总结1例急性A型主动脉夹层伴多器官灌注不良患者的护理体会。针对患者病情复杂、术后并发症多的问题,护理重点：做好早期器官灌注不良症状及体征的观察和术前全面评估;术后严密监测血流动力学变化,维持机体有效灌注;组建多学科管理团队,为灌注不良器官提供精细化的功能支持护理;重视术后并发症的预防及院外随访管理。术后第25天患者由ICU转入普通病房,术后第30天好转出院。
To summarize the nursing experience of a patient with type A aortic dissection complicated with multiorgan malperfusion syndrome. Such patients usually have complex conditions,severe postoperative complications and difficult care. Main points of nursing included observation of signs and symptoms of malperfusion and comprehensive preoperative evaluation,close monitoring of postoperative hemodynamic changes and maintenance of effective perfusion,formation of a multidisciplinary management team to provide patients with precision organ support for malperfusion organs,preventing the related complications postoperatively and out-of-hospital follow-up management. The patient was transferred from ICU to general ward on the 25th day and discharged on the 30th day after operation.
[1] 林曦,张卫达. 急性A型主动脉夹层合并器官灌注不良的治疗进展[J]. 医学研究生学报,2020,33(9):985-989.
Lin X,Zhang WD.Advances in the treatment of acute type A aortic dissection with organs malperfusion[J]. J Med Postgrad,2020,33(9):985-989.
[2] Zindovic I, Gudbjartsson T, Ahlsson A,et al. Malperfusion in acute type A aortic dissection:an update from the nordic consortium for acute type A aortic dissection[J]. J Thorac Cardiovasc Surg,2019,157(4):1324-1333.e6.
[3] Norton EL, Khaja MS, Williams DM,et al.Type A aortic dissection complicated by malperfusion syndrome[J]. Curr Opin Cardiol,2019,34(6):610-615.
[4] 李够雄,欧玉兰,万艳平. 主动脉夹层患者术前护理研究现状[J]. 中国实用护理杂志,2019,35(3):238-241.
Li GX,Ou YL,Wan YP.Current situation in preoperative nursing of the patients with aortic dissection[J]. Chin J Pract Nurs,2019,35(3):238-241.
[5] 刘大为,王小亭,张宏民,等. 重症血流动力学治疗:北京共识[J]. 中华内科杂志,2015,54(3):248-271.
Liu DW,Wang XT,Zhang HM,et al.Hemodynamic therapy of severe cases:Beijing consensus[J]. Chin J Intern Med,2015,54(3):248-271.
[6] Pourmand A, Pyle M,Yamane D,et al.The utility of point-of-care ultrasound in the assessment of volume status in acute and critically ill patients[J]. World J Emerg Med,2019,10(4):232-238.
[7] Saint-Pierre C,Herskovic V,Sepúlveda M.Multidisciplinary col-laboration in primary care:a systematic review[J]. Fam Pract,2018,35(2):132-141.
[8] Yang J,Ji D,Zhu YQ,et al.Hemoperfusion with HA380 in acute type A aortic dissection patients undergoing aortic arch operation(HPAO):a randomized,controlled,double-blind clinical trial[J]. Trials,2020,21(1):954.
[9] Segaran E,Barker I,Hartle A.Optimising enteral nutrition in critically ill patients by reducing fasting times[J]. J Intensive Care Soc,2016,17(1):38-43.
[10] 孙建华,张青,郭海凌,等. 重症超声在ICU患者护理评估中的应用现状及展望[J]. 中华现代护理杂志,2018,24(28):3367-3370.
Sun JH,Zhang Q,Guo HL,et al.Application and prospect of critical ultrasonography in nursing assessment of ICU patients[J]. Chin J Mod Nurs,2018,24(28):3367-3370.
[11] 李咪琪,黄素芳. 主动脉夹层病人随访的研究进展[J]. 护理研究,2020,34(9):1569-1572.
Li MQ,Huang SF.Research progress on the follow-up of aortic dissection patients[J]. Chin Nurs Res,2020,34(9):1569-1572.
