13例全胸腹主动脉置换术后脊髓损伤患者的护理

doi:10.3761/j.issn.0254-1769.2023.19.015

中华护理杂志 ›› 2023, Vol. 58 ›› Issue (19): 2405-2408.DOI: 10.3761/j.issn.0254-1769.2023.19.015

13例全胸腹主动脉置换术后脊髓损伤患者的护理

李永刚(), 吴荣, 马艳, 黄雨佳, 张辰()

100037 北京市中国医学科学院阜外医院成人外科恢复室一区（李永刚，吴荣，黄雨佳），手术室（马艳），护理部（张辰）

收稿日期:2022-12-16 出版日期:2023-10-10 发布日期:2023-10-12
通讯作者: 张辰，E-mail：zhizhizc@126.com
作者简介:李永刚：男，硕士，主管护师，E-mail：qq515223648@126.com
基金资助:
中国医学科学院阜外医院护理部专项基金(HLB2020007)

Nursing care of 13 patients with spinal cord injury after total thoracoabdominal aortic replacement

LI Yonggang(), WU Rong, MA Yan, HUANG Yujia, ZHANG Chen()

Received:2022-12-16 Online:2023-10-10 Published:2023-10-12

摘要/Abstract

摘要：

总结13例全胸腹主动脉置换术后脊髓损伤患者的护理经验。护理要点如下：提升平均动脉压和防止一过性低血压，预防体温异常引起的脊髓氧耗增加，预防呼吸肌无力和肺部感染等引起的低氧血症，加强脑脊液压力监测及引流护理，做好体液平衡和肾功能监测，预防皮肤压力性损伤及切口感染。经过精心的治疗和护理，出院时3例发生永久性脊髓损伤，10例部分或完全康复。

关键词: 脊髓损伤, 全胸腹主动脉置换术, 护理

Abstract:

To summarize the nursing experience of 13 patients with spinal cord injury after total thoracoabdominal aortic replacement. The mainly nursing points are as follows：to raise mean arterial pressure and prevent transient hypotension，to prevent the increased spinal cord oxygen consumption caused by abnormal body temperature，to prevent hypoxemia caused by respiratory muscle weakness and lung infection，to intensify cerebrospinal fluid pres-sure monitoring and drainage nursing，to finish fluid balance and renal function monitoring，to prevent the skin pressure injury and wound infection. After careful treatment and nursing care，permanent spinal cord injury occurred in 3 cases and partial or complete recovery occurred in 10 cases at discharge.

Key words: Spinal Cord Injury, Total Thoracoabdominal Aortic Replacement, Nursing Care

李永刚, 吴荣, 马艳, 黄雨佳, 张辰. 13例全胸腹主动脉置换术后脊髓损伤患者的护理[J]. 中华护理杂志, 2023, 58(19): 2405-2408.

LI Yonggang, WU Rong, MA Yan, HUANG Yujia, ZHANG Chen. Nursing care of 13 patients with spinal cord injury after total thoracoabdominal aortic replacement[J]. Chinese Journal of Nursing, 2023, 58(19): 2405-2408.

参考文献 11

[1]	Gaudino M, Khan FM, Rahouma M, et al. Spinal cord injury after open and endovascular repair of descending thoracic and thoracoabdominal aortic aneurysms:a meta-analysis[J]. J Thorac Cardiovasc Surg, 2022, 163(2):552-564. DOI URL
[2]	Pini R, Faggioli G, Paraskevas KI, et al. A systematic review and meta-analysis of the occurrence of spinal cord ischemia after endovascular repair of thoracoabdominal aortic aneurysms[J]. J Vasc Surg, 2022, 75(4):1466-1477. DOI URL
[3]	Coselli JS, Green SY, Price MD, et al. Spinal cord deficit after 1114 extent II open thoracoabdominal aortic aneurysm repairs[J]. J Thorac Cardiovasc Surg, 2019:S0022 -S5223(19)30352-6.
[4]	Conrad MF, Ye JY, Chung TK, et al. Spinal cord complications after thoracic aortic surgery:long-term survival and functional status varies with deficit severity[J]. J Vasc Surg, 2008, 48(1):47-53. DOI PMID
[5]	Chatterjee S, Casar JG, LeMaire SA, et al. Perioperative care after thoracoabdominal aortic aneurysm repair:the Baylor College of Medicine experience. Part 2:postoperative management[J]. J Thorac Cardiovasc Surg, 2021, 161(2):699-705. DOI PMID
[6]	Dolapoglu A, Volguina IV, Price MD, et al. Cardiac arrhythmia after open thoracoabdominal aortic aneurysm repair[J]. Ann Thorac Surg, 2017, 104(3):854-860. DOI PMID
[7]	Grigorean VT, Sandu AM, Popescu M, et al. Cardiac dysfunctions following spinal cord injury[J]. J Med Life, 2009, 2(2):133-145. PMID
[8]	万建红, 李晓妹, 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. DOI
	Wan JH, Li XM, Han C, et al. Research progress on nursing intervention of acute respiratory insufficiency after operation in patients with type A aortic dissection[J]. Chin J Nurs, 2020, 55(4):553-557.
[9]	Banga PV, Oderich GS, Reis de Souza L, et al. Neuromonitoring,cerebrospinal fluid drainage,and selective use of iliofemoral conduits to minimize risk of spinal cord injury during complex endovascular aortic repair[J]. J Endovasc Ther, 2016, 23(1):139-149. DOI URL
[10]	Tanaka A, Safi HJ, Estrera AL. Current strategies of spinal cord protection during thoracoabdominal aortic surgery[J]. Gen Thorac Cardiovasc Surg, 2018, 66(6):307-314. DOI
[11]	周宏艳, 王冀, 袁素, 等. 规范化综合性脊髓保护措施能够降低主动脉手术患者围手术期脊髓损伤发生率:8年回顾性分析[J]. 中华危重病急救医学, 2019, 31(5):633-636.
	Zhou HY, Wang J, Yuan S, et al. Standardized multidisciplinary spinal cord protection strategies reduce spinal cord injury during perioperative period of aortic surgery:an 8-year retrospective analysis[J]. Chin Crit Care Med, 2019, 31(5):633-636.

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13例全胸腹主动脉置换术后脊髓损伤患者的护理

Nursing care of 13 patients with spinal cord injury after total thoracoabdominal aortic replacement

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