1、主動(dòng)脈瓣置換術(shù)后的護(hù)理(共38張)主動(dòng)脈瓣置換術(shù)后的護(hù)理(共38張)正常的主動(dòng)脈瓣有三個(gè)瓣葉：左半月瓣、右半月瓣和后半月瓣正常的主動(dòng)脈瓣有三個(gè)瓣葉：左半月瓣、右半月瓣和后半月瓣心室舒張期Ventricular diastole心室收縮期Ventricular systole心室舒張期Ventricular diastole心室收縮主動(dòng)脈瓣置換術(shù)后的護(hù)理(共38張)主動(dòng)脈瓣狹窄的病因Causes of aortic stenosis先天性畸形Congenital malformations老年性主動(dòng)脈瓣鈣化Senile aortic valve calcification風(fēng)濕性心臟病Rheuma

2、tic heart disease主動(dòng)脈瓣葉粘連、融合Aortic valve leaflets adhesion, fusion主動(dòng)脈瓣狹窄的病因Causes of aortic ste主動(dòng)脈瓣狹窄aortic stenosis主動(dòng)脈瓣開(kāi)口面積減少肺靜脈高壓 右心衰竭左心室射血負(fù)荷左室向心性肥厚 左心室收縮功能心排血量下降室壁張力順應(yīng)性下降室壁張力左心衰病理生理pathophysiologyPulmonary venous hypetension主動(dòng)脈瓣狹窄aortic stenosis主動(dòng)脈瓣肺靜脈高壓心內(nèi)膜下心肌缺血和灌注不足aortic stenosis腦血流灌注下降左心室做功心肌耗氧

3、量順應(yīng)性下降舒張末壓力CO冠狀動(dòng)脈平均灌注壓心絞痛暈厥Angina pectorisSyncope心內(nèi)膜下心肌缺血和灌注不足aortic stenosis腦主動(dòng)脈瓣置換術(shù)后的護(hù)理(共38張)急性Acute :1.感染性心內(nèi)膜炎Infective endocarditis2.主A夾層 Aortic dissection3.外傷Trauma4.人工瓣膜撕裂Prosthetic valve tear慢性Chronic:主動(dòng)脈瓣疾病Aortic valve disease2/3為風(fēng)心病主動(dòng)脈根部擴(kuò)張Aortic root dilatation主動(dòng)脈瓣關(guān)閉不全的病因Causes of aortic in

4、competence主動(dòng)脈瓣纖維化、增厚、縮短、變形急性Acute :1.感染性心內(nèi)膜炎慢性Chronic:主動(dòng)主動(dòng)脈瓣關(guān)閉不全Aortic valves incompetence主動(dòng)脈內(nèi)血液在舒張期返流入左室偏心性肥厚、擴(kuò)大左心衰左心室容量負(fù)荷Sp、Dp 左心室舒張末期壓力CO室壁張力心絞痛pulmonary hypertension右心衰pathophysiology主動(dòng)脈瓣關(guān)閉不全Aortic valves incompetSystemic vascular resistanceLV：70mm,EF:55%低效性呼吸型態(tài)（Ineffective breathing pattern）Exp

5、lain to patients the importance of taking warfarin orally, Take anticoagulant medicine regularly and quantitatively術(shù)后1個(gè)月內(nèi)避免劇烈體育活動(dòng)，3個(gè)月內(nèi)應(yīng)限量活動(dòng)，以后可逐漸增大活動(dòng)量，6個(gè)月后可恢復(fù)正常學(xué)習(xí)和工作, 但所有鍛煉和運(yùn)動(dòng)均不應(yīng)過(guò)度。Congenital malformations三尖瓣輕度關(guān)閉不全The drainage tube monitoring：Central venous pressure was 9-10.Echocardiography:Reverse

6、 flow aera of the sizeWhat is valvereplacemengsurgeryPulmonary venous hypetension反流面積的大小 心動(dòng)周期舒張期的長(zhǎng)短 AI反流量體循環(huán)血管阻力AI reverse flowReverse flow aera of the sizeBeckoning cycle diastolic lengthSystemic vascular resistanceSystemic vascular resistance反流雙擊添加標(biāo)題文字急性主動(dòng)脈瓣關(guān)閉不全左心室舒張期充盈量突然增加 壓力迅速增高左房壓、肺靜脈壓迅速升高急性肺水

