I. Discharge precautions for post-operative cardiac patients
Patients discharged from the hospital is only the end of surgical treatment, does not mean that the body is completely recovered, therefore, the following issues should be noted after discharge.
(1) life should be regular: patients with precordial disease are weak after discharge, pay attention to rest, do not watch too much television, play and work, to ensure sufficient sleep, to maintain the appropriate temperature and humidity, family members and outsiders do not smoke in the patient’s bedroom, to keep the air fresh, the window can be opened every morning for half an hour, open the window to keep warm, the time should not be too long. If there is no condition for bathing, use warm water to scrub and keep the skin clean. Within 3 months of discharge, it is not advisable to go to public places to prevent infection of diseases. For heavier patients, it is best to have oxygen bags and bottles at home to use when necessary.
(2) Pay attention to dietary hygiene: Patients should pay attention to supplemental nutrition after discharge, and there are generally no special contraindications, but they should consume nutritious and easily digestible food, such as lean meat, fish, eggs, fruits and seasonal vegetables. General patients do not need to restrict the amount of salt. Those with complex deformities, low heart function and persistent postoperative congestive heart failure should strictly control salt intake, 4~8 grams per day for adults and 2~4 grams for children, and give easy-to-digest soft foods, such as chaos, noodles and thin rice.
Patients are advised to eat less and more meals, and the amount of food should not be too full, not to mention overeating, so as not to increase the burden on the heart. The diet should be fresh and hygienic to prevent diarrhea from aggravating the condition. Children should control snacks and drinks, and not consume snacks that are not clean, expired or contain more coloring and additives.
(3) Pay attention to appropriate activities: For patients with successful surgery, satisfactory deformity correction and faster postoperative recovery, activities are generally not restricted after discharge from the hospital. For those with cardiac function in class I or II, they can do some physical activities in daily life within their ability according to the situation. The range of activities should be indoor first and then outdoor.
Most patients can go to school or work after 3 months if there is no change in their condition after discharge, and gradually transition from light work to normal work. If you feel exertion or shortness of breath, you should stop working and continue to rest. Pre-operative patients with cardiac function above grade III, severely enlarged heart, severe pulmonary hypertension patients with normal or basically normal heart for a longer period of time should not rush to activities after discharge, pay attention to rest, maintain physical strength, appropriate amount of activities with the condition, but do not feel fatigue, so as not to increase the burden on the heart.
(4) Post-discharge medication: simple congenital heart disease patients with better postoperative recovery and normal heart function generally do not need to use cardiac and diuretics, patients with complex malformations and severe pulmonary hypertension or poor heart function should use cardiac (digoxin), diuretics or vasodilators for 3-6 months under the guidance of a doctor according to the correction of malformations, patients should use medication according to the doctor’s orders and should not be taken indiscriminately to avoid Danger.
(5) Maintain an optimistic mood. Regularly visit the hospital for checkups, at first monthly, then every 3 months until annual. If you have chest tightness or swelling of the lower limbs, you should come to the hospital for follow-up at any time. Avoid coughing and catching colds to avoid aggravating the heart burden. For rheumatic heart patients, it is important to prevent inflammation of the pharynx or tonsils after mitral valve separation surgery to avoid re-activation of rheumatism and reduce the effect of surgery.
(6) Certain common problems: the incision mostly heals in 7~8 days after surgery, and you can take a shower 10 days after surgery to avoid getting cold and rubbing the wound, and clean the wound with sterile water after the shower; if you find that the incision is oozing and red and swollen, you need to go to the hospital. It takes about 3 months for the sternum to heal, so pay attention to the correct posture to avoid the occurrence of “chicken chest”. If there is any discomfort or psychological factor, the fixed wire can be removed under local anesthesia one year after surgery. For details, please follow the doctor’s advice.
