2020年8月护理学报August,2020
第27卷第15期Journal of Nursing(China)Vol.27No.15
的护理配合
许斌，韩杰，董瑶，张鸿英
(首都医科大学附属北京安贞医院北京市心肺血管病研究所心外科手术室，北京100029)
[摘要]目的总结我院采用OZAKI自体心包主动脉瓣膜成形术主动脉瓣疾病的护理配合经验。方法收集2015年11月—2019年12月我院32例主动脉瓣病变患者，均于静脉+吸入复合全身麻醉下接受OZAKI自体心包主动脉瓣膜成形手术。
手术室器械护士术前熟知手术方案及步骤，提前准备瓣膜修复器械，配合自体心包瓣叶制作及缝合等手术步骤。巡回护士准备好心包固定液，准确记录戊二醛浸泡和冲洗时间。结果32例主动脉瓣病变患者均
手术修复成功取得满意效果，无围术期死亡、无护理并发症发生。术后1周复查超声心动图，主动脉瓣血液动力学纠正效果满意。结论手术室护士熟知并掌握OZAKI自体心包主动脉瓣膜成形手术的方法及技术特点，护理配合应注意自体心包瓣叶制作的关键步骤，以及戊二醛溶液的配制及术中妥善管理，协助外科医生顺利完成手术。
[关键词]自体心包主动脉瓣成形术；主动脉瓣狭窄；主动脉瓣关闭不全；护理配合
[中图分类号]R472.3[文献标识码]A[DOI]10.16460/j.issn1008-9969.2020.15.066
Nursing Cooperation in Ozaki Technique for Aortic Valve Reconstruction:A32-case Study
XU Bin,HAN Jie,DONG Yao,ZHANG Hong-ying
(Dept.of Cardiac Operating Room,Beijing Anzhen Hospital Affiliated to Capital Medical University,
Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing100029,China)
Abstract:Objective To summarize the nursing experience in OZAKI technique for aortic valve reconstruction.Methods The data of32patients with aortic valve disease who underwent Ozaki procedure in our hospital from November2015to December 2019were collected.Instrument nurses sh
ould be familiar with surgical plan and procedures before surgery,prepare valve reconstruction equipment,and cooperate with surgeons in surgical procedures such as the preparation and suture of autologous pericardial cups. Circulating nursesshould prepare appropriate concentration of glutaraldehyde for immobilization of pericardial tissue and accurately record the duration of immersion and rinsing.Results Allthe surgeries of the32patients were completed successfully,achieving satisfactory results without perioperative death or nursing complications.Echocardiography was performed one week after the operation,showing satisfactory results of hemodynamic correction of aortic valve.Conclusion Nurses in operating room should be familiar with the process and technical characteristics of OZAKI technique for pericardial aortic valve reconstructionin order to assist surgeons to complete the operation successfully.Some key steps in the preparation of autopericardial leaflets as well as preparation and management of glutaraldehyde solution should be noticed during nursing cooperation.
Key words:autologous pericardium aortic valve reconstruction;aortic stenosis;aortic insufficiency;nursing cooperation
目前，主动脉瓣置换术是主动脉瓣病变的
最常见的外科方法。然而，术后抗凝药物引起的
并发症以及人工瓣膜的耐久性等影响着主动脉瓣置
换术后的患者的生存[1-2]。此外，瓣膜置换后的主动脉瓣环被人工瓣膜固定，从而失去了生理性主动脉
瓣环的正常功能。近年来,Ozaki等[3]开展了新式的自体心包主动脉瓣成形术(aortic valve neo-cuspidization,AVneo)，与以往的主动脉瓣膜修复手术方法不同，根据患者主动脉窦部的大小，采用自体心包，分别制作相对应的主动脉瓣叶进行瓣叶置换，将主动脉瓣重建流程“标准化、模式化”，取得满意的手术及随访效果。该术式保留了主动脉瓣环的自然
结构，有助于心室、主动脉根部以及升主动脉的协调
运动，改善主动脉瓣血流[4]。个体化瓣叶制作，极大提高了瓣叶的对合高度，对术后瓣膜反流起到预防
作用。正常情况下，主动脉瓣瓣叶有效对合高度为2~6mm，通过该方法重建后的主动脉瓣叶对合高度可以达到7~11mm。此外，瓣叶重建采用患者自体心包，减少了人工瓣膜产生的费用，降低了患者总体费用。该术式作为新技术效果明确，有推广价值，由于未见手术配合方法的报道，现总结我院2015年11月—2019年12月32例Ozaki手术护理配合经验如下。
[收稿日期]2019-12-16
[作者简介]许斌(1970-)，女，北京人，本科学历，副主任护师。66
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