流通畅。结果:手术均顺利，无手术死亡，平均待呼吸机 时间66分，4例出现右肺不张，住监护室时间平均16小时，手术后5～7天出院。结 论：通过术前、术中、术后加强呼吸道管理可以有效减少全胸腔镜下心脏手术后肺部并 发症的发生。 [关键词](胸)腔镜；先心病：围手术期护理 TheCareSt(ra)tegiesofPerioperativeofTotallyThoracoscopicCardiac Operation Qiu-yingYinZengshanMaFu-YunFengGui-HuaXueLexinWang DepartmentofCa()liacSurgery,LiaochengPeoplesHospitalandLiaochengClinicalSchool ofTaishanMedicalUniversity,Liaocheng,Shandong,252000,China [Abstract]ObjeetiveToexploretherespiratorycarestrategiesofperioperativeof totallythoraeoseol(c)cardiacoperation.Methods146pateintswereunderwentedoperationof totallythoraeoscc(ic).Toexcludepreoperativepulmonarydisease,guidingpatientswith respiratoryfuncti (n)exercise.Intraoperativeexpansionoftherightlungregularity, postoperativeme(c)aniealventilationplusconventionalventilationPEEP,suctioneasytime breathingafter (tl ) ballooninflatedlung,dilutionpluslowmolecularweightdextran inhalationhorm(o )es,surgery,post-operativeconventionalintravenousdiureticsand Methylprednisolo(n)NaSuecinateandmaintainsmoothclosedthoracicdrainage.ResultsAll Patientswithope(n)tedweresuecessfull,andnooperativemortality,theaverageventilator timewith66min,( )patientshadfightlungatelectasis,livinganaverageof16hoursintensive careunit,5～7daysaftersurgeryanddiseharged.ConclusionThestrengtheningairway managementwith( ) preoperative,Intraoperativeandpostoperativecanseffectivelyreduceof pulmonaryeompli(ca)tionsafteratotallythoracoscopiccardiacsurgery. [KeyWords]Thoracoscopic;