Transiliac Vein Approach to a Permanent Pacemaker Implantation After Aortic Valve Reoperation

This article describes the case of a 71 -year-old woman in whom a permanent pacemaker implantation was performed through an iliac vein because of superior vena cava obstruction after aortic valve reoperation. During a 6-month follow-up, the patient did well and the pacemaker performance was satisfactory.     

经导管主动脉瓣植入术患者的手术护理体会

目的 探讨和总结主动脉瓣重度狭窄患者经导管植入主动脉瓣植入术(transcatheter aortic valve implantation,TAVI)的手术护理体会。方法 本组共8例主动脉瓣重度狭窄患者,术前予卫生宣教、心理护理,并备齐手术中所需药物、器械、仪器设备等;术中严格无菌原则,密切观察患者生命体征、活化凝血时间(activated clotting time,ACT)监测、穿刺点周围出血情况,重点做好器械准备、麻醉配合、食道超声定位、血流动力学监测及临时起搏器和心脏除颤仪的管理;发生并发症时,积极有效地配合医生进行处理。结果 成功完成8例患者经导管主动脉瓣植入术,其中:7例主动脉瓣返流程度改善,1例加重,均无严重并发症发生。结论 熟悉手术步骤,掌握每一步操作的护理配合要领,是保证手术顺利进行和手术成功的重要条件。     

24例经导管主动脉瓣植入术中并发症的观察及护理

共24例主动脉瓣重度狭窄的患者,行经导管主动脉瓣植入术均获成功。术中发生并发症4例,1例室性颤动,2例血管并发症,1例腹膜后血肿,3例Ⅲ度房室传导阻滞,经及时处置均手术成功。因该组患者高龄、病情重、手术风险高,需备齐术中所需物品、药品;术中做好手术配合,操作规范细致;密切观察心电图、血压、血氧饱和度的异常改变,以及穿刺点周围出血情况;设1名专门护士,重点做好临时起搏器及除颤仪的管理,一旦发生并发症,及时配合医生处理。认为护士应在术中熟练掌握监护仪、除颤仪、临时起搏器等仪器操作,熟悉手术进程,熟知术者每一操作配合要领及潜在的风险,及时发现并发症、有效配合抢救。     

经导管主动脉瓣置入术中的护理

目的分析总结经导管主动脉瓣置入的术中护理要点,以指导临床术中护理。方法回顾性分析2012年4月-5月新开展经股动脉逆行法经导管主动脉瓣置入术3例患者的临床资料。术前备齐手术用物及急救药品、术中协助患者正确体位,准确使用临时起搏器、除颤仪、认真做好病情及并发症观察和护理,总结术中临床护理方法。结果经导管主动脉瓣置入手术顺利成功,术中护理效果满意,无因物品或药品准备不齐及护理不当而影响手术进程、造成患者意外损伤及并发症发生。结论经导管主动脉瓣置入术,术前备齐相应的导管导丝,术中操作规范细致、及时、准确传递用物、认真进行临床观察和护理,手术顺利、成功无不良事件发生及并发症发生。     

Transcatheter Aortic Valve Replacement: Clinical Update for Nurse Practitioners

Aortic stenosis is one of the most prevalent types of valvular heart disease in the United States, and nurse practitioners in multiple practice settings can play a vital role in the care of these patients. Early identification and treatment are key to improved patient outcomes. Treatment options have advanced over the last decade and include a less invasive procedure called transcatheter aortic valve replacement. The purpose of this article is to improve nurse practitioner’s knowledge of aortic stenosis, discuss treatment options with a focus on transcatheter aortic valve replacement, and provide their patients with an improved quality and longevity of life.     

永久性心脏起搏器安置术后并发症的护理

随着我国心律失常介入治疗的迅速开展,心脏起搏器的临床应用日益广泛,安置心脏起搏器是治疗不可逆性心脏传导功能障碍的安全有效的方法,特别是治疗因“窦房结病变”和“心脏传导系统病变”引起的重症缓慢心律失常。2009年1—12月,我院心内科安置永久性心脏起搏器患者141例,     

人文关怀式健康教育对永久性起搏器植入患者的影响

目的探讨人文关怀式健康教育对永久性起搏器植入患者的教育效果。方法将104例永久性起搏器植入患者按随机数字表法分为观察组与对照组,每组52例。对照组患者给予常规健康教育,观察组患者在常规健康教育的基础上实施人文关怀式健康教育。在两组患者入院时及起搏器植入术前,采用焦虑自评量表（self-rating anxiety scal,SAS）对两组患者进行焦虑评分并比较,同时观察并比较两组患者术后并发症的发生情况。结果两组患者入院时SAS评分差异无统计学意义（P〉0.05）;经健康教育后,两组患者手术前SAS评分较入院时均显著降低（P〈0.01）,观察组评分较对照组下降更为明显（P〈0.01）;术后观察组发生并发症的例数少于对照组（P〈0.05）。结论人文关怀式健康教育能减轻永久性起搏器植入患者的焦虑情绪,减少术后并发症的发生,提高患者的自护能力,从而提高患者的生活质量。     

