1、主动脉夹层病人的护理Nursing care of patients with aortic dissection,心内科杉达周超琼指导老师：丁力,Contents,Concepts and IncidencePathogenesis and Susceptible factor ClassificationClinical manifestationTreatmentPre-hospital careNursing measuresHealth education,概念(Concepts),主动脉夹层（aortic dissection,AD）是指主动脉腔内的血液通过内膜的破口进入主动脉壁中
2、层而形成的血肿。,Cross-Section of an Aortic Dissection主动脉夹层的横截面,发病率(Incidence),The estimated incidence of aortic dissection is 3 to 4 per 100,000 people per year. However, it is thought that for every correct diagnosis, there are 2 undiagnosed cases.Aortic dissection occurs 2 to 3 times more frequently in m
3、en than in women of the same age.,发病机制(Pathogenesis),本病主要表现为主动脉中层的退行性病变 , 任何破坏中层弹性或肌肉成分完整性的疾病进程或其他条件都能使主动脉易患夹层分离。,高血压主动脉粥样硬化,内膜撕裂：二叶主动脉瓣、主动脉狭窄,text3,主动脉中层病变,text2,妊娠主动脉炎创伤,text4,text1,易患因素(Susceptible factor),分型(Classification1),DeBakeyType I: ascending aorta, aortic arch, anddescending aortaType II
4、: ascending aorta onlyType III: descending aorta distal to the subclavian artery,The DeBakey Classification System,分型(Classification2),StanfordType A: ascending and descending aortaType B: descending aorta beginning distal to the left subclavian artery,临床表现(Clinical manifestation),辅助检查(Diagnostic Te
5、sts),EKGChest x-rayAngiographyCT最常用MRIEchocardiographyBiochemical markers,治疗（Treatment）,Stanford B 型的首选经皮覆膜支架置入术，必要时外科手术治疗,The swollen tube is an artificial blood vessel that has been implanted to replace a defective aortic arch. Its attached to the heart and connects at its other end to the rest of
6、 the aorta.,院前急救（Pre-hospital care）,原则控制血压镇静止痛对症处理降低病死率,护理措施（Nursing measures）,1.Assessment：严密观察疼痛的部位、性质、时间、程度，使用强镇痛剂后，观察疼痛是否改善，进行疼痛的连续性评估。,护理措施（Nursing measures）,2.Monitoring：严密监测生命体征的变化，控制血压可维持在90120/6090mmHg，记录液体出入量，严密观察动脉搏动情况，发现异常情况及时报告医生。,护理措施（Nursing measures）,3.Psychosocial nursing：患者易产生烦躁不安、
7、精神紧张、焦虑的情绪，应加强心理护理，及时与患者沟通。,4.Rest and activity：绝对卧床休息，避免过多活动及剧烈咳嗽。,护理措施（Nursing measures）,5.Medication nursing：遵医嘱应用减慢心率，控制血压的药物时，应密切观察生命体征、尿量等情况，注意观察药物的效果和不良反应。硝普钠属血管平滑肌松弛剂，注意避光，现用现配，超过6h应重新配制。,护理措施（Nursing measures）,6.Diet：以清淡、易消化、富含维生素的流质或半流质食物为宜；做好口腔护理，鼓励患者多饮水，进食新鲜水果、蔬菜和低盐低脂的食物。7.Excretion：保持大便
8、通畅，减少便秘，必要时给予通便药物，防止排便时血压骤升，导致夹层破裂。,护理措施（Nursing measures）,8.Skin care：定时协助翻身，动作应轻柔。可铺防褥疮气垫床，用软垫保护受压部位，预防压疮发生。9.保证抢救药品及物品处于功能位，发生病情变化时及时报告医生，给予对症处理。,健康教育（Health education）,戒烟戒酒低盐低脂饮食,坚持服药控制血压自测脉搏,调整心态心情舒畅避免激动,门诊复查不适随诊,避免复发延长生命,按时休息劳逸结合循序渐进,主动脉夹层的概述和发病率,发病机制、易患因素及分型,治疗及院前急救,临床表现及辅助检查,回顾（Review ）,护理措施
9、及健康教育,参考文献（References）,1Linda Scheetz, EdD, RN.Aortic dissectionJ.Am J Nurs 2006 Apr;106 (4):55-92Maria Dixon, RN, MSN.Misdiagnosing aortic dissection: A fatal mistakeJ.J Vasc Nurs 2011;29:139-1463WANG Dong-jin,FAN Fu-dong,WANG Qiang.Preliminary characterization of acute aortic dissection in the mainland of ChinaJ.Chin Med J 2011;124(11):1726-1730,提问（Questions）,主动脉夹层的分型有哪些？主动脉夹层典型的临床表现有哪些？,Thank You !,
