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医学精萃系列--经导管主动脉瓣置换操作指南手册
$70.62
《经导管主动脉瓣置换操作指南手册》针对经导管主动脉瓣置换术(TAVR)这一革命性心血管疾病治疗技术,涵盖了手术、麻醉、护理、重症监护、体外循环等各个环节,详细描述了TAVR手术患者影像学筛选评估方法、术前准备、手术操作、并发症防范处理策略、体外生命支持、术后监护、康复等全流程技术操作规范,重点突出细节规范性和实用操作性。《经导管主动脉瓣置换操作指南手册》实用性强,对临床有较高参考性,层级清晰,图文并茂,是各医院建设心脏团队的参考蓝本及TAVR技术从业人员的随身参考书。
杨剑,主任医师,博士研究生导师。美国心脏协会专家会员(FAHA)、 美国心脏病学会专家会员(FACC)、中国医师协会心血管外科医师分会结构性心脏病专业委员会副主任委员。临床专长于复杂结构性心脏病的微创及介入治疗,在以经导管主动脉瓣置换为代表的结构性心脏病微创治疗、微创心血管器械研发及以3D打印为主的多模态影像学评估方面有一定建树。刘洋,博士,副教授,硕士研究生导师。国家心血管病专家委员会微创心血管外科专业委员会委员。专注心血管疾病微创治疗。国内较早开展经皮微创介入瓣膜病修复及置换术,瓣膜置换术后瓣周漏介入封堵术等多项心血管疾病微创治疗新技术。刘金成,主任医师。中华医学会陕西省心血管外科分会副主任委员,中国医师协会心血管外科分会常委。临床专长于瓣膜病及冠心病的微创治疗。
第1章 经导管主动脉瓣置换术发展概况 0011.1 经导管主动脉瓣置换术概述 0011.2 经导管主动脉瓣膜置换器械发展概况 0021.3 经导管主动脉瓣置换术临床应用适应证的发展 008第2章 TAVR 应用解剖 0132.1 主动脉瓣叶 0142.2 主动脉瓣环 0152.3 主动脉窦 0162.4 冠状动脉 0162.5 纤维三角以及其与二尖瓣及隔膜的关系 0172.6 主动脉瓣和传导系统之间的关系 0192.7 TAVR 适应人群的主动脉根部解剖特点 019第3章 TAVR 术前CT 评估 0213.1 TAVR 术前CT 数据采集方法 0213.2 TAVR 术前CT 评估 024第4章 3D 打印在TAVR 评估中的应用 0474.1 主动脉根部3D 打印的方法 0474.2 主动脉根部3D 打印模型TAVR 术前模拟及并发症评估 0484.3 TAVR 术前手术训练及模拟 052第5章 TAVR 患者术前基本情况评估 0555.1 临床表现 0555.2 辅助检查 0565.3 外科手术风险评估 0575.4 适应证 0595.5 禁忌证 0595.6 手术策略制定 060第6章 TAVR 物品耗材准备 0716.1 经股动脉及其他外周途径TAVR 物品耗材准备 0716.2 经心尖途径TAVR 介入耗材准备 073第7章 TAVR 围手术期超声监测 0757.1 经胸超声心动图 0757.2 经食管超声心动图 086第8章 TAVR 的麻醉管理 0938.1 术前评估 0938.2 术前准备 0958.3 麻醉处理 096第9章 TAVR 手术操作 0999.1 经股动脉穿刺入路自膨胀瓣膜TAVR 手术操作(VenusA 为例) 0999.2 经股动脉入路切开途径TAVR 手术操作 1079.3 球囊扩张式瓣膜手术操作(Sapien 为例) 1089.4 经心尖入路带定位件瓣膜TAVR 手术操作(J-Valve 为例) 1129.5 经颈动脉入路TAVR 手术操作 1199.6 经升主动脉入路TAVR 手术操作 1199.7 经锁骨下动脉入路TAVR 手术操作 1209.8 经股静脉入路TAVR 手术操作 120第10章 TAVR 手术中体外生命支持技术的应用 12110.1 CPB 物品准备 12110.2 ECMO 物品准备 12210.3 备台工作流程 12210.4 辅助循环工作流程 12210.5 紧急介入工作流程 12310.6 血液回收工作流程 12410.7 术中管理注意事项 12410.8 