再次心脏瓣膜替换术病人围手术期护理

总结17例再次换瓣手术患护理体会。认为再次换瓣病人病情重，心静功能差，术前、术后护理有别于首次换瓣病人。术前严密监测心功能变化，防止一切造成心功能恶化的因素，要求病人严格卧床休息，注意药物应用的护理，严格记录出入量；加强感染性心内膜炎的护理，密切观察体温变化；做好抗凝治疗的护理，术前3天停服抗凝剂。病情恶化快需急诊手术，术前静脉注射VitK1 20mg；术后低心排是死亡的主要原因之一，监测血流动力学指标、尿量、心率；观察恶性心律失常及血管活性药物应用的监护；呼吸机使用时间相对延长，加强呼吸功能监测及肾脏保护。

Perioperative care of patients with heart valve re-replacement

In this paper, the authors summarize the perioperative care of 17 patients with heart valve re replacement. They argue that the perioperative care of re replacement is different from that at the first operation of replacement. Before re replacement, close monitoring of heart function should be done to prevent all factors causing heart dysfunction. Patients are kept in bed. The nursing of medication wants carrying out by strictly recording its output and input. The nursing of septic endocarditis should be strengthened by close observation of the body temperature. 3 d before operation, anticoagulant must be stopped. In emergency, 20 mg VitK1 should be intravenously injected before sending the patients to the operation room. After operation, low cardic output syndrome is one of the main causes of postoperative death. It is imperative to monitor hemodynamic parameter, urinal output, heart rate, heart rhythm, lung function and kidney function to prevent the deaths.