直视微创心脏小切口手术的护理配合

目的总结直视微创心脏小切口手术的护理配合要点。方法对271例患者实施直视微创心脏小切口手术,做好手术配合并实施相应的护理。结果患者手术顺利,平均体外循环时间（117.3±47．1）min,主动脉阻断时间（82．6±32．1）min。无术后并发症发生,均痊愈出院,住院时间（6．8±2．6）d。围术期及出院后无1例死亡。结论直视微创心脏手术的近期手术效果良好,手术安全性高。术前做好患者配合手术的健康指导,术中做好手术配合是手术成功的重要措施。     

右侧乳房下小切口微创二尖瓣手术的配合

【】 目的：总结30例右侧乳房下小切口微创行二尖瓣手术的临床经验和疗效、探讨术中配合方法。方法：对2008年10月至2009年8月间我科采用右侧乳房下小切口二尖手术30例术中配合总结分析。结果：右侧乳房下小切口第四肋进胸结合术者头灯光源辅助、周围体外循环的方法微创行二尖瓣手术,术野暴露良好、操作简便易掌握,术中配合简单,较常规正中开胸手术创伤小、出血少、住院时间短、切口美观隐蔽,术后早期效果理想。     

微创小切口二尖瓣成形术围手术期的护理

目的 探讨微创小切口二尖瓣成形术围术期的护理方案。方法 对30例患者的围手术期进行周密细致的护理、正确实施健康教育及临床护理。结果 总结出围手术期的有效护理方法,为手术顺利进行和术后早日康复提供有力保证。结论完善的术前准备及有效的健康教育,高质量的术后监护是微创小切口二尖瓣成形术是患者康复的关健。     

小切口微创祛腋臭术的围手术期护理

总结298例小切口微创祛腋臭患者的围手术期护理经验,包括术前做好心理护理和宣教,术中配合医师并做好病情观察,术后做好伤口换药护理。认为密切的护理配合能提高手术效率,预防感染,减少术后并发症的发生。     

胸腔镜辅助微创二尖瓣置换术的手术配合

目的：总结81例胸腔镜辅助微创二尖瓣置换术的手术配合。方法：81例患者均在全麻低温循环下行二尖瓣置换术,术前准备好特殊的物品、仪器;术中建立正确的静脉通道、注意体位摆放、电刀安全使用;关闭胸腔后观察胸腔引流效果;术中器械护士做好周围循环插管的配合、器械准确传递及胸腔镜头的保护等。结果：手术护理配合顺利,81例患者均顺利完成手术,术后恢复快、效果好,顺利出院。结论：熟悉胸腔镜心脏手术配合的特点,做好手术全过程的护理,使手术顺利完成,减少术后并发症,是手术成功的重要保证。     

心脏外科微创手术的配合

心脏微创手术是国外近几年来开展的一种新的手术方法。目前,我国巳将此技术作为心脏外科的发展方向。我院自1996年10月~1998年5月,对90例心脏病人实施了微创手术,切口长度均为6~10cm,手术时间比传统手术切口平均缩短60min以上,无1例发生并发症,获得良好的效果。笔者针对切口缩小、术野受限的特点,系统总结了90例心脏病人实施微创手术配合的特点,如增设外周主干血管插管转流所用器械,特制双开口腹单及手术如何分组同时进行操作的方法等。并针对所遇心脏插管、排气、除颤等问题提出了相应处理措施。为今后配合临床开展微创手术提供内容方法等方面的参考,以促进我国心脏微创手术的广泛开展。     

正中小切口全胸骨劈开术应用于多数心脏手术策略

目的：探讨正中小切口全胸骨劈开术应用于多数心脏手术策略和实施技巧。方法：作者总结了个人近两年进行的302例全胸骨劈开正中小切口心脏直视手术经验;同时选取不同手术方式的二尖瓣修复手术进行手术效果、手术时间、主动脉阻断时间、出血量和ICU停留时间的比较。结果：正中小切口这种微创手术方式,将胸骨全切开,但将常规的20cm切口长度缩小到6～8cm,胸骨只撑开6cm,可以进行多数心脏手术,取得良好效果。适应症广泛,具备微创手术的切口小,美观的优点,对胸廓影响小,又具备正中开胸的心脏显露清楚,手术迅速确切,心脏中心插管,手术安全性高,不增加手术时间、主动脉阻断时间、出血量和ICU停留时间,不需要单肺通气等诸多优势。结论：正中小切口这种微创手术方式,适应症广泛,操作比较方便,尤其易于推广。     

