Mali Shahriar, Haghaninejad Hasan
Department of Cardiovascular Surgery, Yazd Cardiovascular Research Centre, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
Department of Cardiology, Yazd Cardiovascular Research Centre, Shahid Sadoughi University of Medical sciences, Yazd, Iran.
Arch Med Sci Atheroscler Dis. 2019 Dec 31;4:e280-e285. doi: 10.5114/amsad.2019.91432. eCollection 2019.
Coronary heart disease is a common diseases of atherosclerosis. Despite the development of noninvasive therapies and the advancement of pharmacological methods and extensive drug regimens, coronary artery bypass grafting surgery is still the ultimate treatment option in many patients. Among the various complications following open heart surgery, one of the common difficulties is pulmonary complications associated with subsequent morbidity and mortality, which should be studied according to preoperative, perioperative, and postoperative factors. Preoperative factors include genetics, age, family history of pulmonary disease, smoking, coexisting disease, etc. Perioperative factors include surgical procedures like sternotomy incision, cardioplegia, and internal mammary artery harvesting; anaesthesia procedure effects like pulmonary collapse, maintenance drugs and morphine administration; and cardiopulmonary bypass pump by systemic inflammatory response syndromes. And finally, postoperative factors, especially mediastinitis and the role of nursing in the intensive care unit. Pulmonary complications after cardiac surgery include atelectasis, pleural effusions, pneumonia, pulmonary oedema, cardiogenic pulmonary oedema, acute respiratory distress syndrome, pulmonary embolism, phrenic nerve injury, pneumothorax, sternal wound infection, and mediastinitis, with different outbreaks in patients reported. Although the preoperative, perioperative, and postoperative factors play an important role in the occurrence of these complications, the preoperative factors, as factors that can be adjusted, should be considered more than the others and explained to the patient, and the preoperative patient's assessment should be noted. Also, postoperative care with the goal of reducing infections and pulmonary complications should be addressed by the nursing team.
冠心病是一种常见的动脉粥样硬化疾病。尽管无创治疗有所发展，药理学方法和广泛的药物治疗方案也不断进步，但冠状动脉旁路移植手术仍是许多患者的最终治疗选择。在心脏直视手术后的各种并发症中，常见的困难之一是与随后的发病率和死亡率相关的肺部并发症，应根据术前、围手术期和术后因素进行研究。术前因素包括遗传因素、年龄、肺部疾病家族史、吸烟、并存疾病等。围手术期因素包括手术操作，如胸骨切开术切口、心脏停搏和乳内动脉采集；麻醉操作的影响，如肺萎陷、维持用药和吗啡给药；以及体外循环泵引起的全身炎症反应综合征。最后是术后因素，尤其是纵隔炎以及重症监护病房护理的作用。心脏手术后的肺部并发症包括肺不张、胸腔积液、肺炎、肺水肿、心源性肺水肿、急性呼吸窘迫综合征、肺栓塞、膈神经损伤、气胸、胸骨伤口感染和纵隔炎，不同患者的发病率报道各异。尽管术前、围手术期和术后因素在这些并发症的发生中起重要作用，但术前因素作为可调整的因素，应比其他因素更受重视并向患者解释清楚，同时应注意对术前患者进行评估。此外，护理团队应以减少感染和肺部并发症为目标进行术后护理。
