Post-operative care of 7 patients with Stanford type A aortic dissection complicated with superior mesenteric artery ischemia

doi:10.3761/j.issn.0254-1769.2022.04.014

Abstract

Abstract:

This article summarizes the postoperative nursing experiences of 7 patients with Stanford type A aortic dissection with superior mesenteric artery ischemia. Nursing points include dynamic monitoring of abdominal symptoms and signs;anticoagulant therapy to prevent postoperative thrombosis;prevention and care of complications;providing nutritional support to promote recovery;moderately moving limbs and providing rehabilitation exercise guidance. After careful treatment and care, 7 patients were discharged from the hospital.

Key words: Aortic Dissection, Superior Mesenteric Artery Ischemia, Perioperative Nursing

摘要：

总结7例Stanford A型主动脉夹层合并肠系膜上动脉缺血患者的术后护理经验。护理要点包括动态监测腹部症状及体征;进行抗凝治疗,预防术后血栓形成;并发症的预防与护理;提供营养支持,促进病情恢复;适度活动肢体,提供康复锻炼指导。经过精心的治疗及护理,7例患者顺利出院。

关键词: 主动脉夹层, 肠系膜上动脉缺血, 围手术期护理

WANG Yuwei, LI Hui, LI Yinling, ZHAO Lihui. Post-operative care of 7 patients with Stanford type A aortic dissection complicated with superior mesenteric artery ischemia[J]. Chinese Journal of Nursing, 2022, 57(4): 476-480.

王玉伟, 李慧, 李银玲, 赵丽慧. 7例Stanford A型主动脉夹层合并肠系膜上动脉缺血患者的术后护理[J]. 中华护理杂志, 2022, 57(4): 476-480.