7、腫心動(dòng)過(guò)速以減少反流量 增加CO二尖瓣舒張期提前關(guān)閉，緩解左房和肺靜脈受左心室高舒張壓的影響 CO減少，低BP急性左心衰竭 急性AI 雙擊添加標(biāo)題文字急性主動(dòng)脈瓣關(guān)閉不全左心室舒張期充盈量突然增What is valvereplacemengsurgery瓣膜置換術(shù)是用人工機(jī)械瓣或生物瓣進(jìn)行替換人心臟瓣膜進(jìn)行置換Valve replacement surgery is to use mechanical valves or biological valves to replace original human valves. What is valvereplacemengsurg主動(dòng)脈瓣置換

8、術(shù)主動(dòng)脈瓣置換術(shù) 病例介紹Case Introduction 病例介紹病史medical history 羅菊梅，女，40歲,云南鎮(zhèn)雄人 Patient Jumei Luo,female,40 years old, from Zhenxiong in Yunnan province. 患者因頭昏、胸痛3年，近一年來(lái)加重，活動(dòng)后心悸、氣促、乏力伴呼吸困難，休息后無(wú)明顯緩解一月余，于 年12月10日以“非風(fēng)濕性主動(dòng)脈瓣狹窄并關(guān)閉不全”收住 She was admitted to the hospital for Non-rheumatic aortic stenosis and incompete

9、nce on December 10th, .because dizziness, chest pain have last three years, heart palpitation and shortness of breath with increased activities , and exertional dyspnea lasting over a month.病史medical history 羅菊梅，女，40Medical History手術(shù)史Surgical operation history2004年行“ 卵巢囊腫摘除術(shù)” ovarian cyst in 2004, 年

10、行“右上臂神經(jīng)源性腫瘤切除術(shù)”“neurogenic tumor resection of right arm” in 過(guò)敏史Allergic history 雙黃連Medical History手術(shù)史Surgical op Echocardiography:1、Aortic valve disease: moderate aortic incompetence, moderate aortic stenosis, and the widening of aortic diameter 2、Mild mitral incompetence, and mild tricuspid incompe

11、tence3、The decreasing of left ventricular diastolic function , LVD：70mm,EF:55% Echocardiograph心臟彩超：1、主動(dòng)脈瓣病變： 主動(dòng)脈瓣中度關(guān)閉不全并中度狹窄， 升主動(dòng)脈內(nèi)徑增寬。2、二尖瓣輕度關(guān)閉不全 三尖瓣輕度關(guān)閉不全3、左心舒張功能降低 LV：70mm,EF:55%心臟彩超：DX檢查：主動(dòng)脈迂曲增寬 Aorta becomes widened and tortuous左室增大left ventricle becomes biggerDX檢查：診治經(jīng)過(guò)12月16日前完善術(shù)前準(zhǔn)備12月17日-19日在I

12、CU治療12月20日患者病情平穩(wěn)搬回病房。Preoperative preparation was completed before December 16th.The patient was stablly moved back to the ward on December 20th診治經(jīng)過(guò)12月16日前完善術(shù)12月17日-19日在ICU治療病 情 12月17日在全麻CPB下行主動(dòng)脈瓣置換術(shù)，術(shù)畢于12：50分帶氣管插管返ICU，呼吸機(jī)輔助呼吸，清醒后，查血?dú)馐菊?，?2：30分拔出氣管插管改面罩供氧。血氧飽和度99-100，患者咳嗽咳痰力量稍差 On december 17th, th

13、e aortic valve replacement was completed under general anesthesia CPB ,and the patient returned the icu at 12:50 with ventilator breathing. After waking, her blood check showed normal, so pulled out endotracheal intubation and it was replace by oxygen masks. The oxygen saturation was respectively 99

