經導管主動脈瓣膜植入術簡介及其照護

Transcatheter Aortic Valve Implantation: An Introduction and Patient Care

主動脈瓣膜狹窄是75歲以上老人家容易罹患的疾病，經導管主動脈瓣膜植入術（transcatheter aortic valve implantation, TAVI）是為了主動脈瓣膜狹窄且合併多種慢性病，加上無法接受主動脈瓣膜置換術（aortic valve replacement, AVR）的患者，孕育而出的最新微創瓣膜置換術。執行TAVI的條件主要根據心臟超音波的檢查數據，部位的選擇主要以股動脈為主，其合併症包括中風、血管剝離、出血、主動脈瓣膜逆流和心律不整等。在臨床成效上，TAVI後的死亡率與AVR的死亡率相比較則無差異；30天內非計畫性之心因性再住院率，TAVI低於AVR；活動耐受力方面，TAVI則顯著優於AVR。完整的護理照護，可以減少TAVI術後相關合併症的發生，TAVI的照護包含術前說明簡介，術後在加護病房階段以儘快移除氣管內管、密切監測神經認知狀況以及早發現中風的情形、監測尿量維持正常腎功能、觀察穿刺部位是否有出血情況、監測心律不整和疼痛等問題，在一般病房的照護則要儘早恢復身體的活動，衛教出院後的出血風險，筆者期望此篇報告能提供臨床護理人員照顧類似患者之參考。

Aortic stenosis has a high prevalence among individuals over 75 years of age. Transcatheter aortic valve implantation (TAVI) is a novel valve-replacement technique for patients with multiple chronic diseases who are at high risk of requiring aortic valve replacement surgery. Most of the time, the indicators of TAVI are detected during an echocardiographic exam. The femoral artery is the primary insertion site. The complications of TAVI include stroke, vascular dissection, bleeding, aortic valve regurgitation, and arrhythmia. In terms of clinical effectiveness, the mortality rate of TAVI is lower than percutaneous ballon valvuloplasty but similar to AVR. The unplanned cardiac-related re-admission rate within 30 days of discharge is lower for TAVI than for AVR. In terms of activity tolerance, TAVI is significantly better than both percutaneous ballon valvuloplasty and AVR. Comprehensive nursing care may reduce the incidence of complications associated with TAVI. Nursing care of TAVI includes explaining and providing instructions regarding TAVI prior to the procedure. After the TAVI procedure and while the patient is in the ICU, remove the endotracheal tube as soon as possible, monitor his / her neuro-cognitive status, monitor for early detection of a stroke event, record urine output to assess renal function, observe bleeding in the puncture site, and evaluate cardiac arrhythmia and pain. While in the general ward, resume early physical activities and educate the patient regarding the risks and the prevention of bleeding. This article provides references for clinical staff responsible to care for post-TAVI surgery patients.