2020 年第 4 期 第 15 卷

经股动脉途径行主动脉瓣置换围术期综合监测及强化心理管理的作用研究

Application of perioperative integrated monitoring and psychological care in patients with transfemoral aortic valve replacement

作者：杨树鹏申云郝楠陈哲刘巍周玉杰刘晓丽

英文作者：Yang Shupeng Shen Yun Hao Nan Chen Zhe Liu Wei Zhou Yujie Liu Xiaoli

单位：首都医科大学附属北京安贞医院心内科 100029

英文单位：Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：主动脉瓣狭窄；经导管主动脉瓣置换；心理管理

英文关键词：Aorticstenosis;Transcatheteraorticvalvereplacement;Psychologicalcare

• 摘要：

• 【摘要】目的    评估经股动脉途径行经导管主动脉瓣置换围术期患者进行综合监测和强化心理管理对患者的影响。方法    2017年3月至2018年11月在首都医科大学附属北京安贞医院完成经股动脉TAVR术36例，根据术后管理方式不同分为常规组和心理干预组，各18例。常规组术前并发症风险评估，术后以呼吸、心率、出入量、体位管理为重点的常规管理；心理干预组在常规管理基础上，分别指派一名负责医生和护士在术前讲解疾病及手术相关知识、治疗效果，术后恢复主要注意事项等内容，并进行心理干预疏导。比较2组患者的术后并发症及平均住院时间。结果    术前2组伴焦虑状态比较差异无统计学意义，术后心理干预组心理障碍患者例数明显少于常规组［术前2例（11.1%）比2例（11.1%），χ2=0.000，P=1.000；术后0比4例（22.2%），χ2=4.500，P=0.034］。共12例(33.3%)发生了严重并发症，其中9例植入永久起搏器、1例发生严重股动脉穿刺部位感染并发症、1例因解剖结构变异导致冠状动脉阻塞，未能完成TAVR，1例因心包压塞转心外科治疗。2组患者围术期并发症比较，差异无统计学意义（P=0.480）。心理干预组平均住院时间短于常规组，差异有统计学意义［(9±5)d比(12±6)d，t=2.030，P=0.044］。结论    针对TAVR围术期患者特点进行心理干预，对患者术后的康复和心理以及缩短住院时间有重要意义。

• 【Abstract】Objective    To evaluate the effect of perioperative integrated monitoring with psychological care on patients undergoing transcatheter aortic valve replacement(TAVR) through femoral approach. Methods    Thirty-six patients undergoing transfemoral TAVR in Beijing Anzhen Hospital, Capital Medical University from March 2017 to November 2018 were divided into general care group(GC) group and psychological care(PC) group, with 18 cases in each group. Comprehensive preoperative risk evaluation and perioperative integrated monitoring involving respiratory function heart rate/rhythm, intake/output and position management were performed in all patients. The PC group was given psychological care by interpreting knowledge of disease, precautions of postoperative recovery and intervening with rational mental counseling. Occurrence of complications and duration of hospital stay were analyzed. Results    There was no significant difference in anxiety status between groups before surgery; after surgery, psychological disturbance in PC group was significantly less than that in GC group［before surgery 2 cases（11.1%） vs 2 cases（11.1%）， χ2=0.000， P=1.000； after surgery 0 vs 4 cases（22.2%）， χ2=4.500， P=0.034］. Serious complications occurred in 12 cases(33.3%), including 9 cases of permanent pacemaker implantation, 1 case of severe femoral puncture site infection, 1 case of TAVR failure due to coronary artery obstruction(anatomical structural variation) and 1 case of transfer to cardiac surgery due to pericardial tamponade. There was no significant difference in perioperative complications between groups(P=0.480). Average hospital stay time in PC group was significantly shorter than that in GC group［(9±5)d vs (12±6)d, t=2.040, P=0.044］. Conclusion    Psychological care in patients undergoing TAVR can promote postoperative rehabilitation and shorten hospital stay.