改良全腔静脉肺动脉连接术患者的护理体会

张伟英　曹琴　侯明君

摘要：改良全腔静脉肺动脉连接术治疗先天性功能性单心室效果良好，其术后护理不同于其他心脏手术。通过对16例改良全腔静脉肺动脉连接手术患者的护理，认为对该类患者应做好：(1)取“V”字型体位；(2)充分镇静，过度通气，同时应用扩血管药物扩张肺血管，降低肺血管阻力；(3)严密监测生命体征及血液动力学各项指标；(4)保持胸管通畅；(5)预防和治疗术后低心排综合征。
关键词：改良全腔静脉肺动脉连接术； 护理
中图分类号：R473.6　　文献标识码：A　　文章编号：1008-9993(2000)05-0041-02

Experience in Nursing Care of Patients with Modified Total Cavopulmonary Connection Operation

ZHANG Wei-ying　CHAO Qin　HOU Ming-jun
(Department of Thoracic and Cardiovascular Surgery，Changhai Hospital，Second Military Medical University，Shanghai 200433，China)

Abstract：Modified total cavopulmonary connection operation is an effective means of treating patients with congenital functional single ventricle. Postoperative nursing care of such patients is characteristic. Our experience in postoperative nursing of 16 patients who received the modified total cavopulmonary connection procedure in our hospital from Dec.1996 through Dec.1999 showed that a “V” position of the patients,increase of pulmonary vascular resistance by hyperventilation and the use of sedation,increase of systemic blood flow into the lungs by vasodilators,intensive monitoring of the vital signs and hemodynamics,patency of the chest tubes,and prevention and treatment of postoperative low cardiac output syndromes are important nursing care measures to assure smooth recovery of such patients.
Key words：modified total cavopulmonary connection； nursing

　　治疗单心室等复杂先心病全腔静脉肺动脉连接术，经典的手术方式存在上下腔静脉血流对冲耗能大、血液在两肺分布不符合生理、氧合受到影响等缺点。随着心脏外科手术技术的提高与心肌保护措施的改进，我院对手术方式进行了改进，采用改良全腔静脉肺动脉连接术治疗复杂先心病功能性单心室，从1996年12月至1999年12月共行手术16例。在护理中，我们逐步总结并形成了改良全腔静脉肺动脉连接术的护理常规，取得了满意的护理效果。

1　临床资料

1.1　一般资料　本组16例，年龄9～15岁，术前诊断：单心室7例，三尖瓣闭锁3例，完全性大动脉转位2例，完全性房室隔缺损1例，右室双出口3例，同期合并肺动脉瓣狭窄（PS）、动脉导管未闭（PDA）、房间隔缺损（ASD）、室间隔缺损（VSD）、左室发育不良、永存左上腔静脉、房室瓣关闭不全等心内畸形。
1.2　手术方法简介　手术均在全麻低温体外循环下施行。16例中6 例在心脏停搏下施行手术，将上腔静脉远端与右肺动脉上缘作端侧吻合，吻合口偏左侧，近心端与右肺动脉下缘作端侧吻合，吻合口偏右侧，另建立心房内隧道；10 例在心脏不停搏下应用心外

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