1、 What is aortic dissection?
Also known as aortic dissection aneurysm, it refers to a hematoma formed by the tearing of the aortic intima caused by various reasons, and the blood in the aortic cavity entering the middle layer of the aortic wall through the rupture of the intima. Its incidence rate has a trend of increasing year by year, with more males than females, and the peak age of incidence is 40-60 years old.
2、 Interventional treatment for aortic dissection: Use of aortic stent graft to close the tear opening, mainly targeting DeBakey III type. Specific method 1: Under local anesthesia, cut open the right inguinal region, separate and expose the femoral artery layer by layer, puncture the femoral artery, insert a 5F arterial sheath, and send it into a pig tail catheter for aortic angiography along the guide wire. Accurately measure the image, select a suitable size covered stent for placement, perform another aortic angiography to confirm the stent is in place, and withdraw the catheter. Suture the femoral artery puncture site, and finally suture the skin layer by layer. Use an arterial compressor to compress and stop bleeding. Specific method 2: Under local anesthesia, the Seldinger technique is used to puncture the femoral artery, insert a 5F arterial sheath, and send it along a guidewire into a pig tail catheter for aortic angiography. Accurate measurements are taken on the monitoring screen based on the image, and a suitable size covered stent is selected for placement. Aortic angiography is performed again to confirm the stent is in place, the catheter is removed, and the arterial compressor is used to compress and stop bleeding.
3： Nursing of aortic dissection:
(1) Preoperative nursing: 1. Psychological nursing: patiently answer questions from patients and their families, build confidence, and cooperate with treatment. 2. Notify seriously ill or critically ill, provide oxygen therapy and electrocardiogram monitoring: focus on monitoring blood pressure and heart rate to avoid adverse factors causing blood pressure to rise (the goal of blood pressure control is to gradually reduce systolic blood pressure to 100-110mmHg and maintain mean arterial pressure at 60-70mmHg; The target for heart rate control is 60-70 beats per minute. 3. Antihypertensive drugs: commonly used ones include levocetirizine, nitroglycerin, sodium nitroprusside, etc. 4. Preventing aneurysm rupture: (1) Braking: absolute bed rest to avoid violent turning, lumbar and abdominal flexion, collisions, squats, etc; Escort the patient for examination and avoid moving the patient multiple times; Avoid activities that increase chest pressure, such as vigorous exercise, coughing, holding your breath and defecating. (2) A light and easily digestible diet rich in vitamins. (3) Emergency treatment: If there is worsening pain, pale complexion, decreased blood pressure, increased pulse, etc., it is highly suspected that the aortic dissection aneurysm has ruptured, and preoperative preparation should be made. 5. Observation of pain: Sudden exacerbation of pain indicates a tendency for aortic dissection aneurysm to rupture; The sudden relief of pain indicates that the distal end of the aortic dissection aneurysm has re ruptured into the vascular lumen. 6. Record 24-hour urine output and use a urinary catheter if necessary. 7. Other things such as quitting smoking and drinking alcohol.
（2） Intraoperative nursing: 1. Comfort the patient and alleviate their fear. 2. Electrocardiogram monitoring, measuring blood pressure every 5 minutes. Due to the possibility of occlusion of the left subclavian artery after release, it may lead to ischemia in the left upper limb. 3. Establish at least 2 venous channels and administer one Saguen intravenously before surgery. 4. Closely observe consciousness, complexion, and breathing; During the stent push, the surgeon should control the blood pressure to drop below 110mmHg before releasing the stent. After the stent is released, adjust the drip rate of the antihypertensive medication in a timely manner.
（3） Postoperative care: 1. Observe vital signs: oxygen inhalation, electrocardiogram monitoring for 24-48 hours, continue to use antihypertensive drugs to control blood pressure after surgery, gradually stop medication, and switch to oral antihypertensive drugs. 2. Position and activity: Lying flat, the head can be raised appropriately to reduce abdominal tension; Stretch and brake the punctured limb horizontally for 24 hours, and take care of the patient during the limb immobilization period. On the day after surgery, perform dorsiflexion and extension exercises on the foot. If the femoral artery is not cut open, the decision to get out of bed depends on the healing of the wound; Patients who undergo femoral artery incision can only get out of bed and move around after the wound is removed. 3. Care for the limb on the puncture side: Cover the wound at the puncture site with gauze, compress it with an arterial compressor for at least 6 hours, and observe whether there is bleeding, seepage, or hematoma formation at the puncture site. Keep the wound dressing clean and dry. Observe the blood circulation at the distal end of the puncture site, and frequently touch the pulse of the dorsal foot artery and skin temperature. The suture is removed 10-14 days after the femoral artery incision. 4. Prevention of infection: Antibiotics should be used for 4-6 days after surgery, followed by oral administration for 1 week. 5. Life care: Drink plenty of water, eat fresh vegetables, and maintain smooth bowel movements. 6. Observation and nursing of complications: (1) Myocardial infarction and acute left heart failure: postoperative observation of whether the patient has pain, the location and nature of pain, changes in electrocardiogram, and laboratory tests. (2) Paralysis: Observe the color, temperature, and muscle tone of both lower limbs. (3) Renal failure: Observe and record 24-hour urine output, and promptly review renal function. (4) Embolism: It is the main complication of covered stents. Observe whether there is bleeding from the wound, whether there are bruises or hematomas around, and whether the dorsalis pedis artery pulse is good. If the dorsalis pedis artery pulse suddenly weakens, there may be lower limb arterial embolism; If swelling is found in the limbs, but the dorsalis pedis artery is pulsating well, it is considered that there may be venous thrombosis. (5) Postoperative syndrome after covered stent implantation: increased body temperature, white blood cell count, and C-reactive protein, as well as decreased platelets and red blood cells. Consider factors such as foreign body reactions after implantation, reabsorption after thrombus formation in the false lumen, and direct mechanical damage to red blood cells by the stent. Mild symptoms can be treated with low-dose prednisone orally, which will recover within 2 weeks. Severe symptoms with Hb below 80 and platelet count below 60 should be transfused. 7. Regular follow-up: It is recommended to have follow-up examinations at 1 month, 3 months, 6 months, 1 year after surgery, and every year thereafter.