References 17

[1]	中国医师协会心血管外科分会大血管外科专业委员会. 主动脉夹层诊断与治疗规范中国专家共识[J]. 中华胸心血管外科杂志, 2017, 33(11):641-654.
	Major Vascular Surgery Professional Committee of Cardiovascular Surgery Branch,Chinese Medical Doctor Association. Chinese experts consensus of standardized diagnosis and treatment for aortic dissection[J]. Chin J Thorac Cardiovasc Surg, 2017, 33(11):641-654.
[2]	万建红, 李晓姝, 韩淳, 等. A型主动脉夹层患者术后急性呼吸功能不全护理干预的研究进展[J]. 中华护理杂志, 2020, 55(4):553-557.
	Wan JH, Li XS, Han C, et al. Research progress on nursing intervention of acute respiratory dysfunction in patients with type A aortic dissection after surgery[J]. Chin J Nurs, 2020, 55(4):553-557.
[3]	朱俊明, 孙立忠, 赵海鹏, 等. 孙氏手术在复杂主动脉夹层中的应用[J]. 中华胸心血管外科杂志, 2013, 29(10):581-584.
	Zhu JM, Sun LZ, Zhao HP, et al. The application of Sun’s procedure on complicated aortic dissection[J]. Chin J Thorac Cardiovasc Surg, 2013, 29(10):581-584.
[4]	肖亦敏, 肖明第, 王连才, 等. Stanford A型主动脉夹层的外科治疗[J]. 中国胸心血管外科临床杂志, 2014, 21(3):361-363.
	Xiao YM, Xiao MD, Wang LC, et al. Surgical treatment for patients with stanford type A aortic dissection[J]. Chin J Clin Thorac Cardiovasc Surg, 2014, 21(3):361-363.
[5]	崔聪, 张力, 高夏, 等. 急性A型主动脉夹层合并下肢缺血的治疗[J]. 中华胸心血管外科杂志, 2018, 34(10):593-596.
	Cui C, Zhang L, Gao X, et al. Clinical treatment of acute type-A aortic dissection with lower limb malperfusion[J]. Chin J Thorac Cardiovasc Surg, 2018, 34(10):593-596.
[6]	Di Eusanio M, Trimarchi S, Patel HJ, et al. Clinical presentation,management,and short-term outcome of patients with type A acute dissection complicated by mesenteric malperfusion:observations from the International Registry of Acute Aortic Dissection[J]. J Thorac Cardiovasc Surg, 2013, 145(2):385-390. DOI PMID
[7]	Orihashi K. Mesenteric ischemia in acute aortic dissection[J]. Surg Today, 2016, 46(5):509-516. DOI URL
[8]	郭敏, 毛雷芳, 弓华, 等. 急性A型主动脉夹层患者术后并发症的观察与护理[J]. 中华护理教育, 2016, 13(9):695-698.
	Guo M, Mao LF, Gong H, et al. Observation and nursing of postoperative complications in patients with type A aortic dissection[J]. Chin J Nurs Educ, 2016, 13(9):695-698.
[9]	李晓曦. 急性肠系膜缺血的药物治疗[J]. 中国实用外科杂志, 2013, 33(12):1056-1058.
	Li XX. Drug therapy of acute mesenteric ischemia[J]. Chin J Pract Surg, 2013, 33(12):1056-1058.
[10]	Pagni S, Ganzel BL, Trivedi JR, et al. Early and midterm outcomes following surgery for acute type A aortic dissection[J]. J Card Surg, 2013, 28(5):543-549. DOI URL
[11]	Mori Y, Sato N, Kobayashi Y, et al. Acute kidney injury during aortic arch surgery under deep hypothermic circulatory arrest[J]. J Anesth, 2011, 25(6):799-804. DOI URL
[12]	宋先荣, 孟丽, 张婉真, 等. Stanford A型主动脉夹层弓部手术后脑部并发症的危险因素分析[J]. 中国心血管病研究, 2017, 15(6):511-515.
	Song XR, Meng L, Zhang WZ, et al. Risk factors for cerebral complications after Stanford type A aortic dissection after arch surgery[J]. Chin J Cardiova Dis, 2017, 15(6):511-515.
[13]	吴海卫, 张晓华, 程晓峰, 等. 杂交手术治疗DeBakeyⅠ型主动脉夹层的体外循环管理[J]. 中国体外循环杂志, 2012, 10(3):151-154,166.
	Wu HW, Zhang XH, Cheng XF, et al. The management of cardiopulmonary bypass in patients with DeBakey type Ⅰ aortic dissection undergoing hybrid procedure[J]. Chin J Extracorpor Circ, 2012, 10(3):151-154,166.
[14]	Rylski B, Siepe M, Blanke P, et al. Adventitial inversion with graft telescopic insertion for distal anastomosis in acute type a aortic dissection[J]. Ann Thorac Cardiovasc Surg, 2012, 18(3):278-280. DOI URL
[15]	彭洁婧, 曾珠, 邓永鸿, 等. 5例左心室辅助装置植入患者的术后护理[J]. 中华护理杂志, 2020, 55(9):1346-1348.
	Peng JJ, Zeng Z, Deng YH, et al. Postoperative nursing care for patients with left ventricular assist device implantation:a five-case study[J]. Chin J Nurs, 2020, 55(9):1346-1348.
[16]	中国医师协会急诊医师分会, 解放军急救医学专业委员会, 中华医学会急诊医学分会, 等. 2020年中国急性肠系膜缺血诊断与治疗专家共识[J]. 中华急诊医学杂志, 2020, 29(10):1273-1278.
	Chinese Medical Association Branch of Emergency Physicians,PLA Emergency Medicine Committee,Chinese Medical Association Branch of Emergency Medicine, et al. Expert consensus on diagnosis and treatment of acute mesenteric ischemia in China in 2020[J]. Chin J Emerge Med, 2020, 29(10):1273-1278.
[17]	杜雨, 张海涛. 低心排血量综合征中国专家共识解读[J]. 中国循环杂志, 2018, 33(S2):84-88.
	Du Y, Zhang HT. Interpretation of the consensus of Chinese experts on low cardiac output syndrome[J]. Chin Circ J, 2018, 33(S2):84-88.