胸主动脉杂交手术的配合体会

张雨嫣; 付琴; 刁文杰; 施超; 余朝文; 刘学刚

doi:10.16766/j.cnki.issn.1674-4152.002750

胸主动脉杂交手术的配合体会

doi: 10.16766/j.cnki.issn.1674-4152.002750

1.
蚌埠医学院第一附属医院手术室，安徽蚌埠 233004
2.
蚌埠医学院第一附属医院心脏外科
3.
蚌埠医学院第一附属医院血管外科

基金项目:

安徽省科技攻关项目 1804h08020280

安徽高校自然科学研究重点项目 KJ2021A0820

详细信息

通讯作者:
付琴, E-mail: 2291823353@qq.com

中图分类号: R472.3 R654.3
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- 文章访问数: 271
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- 被引次数: 0
出版历程
- 收稿日期: 2022-02-11
- 网络出版日期: 2022-12-30

Experience in coordination in thoracic aortic hybrid surgery

1.
Operating Room, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的探讨单纯胸主动脉腔内隔绝修复术(TEVAR)和杂交颈部血管转流+TEVAR手术的配合要点，提高手术效率和安全性。方法回顾总结2020年1月—2021年12月蚌埠医学院第一附属医院收治的130例主动脉病变的患者，其中101例行单纯TEVAR手术(单纯TEVAR组)，29例行杂交颈部血管转流+TEVAR手术(杂交手术组)。统计2组患者性别、年龄、体重、身高及合并症，总结2种不同手术方式的术前准备、术中配合及体会等相关要点。结果 2组所有患者均顺利完成手术，单纯TEVAR组手术时间为(116.32±37.15)min，术后住院时间为(7.45±3.88)d，术后腹股沟切口淋巴漏1例；杂交手术组手术时间为(261.07±57.39)min，术后住院时间为(11.66±6.32)d；2组患者均无严重并发症发生。结论杂交复合手术室的护士以高标准的术前准备、严格的术中及术后护理和规范、熟练的手术配合，可以提高TEVAR和杂交颈部血管转流+TEVAR手术的效率和手术安全性。
- 主动脉病变 /
- 胸主动脉腔内修复术 /
- 腔内隔绝修复术 /
- 手术配合 /
- 杂交手术室
Abstract: Objective To explore the key points of cooperation between thoracic endovascular aortic repair (TEVAR) and hybrid cervical vascular bypass+TEVAR, so as to improve the efficiency and safety of the operation. Methods A total of 130 patients with the aortic disease treated in the First Affiliated Hospital of Bengbu Medical College from January 2020 to December 2021 were reviewed, including 101 patients underwent TEVAR surgery alone (the TEVAR group) and 29 patients underwent hybrid cervical vascular bypass+TEVAR surgery (the hybrid operation group). The gender, age, weight, height, complications, as well as the preoperative preparation, intraoperative cooperation and experience of the two different surgical methods were analysed. Results All patients in the two groups completed surgery. In the TEVAR group, the operation time was (116.32±37.15) min, the postoperative hospital stay was (7.45±3.88) days, and there was 1 case of postoperative inguinal incision lymphatic leakage. Meanwhile, in the hybrid operation group, the operation time was (261.07±57.39) min, and the hospital stay was (11.66±6.32) days. There were no serious complications in both groups. Conclusion Hybrid composite operating room nurses to high standards of preoperative preparation, intraoperative and postoperative nursing, and skilled operation coordination can improve the TEVAR and hybrid cervical vascular bypass + TEVAR operation efficiency and operation safety.
- Aorta /
- Thoracic endovascular aortic repair /
- Thoracic endovascular aortic repair /
- Surgical cooperation /
- Hybrid operating room

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参考文献(24)

