摘要
总结1例合并类风湿关节炎相关间质性肺病的老年冠心病患者行冠状动脉旁路移植术的护理经验。护理要点:术前通过呼吸功能训练提高患者活动耐力;实施包括早期营养支持、疼痛管理、凝血功能监测在内的多维度预康复干预;术中采取前瞻性护理预防低体温、压力性损伤、低血压及肺部感染;优化拔管策略,提高拔管安全性;术后实施降阶梯氧疗序贯管理,加快血氧改善;严格执行口腔、呼吸道及切口感染预防措施;开展组合式心肺康复锻炼;提供个体化营养支持;并通过延续性护理巩固康复效果。通过系统化、全程化的护理干预,患者术后恢复顺利,于术后第12天出院,预后良好。
This article summarizes the nursing experience of an elderly patient with coronary heart disease and comorbid rheumatoid arthritis-associated interstitial lung disease undergoing coronary artery bypass grafting.Key nursing focuses included:improving the patient′s exercise tolerance through preoperative respiratory function training;implementing multidimensional prehabilitation interventions such as early nutritional support,pain management,and coagulation monitoring;adopting proactive intraoperative nursing to prevent hypothermia,pressure injuries,hypotension,and pulmonary infection;optimizing extubation strategies to enhance safety;implementing a step-down sequential oxygen therapy management postoperatively to accelerate blood oxygen improvement;strictly implementing infection prevention measures for the oral cavity,respiratory tract,and surgical incision;performing combined cardiopulmonary rehabilitation exercises;providing individualized nutritional support;and reinforcing recovery outcomes through continuity of care.Through systematic and holistic nursing interventions,the patient recovered smoothly and was discharged on postoperative day 12 with a favorable prognosis.
作者
王亮亮
WANG Liangliang(Department of Cardiothoracic Surgery,Nanjing Drum Tower Hospital Group Suqian Hospital,Suqian 223800,China)
关键词
类风湿关节炎
间质性肺病
冠状动脉旁路移植术
个案护理
rheumatoid arthritis
interstitial lung disease
coronary artery bypass grafting
case nursing
