1例主动脉夹层患者合并消化道出血的护理

回顾性总结1例主动脉夹层患者合并消化道出血的护理。患者因腹痛伴左下肢麻木1d入院,诊断为主动脉夹层Ⅲ型。诊断明确后,立即控制心率、血压,抑酸,给予止血治疗,并行主动脉腔内隔绝术。术后,予以精心护理,患者症状缓解,顺利出院。     

主动脉夹层腔内隔绝术患者围手术期护理

目的 总结主动脉夹层(aortic dissection,AD)腔内隔绝术的护理经验.方法 对17例行主动脉夹层腔内隔绝术的AD患者进行术前、术后护理.结果 所有患者未发生护理并发症,术后均痊愈出院.结论对AD腔内隔绝术患者,术前加强疼痛及血压控制等,预防夹层撕裂,术后密切观察患者生命体征,加强呼吸道护理,可降低并发症的发生,促进患者恢复.     

Stanford B型主动脉夹层合并迷走右锁骨下动脉畸形8例腔内修复术围手术期的护理

总结8例Stanford B型主动脉夹层合并迷走右锁骨下动脉畸形患者行腔内修复术的围手术期护理。护理措施主要是术前做好专科查体、心理护理、疼痛护理,控制血压、心率,评估肾脏功能,预防夹层破裂发生,维持水电解质平衡;术后密切观察生命体征和病情变化,做好一期颈部血管重建术后护理及主动脉夹层腔内修复术后的护理,密切观察术后有无脑缺血、急性上肢动脉缺血和脏器缺血表现,警惕和预防主动脉夹层腔内修复术后并发症的发生。本组2例直接行腔内修复术,6例患者一期先行颈部血管重建术,其中5例采用杂交技术、1例采用"烟囱"技术,再二期实施主动脉腔内修复术;术后并发内漏、体温升高伴胸腔积液1例,右上肢肌力下降伴间歇性跛行1例,6例患者术后随访无内漏、夹层复发。     

22例Stanford B型主动脉夹层腔内隔绝术的围手术期护理

目的探讨Stanford B型主动脉夹层腔内隔绝术的围手术期护理要点。方法回顾性分析22例行胸主动脉腔内修复术的Stanford B型主动脉夹层患者的临床资料,总结护理经验。结果 22例患者手术经过顺利,术后出现1例逆行性A型夹层,15例体温过高,予对症治疗后恢复。患者均治愈出院,术后3个月随访,均未出现Ⅰ型内漏。结论术前做好心理护理,控制血压,术后继续控制血压,做好并发症护理,加强饮食及活动指导,是促进患者早期康复出院的关键。     

主动脉夹层腔内隔绝术12例围术期护理

目的:探讨主动脉夹层腔内隔绝术治疗主动脉夹层患者的护理方法.方法:做好围术期护理.结果:1例发生切口渗血、10例发生术后综合征,经进行控制血压、抗凝、抗感染、补液支持治疗均治愈,患者均痊愈出院,日常生活基本自理.结论:在围术期对患者精心护理可促进其康复.     

主动脉夹层腔内隔绝术12例围术期护理

目的：探讨主动脉夹层腔内隔绝术治疗主动脉夹层患者的护理方法。方法：做好围术期护理。结果：1例发生切口渗血、10例发生术后综合征，经进行控制血压、抗凝、抗感染、补液支持治疗均治愈，患者均痊愈出院，日常生活基本自理。结论：在围术期对患者精心护理可促进其康复。     

覆膜支架置入术治疗DebakeyⅢ型主动脉夹层围手术期的护理

目的:探讨覆膜支架置入术治疗DEbakeyⅢ型主动脉夹层围手术期的护理。方法:对32例DebakeyⅢ型主动脉夹层患者行覆膜支架置入术治疗,术前注意病情变化,做好患者的心理护理和充分的术前准备,严密监测血压变化,预防动脉夹层破裂;术中严格无菌操作,积极配合医师顺利完成手术;术后密切监测患者的生命体征,尤其是体温、血压和尿量的变化,做好切口部位的护理,采取有效的护理措施防止并发症的发生。结果:患者均痊愈出院,随访3个月,支架无移位、无内漏,无严重心脑血管并发症。结论:通过对应用覆膜支架置入术治疗的DebakeyⅢ型主动脉夹层患者实施围手术期整体护理,其成功率高且安全有效。     

