Aortic dissection surgery process and postoperative monitoring

Aortic dissection is a relatively difficult disease in arteries, and its current treatment mainly adopts surgery. Many patients are unwilling to undergo surgery and are afraid of it. In fact, the surgical process for aortic dissection is not complicated. The entire process is under strict instrument detection and is a relatively safe surgical treatment method.

1. Preoperative

1. Patients entering the ICU must stay in bed and are not allowed to move.

2. Hemodynamic monitoring, continuous ECG monitoring, close observation of vital signs, heart rate and blood pressure, etc. (Actively perform arteriovenous puncture under local anesthesia, monitor blood pressure, and control blood pressure (drugs include Perle, Nitroglycan, Nitroprusside, and Yalingding), 100-120 mmHG, heart rate 60-90 beats/min)

3. Closely observe the location, nature, time and degree of pain. (The location of pain may indicate the location of the rupture. For example, pain in the front chest, neck, throat, or jaw may indicate ascending aortic dissection. Pain in the shoulder blade, back, or abdomen may indicate descending aortic dissection. Increasing pain reflects the progression of the disease, indicating that the aortic intima is progressing and should be taken seriously. Drugs used include: morphine, pethidine, and dulipristal).

2. Postoperative

1. Respiratory system monitoring ⑴ Connect the ventilator for mechanical ventilation and adjust the ventilator parameters. (SIMV mode, TV: 6-10ml/kg, f: 12-16 times/min, FiO2: 60%, PEEP: 5, PASP: 10) ⑵ Adjust ventilator parameters according to blood gas analysis and saturation, maintain PaO2: 100-150, PaCo2: 35-45 ⑶ Properly fix the endotracheal tube, keep the airway open, clear the respiratory and oral secretions in time, pay attention to aseptic operation, and prevent lung infection. (4) The oxygen saturation after dissection surgery is generally poor. In addition to increasing the oxygen concentration and PEEP, appropriate lung inflation and physical therapy can be used to improve oxygen and saturation.

2. Circulatory system monitoring ⑴ Continuous ECG monitoring, observing heart rate, blood pressure, CVP, PAP and SPO2, limb arterial pulsation and activity, peripheral warmth, and urination. Pay attention to the presence of arrhythmias, closely monitor blood pressure (100-120 mmHG), and adjust the dosage of antihypertensive drugs as needed. ⑵ Pay attention to the condition of the pleural effusion (the amount discharged per hour, the color change, the presence of clots, and if there are no clots, repeat the ACT test). If it is 100-50ml/h, decisively use hemostatic drugs (prothrombin complex, fibrinogen, hemostatic triple), plasma, oligoplasma, and cryoprecipitate. If it lasts for more than 4 hours and is >200ml/h, consider bleeding and report to your superior promptly for treatment.

3. Neurological monitoring ⑴ Closely observe pupils, consciousness, and activities after surgery. (If pupils are not equal or become larger, timely TC examination is required) ⑵ Generally, the patient is agitated, unconscious, and uncooperative on the first day. Wait until the patient is fully awake before considering extubation