正中小切口全胸骨劈开术治疗心脏疾病的手术策略及应用技巧

目的:探讨正中小切口全胸骨劈开术应用于多数心脏手术策略和实施技巧。方法:总结2017年11月至2019年12月复旦大学附属中山医院302例全胸骨劈开正中小切口心脏直视手术经验,与常规正中切口手术和右侧开胸微创手术的二尖瓣修复手术的手术效果、手术时间、主动脉阻断时间、出血量和ICU停留时间进行比较。结果:正中小切口手术将胸骨全切开,但将常规的20 cm切口长度缩小到6～8 cm,胸骨只撑开6 cm,可进行多数心脏手术,取得良好效果,适应证广,且具备微创手术切口小、美观的优点,对胸廓影响小,又具备正中开胸的心脏显露清楚,手术迅速确切,心脏中心插管,手术安全性高,不增加手术时间、主动脉阻断时间、出血量和ICU停留时间,不需要单肺通气等诸多优势。结论:正中小切口这种微创手术方式,适应证广泛,操作较方便,易于临床推广。     

右前外侧小切口微创心脏手术的临床研究

目的探讨右前外侧小切口微创心脏手术的临床疗效。方法选取二尖瓣病变或房间隔缺损患者43例,将其分成小切口组21例和正中切口组22例。比较两组患者疼痛度、输血量、术后引流量、建立体外循环时间、阻断时间、ICU监护时间及转流时间。结果小切口组建立体外循环时间、转流时间及阻断时间均与正中切口组无显著差异,而切口长度、引流量、输血量、术后呼吸机通气时间、ICU监护时间、住院时间、曲马多使用次数均较正中切口组减少,差异具有显著性。小切口组出现右肺局限性肺不张2例。因主动脉根部插管部位出血延长切口止血1例,起搏导线失效1例,二次开胸止血1例。结论右胸前外侧小切口行微创心脏手术安全有效,美容效果好,但需注意防止并发症的发生。     

经右侧胸前小切口微创二尖瓣置换术手术护理配合

[目的]总结经右侧胸前小切口二尖瓣置换术的手术配合经验。[方法]收集2015年9月—2016年3月经右侧胸前小切口微创二尖瓣置换术(MVR)病例78例,总结手术护理配合经验,术前认真准备,术中仔细配合。[结果]78例右侧胸前小切口微创MVR的手术准备完善,手术配合密切,手术进度加快,手术经过顺利。[结论]通过熟练的手术护理配合,很大程度上提高了右侧胸前小切口微创MVR的手术护理配合质量,得到了手术医生的满意。     

小切口微创二尖瓣手术的临床研究

[目的]比较右前外侧小切口和传统正中开胸二尖瓣手术的临床结果.[方法]2009年10月至2011年5月,行微创二尖瓣手术46例(小切口组),选择同期传统正中开胸二尖瓣手术45例(正中切口组).比较两组手术情况、患者术后情况及围术期心功能变化.[结果]两组患者均无院内死亡、低心排综合征、呼吸系统及中枢神经系统并发症.小切...     

Minimally invasive valve surgery: different techniques and approaches

Less invasive approaches to cardiac surgical procedures are being developed in an effort to decrease patient morbidity and enhance postoperative recovery in comparison with conventional methods. Although full median sternotomy has been the standard surgical approach to the heart for more than 30 years, minimally invasive techniques using limited incisions are rapidly gaining acceptance. Potential advantages of a small skin incision include less trauma and tissue injury, leading to a less painful and quicker overall recovery, as well as shorter hospital stays for patients. Decreasing the size of the skin incision for minimally invasive valve surgery to significantly less than the cardiac size requires specific access to the valve to be repaired or replaced. Thus, various minimally invasive techniques and approaches have been described for aortic and mitral valve surgery [111]. This article will review the different minimally invasive techniques and approaches, as well as early results and outcomes for aortic and mitral valve surgery.     

Minimally invasive valve surgery: different techniques and approaches

Less invasive approaches to cardiac surgical procedures are being developed in an effort to decrease patient morbidity and enhance postoperative recovery in comparison with conventional methods. Although full median sternotomy has been the standard surgical approach to the heart for more than 30 years, minimally invasive techniques using limited incisions are rapidly gaining acceptance. Potential advantages of a small skin incision include less trauma and tissue injury, leading to a less painful and quicker overall recovery, as well as shorter hospital stays for patients. Decreasing the size of the skin incision for minimally invasive valve surgery to significantly less than the cardiac size requires specific access to the valve to be repaired or replaced. Thus, various minimally invasive techniques and approaches have been described for aortic and mitral valve surgery. This article will review the different minimally invasive techniques and approaches, as well as early results and outcomes for aortic and mitral valve surgery.     

Minimally invasive heart valve surgery: already established in clinical routine?