体外循环操作人员防护 124第11章 TAVR 术中护理配合 12511.1 手术间准备 12511.2 手术前准备 12511.3 药品准备 12711.4 洗手护士台上准备 12711.5 护理文书及其他准备 12811.6 洗手护士台上配合要点 12811.7 巡回护士术中配合要点 12911.8 术毕整理 130第12章 TAVR 术后监护管理 13112.1 术后返回监护室交接班注意事项 13112.2 术后患者意识监测 13212.3 术后患者循环管理 13212.4 呼吸功能管理 13212.5 术后患者肾功能管理 13312.6 术后患者肝功能管理 13312.7 术后患者出凝血管理 13312.8 术后患者感染监测 13412.9 术后患者疼痛管理 13412.10 术后高危患者营养管理 134第13章 TAVR 手术并发症及处理预案策略 13513.1 常见并发症及处理预案 13513.2 少见并发症及处理预案 144第14章 TAVR 术后治疗、护理及康复 14714.1 术后治疗要点 14714.2 护理措施 15114.3 术后康复训练 15314.4 出院康复指导 153第15章 TAVR 典型病例 155病例1 重度主动脉瓣狭窄TAVR(VenusA) 156病例2 主动脉瓣狭窄关闭不全TAVR(VenusA 瓣中瓣) 166病例3 重度主动脉瓣关闭不全TAVR(J-Valve) 176病例4 重度主动脉瓣狭窄TAVR(J-Valve) 186病例5 0 型二叶瓣重度主动脉瓣狭窄TAVR(VenusA) 196参考文献 206
经导管主动脉瓣置换术(TAVR)具有手术时间短、创伤小、康复快等特点,不再需要开胸及体外循环,能够极大减轻病患痛苦,是近年来快速发展的一项革命性心血管疾病治疗新技术。经过十余年的发展,其安全性和有效性已得到大量临床研究证实,是主动脉瓣狭窄与关闭不全患者的可靠治疗手段。TAVR 技术不同于传统瓣膜病治疗方式,除手术技术本身的革新外,更加强调诊断—评估—手术—随访—康复全过程的团队协作。心脏团队中心血管内、外科,超声医学科,放射影像科,麻醉科等各个岗位人员团结协作是保证每一例手术成功的基石,欧美指南均将心脏团队建设作为TAVR 技术成功开展的条件进行推荐。TAVR 技术在我国尚属起步阶段,临床病例数较为有限,国内常规应用器械与国外产品也有显著区别,因此,迫切需要一套关于该技术的团队建设和技术操作规范作为参考。笔者所在西京医院心血管外科在国内较早开展了经导管主动脉瓣置换术,在心脏团队建设和国内常用各型TAVR 器械方面积累了一定经验。针对国内TAVR 技术团队建设、人员培训等问题,团队核心成员从各岗位角度出发编写了这本《经导管主动脉瓣置换操作指南手册》。针对心脏团队这一新的治疗模式特点,本书涵盖了手术、麻醉、护理、重症监护、体外循环等各个环节,详细描述了TAVR 患者影像筛选评估方法、术前准备、手术操作、并发症防范处理策略、体外生命支持、术后监护、康复等全流程技术操作规范,重点突出细节规范性和实用操作性。全书共分为15 章,含附图400 余幅,其中绝大多数均为笔者所在心脏团队的原创性工作,并得到西安马克医疗科技有限公司的大力支持和帮助。全书内容追求简洁,力求突出实用性和随身工具书特色。期待本书对于早期开展TAVR 的心脏团队中各级心血管内、外科医师,麻醉、放射学及超声影像学等专业医师以及护理人员和其他医疗工作者在临床实践中有所帮助。本书的出版得到了国家重点研发计划(2020 YFC 2008100)、国家自然科学基金项目(81774415)、陕西省创新能力支撑计划- 科技创新团队项目(S2020-ZCTD-0034)、西京医院学科助推计划(XJZT18Z02、XJZT18RL10、XJZT19ML36)等课题的资助,在此一并表示感谢。由于编写时间仓促,加之作者学识有限,书中可能存在不足之处,望广大读者不吝指正。杨剑 刘洋 刘金成于西京医院2021 年8 月20 日
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