Abstract:

To summarize the clinical nursing experience of a patient with thrombotic thrombocytopenic purpura after secondary heart valve replacement. Nursing key points：dynamic monitoring of hemodynamic indexes，the refinement of fluid management；sequential anticoagulant therapy to reduce bleeding risk；closely monitoring blood calcium concentration to avoid citric acid accumulation reaction；strengthening the breathing training and shortening the mechanical ventilation time；early enteral nutrition support to reduce gastrointestinal stress response. After careful treatment and nursing care，the symptoms and signs of patients improved significantly 26 days after surgery. The respiratory support of patients was changed from invasive ventilator assisted ventilation to venturi mask oxygenation，and he was transferred to the general ward for further treatment.

Key words: Heart Valve Diseases, Heart Valve Prosthesis, Purpura, Thrombotic Thrombocytopenic, Nursing Care

摘要：

总结1例二次心脏瓣膜置换术后患者并发血栓性血小板减少性紫癜的护理经验。护理要点：动态监测血流动力学指标，实施精细化液体管理；序贯式抗凝治疗，降低出血风险；严密监测血钙浓度，避免出现枸橼酸蓄积；强化呼吸训练，缩短机械通气时间；早期肠内营养支持，降低胃肠道应激反应。经过精心的治疗与护理，术后26 d，患者症状及体征显著改善，呼吸支持由有创呼吸机辅助通气改为文丘里面罩给氧，转至普通病房继续治疗。

关键词: 心脏瓣膜疾病, 人工心脏瓣膜, 紫癜, 血栓性血小板减少性, 护理