心脏再同步化治疗应用轨道法植入左室心内膜电极的护理

目的 总结心力衰竭(心衰)病人行轨道法植入心脏再同步化治疗(CRT)或者心脏再同步化治疗并心律转复除颤器(CRT-D)左室心内膜电极护理方法、疗效及术后并发症预防。方法 选取2017年3月1日至2017年12月31日在安徽医科大学第一附属医院行CRT/CRT-D 左室心内膜电极植入术的心衰病人6例,采用轨道法先后建立股静脉-房间隔-股动脉轨道和股动脉-房间隔-锁骨下静脉轨道,并成功植入左室心内膜电极,采用优化护理方法,加强术中及术后心电监测,维持主动脉球囊反搏正常工作,加强术后抗凝治疗与监测。结果 6例病人术后1周随访,5例病人临床症状明显改善,临床治疗效果显著,1例轻度改善。1例病人发生左心室电极穿孔,床边心超示心包少量积液,予以左室电极重置后好转,其余无明显并发症。结论 轨道法是植入心脏再同步化治疗左室心内膜电极的一种切实可行的术式。注重术中及术后心电监护及出凝血监测,加强主动脉球囊反搏护理监测,科学有效的临床护理是手术成功的关键之一。

Application of cardiac resynchronization therapy in nursing care of left ventricular endocardial electrode by orbital implantation

Objective To summarize the nursing methods,curative effect and complications prevention of heart failure patients with orbital implantation of cardiac resynchronization therapy (CRT) or cardiac resynchronization therapy and implantable cardioverter defibrillator (CRT-D) left ventricular endocardial electrode.Methods Six cases of heart failure patients undergoing CRT/CRT-D left ventricular endocardial electrode implantation in The First Affliated Hospital of Anhui Medical University from March 1,2017 to December 31,2017 were selected,and using the orbital method to establish femoral venous-interatrial septum-femoral artery orbital and femoral artery-interatrial septum-subclavian vein orbital,and the left ventricular endocardial electrode was successfully implanted.The optimized nursing method was used to evaluate the postoperative curative effect and complication prevention.Results Six patients were followed up one week after surgery.The clinical symptoms of 5 patients were significantly improved,and the clinical effect was significant,1 case was slightly improved.One patient had left ventricular electrode perforation,and a small amount of effusion was found in pericardium by the bedside ultrasonic cardiogram (UCG),and the left ventricular electrode was reset and improved,with no obvious others complications.Conclusion Orbital method is a feasible method to implantation cardiac resynchronization therapy for left ventricular endocardial electrode.More attention should be paid to intraoperative and postoperative electrocardiogram monitoring and coagulation monitoring,and strengthening IABP nursing monitoring can effectively prevent heart failure,scientific and effective clinical nursing is one of the keys to successful operation.