薛琴丹 胡伟珍 吴圣杰 潘培培

[摘要] 目的 总结房室结消融联合希氏束起搏术治疗持续性心房颤动伴心力衰竭患者术后的有效护理措施。 方法 选取2018年1月～2019年6月在我院心内科成功行房室结消融联合希氏束起搏术治疗的持续性心房颤动伴心力衰竭患者44例进行术后护理干预，包括进行严密的心电监护、术后并发症观察、康复指导等，出院后门诊随访至少6个月。 结果 44例患者术后有2例出现起搏器囊袋出血，予以延长沙袋压迫后无出血现象。出院6个月后随访成功者为40例，患者术后左室射血分数（LVEF）为（44.2±13.0）%，明显高于术前的（34.5±9.0）%，差异有统计学意义（P<0.01）;术后左室舒张末期容积（LVEDV）为（134.8±55.9）mL，低于术前的（162.5±57.9）mL，差异有统计学意义（P<0.05）。 结论 通过对房室结消融联合希氏束起搏术后的患者开展针对性护理，可减少术后并发症，有利于患者术后恢复，改善患者心功能，提高患者生命质量。

[关键字] 房室结消融术;希氏束起搏术;持续性房颤;心力衰竭;护理

[中图分类号] R541.7          [文献标识码] B          [文章编号] 1673-9701（2020）35-0175-04

[Abstract] Objective To summarize the effective nursing measures in patients with persistent atrial fibrillation and heart failure treated with atrioventricular node ablation combined with His bundle pacing. Methods A total of 44 patients with persistent atrial fibrillation and heart failure who successfully treated with atrioventricular node ablation combined with His bundle pacing in the cardiology department of our hospital from January 2018 to June 2019 were intervened with postoperative nursing intervention， including strict ECG monitoring， observation of postoperative complications， and rehabilitation guidance. The outpatient follow-up lasted for at least six months after discharge. Results Two of the 44 patients had pacemaker pocket bleeding after surgery. And there was no bleeding after prolonged sandbag compression. Six months after discharge， 40 patients were followed up successfully. The postoperative left ventricular ejection fraction （LVEF） was （44.2±13.0）%， which was significantly higher than that（34.5±9.0）% before surgery （P<0.01）. The ventricular end-diastolic volume（LVEDV） after surgery was（134.8±55.9） mL， which was lower than that （162.5±57.9） mL before surgery（P<0.05）. Conclusion The targeted nursing of patients after atrioventricular node ablation combined with His bundle pacing can reduce postoperative complications， help patients recover after surgery， improve patients' cardiac function， and improve their quality of life.

[Key ords] Atrioventricular node ablation; His bundle pacing; Persistent atrial fibrillation; Heart failure; Nursing

心房顫动简称房颤，是临床上一种常见的心律失常，临床上可分为阵发性房颤、持续性房颤和永久性房颤。房颤时患者心室自主心律快、舒张期缩短、心室灌注减少，久而久之极易导致心力衰竭。房颤消融术治疗阵发性房颤效果较好，而持续性房颤患者存在消融失败或消融术后复发等问题，消融成功率低于50%[1]。反复的消融手术，无疑增加了患者的心理和经济负担，且患者的心力衰竭症状得不到有效改善。近年来，对于持续性房颤伴心力衰竭患者，特别是药物治疗不佳时，有些专家予以房室结消融术来控制心室自主心律，联合双心室起搏或右心室起搏给予起搏支持。但此术式并非最理想的手术方式，有学者对持续性房颤伴心力衰竭患者进行房室结消融联合希氏束起搏术，发现患者LVEF值明显提高、心功能得到改善[2]。……