机器人冠脉杂交手术围手术期护理

目的：探讨机器人冠状动脉旁路移植并支架植入“杂交”手术围手术期的护理。方法对2007年1月-2013年9月收治的行机器人冠状动脉旁路移植术患者分阶段做好健康教育，根据治疗流程分别做好各阶段专科护理。术前主要控制心绞痛的发作及加强肺功能锻炼，术后早期做好血流动力学监测及引流液的观察，同时加强肺部、疼痛及抗凝护理。在行经皮冠状动脉介入治疗（ PCI ）术前做好强化抗凝治疗，PCI术后主要观察心、肾功能情况，做好饮水指导，防止发生造影剂肾损伤，同时做好穿刺局部伤口的观察与护理，预防并发症发生。结果本研究无手术死亡病例，围手术期无并发症发生。术毕患者循环稳定，恢复顺利。术后第2天患者即下地活动。患者平均住ICU时间（37．8±5．6） h。患者支架置入术中造影检查未发现旁路血管狭窄，支架置入术后3～5d出院，无心血管事件发生。结论全面做好围手术期护理是机器人冠状动脉旁路移植并支架植入“杂交”手术患者顺利康复的有效保障。

Perioperative nursing of patients undergoing hybrid coronary revascularization

Objective This study described our experience on perioperative nursing care for hybrid revascularization by endoscopic robotic coronary artery bypass on the beating heart with percutaneous coronary intervention （ PCI） in a staged approach .Methods Patients undergoing hybrid coronary revascularization from January 2007 to September 2013 were included in the study .The progressive patient care was different compared with conventional coronary artery bypass graft surgery （ CABG ） , so the health education and specific nursing were of great importance in different phases .The preoperative angina pectoris attacks therapy and pulmonary function training were necessary , and the hemodynamic monitoring , hemorrhage volume record , lung caring, pain therapy and anticoagulation after robotic assisted CABG were also important .At the same time, the intensive anticoagulation before PCI and renal injury , arterial hemorrhage prevention after PCI needed much attention.Results There was no death patients during the study phase . After the hybrid coronary revascularization, patients were stable and no severe complication was occurred .After 2 days of surgery, patients could take a walk at bedside .The mean time of ICU stay was （37.8 ±5.6） hours.After PCI, no bypass vascular stenosis occurred .Conclusions The comprehensive perioperative nursing care is necessary for patients received hybrid coronary revascularization surgery .