梅氏微创房颤消融术的手术配合及体会

目的 总结全胸腔镜下单纯左胸径路房颤超微创外科射频消融术（梅氏微创房颤消融术）的手术配合及体会。 方法 2010年9月至2013年12月，共201例房颤患者于我院接受梅氏微创房颤消融术，阵发性房颤98例，持续性及长程性房颤103例。其中，男106例，女95例；年龄29~81岁，平均年龄（58.7±15.4）岁。回顾性分析患者的临床资料，总结相关手术配合及护理经验，包括：术前访视；手术专用设备、器械及材料的准备；术中体位摆放，设备仪器的连接使用，手术台上操作配合以及对术中突发异常情况的配合。 结果 患者均顺利完成手术，无术中转为开胸手术，平均手术时间为104.9±37.2分钟，手术配合及护理达到预期目的。术中平均失血量小于50 ml，均无输血。73例（70.9%）持续性或长程性房颤接受术中电复律。所有患者离开手术室时均维持窦性心律，仅1例患者术中预放置心外膜临时起搏导线，无起搏器植入病例。8例患者术后住院期间行电复律治疗，出院时190（94.5%）例患者维持窦性心律。所有患者围术期均无脑卒中、大出血等严重并发症发生，无永久起搏器植入，无死亡病例。 结论 梅氏微创房颤消融术安全、有效。完善的术前护理准备，高质量的术中护理配合，对顺利的开展梅氏微创房颤消融术具有重要的临床意义。

Intraoperative Management for Mei Mini Maze Procedure

Objective To summarize the experience of intraoperative management for complete thoracoscopic surgical atrial fibrillation (AF) ablation via the left chest (Mei mini maze procedure). Methods From September 2010 to December 2013, 201 patients (male 106 cases, age 58.7±15.4) with AF (Paroxysmal AF 98 cases, persistent or long-standing persistent AF 103 cases) underwent Mei mini maze procedure in our hospital. All patients were retrospectively analyzed, and the experiences of intraoperative nursing management were summarized. Results All the patients successfully underwent the minimally invasive ablation procedure. No patient required conversion to sternotomy during the surgery. The average time of operation was 104.9±37.2 min. Average blood loss was less than 50 ml, and no blood transfusion was needed. 73 cases (70.9%) of persistent or long-standing persistent AF received intraoperative electrical cardioversion. All patients were restored to sinus rhythm before leaving operating room. The maintenance of sinus rhythm was 94.5% (190/201) at discharge. There was no early death, stroke, hemorrhage or permanent pacemaker implantation during perioperation. Conclusion Mei mini maze procedure was safe and effective for curing AF. Reasonable nursing management and high quality of nursing care can ensure Mei mini maze procedure was performed successfully.