覆膜支架置入术治疗DebakeyⅢ型主动脉夹层围手术期的护理

目的:探讨覆膜支架置入术治疗DebakeyⅢ型主动脉夹层围手术期的护理.方法:对32例DebakeyⅢ型主动脉夹层患者行覆膜支架置入术治疗,术前注意病情变化,做好患者的心理护理和充分的术前准备,严密监测血压变化,预防动脉夹层破裂;术中严格无菌操作,积极配合医师顺利完成手术;术后密切监测患者的生命体征,尤其是体温、血压和尿量的变化,做好切口部位的护理,采取有效的护理措施防止并发症的发生.结果:患者均痊愈出院,随访3个月,支架无移位、无内漏,无严重心脑血管并发症.结论:通过对应用覆膜支架置入术治疗的DebakeyⅢ型主动脉夹层患者实施围手术期整体护理,其成功率高且安全有效.     

覆膜支架置入术治疗DebakeyⅢ型主动脉夹层围手术期的护理

目的：探讨覆膜支架置入术治疗DebakeyⅢ型主动脉夹层围手术期的护理。方法：对32例DebakeyⅢ型主动脉夹层患者行覆膜支架置入术治疗，术前注意病情变化，做好患者的心理护理和充分的术前准备，严密监测血压变化，预防动脉夹层破裂；术中严格无菌操作，积极配合医师顺利完成手术；术后密切监测患者的生命体征，尤其是体温、血压和尿量的变化，做好切口部位的护理，采取有效的护理措施防止并发症的发生。结果：患者均痊愈出院，随访3个月，支架无移位、无内漏，无严重心脑血管并发症。结论：通过对应用覆膜支架置入术治疗的DebakeyⅢ型主动脉夹层患者实施围手术期整体护理，其成功率高且安全有效。     

1例双胎妊娠合并Stanford B型急性主动脉夹层患者的术后护理

总结1例双胎妊娠合并Stanford B型急性主动脉夹层患者的术后护理经验。本例患者腰麻下行子宫下段剖宫产术,剖宫产术后转静吸复合全麻,在数字减影血管造影下行降主动脉腔内隔绝术。术后密切观察患者生命体征及出入量管理;产后护理包括子宫收缩与恶露的观察、乳房按摩及有效镇痛,给予心理护理。通过积极治疗与护理预防患者术后出血、主动脉瘤破裂、心律失常、肾功能不全、感染等并发症的发生。经对症治疗及精心护理,术后恢复良好,无并发症的发生,治愈出院。     

Total endovascular repair of an intraoperative stent-graft deployed in the false lumen of Stanford type A aortic dissection: A case report

BACKGROUND A 46-year-old male underwent ascending aortic replacement,total arch replacement,and descending aortic stent implantation for Stanford type A aortic dissection in 2016.However,an intraoperative stent-graft was deployed in the false lumen inadvertently.This caused severe iatrogenic thoracic and abdominal aortic dissection,and the dissection involved many visceral arteries.CASE SUMMARY The patient had pain in the chest and back for 1 mo.A computed tomography scan showed that the patient had secondary thoracic and abdominal aortic dissection.The ascending aortic replacement,total arch replacement,and descending aortic stent implantation for Stanford type A aortic dissection were performed 2 years prior.An intraoperative stent-graft was deployed in the false lumen.Endovascular aneurysm repair was performed to address this intractable situation.An occluder was used to occlude the proximal end of the true lumen,and a covered stent was used to direct blood flow back to the true lumen.A three-dimensional printing technique was used in this operation to guide prefenestration.The computed tomography scan at the 1stmo after surgery showed that the thoracic and abdominal aortic dissection was repaired,with all visceral arteries remaining patent.The patient did not develop renal failure or neurological complications after surgery.CONCLUSION The total endovascular repair for false lumen stent-graft implantation was feasible and minimally invasive.Our procedures provided a new solution for stent-graft deployed in the false lumen,and other departments may be inspired by this case when they need to rescue a disastrous stent implantation.     

Endovascular stent-graft repair of descending thoracic aortic aneurysms: the nursing implications for care.