[1]	BOSSONE E, EAGLE K A. Epidemiology and management of aortic disease: Aortic aneurysms and acute aortic syndromes[J]. Nat Rev Cardiol, 2021, 18(5): 331-348. doi: 10.1038/s41569-020-00472-6
[2]	中国医师协会心血管外科分会大血管外科专业委员会. 急性主动脉综合征诊断与治疗规范中国专家共识(2021版)[J]. 中华胸心血管外科杂志, 2021, 37(5): 257-269. Committee of Great Vessels of Chinese Association of Cardiovascular Surgeons, ZHANG H J, SUN L Z, et al. Chinese experts'consensus of standardized diagnosis and treatment for acute aortic syndrome(2021)[J]. Chinese Journal of Thoracic and Cardiovascular Surgery, 2021, 37(5): 257-269.
[3]	BOSSONE E, RANIERI B, ROMANO L, et al. Acute aortic syndromes: Diagnostic and therapeutic pathways[J]. Heart Fail Clin, 2020, 16(3): 305-315. doi: 10.1016/j.hfc.2020.03.002
[4]	ESPOSITO D, GONFIANTINI F, FARGIONA A T, et al. Hybrid operating room applications in the increasingly complex endovascular era: The trump card of modern vascular surgery[J]. Ann Surg Treat Res, 2021, 100(1): 54-58. doi: 10.4174/astr.2021.100.1.54
[5]	MCLIURE R S, BERRY R F, DAGENAIS F, et al. The many care models to treat thoracic aortic disease in Canada: A nationwide survey of cardiac surgeons, cardiologists, interventional radiologists, and vascular surgeons[J]. CJC Open, 2021, 3(6): 787-800. doi: 10.1016/j.cjco.2021.02.005
[6]	PATEL S, LINDENBERG M, ROVERS M M, et al. Understanding the costs of surgery: A bottom-up cost analysis of both a Hybrid operating room and conventional operating room[J]. Int J Health Policy Manag, 2022, 11(3): 299-307.
[7]	JIN H, LU L G, LIU J W, et al. A systematic review on the application of the hybrid operating room in surgery: Experiences and challenges[J]. Updates Surg, 2022, 74(2): 403-415. doi: 10.1007/s13304-021-00989-6
[8]	KIM G, NATCHEVA H. Imaging of cardiovascular thoracic emergencies: Acute aortic syndrome and pulmonary embolism[J]. Radiol Clin North Am, 2019, 57(4): 787-794. doi: 10.1016/j.rcl.2019.02.012
[9]	BOSSONE E, LABOUNTY T M, EAGLE K A. Acute aortic syndromes: Diagnosis and management, an update[J]. Eur Heart J, 2018, 39(9): 739-749d. doi: 10.1093/eurheartj/ehx319
[10]	高宏波, 尤海涛, 赵泐. C臂DSA机与CT机的联合导向在介入手术中的应用[J]. 中国医疗器械信息, 2021, 27(17): 71-72. doi: 10.3969/j.issn.1006-6586.2021.17.029 GAO H B, YOU H T, ZHAO L. Application of combined guidance of C-Arm DSA and CT in interventional surgery[J]. China Medical Device Information, 2021, 27(17): 71-72. doi: 10.3969/j.issn.1006-6586.2021.17.029
[11]	张玲玲, 刘艳. MR高压注射器使用操作技巧与注意事项[J]. 影像研究与医学应用, 2020, 4(9): 114-115. https://www.cnki.com.cn/Article/CJFDTOTAL-YXYY202009066.htm ZHANG L L, LIU Y. Operation skills and precautions of MR High-pressure syringe[J]. Journal of Imaging Research and Medical Applications, 2020, 4(9): 114-115. https://www.cnki.com.cn/Article/CJFDTOTAL-YXYY202009066.htm
[12]	姚媛, 金艳, 纪媛媛, 等. Stanford B型主动脉夹层介入手术围手术期综合护理[J]. 西南国防医药, 2021, 31(4): 331-333. https://www.cnki.com.cn/Article/CJFDTOTAL-XNGF202104015.htm YAO Y, JIN Y, JI Y Y, et al. Comprehensive nursing in perioperative period of intervention operation of Stanford type B aortic dissection[J]. Medical Journal of National Defending Forces in Southwest China, 2021, 31(4): 331-333. https://www.cnki.com.cn/Article/CJFDTOTAL-XNGF202104015.htm
