主动脉瓣置换术后的护理课件

1、主动脉瓣置换术后的护理The nursing of aortic valve replacement正常的主动脉瓣有三个瓣叶：左半月瓣、右半月瓣和后半月瓣心室舒张期Ventricular diastole心室收缩期Ventricular systole主动脉瓣狭窄的病因Causes of aortic stenosis先天性畸形Congenital malformations老年性主动脉瓣钙化Senile aortic valve calcification风湿性心脏病Rheumatic heart disease主动脉瓣叶粘连、融合Aortic valve leaflets adhesion

2、, fusion主动脉瓣狭窄aortic stenosis主动脉瓣开口面积减少肺静脉高压 右心衰竭左心室射血负荷左室向心性肥厚 左心室收缩功能心排血量下降室壁张力顺应性下降室壁张力左心衰病理生理pathophysiologyPulmonary venous hypetension心内膜下心肌缺血和灌注不足aortic stenosis脑血流灌注下降左心室做功心肌耗氧量顺应性下降舒张末压力CO冠状动脉平均灌注压心绞痛晕厥Angina pectorisSyncope主动脉瓣关闭不全Aortic valves incompetence主动脉内血液在舒张期返流入左室偏心性肥厚、扩大左心衰左心室容量负荷

3、Sp、Dp 左心室舒张末期压力CO室壁张力心绞痛pulmonary hypertension右心衰pathophysiology双击添加标题文字急性主动脉瓣关闭不全左心室舒张期充盈量突然增加 压力迅速增高左房压、肺静脉压迅速升高急性肺水肿心动过速以减少反流量 增加CO二尖瓣舒张期提前关闭，缓解左房和肺静脉受左心室高舒张压的影响 CO减少，低BP急性左心衰竭 急性AI 主动脉瓣置换术 病例介绍Case Introduction病史medical history 罗菊梅，女，40岁,云南镇雄人 Patient Jumei Luo,female,40 years old, from Zhenxion

4、g in Yunnan province. 患者因头昏、胸痛3年，近一年来加重，活动后心悸、气促、乏力伴呼吸困难，休息后无明显缓解一月余，于2014年12月10日以“非风湿性主动脉瓣狭窄并关闭不全”收住 She was admitted to the hospital for Non-rheumatic aortic stenosis and incompetence on December 10th,2014.because dizziness, chest pain have last three years, heart palpitation and shortness of brea

5、th with increased activities , and exertional dyspnea lasting over a month.Medical History手术史Surgical operation history2004年行“ 卵巢囊肿摘除术” ovarian cyst in 2004,2011年行“右上臂神经源性肿瘤切除术”“neurogenic tumor resection of right arm” in 2011过敏史Allergic history 双黄连 Echocardiography:1、Aortic valve disease: moderate

6、aortic incompetence, moderate aortic stenosis, and the widening of aortic diameter 2、Mild mitral incompetence, and mild tricuspid incompetence3、The decreasing of left ventricular diastolic function , LVD：70mm,EF:55%DX检查：主动脉迂曲增宽 Aorta becomes widened and tortuous左室增大left ventricle becomes bigger诊治经过1

7、2月16日前完善术前准备12月17日-19日在ICU治疗12月20日患者病情平稳搬回病房。Preoperative preparation was completed before December 16th.The patient was stablly moved back to the ward on December 20th病 情 HR95-110次/分，为窦性心律。BP由多巴胺4.9ug/kg/min, 维持在88-122/65-84mmhg,CVP14-7,容量欠，引流液不多, 总量为500ml,尿色、尿量正常,精神饮食稍差，鼓励进食。The heart rate of the

8、patient and 95-110times/min. BP by dopamine 4.9ug/kg/min, maintained at 88-122/65-84mmhg. Central venous pressure was 9-10. Drainage of fluid was normal, The total amount of fluid drainage is 500ml. Urine was normal, patients spirit and diet was slightly poor. She was encouraged to eat . 护理问题 Nursin

