探讨采用改良Morrow术治疗梗阻性肥厚型心肌病(HOCM)患者的治疗效果及围手术期护理要点。

选择首都医科大学附属北京安贞医院2016年1月至2017年1月收治的35例行改良Morrow术治疗HOCM患者。术前对患者进行心理护理，完善相关检查，指导患者进行呼吸锻炼，术中护士不应离开手术室，术后密切观察患者心电图变化，固定好临时起搏器，检查临时起搏器功能是否处于正常状态，加强患者应用起搏器的健康教育及安全指导。术后常规进行心电监护，完善血气分析、血常规、肝肾功能等相关检查，注意维护患者内环境稳定及电解质平衡等。加强患者肺部护理，鼓励咳痰。护士要经常巡视病房，询问患者有无不适。观察记录患者术中合并手术情况、体外循环时间、主动脉阻断时间及是否存在二次转机等情况发生；观察患者在ICU是否顺利脱离呼吸机、拔除气管插管，是否存在心动过缓并需要临时起搏器治疗或植入永久起搏器治疗；记录患者住院时间；记录患者出院前超声指标及术后是否有严重并发症发生或是否有死亡情况。

本组35例HOCM患者均进行改良Morrow术，同期合并二尖瓣成形术5例(14.3%)，三尖瓣成形术5例(14.3%)，心房颤动射频消融术1例(2.9%)，无同期行二尖瓣置换术和主动脉瓣置换术患者。术中平均体外循环时间(115.7±44.3) min；升主动脉平均阻断时间为(72.3±25.4) min，无二次转机情况发生。术后即刻，食道超声显示左心室流出道压差8.7(5.9, 11.7) mmHg (1 mmHg＝0.133 kPa)。所有患者在ICU均顺利脱离呼吸机、拔除气管插管，住ICU时间58.9(47.6, 71.5) h，机械通气时间18.0(17.0, 24.5) h，术后发生一过性房室传导阻滞2例(5.7%)，后均恢复窦性心律。所有患者平均住院时间为(8.5±3.8) d，患者出院前超声结果显示：32例患者二尖瓣轻度反流，3例患者中度反流，无主动脉瓣反流，所有患者出院前左心室流出道压差9.2(6.8, 12.3) mmHg，此外，有1例患者发生三度房室传导阻滞行永久起搏器植入治疗，其余患者经积极治疗和精心护理，均痊愈出院，无严重并发症发生，无患者死亡。

改良Morrow术可有效解除HOCM患者左心室流出道梗阻，对患者进行细致、耐心的围手术期护理，对确保手术成功、改善预后起到至关重要的作用。

To explore the therapeutic effect of modified Morrow operation in the treatment of patients with obstructive hypertrophic cardiomyopathy (HOCM) and main points of perioperative nursing.

Thirty-five patients undergoing modified Morrow operation in the Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, from January 2016 to January 2017 were selected. Psychological care for the patient before the operation was carried out, related examinations were improved and the patient to perform breathing exercises were guided. During the operation, the nurse should not leave the operating room. After the operation, the patients′ ECG changes was closely observed, the temporary pacemaker was fixed, and the temporary pacemaker function was checked to make sure whether it was in a normal state, the health education and safety guidance of patients using pacemakers were strengthened. Routine ECG monitoring after surgery, blood gas analysis, blood routine, liver and kidney function and other related checks were performed, and maintaining the stability of the patient′s internal environment and electrolyte balance should be paid attention. Patient′s lung care and sputum expectoration were strengthened and encouraged. Nurses should visited the ward frequently and asked patients if they felt unwell. The intraoperative complications, extracorporeal circulation time, aortic block time, and the presence of secondary rotation were detected; whether the patients were successfully weaned from the ventilator and tracheal intubation in ICU, whether there was bradycardia and needed temporary pacemaker or permanent pacemaker implantation were obserbed; the hospitalization time were recorded; the ultrasound indexes before discharge and whethwe there were any serious complications or death after operation were recorded.

All the 35 patients underwent modified Morrow operation, including mitral valvuloplasty in 5 cases (14.3%), tricuspid valvuloplasty in 5 cases (14.3%), and radiofrequency ablation of atrial fibrillation in 1 case (2.9%). No patients underwent mitral value replacement or aortic value replacement at the same time. The mean cardiopulmonary bypass time was (115.7±44.3) min, and the mean aortic occlusion time was (72.3±25.4) min, and no secondary transfer occurred. Immediately after the operation, the esophageal ultrasound showed the left ventricular outflow tract pressure difference 8.7(5.9, 11.7) mmHg (1 mmHg=0.133 kPa). All patients were successfully removed from the ventilator in the ICU and the tracheal intubation was removed. The ICU stay time was 58.9(47.6, 71.5) h and the mechanical ventilation time was 18.0(17.0, 24.5) h. Transient atrioventricular block occurred in 2 patients (5.7%) after operation, and sinus rhythm was restored afterwords. The average hospital stay of all patients was (8.5±3.8) d. The ultrasound results before discharge showed that there were 32 patients with mild mitral regurgitation, 3 patients with moderate regurgitation and no aortic regurgitation. The left ventricular outflow tract pressure of all patients before discharge was 9.2(6.8, 12.3) mmHg. In addition, one patient occoured third degree atrioventricular block and received permanent pacemaker implantation. The rest patients were cured and discharged after active treatment and careful nursing. No serious complications occurred and no patient died.

The modified Morrow operation can effectively relieve left ventricular outflow tract obstruction in patients with HOCM, and careful and patient perioperative nursing plays an important role in ensuring the success of operation, and improving the prognosis.