Nursing _ not closed is treated to get involved and treat child's artery conduit with Amplatzer closing in device

Nursing _ not closed is treated to get involved and treat child's artery conduit with Amplatzer closing in device
The artery conduit has not been closed (PDA) It is a kind of common congenital heart disease. With the development of medical science of getting involved, the involvement treatment of what is already many kinds of apparatus applied to PDA at present. Amplatzer closing in device is a mushroom closing in device put out in 1998, compared with other closing in devices, its advantage is easy and simple to handle, transport the sheath with 6F, it is small to a whiff of intravenous damage, are suitable for infants; The closing in device incident is lossed or shifted; Even a few remnants are shunted, can all disappear after 48 h; Can close in PDA of the diameter 6 mm, get involved and treat the range [1 ] after expanding PDA. In September of 1998 - April of 1999, our department employed Amplatzer closing in device to succeed in treating 3 PDA infants, would attend to the report as follows now.
1.Clinical materials
1.1 General materialsIn 3 infants, the number of the man is one, 2.5 years old, find heart murmur for one year; 2 women, among them one is 9 years old, find heart murmur is 9 years, weak 3 years; Another 1, 3.5 years old, 3 year more uncomfortable move vigorously. Check the body: Brestbone left reason can hear between the second rib and pairs of issues of the intersection of machinery and kinds of the intersection of continuity and noise, point out PDA in electrocardiogram, chest one, colored supersound of heart.
1.2 Therapeutic method3 infants are in the down arteria femoralis of general anesthesia, whiff are intravenous puncture the skill. From burst being intravenous to insert the intersection of end and the intersection of hole and conduit, reach the intersection of lung and artery by right room, right room, pass PDA, get the intersection of chest and aorta; And then insert pig's tail conduit to the radiography behind the arch of aorta by the arteria femoralis, confirm PDA shape (funnel or tube is the best) , internal diameter and relation with trachea, select the stopping up and closing the umbrella of suitable type for use, replace the end hole conduit by exchanging and leading silks, along exchanging leading silks to insert and stop up and close the system, by transporting the tube to send into the mushroom umbrella, releases in PDA, after radiography, auscultation confirm that has already closed stifledly, withdraw and transport the steel wire, pig's tail conduit.
1.3 ResultPairs of continuity murmur of 3 infant's postoperative auscultation hearts disappear, electrocardiogram, chest scene, Ultrasonography B reveal the therapeutic effect is satisfied, not shunting residually, postoperative 5 d- 6 d leaves hospital, tracks that it is definite to observe curative effect after leaving hospital. [Medical science is taught Breed the network Collect and put in order ]
2.Nursing
2.1 Nursing before the skill
2.1.1 Basic nursing. The infant lives in the single room, examine basic blood pressure, pay attention to sterilizing and isolating and cold-proof, prevent upper airway infection. Guarantee the sufficient sleep, make it in best operation state.
2.1.2 The psychology is attended to. Introduce medical new development and operation method to infant and relative, let it watch operation video, make it have some perceptual knowledge in treating, keep in touch with the infant more at the same time, and explain some relevant knowledge easy to understand, make the trust and cooperation between infant and relative.
2.1.3 Routine inspection before the skill and planning to work. Routine of hematuria of routine inspection, blood coagulation time and liver renal function appearing,etc.. 1 d it makes iodine and Procaine to be irritated to test in front of the skill; Prohibit to eat 6 h before the skill, prohibit water 4 h; Urinate and inject intramuscularly, use medicine in front of the skill half an hour in front of the skill; Get various first aid apparatus and medicines ready in the operating room of heart conduit.
2.2 Postoperative nursing
2.2.1 Lie in bed strictly. Infant go pillow lie the intersection of 4h- and 6h while being flat, hair partial to side, keeps the lower extremities stretching and applying the brake and paying sedative when being uncooperative, if is stable. Lie in bed, can leave the bed activity behind the 48h, and advise infants and drink the water more, in order to facilitate radiography pharmaceutical discharging. Leave the urine to inspect by ready samples in the postoperative mornings.
2.2.2 Observe the condition change closely. Give infants oxygen intake to anaesthetize soberly, oxygen flow 1L/min- 2L/min, guard 24h for the electricity of heart conventionally, whether the auscultation heart has murmur, observe infant's complexion, heart rate, breathes, the change of the blood pressure closely.
2.2.3 Observation of the postoperative complication:
2.2.3.1 Hematoma and bleeding. Observe the intersection of infant and inguinal the intersection of place and the intersection of wound and dressing, ooze blood, some to bleed and hematoma, the postoperative 1.5kg sand bag oppression styptic 4h- 6h of using 1.0kg- conventionally, if find the part oozes the blood more or there is hematoma to take shape, should notify the doctor to deal with in time. This group has an example part that oozes more and forming hematoma blood, after infusing urine kinase 1* 104U, physiological saline 250ml vein, some hematoma see, increase, hematoma disappears behind the 3d.
2.2.3.2 Thrombosis. Observe the intersection of infant and artery, puncture the intersection of side and the intersection of instep and artery, beat situation and the intersection of limb and the intersection of skin and temperature,etc. tightly, find instep artery beat, subside or disappear, limb the intersection of end and skin become cold turning white or ing purple, there may be thrombosis, should notify the doctor and look for the reason and deal with in time immediately. The thrombus takes place in the same way to this group.
2.2.3.3 Hypertension reacts. The postoperative PDA patient because blood flow dynamics changes, ( 24h) in short term Apt to erupt hypertension simultaneously to reflect [2 ], present more passings. So should examine the infant's basic blood pressure before the skill, in order to compare with postoperative blood pressure. If postoperative blood pressure unusually increases, should notify the doctor immediately. Basic blood pressure is as 12.8/5.3kPa before this group has example infant's skill, the difference of pulse pressure is great, postoperative blood pressure is 12.4/11.3kPa, the diastolic pressure increases, has not done special-purpose processing, blood pressure returns to normal after 24h. [Medical education network Collection Put in order ]
2.2.3.4 Cut-out and infect. Change and cut-out dressing of place every day, observing the wound heals the situation; Keep some skin to be clean and dry, prevent urine from pollute wound is regular to resist infection, treat while being competent. This 3 groups have not cut-outed and infected.
References
1,Zhang YuWei. Getting involved therapeutic progress [J ] of congenital heart disease. Magazine of practical internal medicine department of China, 1999, 19( 3) : 142
2,Dong XiuZhi, Ren MeiE, Du LeYing. Artery conduit does not close, erupt the nursing [J ] that hypertension react simultaneously while being postoperative. Nursing magazine, 1998, 13( 4) : 210
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