9、g Problem低效性呼吸型态（Ineffective breathing pattern） 与手术及术后伤口疼痛致咳痰无力有关operationand postoperativewound pain induced sputum weakness 心输出量减少(decreased cardiac output)： 与心脏疾病、体液不足有关Associated with heart disease, insufficient body fluid潜在并发症（ potential complication ） 抗凝不足或抗凝过度Inadequate or excessive anticoagu

10、lation、 2、持续心电监护，严密观察心率、血压、呼吸、血氧饱和度 Continuous ECG monitoring, and close observation of heart rate, blood pressure, respiration, and oxygen saturation.（一）低效性呼吸型态 3、定时监测血气分析结果，根据病人的生命体征和血气情况，调整供氧方式及流量。 Regularly monitor the result of blood gas analysis and adjust the way and the flow rate of oxygen o

11、ffer based on the patients vital signs and blood gas. 4、遵医嘱适当予以止痛剂，以减少病人呼吸肌做功 Provide analgesics appropriately according to prescription to reduce the acting of patients breathing muscles. （一）低效性呼吸型态(二)心输出量减少(decreased cardiac output)（1）严密监测心律、HR、BP、CVP及末梢情况，发现异常要及时报告医生 Keep close monitoring in the

12、change of rhythm, HR, BP, CVP and Peripheral situation, and report to the doctor promptly when abnormal situation is found.nursing intervention(二)心输出量减少(decreased cardiac output) （3）引流管的监测 The drainage tube monitoring： 定时挤压引流管保持引流管的通畅 Squeeze drainage tube regularly to keep its patency. 观察引流液量及性质， O

13、bserve the drainage amount and nature. 观察伤口有无渗血 Observe whether there is bleeding or not in wound.(二)心输出量减少(decreased cardiac output) (4)准确记录出入量，注意水电解质平衡 Record intake and output accurately, and pay attention to the balance of water electrolyte.（5）鼓励患者进食 Encourage patients to eatnursing intervention

14、（三）潜在并发症的预防和护理 1、抗凝不足与抗凝过度 Inadequate anticoagulation and excessive anticoagulation (1)、为避免血栓形成，机械瓣置换术后，需终身抗凝治疗，生物瓣术后抗凝3-6个月。要定时定量口服 Explain to patients the importance of taking warfarin orally, Take anticoagulant medicine regularly and quantitatively The dose is 2.5-5 milligram（2）、服药期间监测INR，使之维持在2.

15、03.0. Monitor INR during the medication to maintain it at 2.0 to 3.0（3）加强患者的监测，如有无皮肤青紫瘀斑、牙龈出血等Strengthen the monitoring of patients, such as the skin bruising , and bleeding gums, etc.（4)、注意饮食对抗凝药物的影响 Pay attention to the infuence of diet on anticoagulants. Health EducationPrevention of infectionDie

16、tPeriodic reviewMedication guideActivity and restSelf-test用药指导Medication guide 华法林只在体内抗凝，通过拮抗维生素K而产生药理作用。常用INR(国际标准化比值)评价 Warfarin anticoagulation only in the body, vitamin K antagonism generated by pharmacological effects. Common INR (international normalized ratio) evaluation记住服药时间要固定哦！DietIt is b

17、est for you to have more nourishing food and easily- digested food, including high-protein,high-vitamins, and so on.At the same time,you should have more meals with less food for each meal,develop good living habits. Avoid cigarettes, alcohol, coffee and spicy food. Patients with poor cardiac functi

18、on should limit sodium intake . Patients should observe the changes in body weight. 保持饮食结构的相对平衡 应进食富含营养，易于消化的食物，报告高蛋白、高维生素等，同时，应少食多餐，养成良好饮食习惯。 禁忌烟酒、咖啡及刺激性食物。 心功能较差的病人要限制钠盐的摄入；应用利尿剂的病人，注意观察尿量及体重的变化。 富含维生素K的食物会降低华法林抗凝作用， 不易长期单调食用某种含维生素K多的绿色青菜活动与休息Activity and rest 术后1个月内避免剧烈体育活动，3个月内应限量活动，以后可逐渐增大活动量，6个月后可恢复正常学习和工作, 但所有锻炼和运动均不应过度。 Within a