李佩涛　李　娜　李宇轩北京大学第三医院危重医学科，北京　100191

1例复杂主动脉夹层术后继发双下肢骨筋膜室综合征患者的护理

李佩涛李娜李宇轩
北京大学第三医院危重医学科，北京100191

本文报道1例复杂主动脉夹层患者行胸主动脉腔内隔绝术后罕见继发双下肢骨筋膜室综合征的护理体会，诊断后积极备术和对症处理，做好围手术期血压控制和心电监护；术后严密观察缺血再灌注肢体，及时发现异常；配合医生行骨筋膜室切开减压术，做好伤口护理和双下肢观察；做好连续肾脏替代治疗和血浆置换，挽救肾功能。经过一系列的治疗和护理，患者肾功能恢复，成功保住双下肢且运动功能恢复，顺利出院。

主动脉夹层；骨筋膜室综合征；血浆置换；护理

［Abstract］This paper reports the nursing experience for the patientwho get complex aortic dissection with a secondary osteofascial compartment syndrome in both lower limbs after endovascular graft exclusion（EVGE）operation.The nursing highlights include:after diagnosis，actively preparing for the surgery and expectant treatment；perioperative period，conducting well blood pressure control and electrocardiographmonitoring；after surgery，do the carefully observing the ischemia reperfusion of the limbs to detect anomalies timely；cooperating with the doctor in open decompression for osteofascial compartment syndrome；taking care of the wound and observing both lower limbs carefully；doing continuous renal replacement therapy and plasma exchange to save renal function.After a series of treatments and nursing cares，the patient was discharged，whose renal function was recovered and both lower limbs and their movement functions were kept successfully.

［Key words］Aortic dissection；Osteofascial compartment syndrome；Plasma exchange；Nursing

主动脉夹层（aortic dissection，AD）是指主动脉腔内血液通过内膜破口渗入主动脉壁中层形成血肿，并沿主动脉长轴延伸剥离的一种心血管系统危重急症［1］。临床上常出现胸、后背和（或）腹部剧烈疼痛、休克及压迫症状，夹层动脉瘤向外膜撕裂则发生大出血，是致死的主要原因［2］。骨筋膜室综合征（osteofascial compartment syndrome，OCS）是指由各种原因造成的肢体筋膜室内压力升高，阻断筋膜室内组织微循环而引发的一系列症状和体征［3］，如果不及时发现和处理将导致肢体坏死，同时肌肉坏死后溶解产生的肌红蛋白可导致急性肾功能衰竭，并危及生命［4］。我科于2015年收治1例胸主动脉全长、肠系膜上动脉、锁骨下动脉、左肾动脉夹层且L4水平以下动……