Endovascular repair of descending thoracic aortic aneurysms is a minimally invasive procedure performed with the patient under epidural or spinal anesthesia as an alternative to the conventional left thoracotomy repair. A Dacron graft, similar to the one used in the conventional repair, is placed in the thoracic aorta with fluoroscopic guidance via the femoral or iliac artery. Once the graft is in place, the aneurysm is excluded from the general circulation, thereby preventing rupture. Endovascular repair is currently being offered at selected sites to patients who otherwise would not be candidates for surgical repair due to severe comorbidities such as cardiac, pulmonary, or renal disease. As both the technique and the devices become perfected, endovascular stent-graft repair of descending thoracic aortic aneurysms will most likely be offered as a method of treatment in both high- and low-risk patients who are anatomic candidates for the procedure. This article describes the conventional repair and the endovascular repair of descending thoracic aneurysms. It discusses the implications for nursing care in the preoperative and postoperative settings and defines guidelines for the long-term follow-up of patients who undergo endovascular repair.     

累及弓部分支的B型主动脉夹层患者原位开窗腔内治疗的护理

目的探讨累及弓部分支的Stanford B型主动脉夹层患者原位开窗腔内治疗的临床护理对策。方法回顾性分析解放军总医院血管外科2012年1月至2013年7月收治的9例累及弓部分支的B型主动脉夹层近端锚定区不足患者采用腔内原位开窗技术治疗的临床资料,总结护理要点。结果所有患者支架置入均一次成功,夹层原发破口完全封闭,无内漏发生,围术期无死亡病例。1例患者出现声音轻微嘶哑,其余患者无相关并发症发生。9例患者的平均住院天数为(12±2)d,均痊愈出院。结论加强累及弓部分支的Stanford B型主动脉夹层近端锚定区不足患者原位开窗腔内治疗的围术期护理,有助于提高患者的手术耐受性、有效预防并发症的发生。     

Endovascular repair of traumatic thoracic aortic disruption

In a patient with multiple trauma, blunt thoracic trauma with concomitant aortic disruption is often eminently lethal, ranking second to head injury as the most common cause of trauma-related deaths. Open surgical repair of the aortic lesion has morbidity and mortality rates that are among the highest in the field of cardiovascular surgery. Results with thoracic endovascular aortic repair for traumatic aortic disruption are promising. The facility requirements, technique, and early results of thoracic endovascular aortic repair for the treatment of this difficult aortic injury are presented.     

复杂B型主动脉夹层术后远端再发内膜破裂诊治回顾

目的探讨B型主动脉夹层腔内隔绝术后远端再发内膜破裂的机制与防治。方法回顾性分析1例B型主动脉夹层术后远端再发内膜破裂的临床资料,并复习相关文献。结果患者因B型主动脉夹层在外院经腔内膈绝术治疗后效果不佳,转入我院。从最初发病到并发症的出现的3年内,共发生了2次支架远端再发内膜破裂及1次支架近端Ⅰ型内漏。在外院及我院先后行2次开胸手术、2次腔内隔绝术,病情恢复良好,随访1.5年病情稳定。结论主动脉夹层腔内隔绝术后远端再发内膜破裂的预防与治疗重点在于选择正确的手术入路、适合的覆膜支架及远端限制性裸支架,以保障手术安全性。     

Thoracic aortic dissection: preventing complications

The patient who is admitted to the intensive care unit (ICU) with an acute thoracic aortic dissection represents a nursing emergency. Through astute nursing actions, most complications can be prevented for those patients who have aortic wall injury due to trauma or medical conditions.     

主动脉夹层患者术前血压控制的护理

目的：探讨主动脉夹层患者术前血压控制的护理经验。方法：回顾性分析了我院2007年1月至2008年1月收治的91例主动脉夹层患者血压控制的护理措施。结果：本组病例通过密切的观察和护理,获得了较好的治疗效果。结论：主动脉夹层患者术前血压控制的过程中,应密切观察,综合分析,采取镇静、止痛、扩血管等措施,才能有效地控制血压,为下一步治疗赢得时间和机会。     

血管内支架移植物置入术治疗StanfordB型主动脉夹层

目的评价血管内支架移植物置入术治疗Stanford B型主动脉夹层的安全性和有效性.方法10名主动脉夹层患者,均在全麻下进行移植物置入术治疗,4例置入TALENT内支架移植物,6例置入国产内支架移植物.结果2例未能有效封堵动脉破裂口,其中1例治疗后12 h因动脉破裂死亡.1例移植物部分遮盖左锁骨下动脉,但无上肢进行性缺血加重,余7例动脉夹层及假腔均较好封堵.术后1周,9例行CTA检查,除1例夹层未得到封堵外,其余8例内支架移植物均无移位,假腔均缩小,真腔均扩大.随访8例(2～38个月),均无症状再发.结论内支架移植物置入术可有效治疗Stanford B型主动脉夹层;严格选择适应证可提高治疗的安全性和有效性.