经导管主动脉瓣置换术后肺动脉压力的变化

目的应用超声心动图评估重度主动脉瓣狭窄患者经导管主动脉瓣置换(TAVI)术后肺动脉压力(PASP)的变化。方法入选94例重度主动脉瓣狭窄患者,均成功完成TAVI手术。根据术前PASP分为两组,无肺动脉高压组(PASP<40mmHg)和肺动脉高压组(PASP≥40mmHg)。结果TAVI术后,无肺动脉高压组和肺动脉高压组PASP均降低。肺动脉高压组具有更小的主动脉瓣面积[(0.58±0.16vs 0.67±0.16)cm^2,P=0.014],更高的主动脉瓣平均跨瓣压差[(60.8±17.3vs 53.9±17.2)mmHg,P=0.035],中度以上二尖瓣反流[(11.6vs 3.9)%,P<0.001]和中度以上三尖瓣反流[(13.9vs 1.9)%,P<0.001]发生率更高。结论TAVI术后1年,肺动脉压力明显降低。     

心脏瓣膜替换术后安置永久起搏器的护理

目的　报告风心病换瓣术后置入永久起搏器的护理措施和体会。方法　回顾性分析 3 0例风心病换瓣术后置入永久起搏器的患者的随访资料。其中男 11例 ,女 19例 ;平均年龄 ( 5 1± 12 )岁。因持续性房颤伴和R R间期 >3s或III度房室传导阻滞 (AVB)( 2 2例 )、严重窦性心动过缓或III度AVB( 8例 )分别在换瓣术后 2个月～ 15年置入永久起搏器。结果　 3 0例患者永久起搏器安置均成功 ,术后平均随访 ( 2 6.14± 2 0 .2 5 )月 ,无穿刺部位和囊袋血肿或感染、电极脱位或功能异常等并发症 ,起搏器的感知和起搏功能均良好。结论　换瓣术后安置永久起搏器的护理重点是术前加强心理护理、围术期正确调控抗凝、术后加强心电监护和健康宣教 ,出院后做好定期随访     

Imaging‐based predictors of permanent pacemaker implantation after transcatheter aortic valve replacement

1 Background

Cardiac conduction abnormalities requiring permanent pacemaker (PPM) implantation are major complications of transcatheter aortic valve replacement (TAVR). We aimed to investigate whether the relationship between prosthetic valve size and cardiac‐gated computed tomography (CT)‐based aortic root complex measurements can aid in recognizing patients at risk for PPM implantation post‐TAVR.

2 Methods

We included 83 of 114 consecutive patients who underwent TAVR with the Edwards Sapien valve (Edwards Lifesciences, Irving, CA, USA) at our institution. We excluded patients with preexisting PPM, patients who required conversion to an open surgical procedure, and patients without CT data. We assessed the significance of various potential predictors of PPM placement post‐TAVR.

3 Results

Following TAVR, eight patients (9.6%) required PPM. Prosthetic valve to sinus of Valsalva (SOV) index was significantly higher in those patients requiring a PPM post‐TAVR (84.1 ± 9.3 vs 76.8 ± 7.1, P  =  0.009).

4 Conclusions

The prosthetic valve size to diameter of SOV index was identified as a novel predictor of PPM implantation after TAVR.     

149名永久起搏器植入术后24h内患者家属需求及影响因素分析

目的了解植入永久起搏器术后24 h内的患者家属的需求,为该特殊人群的护理提供科学依据,为改进医院护理管理和提高护理质量提供参考依据。方法选取149名植入永久起搏器术后24 h内的患者家属为调查对象,采用家属一般情况调查表和危重患者家属需求量表进行调查,包括病情保证、获取信息、接近患者、获得支持和自身舒适5个维度的需求。结果植入永久起搏器的患者家属最重要的需求是病情保证的需求(3.44±0.33)分,其次为接近患者的需求(3.08±0.34)分,获取信息的需求(3.00±0.37)分,自身舒适的需求(2.38±0.50)分和获得支持的需求(2.34±0.43)分。多元回归分析(stepwise法)结果显示家庭月收入是患者家属的总体需求、接近患者需求及获得支持需求的影响因素(P<0.01);此外,患者有无起搏器植入的经历为家属自身舒适需求的影响因素(P<0.05)。结论心律失常中心护士应理解和重视植入永久起搏器术后24 h患者家属的不同需求,针对每位家属实行个体化护理,使其更好配合患者的治疗护理,促进患者康复。     

永久心脏起搏器植入术后并发症的原因分析及护理对策

目的探讨永久心脏起搏器植入术后并发症及其原因,并总结护理对策。方法回顾分析2005年1月至2007年2月54例永久心脏起搏器植入术患者的临床和护理资料。结果术后发生并发症9例(11例次),发生率为20.4%(11/54),其中电极脱位5例次(45.4%),囊袋积血3例次(27.3%),起搏器感知功能障碍2例次(18.2%),起搏器综合征1例次(9.1%);所有并发症经相应处理后,患者均恢复正常。结论永久心脏起搏器植入术后并发症以电极脱位和囊袋积血为多见;熟悉永久起搏器植入术相关理论知识、术后密切观察和护理,对预防及减少术后并发症的发生有重要作用。     

Permanent Pacemaker Implantation in a Pregnant Woman with the Guidance of ECG and Two-Dimensional Echocardiography

A 30-year-old pregnant woman was admitted to the Cardiology Research Center with syncope, dizziness, and fatigue on exertion. On ECG complete atrioventricular block was diagnosed. Permanent pacemaker implantation was performed with the guidance of ECG and two-dimensional echocardiography and without the use of fluoroscopy.