主動脈夾層病人的護(hù)理(雙語)

1、主動脈夾層病人的護(hù)理Nursing care of patients with aortic dissection,心內(nèi)科杉達(dá)周超瓊指導(dǎo)老師：丁力,Contents,Concepts and IncidencePathogenesis and Susceptible factor ClassificationClinical manifestationTreatmentPre-hospital careNursing

2、 measuresHealth education,概念(Concepts),主動脈夾層（aortic dissection,AD）是指主動脈腔內(nèi)的血液通過內(nèi)膜的破口進(jìn)入主動脈壁中層而形成的血腫。,,,,Cross-Section of an Aortic Dissection主動脈夾層的橫截面,發(fā)病率(Incidence),The estimated incidence of aortic dissection is 3 to 4

3、 per 100,000 people per year. However, it is thought that for every correct diagnosis, there are 2 undiagnosed cases.Aortic dissection occurs 2 to 3 times more frequently in men than in women of the same age.,發(fā)病機(jī)制(Patho

4、genesis),本病主要表現(xiàn)為主動脈中層的退行性病變 , 任何破壞中層彈性或肌肉成分完整性的疾病進(jìn)程或其他條件都能使主動脈易患夾層分離。,,,高血壓主動脈粥樣硬化,內(nèi)膜撕裂：二葉主動脈瓣、主動脈狹窄,text3,主動脈中層病變,text2,妊娠主動脈炎創(chuàng)傷,text4,text1,易患因素(Susceptible factor),分型(Classification1),DeBakeyType I: ascending ao

5、rta, aortic arch, anddescending aortaType II: ascending aorta onlyType III: descending aorta distal to the subclavian artery,The DeBakey Classification System,分型(Classification2),StanfordType A: ascending and descend

6、ing aortaType B: descending aorta beginning distal to the left subclavian artery,臨床表現(xiàn)(Clinical manifestation),,輔助檢查(Diagnostic Tests),,EKGChest x-rayAngiographyCT最常用MRIEchocardiographyBiochemical markers,治療（Treatm

7、ent）,,,Stanford B 型的首選經(jīng)皮覆膜支架置入術(shù)，必要時(shí)外科手術(shù)治療,,The swollen tube is an artificial blood vessel that has been implanted to replace a defective aortic arch. It’s attached to the heart and connects at its other end to the rest

8、 of the aorta.,院前急救（Pre-hospital care）,原則控制血壓鎮(zhèn)靜止痛對癥處理降低病死率,護(hù)理措施（Nursing measures）,1.Assessment：嚴(yán)密觀察疼痛的部位、性質(zhì)、時(shí)間、程度，使用強(qiáng)鎮(zhèn)痛劑后，觀察疼痛是否改善，進(jìn)行疼痛的連續(xù)性評估。,護(hù)理措施（Nursing measures）,2.Monitoring：嚴(yán)密監(jiān)測生命體征的變化，控制血壓可維持在90～120/60～90mmH

9、g，記錄液體出入量，嚴(yán)密觀察動脈搏動情況，發(fā)現(xiàn)異常情況及時(shí)報(bào)告醫(yī)生。,護(hù)理措施（Nursing measures）,3.Psychosocial nursing：患者易產(chǎn)生煩躁不安、精神緊張、焦慮的情緒，應(yīng)加強(qiáng)心理護(hù)理，及時(shí)與患者溝通。,4.Rest and activity：絕對臥床休息，避免過多活動及劇烈咳嗽。,,護(hù)理措施（Nursing measures）,5.Medication nursing：遵醫(yī)囑應(yīng)用減慢心率，控制血壓的

10、藥物時(shí)，應(yīng)密切觀察生命體征、尿量等情況，注意觀察藥物的效果和不良反應(yīng)。硝普鈉屬血管平滑肌松弛劑，注意避光，現(xiàn)用現(xiàn)配，超過6h應(yīng)重新配制。,護(hù)理措施（Nursing measures）,6.Diet：以清淡、易消化、富含維生素的流質(zhì)或半流質(zhì)食物為宜；做好口腔護(hù)理，鼓勵患者多飲水，進(jìn)食新鮮水果、蔬菜和低鹽低脂的食物。7.Excretion：保持大便通暢，減少便秘，必要時(shí)給予通便藥物，防止排便時(shí)血壓驟升，導(dǎo)致夾層破裂。,護(hù)理措施（Nur

11、sing measures）,8.Skin care：定時(shí)協(xié)助翻身，動作應(yīng)輕柔。可鋪防褥瘡氣墊床，用軟墊保護(hù)受壓部位，預(yù)防壓瘡發(fā)生。9.保證搶救藥品及物品處于功能位，發(fā)生病情變化時(shí)及時(shí)報(bào)告醫(yī)生，給予對癥處理。,健康教育（Health education）,,戒煙戒酒低鹽低脂飲食,堅(jiān)持服藥控制血壓自測脈搏,調(diào)整心態(tài)心情舒暢避免激動,門診復(fù)查不適隨診,避免復(fù)發(fā)延長生命,按時(shí)休息勞逸結(jié)合循序漸進(jìn),,主動脈夾層的概述和發(fā)

12、病率,發(fā)病機(jī)制、易患因素及分型,治療及院前急救,臨床表現(xiàn)及輔助檢查,回顧（Review ）,護(hù)理措施及健康教育,參考文獻(xiàn)（References）,[1]Linda Scheetz, EdD, RN.Aortic dissection[J].Am J Nurs 2006 Apr;106 (4):55-9[2]Maria Dixon, RN, MSN.Misdiagnosing aortic dissection: A fatal mis

13、take[J].J Vasc Nurs 2011;29:139-146[3]WANG Dong-jin,FAN Fu-dong,WANG Qiang.Preliminary characterization of acute aortic dissection in the mainland of China[J].Chin Med J 2011;124(11):1726-1730,提問（Questions）,主動脈夾層的分型有哪些？