体外循环+原位三开窗技术治疗Stanford A型主动脉夹层的临床护理体会
摘要
总结体外循环+原位三开窗技术治疗Stanford A型主动脉夹层3例患者的围手术期护理体会。护理重点为术前加强心理护理、缓解患者疼痛,并积极控制血压;术后密切监测生命体征,做好呼吸道的护理、神经系统的观察、肾功能监测、手术切口的护理,积极处理胸主动脉腔内修复术后综合征,警惕内漏或逆行夹层的发生,出院前做好出院指导。3例患者支架均置入成功,夹层原发破口完全封闭,围手术期无脑梗死、逆行夹层、截瘫、死亡等严重并发症发生,平均住院时间(15±2) d,均痊愈出院。
引文
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[2] WANG J,LI Y,LI Y,et al.Endovascular stent-graft placement in patients with stanford type B aortic dissection in China:a systematic review[J].Ann Vasc Surg,2016(36):298-309.
[3] 付强,王若昕,魏民新.阿罗洛尔联合硝苯地平对Stanfor B型主动脉夹层患者降主动脉腹膜支架隔绝术后血压、心率的影响[J].中华高血压杂志,2014,22(11):1081-1083.
[4] ZHU J,ZHAO L,DAI X,et al.Fenestrated thoracic endovascular aortic repair using physician modified stent grafts for acute type B aortic dissection with unfavourable landing zone[J].Eur J Vasc Endovasc Surg,2018,55(2):170-176.
[5] 陆利冲,葛敏,王东进.脑脊液引流救治急性主动脉综合征引起的截瘫一例[J].中华危重症医学杂志(电子版),2017,10(2):136-139.
[6] 张韬,熊江,贾鑫,等.主动脉瘤腔内治疗术后全身炎症反应综合征的风险因素研究[J].中华普通外科杂志,2012,27(12):992-995.
[7] 徐晓艳,崔宇,潘伟,等.累及弓部分支的B型主动脉夹层患者原位开窗腔内治疗的护理[J].解放军护理杂志,2014,31(16):47-49,57.
[8] 刘炎东,柏骏,曲乐丰.原位开窗在胸主动脉腔内修复术中的运用进展[J].中华普通外科杂志,2018,33(3):262-264.
[9] MA T,DONG Z H,FU W G,et al.Incidence and risk factors for retrograde type A dissection and stent graft-induced new entry after thoracic endovascular aortic repair[J].J Vasc Surg,2018,67(4):1026-1033.
[10] YIP H C,CHAN Y C,QING K X,et al.Retrograde type A dissection following hybrid supra-aortic endovascular surgery in high-risk patients unfit for conventional open repair[J].J Cardiovasc Surg (Torino),2018,59(2):243-251.