主动脉瓣置换术后护理.ppt

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, fusion 瓣膜置换术是用人工机械瓣或生物瓣进行替换人心脏瓣膜进行置换 病史medical history 罗菊梅，女，40岁,云南镇雄人 Patient Jumei Luo,female,40 years old, from Zhenxiong 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 breath with increased activities , and exertional dyspnea lasting over a month. Medical History Echocardiography: 1、Aortic valve disease: moderate aortic incompetence, moderate aortic stenosis, and the widening of aortic diameter 2、Mild mitral incompetence, and mild tricuspid incompetence 3、The decreasing of left ventricular diastolic function , LVD：70mm,EF:55% 心脏彩超： 1、主动脉瓣病变： 主动脉瓣中度关闭不全并中度狭窄， 升主动脉内径增宽。 2、二尖瓣轻度关闭不全 三尖瓣轻度关闭不全 3、左心舒张功能降低 LV：70mm,EF:55% 病 情 12月17日在全麻CPB下行主动脉瓣置换术，术毕于12：50分带气管插管返ICU，呼吸机辅助呼吸，清醒后，查血气示正常，于22：30分拔出气管插管改面罩供氧。血氧饱和度99--100％，患者咳嗽咳痰力量稍差 On december 17th, the 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%--100％. Patients with cough and expectoration somewhat less power. 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。 护理措施nursing intervention （一）低效性呼吸型态 1、加强呼吸道护理，听诊双肺呼吸音，定时拍背、雾化， 鼓励患者咳嗽、咳痰。 Strengthen respiratory care, auscultation of lung breath sound, timed back patting ,and atomization ,and encourge