[13]	齐瑞东, 朱俊明, 陈雷, 等. 支架象鼻置入联合左锁骨下动脉-左颈总动脉转流术治疗急性Stanford B型主动脉夹层累及远端主动脉弓的临床经验[J]. 中国医药, 2018, 13(1): 36-39. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYG201801010.htm QI R D, ZHU J M, CHEN L, et al. Clinical experience in the treatment of acute Stanford Type B aortic dissection involving distal aortic arch with stenting and left subclavian artery-left common carotid artery bypass[J]. China Medicine, 2018, 13(1): 36-39. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYG201801010.htm
[14]	乔杰, 赵婵, 蔡华玲. 急性期A型主动脉夹层患者情绪反应及Roy适应模式临床管理效果分析[J]. 中国医药, 2021, 16(5): 676-679. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYG202105008.htm QIAO J, ZHAO C, CAI H L. Analysis of emotional response and clinical management effect of Roy adaptation model in patients with acute type A aortic dissection[J]. China Medicine, 2021, 16(5): 676-679. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYG202105008.htm
[15]	陈盛帆, 黄建琪, 高正. 手术室高值耗材智能管理系统的开发[J]. 中国医疗器械杂志, 2021, 45(1): 42-45. doi: 10.3969/j.issn.1671-7104.2021.01.009 CHEN S F, HUANG J Q, GAO Z. Development of intelligent management system for high value consumable material in operating room[J]. Chinese Journal of Medical Instrumentation, 2021, 45(1): 42-45. doi: 10.3969/j.issn.1671-7104.2021.01.009
[16]	沈剑辉, 高兴莲, 鄢利芳, 等. 经心尖入路主动脉瓣植入术老年患者的手术期护理[J]. 护理学杂志, 2018, 33(18): 46-48. doi: 10.3870/j.issn.1001-4152.2018.18.046 CHEN J H, GAO X L, YAN L F, et al. Intra-operative nursing care of elder patients undergoing aortic valve implantation through apical approach[J]. Journal of Nursing Science, 2018, 33(18): 46-48. doi: 10.3870/j.issn.1001-4152.2018.18.046
[17]	ROGUIN A, NOLAN J. Radiation protection in the cardiac catheterisation lab: Best practice[J]. Heart, 2021, 107(1): 76-82. doi: 10.1136/heartjnl-2019-316369
[18]	PLOUSSI A, EFSTATHOPOULOS E P, BROUNTZOS E. The importance of radiation protection education and training for medical professionals of all specialties[J]. Cardiovasc Intervent Radiol, 2021, 44(6): 829-834. doi: 10.1007/s00270-020-02744-7
[19]	NG K H, BRADY Z, NG A H, et al. The status of radiation protection in medicine in the Asia-Pacific region[J]. J Med Imaging Radiat Oncol, 2021, 65(4): 464-470. doi: 10.1111/1754-9485.13165
[20]	SCHUETZE K, EICKHOOFFA, DEHNER C, et al. Radiation exposure for the surgical team in a hybrid-operating room[J]. J Robot Surg, 2019, 13(1): 91-98. doi: 10.1007/s11701-018-0821-6
[21]	JÖNSSON M, BERG S K, MISSEL M, et al. Am I going to die now? Experiences of hospitalisation and subsequent life after being diagnosed with aortic dissection[J]. Scand J Caring Sci, 2021, 35(3): 929-936. doi: 10.1111/scs.12912
[22]	LIN Y J, CHEN Y P, PENG Y C, et al. Symptoms of post-traumatic stress disorder and associated risk factors in type A aortic dissection[J]. J Cardiovasc Surg (Torino), 2021, 62(3): 286-293.
[23]	肖佳. 心理暗示联合营养照护A型夹层术后患者心理弹性、营养状况及睡眠质量的影响[J]. 心血管外科杂志: 电子版, 2020, 9(2): 28. doi: 10.3969/j.issn.2095-2260.2020.02.023 XIAO J. Effects of psychological suggestion combined with nutritional care on psychological resilience, nutritional status and sleep quality of patients after Type A dissection[J]. Journal of Cardiovascular Surgery (Electronic Edition), 2020, 9(2): 28. doi: 10.3969/j.issn.2095-2260.2020.02.023
[24]	陈晓菁. 综合性介入治疗的规范化护理管理模式构建[J]. 中外医学研究, 2019, 17(4): 115-116. doi: 10.14033/j.cnki.cfmr.2019.04.055 CHEN X J. Construction of standardized nursing management model for comprehensive interventional therapy[J]. Chinese and Foreign Medical Research, 2019, 17(4): 115-116. doi: 10.14033/j.cnki.cfmr.2019.04.055