一站式杂交手术治疗房颤的术中护理要点

周明伟　吕宝胜

【摘 要】目的：探讨一站式杂交手术治疗持续性房颤的手术护理配合要点。方法：总结2015年5月至2019年4月期间42例持续性房颤一站式杂交手术，经左侧胸壁全胸腔镜途径消融两侧肺静脉、左心房后壁及Marshall韧带，并切除左心耳，经导管心内膜途径对外科消融径线的完整性进行验证并阻断残存传导，进行心房的基质改良[1]的手术配合过程，进行学习总结和交流探讨。结果：所有患者均实现两侧肺静脉在内的左心房后壁隔离及左心耳切除，内科介入下的导管射频消融，其中35例患者恢复了窦性心律，手术成功率为83.3%，所有患者手术进行顺利，无感染和其他重要脏器并发症的发生。结论：熟练掌握一站式杂交手术间各类仪器的使用操作规范，严格遵循无菌操作原则，密切关注手术进程，精准快速的传递器械，可以缩短手术时间，降低手术风险，保证手术顺利完成[2]。

【关键词】一站式杂交手术;房颤;手术配合要点

【中图分类号】R541.75【文献标识码】B【文章编号】1002-8714（2019）11-0180-01

【abstract】 Objective To explore the key points of operation nursing coordination in one-stop hybrid surgery for persistent atrial fibrillation. Methods From May 2015 to April 2019， 42 patients with persistent af one-stop hybrid surgery during the melting on the left side of the chest wall full thoracoscope way on both sides of the pulmonary vein， left atrial wall and Marshall after ligament， and resection of left atrium， after transcatheter endocardial way to authenticate the integrity of the surgical ablation lines blocking the remnants of the conduction and modified for atrial substrate [1] surgery coordination with the process， the study conclusion and communication. Results All patients achieved posterior wall isolation of left atrium including bilateral pulmonary veins and resection of left atrial auricle， and radiofrequency catheter ablation under medical intervention. Among them， 35 patients recovered sinus rhythm， with a success rate of 83.3%. All patients underwent surgery smoothly， without infection or other important organ complications. Conclusion Proficiency in the operation specifications of all kinds of instruments in one-stop hybridization surgery， strict adherence to the principle of aseptic operation， close attention to the operation process， and accurate and rapid delivery of instruments can shorten the operation time， reduce surgical risks， and ensure the smooth completion of surgery [2].

1 房顫的相关知识

心房颤动（atrial fibrillatafion，AF，以下简称房颤）是临床常见的有不良预后的心律失常，其发生率随着年龄增长而提高，其发作时的心悸、气促等症状严重影响患者生活质量[2]。心房颤动是临床最常见的慢性心律失常，其在普通人群中的发病率大约为1%～2%[3-5] 。可增加患者病死率及脑卒中风险，加重心功能不全，55岁以上男性患房颤的终生风险为23.8%，女性为22.2%，随着人口老龄化的进展，患病率将继续升高[6]。心房纤颤的……