摘要
目的总结7例"零输血"A型急性主动脉夹层患者围手术期实施血液保护的护理体会。方法术前风险评估,控制心率血压、镇痛镇静避免夹层破裂;术中充分保暖、回收术野血液;术后避免心率血压波动,减少渗血,监测凝血指标,观察引流液量及性状,保证肾脏替代治疗时的抗凝安全,避免血液浪费。结果7例患者均顺利过渡到手术,术中及术后输注预贮式及回收式自体血200~1200 ml,未输注异体血。1例患者术后引流多,当天及第1天引流量1450 ml,予自体血输注联合止血药物使用,血红蛋白能维持在80 g/L之上;2例患者并发低氧血症,予序贯高流量给氧;2例患者并发急性肾损伤行连续性肾脏替代治疗,未出现非计划性下机。7例患者经积极处理均康复出院。结论对于A型急性主动脉夹层手术患者,通过精细的血液保护护理,可以减少对异体血的依赖。
Objective To summarize the nursing experience of 7 cases of"zero blood transfusion"type A acute aortic dissection during the perioperative period.Methods Preoperative risk assessment,control of heart rate,blood pressure,analgesia and sedation to avoid dissection;fully keep warm during operation and recover blood from operation field;after operation,avoid heart rate and blood pressure fluctuations to reduce oozing,monitor coagulation indicators,observe the amount and characteristics of drainage fluid,ensure the safety of anticoagulation during Renal replacement therapy,and avoid blood waste.Results The 7 patients all transitioned to the operation smoothly.Intraoperative and postoperative infusion of pre-storage and recovery autologous blood of 200-1200 ml,no allogeneic blood transfusion.One patient had a lot of drainage after surgery.The drainage volume was 1450 ml on the day and the first day.He was given autologous blood infusion combined with hemostatic drugs,and the hemoglobin could be maintained above 80 g/L;2 patients complicated with hypoxemia,were sequential High-flow oxygen;2 patients with acute kidney injury underwent continuous renal replacement therapy without unplanned dismissal.All 7 patients recovered and were discharged after active treatment.Conclusions For patients with type A acute aortic dissection surgery,through careful blood protection care,you can reduce dependence on allogeneic blood.
作者
余云
王哲芸
Yu Yun;Wang Zheyun(Intensive Care Unit of Cardiothroracic Surgery,the Affiliated Drum Tower Hospital of Nanjing University Medical School,Nanjing 210008,China)
出处
《中国实用护理杂志》
2021年第16期1230-1234,共5页
Chinese Journal of Practical Nursing
关键词
主动脉夹层
血液保护
零输血
围手术期护理
Aortic dissection
Blood protection
Zero blood transfusion
Perioperative nursing