Second, cardiac surgery patients after discharge from hospital for review
Cardiac surgery patients should keep the discharge summary when they are discharged from the hospital, and should bring the discharge summary and the results of various tests done in other hospitals, such as X-ray chest film, electrocardiogram, laboratory tests, etc. for reference when they are reviewed. You can also contact the hospital by letter. The correspondence should include: how much activity you are currently doing (e.g., how many floors you can go up, how many miles you can walk, etc.); what kind of work and physical activities you can do; what symptoms or discomforts you usually have; what your diet is like; how much you urinate daily; whether you have been to the hospital recently for checkups, and if so, the results of your checkups; what medications you are currently taking and how much you are taking; and what other special discomforts you need from the hospital. Any other special discomfort that needs to be answered and assisted by the hospital.
After heart surgery, patients should seek medical review if they have
(1) Infection in any part of the body.
(2) Fever of unknown origin.
(3) If there is significant shortness of breath and swelling.
(4) If you have frothy, bloody sputum.
(5) When there is bleeding tendency such as subcutaneous bleeding or hematuria.
(6) When there is yellow staining of the sclera and peripheral skin.
(7) When new arrhythmia occurs.
(8) Sudden syncope, hemiparesis, or pain, cyanosis, or pallor in the lower extremities.
Early self-care after valve replacement
The 3 months after surgery is considered as “early postoperative period”, which is an important stage to recover the surgical trauma and stabilize the balance of various systems and organs. Within 3 months after surgery, patients should take sufficient rest, arrange regular rest and rest time, not to overwork, overexcite and participate in social activities; prevent colds, such as colds should be treated immediately with medication; increase activities appropriately and gradually, and do it according to ability, rest immediately when feeling panic and shortness of breath, and reduce the amount of activities; pay attention to increase nutrition in diet, eat more fruits, tonic, avoid overeating and alcoholism, control over According to the medical advice at the time of discharge, take some necessary medicines, such as anticoagulants, cardiac diuretics and potassium salts on time. During the medication period, you should pay attention to the change of your urine volume, any swelling and heaviness of the limbs. Check the prothrombin time regularly.
If the recovery is smooth and the body is capable of light work, gradually increase the workload to the extent that there is no panic and shortness of breath for another 2~3 months. Then you can resume full day light work, and then gradually try to transition to normal work, do not be happy for a while, suddenly increase the workload, resulting in damage to cardiac function.
Fourth, the law of anticoagulation therapy
After the installation of mechanical valves in the heart, must be lifelong anticoagulation, otherwise blood coagulation will occur in and around the valve, that is, affect the valve opening and closing function, but also can cause embolism of important organs of the body. Therefore, some kind of anticoagulant is required after valve replacement surgery to reduce blood coagulation and to prevent embolism from occurring. However, if anticoagulants are used improperly or in excess, they can easily cause bleeding tendency and are dangerous. Therefore, taking anticoagulants after surgery is a long-term and meticulous task.
(1) Anticoagulation therapy routine: anticoagulants are applied starting the day after mechanical flap replacement. Patients only need to follow the doctor’s instructions and cooperate closely. Currently, the commonly used oral anticoagulant is “Warfarin”. Usually Warfarin is 2~6 mg, taken once a day, and scheduled to be taken at a fixed time (afternoon), so that it will not be forgotten if it forms a habit.
(2) Prognosis and adjustment of drug dosage: blood coagulation examination should be conducted once in 1-2 weeks at the beginning of discharge, and if the prothrombin time or activity is stable within the satisfactory range for 1 consecutive month, the rechecking of prothrombin time can be extended, once in 3-4 weeks, and not less than once in 1 month thereafter. Each time the drug is adjusted, 1/4 of the maintenance dose can be increased or decreased, and the dose can be adjusted after 5~7 days of rechecking, as appropriate. If there is a tendency to bleeding should be reduced by 1/2 or suspended for 1 day, and then take half the amount for 3~5 days to review.
(3) Factors affecting the effect of anticoagulation.