Cardiac valve replacement with the need for open heart surgery still has the highest morbidity and mortality rates among routine cardiac surgery, with the exception of aortic aneurysm repair and surgery for congenital heart defects. Reducing invasiveness is a desirable goal, and different strategies and approaches have been used to achieve this with valve repair or replacement less invasive. Despite the good results reported with minimally invasive techniques, time on extracorporal circulation is always longer compared with the conventional procedures. Since these techniques do not reduce real invasiveness but rather improve the cosmetic results, minimal-access surgery would be a better nomenclature. With the exception of patients at a high risk for sternal infections or redo heart operations, a reduction in postoperative morbidity by the avoidance of a median sternotomy is not yet definitely proven. Meanwhile, most surgeons comply with the demand for minimally invasive surgery posed by patients by reducing the length of the incision in aortic valve replacement and by using a right anterolateral approach with a limited incision for mitral valve operations. However, the use of endoscopic or robotic devices is limited to a few centers, and has not yet found its way into clinical routine. Nonetheless, minimally invasive or minimal-access surgery is now established in many centers, and patients should always be informed of these techniques. When this information is provided objectively and patient selection is carried out accurately, these alternative approaches can help to improve postoperative convalescence.     

Minimally invasive heart valve surgery: already established in clinical routine?

Cardiac valve replacement with the need for open heart surgery still has the highest morbidity and mortality rates among routine cardiac surgery, with the exception of aortic aneurysm repair and surgery for congenital heart defects. Reducing invasiveness is a desirable goal, and different strategies and approaches have been used to achieve this with valve repair or replacement less invasive. Despite the good results reported with minimally invasive techniques, time on extracorporal circulation is always longer compared with the conventional procedures. Since these techniques do not reduce real invasiveness but rather improve the cosmetic results, minimal-access surgery would be a better nomenclature. With the exception of patients at a high risk for sternal infections or redo heart operations, a reduction in postoperative morbidity by the avoidance of a median sternotomy is not yet definitely proven. Meanwhile, most surgeons comply with the demand for minimally invasive surgery posed by patients by reducing the length of the incision in aortic valve replacement and by using a right anterolateral approach with a limited incision for mitral valve operations. However, the use of endoscopic or robotic devices is limited to a few centers, and has not yet found its way into clinical routine. Nonetheless, minimally invasive or minimal-access surgery is now established in many centers, and patients should always be informed of these techniques. When this information is provided objectively and patient selection is carried out accurately, these alternative approaches can help to improve postoperative convalescence.     

保留瓣下结构二尖瓣置换术65例护理体会

目的:探讨保留瓣下结构二尖瓣置换术的护理配合。方法:回顾性总结65例保留瓣下结构二尖瓣置换术患者的手术护理。结果:65例患者未发生并发症,均顺利康复出院。结论:需要有扎实的理论基础,熟练掌握手术操作规程,才能更好的配合完成手术。     

胸腔镜下二尖瓣置换术的护理配合

目的总结胸腔镜下二尖瓣置换术的护理配合要点。方法 2011年7月-12月利用腔镜技术以肋间开胸方式对5例心脏疾患患者施行二尖瓣置换手术,术前充分准备和术中密切配合,确保了手术的顺利施行和完成。结果除1例患者因术中出血改为传统开胸手术外,其余4例均顺利完成手术。患者术中出血量平均约300 mL,术后平均引流量约100 mL,手术平均时间4 h,患者术后在监护室留观1 d后转入病房。结论腔镜二尖瓣置换术是一项值得推广的手术方式,护理人员要不断加强知识的学习和更新,以适应新术式发展对护理工作的挑战和要求。     

Intraoperative transesophageal echocardiography in minimally invasive cardiac valve surgery.

The minimally invasive procedure is a new surgical technique that uses a small sternal incision. Because of limited surgical exposure, removal of intracavitary air and visual assessment of cardiac function are not possible. We studied the utility of intraoperative transesophageal echocardiography (IOE) before and after cardiopulmonary bypass in 112 patients (mean age 53.1 +/- 15.2 years, 74 males) who underwent minimally invasive valvular surgery. Surgical procedures included 52 isolated mitral valve procedures (49 repairs, 3 prostheses), 58 isolated aortic valve procedures (16 repairs, 26 prostheses, 16 homografts), and 2 combined aortic and mitral valve repairs. Prepump IOE was useful to confirm valve dysfunction and assist determination of arterial cannulation site. Postpump IOE identified intracardiac air in all patients, which was defined as extensive in 58 (52%) cases. Postoperatively, new left ventricular dysfunction was noted in 22 (20%) patients, more often in the group with extensive air by IOE (17 [30%] of 58 patients) compared with those without extensive air (5 [10%] of 54 patients, P =.01). Second pump runs were required in 7 (6%) of 112 patients: 3 cases of residual aortic regurgitation, 1 case of residual mitral regurgitation, and 3 cases with new ventricular dysfunction. No deaths occurred. We conclude that IOE is essential in minimally invasive valvular surgery because it detects problems that require immediate remedy. IOE allows real-time assessment of ventricular filling, ventricular and valvular function, and intracardiac air.