植入起搏除颤器在扩张型心肌病一级预防中的护理体会

张锦涛 郑雅玲 陈倩 万霞

作者简介： 张锦涛，1976.09 四川都江堰市 主管护师，本科，内科【摘要】目的 扩张型心肌病死亡可发生于疾病的任何阶段。病死率较高，慢性心衰和恶性心律失常是导致患者发生心脏性猝死的主要原因。ICD，CRT-D不仅能有效地改善心衰患者的症状、运动耐量、生活质量，还能有效地降低患者的住院率和心力衰竭死亡率,。 方法;对两例植入起搏除颤器患者与评估、计划、实施，给予有效的护理。结果结论 植入前做好沟通，做好手术的评估，保证病员术中情绪稳定，做好植入后的护理，防止起搏器囊袋感染，保证电极的稳固连接，起搏器功能正常。

【关键词】ICD，CRT-D, 扩张型心肌病, 心衰和恶性心律, 心脏性猝死

【Abstract】Death could be resulted at any stage of an expansionary cardiomyopathy. It has high case fatality rate. Chronic heart failure and m alignant arrhythmia are the main reasons to cause sudden cardiac death. ICD, CRT-D can not only reduce the symptoms in patients with heart failure effectively, physical exercise tolerance and life quality, but also reduce the rate of hospitalization and mortality in patients with heart failure. Before the implantation of ICD, CRT-D, it is nessisary to make good communication with pacients, to do surgery assessment and to ensure the operation of emotional stability. In the same time, make a better nursing after the implantation, prevent infection from the pacemaker pocket, ensure the stable connection between the electrodes and the normal function of pacemaker.

【key words 】ICD, CRT-D, Expansionary cardiomyopathy, Heart failure and m alignant arrhythmia, Sudden cardiac death.

【中圖分类号】R473 【文献标识码】B【文章编号】1004-4949(2014)07-0060-02

扩张型心肌病（dilated carduomyoparthy,DCM）是一侧或双侧心腔扩大并伴有心肌肥厚收缩期泵血功能障碍，产生充血性心力衰竭。特征为左或右心室或双侧心室扩大，并伴有心肌肥厚。心室收缩功能减退，伴或不伴充血性心力衰竭。室性或房性心律失常多见。病情呈进行性加重，死亡可发生于疾病的任何阶段。病死率较高。而慢性心衰和恶性心律失常是导致患者发生心脏性猝死的主要原因。我科近两年来将具有ICD和 双重功能的装置(CRT–D)植入各一例作为扩心病的一级预防，取得了一定的效果。。国外研究证实心脏再同步化治疗(cardiac resynchronization therapy CRT)即双心室起搏治疗有助于纠正患者的血液动力学紊乱和改善临床症状可以从多方面纠正心脏电机械……