14、%-100. Patients with cough and expectoration somewhat less power.病 情 12月17日在全麻CPB下行主動(dòng)脈瓣置換術(shù)，術(shù)畢于nursing interventionOn december 17th, the aortic valve replacement was completed under general anesthesia CPB ,and the patient returned the icu at 12:50 with ventilator breathing.總量為500ml,尿色、尿量正常,精神飲食稍差，鼓勵(lì)進(jìn)

15、食。Associated with heart disease, insufficient bodySystemic vascular resistanceRheumatic heart diseaseShe was encouraged to eat .Explain to patients the importance of taking warfarin orally, Take anticoagulant medicine regularly and quantitatively(4)準(zhǔn)確記錄出入量，注意水電解質(zhì)平衡Observe whether there is bleeding o

16、r not in wound.Ventricular systole觀察傷口有無(wú)滲血升主動(dòng)脈內(nèi)徑增寬。(二)心輸出量減少(decreased cardiac output)Drainage of fluid was normal, The total amount of fluid drainage is 500ml.Aortic dissectionnursing intervention病 情 HR95-110次/分，為竇性心律。BP由多巴胺4.9ug/kg/min, 維持在88-122/65-84mmhg,CVP14-7,容量欠，引流液不多, 總量為500ml,尿色、尿量正常,精神飲食稍

17、差，鼓勵(lì)進(jìn)食。The heart rate of the 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 en

18、couraged to eat .nursing intervention病 情 HR95 護(hù)理問(wèn)題 Nursing Problem低效性呼吸型態(tài)（Ineffective breathing pattern） 與手術(shù)及術(shù)后傷口疼痛致咳痰無(wú)力有關(guān)operationand postoperativewound pain induced sputum weakness 心輸出量減少(decreased cardiac output)： 與心臟疾病、體液不足有關(guān)Associated with heart disease, insufficient body fluid潛在并發(fā)癥（ potential

19、complication ） 抗凝不足或抗凝過(guò)度Inadequate or excessive anticoagulation、 護(hù)理問(wèn)題低效性呼吸型態(tài)（Ineffective護(hù)理措施nursing intervention（一）低效性呼吸型態(tài) 1、加強(qiáng)呼吸道護(hù)理，聽(tīng)診雙肺呼吸音，定時(shí)拍背、霧化， 鼓勵(lì)患者咳嗽、咳痰。 Strengthen respiratory care, auscultation of lung breath sound, timed back patting ,and atomization ,and encourge patients to cough and exp

20、ectorate.護(hù)理措施nursing intervention（一）低效 2、持續(xù)心電監(jiān)護(hù)，嚴(yán)密觀察心率、血壓、呼吸、血氧飽和度 Continuous ECG monitoring, and close observation of heart rate, blood pressure, respiration, and oxygen saturation.（一）低效性呼吸型態(tài)（一）低效性呼吸型態(tài) 3、定時(shí)監(jiān)測(cè)血?dú)夥治鼋Y(jié)果，根據(jù)病人的生命體征和血?dú)馇闆r，調(diào)整供氧方式及流量。 Regularly monitor the result of blood gas analysis and adj

21、ust the way and the flow rate of oxygen offer based on the patients vital signs and blood gas. 4、遵醫(yī)囑適當(dāng)予以止痛劑，以減少病人呼吸肌做功 Provide analgesics appropriately according to prescription to reduce the acting of patients breathing muscles. （一）低效性呼吸型態(tài) 3、定時(shí)監(jiān)測(cè)血?dú)夥治鼋Y(jié)果，根據(jù)病人的生命體征和血?dú)馇闆r，調(diào)(二)心輸出量減少(decreased cardiac ou

22、tput)（1）嚴(yán)密監(jiān)測(cè)心律、HR、BP、CVP及末梢情況，發(fā)現(xiàn)異常要及時(shí)報(bào)告醫(yī)生 Keep close monitoring in the change of rhythm, HR, BP, CVP and Peripheral situation, and report to the doctor promptly when abnormal situation is found.nursing intervention(二)心輸出量減少(decreased cardiac ouWhat is valvereplacemengsurgery術(shù)后1個(gè)月內(nèi)避免劇烈體育活動(dòng)，3個(gè)月內(nèi)應(yīng)限量活動(dòng)，