Drugs — Some drugs directly or indirectly affect the coagulation and anticoagulation effect, (such as aspirin, pansentin, low molecular dextrose, bactrim, broad-spectrum antibiotics and long-acting sulfonamide, sodium hydantoin, etc. have increased the anticoagulation effect. Vitamin K, phenobarbital good, sleeper, birth control pills and hormonal drugs can reduce the anticoagulant (promote coagulation) effect, should try to switch to alternative drugs, such as must use, we must diligently check the prothrombin time and activity to adjust the amount of anticoagulant drugs as appropriate.
Food – Some foods contain vitamin K, such as spinach, cabbage, cauliflower, peas, and pork liver, etc. Excessive consumption will reduce the effect of anticoagulant drugs. After consumption, the prothrombin time and activity should be checked promptly to adjust the dose of anticoagulant drugs.
Disease—hepatobiliary disorders and heart failure will reduce the manufacture and secretion of vitamin K in the body, thus enhancing the effect of anticoagulants and predisposing to bleeding tendency, and the amount of anticoagulants should be reduced according to the prothrombin time and activity as appropriate.
(4) The performance and treatment of inappropriate anticoagulation.
Inadequate anticoagulation: Inadequate anticoagulation for a long time is likely to produce blood coagulation in and around the prosthetic valve, forming a thrombus. When the opening and closing of the prosthetic valve is affected, the first manifestation of cardiac insufficiency will occur, such as panic and shortness of breath, weakness, and restricted activity. At this time, the sound of opening and closing the prosthetic valve is not as crisp as before, and the sensation is low and dull, or even not easy to hear, so you should go to the hospital for examination.
Anticoagulation overdose: Due to the patient’s fear, most people take too much medication, resulting in bleeding tendencies. The common ones are gum bleeding, subcutaneous bleeding, subconjunctival bleeding, hematuria, prolonged menstruation, hemoptysis, vomiting blood and blood in stool, some of them show pain or paralysis in lower limbs, atrophy, which are signs of intermuscular bleeding, and in serious cases, intracranial bleeding may occur, causing coma and serious consequences. In the case of the above, anticoagulants can be stopped first, and nasal and gum bleeding can be directly blocked and compressed, while going to the hospital quickly to check the prothrombin time and activity, so as to adjust the amount of anticoagulants.
(5) replacement of biological or artificial valve ring anticoagulation: early after the replacement of biological or artificial valve ring (within 3 – 6 months) should be anticoagulation therapy, prothrombin time can be extended 1.5 times (18 – 20 seconds). Sometimes aspirin and pentoxifylline are used instead of anticoagulants.
V. Long-term postoperative precautions for patients with valve replacement.
(1) Strict control of infection: because once bacteria enter the bloodstream it is easy to cause endocarditis, affect the activity of the prosthetic valve, or cause embolism due to embolus dislodgment. Inflammation of whatever part of the body such as boils, gingivitis, colds, traumatic infections, pneumonia, nephritis, etc., should be promptly sought and immediately controlled with antimicrobial agents.
(2) Pay attention to the emergence of heart failure and arrhythmia: when the patient’s activities are more restricted than usual, easily appearing panic and shortness of breath, fatigue and weakness, or even unable to lie down, it means that the heart function is reduced, such as seeing a decrease in urine volume, swelling of the lower limbs, although taking cardiac diuretics still do not work, you should immediately go to the hospital for treatment.
Sixth, about rheumatic heart disease.
Abbreviated as rheumatic heart disease, is a common heart disease, is the consequence of rheumatic lesions invade the heart, manifested as valve orifice stenosis or incomplete closure, more women than men among patients. The damaged valve is most commonly the mitral valve, but several valves can be involved at the same time, called combined valve lesions. Due to recurrent valve inflammation, valve thickening and shortening, adhesions, and fibrosis result in valvular insufficiency and stenosis. In the early stage, it can be asymptomatic, but over time, it produces heart enlargement and arrhythmias, and heart failure usually occurs gradually over 10~15 years. Therefore, people suffering from wind heart disease should take rest and be treated under the guidance of a physician.