心脏瓣膜置换术同期双极射频消融治疗永久性心房颤动的围手术期护理

目的探讨心内直视下同期行改良冲洗式双极射频消融治疗心瓣膜病合并永久性心房颤动的围手术期护理要点。方法回顾性分析2010年6月至2013年2月心脏瓣膜病合并永久心房颤动55例患者在体外循环下行心瓣膜置换术＋改良冲洗式双极射频消融手术的临床资料。55例患者均合并永久性心房颤动，术前给予患者心理护理及健康宣教，术中采用Medtronic Cardioblate 68000冲洗式双极射频消融系统进行消融操作，术后除做好瓣膜置换术后常规护理外，重视心律和心率的监测，心功能的维护，引流的观察，电解质平衡的维持，起搏器的观察，应用胺碘酮的观察及护理，以及健康指导与心理护理。结果55例手术均顺利完成，术后当天有48例恢复为窦性心律。全组2例出现Ⅲ度房室传导阻滞，安装永乡起搏器治疗，全组无心脏穿孔及术后大出血，无手术死亡。平均住院（12．5±2．1）d，术后平均随访（8．6±3．0）个月，87．3％的患者维持窦性心律，9．1％的患者为房颤心律，3．6％的患者为起搏心律。结论心内直视下同期改良冲洗式双极射频消融治疗心脏瓣膜病合并永久性心房颤动是一种简易、安全、有效的方法，高质量的围手术期护理是提高手术成功率，降低死亡率的关键。

Perioperative nursing of modified maze procedure using bipolar radiofrequency ablation accompanied with valve replacement for surgical treatment of permanent atrial fibrillation

Objective To summarize the perioperative nursing of modified maze procedure using bipolar radiofrequency ablation accompanied with valve replacement for the surgical treatment of heart valve diseases complicated with permanent atrial fibrillation （AF）. Methods A total of 55 patients with permanent AF and heart valves diseases were undergone surgical treatment from June 2010 to February 2013 in the Second Affiliated Hospital of Anhui Medical University. Preoperative psychological care and health education were given to patients. The Medtronic Cardioblate 68000 flush bipolar radiofrequency ablation system was applied to all patients. After valve replacement surgery in addition to routine care, rhythm and heart rate monitoring were paid attention to, maintenance of cardiac function, observation of drainage, maintenance of electrolyte balance, observation of pacemaker, observation of amiodarone medication and nursing, as well as health guidance and psychological care were implemented. Results The surgery of 55 patients was successfully completed. The day after surgery, atrial fibrillation in 48 cases turned into sinus rhythm. In all patients, 2 of them had suffered Ⅲ degree atrioventricular block after surgery and permanent pacemakers were applicated. There were no cardiac perforation and nonhospital mortality. The average length of stay was（ 12.5±2.1 ） d. The mean follow-up was（8.6±3.0） months. 87.3% of patients maintained sinus rhythm, 9.1% in AF rhythm, 3.6% in paced rhythm. Conclusions Modified maze procedure using bipolar radiofrequency ablation is a simple, safe and effective surgical procedure for the treatment of permanent atrial fibrillation. High quality of perioperative nursing is to improve the success rate of surgery and the key to reduce mortality.