主动脉瓣置换术后的护理Thenursingofaorticvalvereplacement正常的主动脉瓣有三个瓣叶：左半月瓣、右半月瓣和后半月瓣心室舒张期Ventriculardiastole心室收缩期Ventricularsystole主动脉瓣狭窄的病因Causesofaorticstenosis先天性畸形Congenitalmalformations老年性主动脉瓣钙化Senileaorticvalvecalcification风湿性心脏病Rheumaticheartdisease主动脉瓣叶粘连、融合Aorticvalveleafletsadhesion,fusion主动脉瓣狭窄aorticstenosis主动脉瓣开口面积减少肺静脉高压右心衰竭左心室射血负荷左室向心性肥厚左心室收缩功能心排血量下降心排血量下降心排血量下降心排血量下降室壁张力室壁张力顺应性下降顺应性下降室壁张力室壁张力左心衰左心衰病理生理pathophysiologyPulmonaryvenoushypetension心内膜下心肌缺血和灌注不足心内膜下心肌缺血和灌注不足心内膜下心肌缺血和灌注不足心内膜下心肌缺血和灌注不足aorticstenosisaorticstenosis脑血流灌注下降脑血流灌注下降脑血流灌注下降脑血流灌注下降左心室做功左心室做功左心室做功左心室做功心肌耗氧量心肌耗氧量心肌耗氧量心肌耗氧量顺应性下降顺应性下降舒张末压力舒张末压力COCOCOCO冠状动脉平均灌注压冠状动脉平均灌注压冠状动脉平均灌注压冠状动脉平均灌注压心绞痛心绞痛晕厥晕厥AnginapectorisSyncope急性Acute:1.感染性心内膜炎Infectiveendocarditis2.主A夹层Aorticdissection3.外伤Trauma4.人工瓣膜撕裂Prostheticvalvetear慢性Chronic:1.主动脉瓣疾病Aorticvalvedisease2/3为风心病2.主动脉根部扩张Aorticrootdilatation主动脉瓣关闭不全的病因Causesofaorticincompetence主动脉瓣纤维化、增厚、缩短、变形主动脉瓣关闭不全Aorticvalvesincompetence主动脉内血液在舒张期返流入左室偏心性肥厚、扩大左心衰左心室容量负荷Sp、Dp左心室舒张末期压力CO室壁张力心绞痛心绞痛pulmonaryhypertension右心衰pathophysiology反流面积的大小心动周期舒张期的长短体循环血管阻力AIreverseflowReverseflowaeraofthesizeBeckoningcyclediastoliclengthSystemicvascularresistance急性主动脉瓣关闭不全左心室舒张期充盈量突然增加压力迅速增高左房压、肺静脉压迅速升高急性肺水肿心动过速以减少反流量增加CO二尖瓣舒张期提前关闭，缓解左房和肺静脉受左心室高舒张压的影响CO减少，低BP急性左心衰竭急性AI瓣膜置换术是用人工机械瓣或生物瓣进行替换人心脏瓣膜进行置换Valvereplacementsurgeryistousemechanicalvalvesorbiologicalvalvestoreplaceoriginalhumanvalves.主动脉瓣置换术病例介绍CaseIntroduction病史medicalhistory罗菊梅，女，40岁,云南镇雄人PatientJumeiLuo,female,40yearsold,fromZhenxionginYunnanprovince.患者因头昏、胸痛3年，近一年来加重，活动后心悸、气促、乏力伴呼吸困难，休息后无明显缓解一月余，于2014年12月10日以“非风湿性主动脉瓣狭窄并关闭不全”收住ShewasadmittedtothehospitalforNon-rheumaticaorticstenosisandincompetenceonDecember10th,2014.becausedizziness,chestpainhavelastthreeyears,heartpalpitationandshortnessofbreathwithincreasedactivities,andexertionaldyspnealastingoveramonth.MedicalHistory◇手术史Surgicaloperationhistory2004年行“卵巢囊肿摘除术”"ovariancyst"in2004,2011年行“右上臂神经源性肿瘤切除术”“neurogenictumorresectionofrightarm”in2011◇过敏史Allergichistory双黄连Echocardiography:1、Aorticvalvedisease:moderateaorticincompetence,moderateaorticstenosis,andthewideningofaorticdiameter2、Mildmitralincompetence,andmildtricuspidincompetence3、Thedecreasingofleftventriculardiastolicfunction,LVD：70mm,EF:55%心脏彩超：1、主动脉瓣病变：主动脉瓣中度关闭不全并中度狭窄，升主动脉内径增宽。2、二尖瓣轻度关闭不全三尖瓣轻度关闭不全3、左心舒张功能降低LV：70mm,EF:55%DX检查：主动脉迂曲增宽Aortabecomeswidenedandtortuous左室增大leftventriclebecomesbigger诊治经过12月16日前完善术前准备12月17日-19日在ICU治疗12月20日患者...
