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1、主動脈瓣置換術(shù)后的護理Thenursingofaorticvalvereplacement正常的主動脈瓣有三個瓣葉：左半月瓣、右半月瓣和后半月瓣心室舒張期Ventriculardiastole心室收縮期Ventricularsystole主動脈瓣狹窄的病因 Causesofaorticstenosis先天性畸形Congenitalmalformations老年性主動脈瓣鈣化Senileaorticvalvecalcification風(fēng)濕性心臟病Rheumaticheartdisease主動脈瓣葉粘連、融合Ao
2、rticvalveleafletsadhesion,fusion主動脈瓣狹窄aorticstenosis主動脈瓣開口面積減少肺靜脈高壓右心衰竭左心室射血負荷左室向心性肥厚左心室收縮功能心排血量下降室壁張力順應(yīng)性下降室壁張力左心衰病理生理pathophysiologyPulmonaryvenoushypetension心內(nèi)膜下心肌缺血和灌注不足aorticstenosis腦血流灌注下降左心室做功心肌耗氧量順應(yīng)性下降舒張末壓力CO冠狀動脈平均灌注壓心絞痛暈厥AnginapectorisSyncope急性Acute
3、:1.感染性心內(nèi)膜炎Infectiveendocarditis2.主A夾層Aorticdissection3.外傷Trauma4.人工瓣膜撕裂Prostheticvalvetear慢性Chronic:主動脈瓣疾病Aorticvalvedisease2/3為風(fēng)心病主動脈根部擴張Aorticrootdilatation主動脈瓣關(guān)閉不全的病因Causesofaorticincompetence主動脈瓣纖維化、增厚、縮短、變形主動脈瓣關(guān)閉不全Aorticvalvesincompetence主動脈內(nèi)血液在舒張期返流入左
4、室偏心性肥厚、擴大左心衰左心室容量負荷Sp?、Dp?左心室舒張末期壓力CO室壁張力心絞痛pulmonaryhypertension右心衰pathophysiology反流面積的大小心動周期舒張期的長短AI反流量體循環(huán)血管阻力AIreverseflowReverseflowaeraofthesizeBeckoningcyclediastoliclengthSystemicvascularresistance雙擊添加標題文字急性主動脈瓣關(guān)閉不全左心室舒張期充盈量突然增加壓力迅速增高左房壓、肺靜脈壓迅速升高急性肺水
5、腫心動過速以減少反流量增加CO二尖瓣舒張期提前關(guān)閉，緩解左房和肺靜脈受左心室高舒張壓的影響CO減少，低BP急性左心衰竭急性AIWhatisvalvereplacemengsurgery瓣膜置換術(shù)是用人工機械瓣或生物瓣進行替換人心臟瓣膜進行置換Valvereplacementsurgeryistousemechanicalvalvesorbiologicalvalvestoreplaceoriginalhumanvalves.主動脈瓣置換術(shù)病例介紹CaseIntroduction病史medicalhistory
6、羅菊梅，女，40歲,云南鎮(zhèn)雄人PatientJumeiLuo,female,40yearsold,fromZhenxionginYunnanprovince.患者因頭昏、胸痛3年，近一年來加重，活動后心悸、氣促、乏力伴呼吸困難，休息后無明顯緩解一月余，于2014年12月10日以“非風(fēng)濕性主動脈瓣狹窄并關(guān)閉不全”收住ShewasadmittedtothehospitalforNon-rheumaticaorticstenosisandincompetenceonDecember10th,2014.because
7、dizziness,chestpainhavelastthreeyears,heartpalpitationandshortnessofbreathwithincreasedactivities,andexertionaldyspnealastingoveramonth.MedicalHistory◇手術(shù)史Surgicaloperationhistory2004年行“卵巢囊腫摘除術(shù)”"ovariancyst"in2004,2011年行“右上臂神經(jīng)源性腫瘤切除術(shù)”“neurogenictumorresectio
8、nofrightarm”in2011◇過敏史Allergichistory雙黃連Echocardiography:1、Aorticvalvedisease:moderateaorticincompetence,moderateaorticstenosis,andthewideningofaorticdiameter2、Mildmitralincompetence,andmildtricuspidin
