全胸腔镜手术治疗肥厚型梗阻性心肌病的围术期护理

目的　总结全胸腔镜手术治疗肥厚型梗阻性心肌病围术期的护理经验。方法　选取2018年12月至2021年6月入住广东省人民医院的36例肥厚型梗阻性心肌病患者为研究对象，其中男性20例、女性16例，年龄（54.6±10.2）岁，均实施全胸腔镜下经二尖瓣改良扩大Morrow术。制定围术期护理方案，术前病情评估和呼吸功能训练，注重心理护理；术中加强病情监测，做好急救准备；术后预防心律失常、呼吸道及体位相关周围神经损伤并发症。主要观察指标为患者术后机械通气时间、重症监护室治疗时间、术后住院时间、术后有无发生肺部感染、肺水肿、肺不张等并发症及住院期间护理满意度。结果　36例患者顺利完成全胸腔镜下经二尖瓣改良扩大Morrow术，效果满意，围术期无死亡。患者术后机械通气时间（24.0±21.2）h，重症监护室治疗时间（76.7±57.8）h，术后住院时间（14.0±8.9）d，术后未发生肺部感染、肺水肿、肺不张等并发症，住院期间护理满意度调查问卷统计结果均为满意。结论　围术期实施有科学依据的护理策略，发挥前瞻性护理效应和家属协同护理效果，有效预防并发症，促进早期康复，提高护理满意度。

Perioperative nursing care of total thoracoscopic surgery for hypertrophic obstructive cardiomyopathy

Objective　To summarize the perioperative nursing experiences of total thoracoscopic surgery for hypertrophic obstructive cardiomyopathy. Methods　A total of 36 patients with hypertrophic obstructive cardiomyopathy admitted to Guangdong Provincial People's Hospital from December 2018 to June 2021 were selected as the study subjects, including 20 males and 16 females, with an age of (54.6±10.2) years old, who underwent modified enlarged Morrow surgery via the mitral valve under thoracoscopy. The perioperative nursing plan was made, including preoperative condition assessment and respiratory function training, paying attention to psychological care, strengthening intraoperative condition monitoring, preparation for emergency treatment, and postoperative prevention of arrhythmia, respiratory tract and postural related peripheral nerve injury complications. The main outcome indexes included postoperative mechanical ventilation time, intensive care unit (ICU) treatment time, postoperative hospitalization time, postoperative pulmonary infection, pulmonary edema, atelectasis, and other complications, and nursing satisfaction during hospitalization. Results　The 36 patients underwent complete thoracoscopic modified mitral valve Morrow surgery, with satisfactory results and no death during the perioperative period. The postoperative mechanical ventilation time was (24.0±21.2) h, the treatment time in ICU was (76.7±57.8) h, and the postoperative hospitalization time was (14.0±8.9) d. No postoperative complications such as pulmonary infection, pulmonary edema, atelectasis, or other complications occurred. The statistical results of nursing satisfaction questionnaire during hospitalization were satisfactory. Conclusion　Perioperative nursing strategies with scientific basis can exert the prospective nursing effect and family coordinated nursing effect, effectively prevent the complications, promote the early recovery, and improve the nursing satisfaction.