23、以后可逐漸增大活動(dòng)量，6個(gè)月后可恢復(fù)正常學(xué)習(xí)和工作, 但所有鍛煉和運(yùn)動(dòng)均不應(yīng)過(guò)度。Encourage patients to eatCentral venous pressure was 9-10.Strengthen respiratory care, auscultation of lung breath sound, timed back patting ,and atomization ,and encourge patients to cough and expectorate.(二)心輸出量減少(decreased cardiac output)華法林只在體內(nèi)抗凝，通過(guò)拮抗維生素K

24、而產(chǎn)生藥理作用。nursing interventionThe drainage tube monitoring：Strengthen respiratory care, auscultation of lung breath sound, timed back patting ,and atomization ,and encourge patients to cough and expectorate.活動(dòng)與休息Activity and rest主動(dòng)脈瓣中度關(guān)閉不全并中度狹窄，正常的主動(dòng)脈瓣有三個(gè)瓣葉：左半月瓣、右半月瓣和后半月瓣(二)心輸出量減少(decreased cardiac ou

25、tput)(二)心輸出量減少(decreased cardiac output)左心室舒張期充盈量突然增加(二)心輸出量減少(decreased cardiac output)（2）運(yùn)用血管活性藥物，根據(jù)患者的生命體征進(jìn)行調(diào)整 Use vasoactive drugs, and adjust according to the patients vital signsWhat is valvereplacemengsurg(二)心輸出量減少(decreased cardiac output) （3）引流管的監(jiān)測(cè) The drainage tube monitoring： 定時(shí)擠壓引流管保持引流管

26、的通暢 Squeeze drainage tube regularly to keep its patency. 觀察引流液量及性質(zhì)， Observe the drainage amount and nature. 觀察傷口有無(wú)滲血 Observe whether there is bleeding or not in wound.(二)心輸出量減少(decreased cardiac ou(二)心輸出量減少(decreased cardiac output) (4)準(zhǔn)確記錄出入量，注意水電解質(zhì)平衡 Record intake and output accurately, and pay at

27、tention to the balance of water electrolyte.（5）鼓勵(lì)患者進(jìn)食 Encourage patients to eat(二)心輸出量減少(decreased cardiac ounursing intervention（三）潛在并發(fā)癥的預(yù)防和護(hù)理 1、抗凝不足與抗凝過(guò)度 Inadequate anticoagulation and excessive anticoagulation (1)、為避免血栓形成，機(jī)械瓣置換術(shù)后，需終身抗凝治療，生物瓣術(shù)后抗凝3-6個(gè)月。要定時(shí)定量口服 Explain to patients the importance of

28、taking warfarin orally, Take anticoagulant medicine regularly and quantitatively The dose is 2.5-5 milligram（2）、服藥期間監(jiān)測(cè)INR，使之維持在2.03.0. nursing intervention（三）潛在并發(fā)癥的預(yù)（3）加強(qiáng)患者的監(jiān)測(cè)，如有無(wú)皮膚青紫瘀斑、牙齦出血等Strengthen the monitoring of patients, such as the skin bruising , and bleeding gums, etc.（4)、注意飲食對(duì)抗凝藥物的影響 Pa

29、y attention to the infuence of diet on anticoagulants.（3）加強(qiáng)患者的監(jiān)測(cè)，如有無(wú)皮膚青紫瘀斑、牙齦出血等Stre Health EducationPrevention of infectionDietPeriodic reviewMedication guideActivity and restSelf-test Health EducationPre用藥指導(dǎo)Medication guide 華法林只在體內(nèi)抗凝，通過(guò)拮抗維生素K而產(chǎn)生藥理作用。常用INR(國(guó)際標(biāo)準(zhǔn)化比值)評(píng)價(jià) Warfarin anticoagulation only in the body, vitamin K antagonism generated by pharmacological effects. Common INR (international normalized ratio) evaluation記住服藥時(shí)間要固定哦！用藥指導(dǎo)Medication guide 華法林只在體內(nèi)DietIt is best