2022 年第 4 期 第 17 卷

局部麻醉超声引导下股静脉径路房间隔缺损封堵术的临床护理

Clinical nursing of atrial septal defect closure through femoral vein approach under local anesthesia and ultrasound guidance

作者：孙君辉谷静媛

英文作者：Sun Junhui Gu Jingyuan

单位：首都医科大学附属北京安贞医院瓣膜外科中心，北京100029

英文单位：Valve Surgery Center Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：房间隔缺损封堵术；局部麻醉；护理安全

英文关键词：Closureofatrialseptaldefect;Localanesthesia;Nursingsafety

• 摘要：

• 目的 总结局部麻醉超声引导下股静脉径路房间隔缺损封堵术后患者的护理要点及经验。方法 回顾性分析2011年2月至2019年8月于首都医科大学附属北京安贞医院瓣膜外科中心行局部麻醉超声引导下股静脉径路房间隔缺损封堵术术后，由手术室直接送返普通病房的127例患者的一般资料、术中情况、术后护理观察指标及处理和预后情况。记录临床护理遇到的问题，总结护理经验。结果 患者男45例，女82例，年龄（38±12）岁，术前超声报告房间隔缺损最大径线（16±9）mm，手术时间为（25±16）min，特级护理时长（10±8）h，术前住院时间（1.3±0.4）d、术后住院时间（2.2±0.9）d。护理过程中观察到心率快、血压低、中心静脉压高，血氧饱和度下降，尿少，尿色深，下肢皮肤凉、皮色发花、动脉搏动弱等情况，共计21例，其中单纯的下肢皮肤凉、皮色发花表现者最多，15例（71.4%），均提示存在并发症或异常情况，及时报告医师给予相应处理后绝大部分好转，1例因封堵伞脱落至腹主动脉，进展为肾功能衰竭，因感染死亡。结论 针对局部麻醉超声引导下股静脉径路房间隔缺损封堵术患者的术后护理措施较其他手术更需进一步加强，如术后生命体征的监测、穿刺部位的护理、早期床上运动等。同时建议建立综合的、多学科的“心脏团队”以保障患者安全。

• Objective To summarize the key points and experience of nursing care of patients after atrial septal defect closure through femoral vein approach under local anesthesia and ultrasound guidance. Methods The general data, intraoperative conditions, postoperative nursing observation indexes, treatment and prognosis of 127 patients admitted to Valve Surgery Center, Beijing Anzhen Hospital, Capital Medical University from February 2011 to August 2019 were retrospectively analyzed. The patients underwent atrial septal defect closure through femoral vein approach under local anesthesia and ultrasound guidance, and then returned to the general ward directly from the operating room. The problems in clinical nursing were recorded, and the nursing experience was summarized. Results There were 45 males and 82 females, age of （38±12） years old. The maximum diameter of atrial septal defect of patients reported by ultrasound before operation was （16±9）mm, the operation time was （25±16）min, special nursing duration was (10±8)h, preoperative length of stay was （1.3±0.4）d, and postoperative length of stay was （2.2±0.9）d. During the nursing process, totally 21 patients′ symptom were observed, including fast heart rate, low blood pressure, high central venous pressure, blood oxygen saturation desaturation, less urine, deep urine color, and lower limbs skin with cool and colored, and week arterial pulse. Of which 15 cases(71.4%) showed simple lower limbs skin with cool and colored, and all of them had complications or abnormalities. Most of them improved after timely reporting to the doctor and giving corresponding treatment; 1 case had blocking umbrella falling to abdominal artery, inducing renal failure, and died of infection finally. Conclusions The postoperative nursing measures for patients after atrial septal defect closure of femoral vein approach under local anesthesia and ultrasound guidance need to be further strengthened than other operations, such as postoperative vital signs monitoring, puncture site nursing, early bed exercise and so on. At the same time, it is suggested to establish a comprehensive and multidisciplinary "heart team" to ensure the safety of patients.