Case study of nursing care for a patient with pregnancy complicated by aortic dissection

CHENG Yun-qing; ZHOU Ying-shan; YANG Yuan-yuan; LI Na; LI Shu-ni; SUN Tu-Cheng

摘要：Background This study aims to analyze and summarize the postoperative nursing care of a patient with preg-nancy complicated by aortic dissection who achieved"four preservations"(preserving the fetus'life,the newborn's life,the pregnant woman's uterus,and the pregnant woman's aortic valve)in our hospital,in order to explore nurs-ing methods for such patients,summarize clinical experience,and guide clinical practice.Methods Our hospital treated a case of pregnancy complicated by aortic dissection in May 2022.After admission,the patient underwent major vascular surgery and developed chylothorax postoperatively.A nutritionist was consulted to calculate the pa-tient's nutritional needs and develop a daily meal plan.The nurse guided the patient to complete the required food in-take.The patient underwent both major vascular surgery and cesarean section;finding a balance between anticoagu-lation and bleeding was essential.A group discussion was organized,with daily blood tests performed to maintain the patient's INR between 1.8-2.5.How to initiate early postoperative activity for a pregnant patient after major vas-cular surgery has not been reported in the literature.The hospital's cardiac rehabilitation doctors and nurses devel-oped an exercise plan for the patient,and the nurse assisted the patient in gradually completing the program.The pa-tient simultaneously faced the dual roles of a mother caring for a newborn and a patient recovering from aortic dis-section surgery,enduring immense psychological pressure.To facilitate role transition and stress relief,a psychia-trist assessed the patient and provided psychological guidance and medication treatment based on the assessment re-sults.The nurse was responsible for monitoring,evaluating,and recording the patient's progress.Results The pa-tient successfully underwent concurrent major vascular replacement surgery and cesarean section,ensuring a safe childbirth for the mother and a successful delivery for the baby.The surgery also preserved the patient's aortic valve,eliminating the need for lifelong anticoagulant use,significantly improving the patient's postoperative quali-ty of life and reducing economic and psychological burdens.A uterine balloon was used intraoperatively and for seven days postoperatively to compress the uterus and stop bleeding,successfully preserving the patient's uterus.This case represents the first in Southern China to achieve"four preservations"in a pregnant patient with aortic dis-section.The patient recovered smoothly postoperatively,with no related complications and currently leads a healthy life.Conclusion Based on the patient's condition and pregnancy status,strengthening multidisciplinary collaboration,adopting the most appropriate surgical approach,and providing personalized nutritional care,antico-agulation care,rehabilitation exercises,and psychological and social support can shorten the hospital stay and pro-mote the patient's early recovery.Pregnancy complicated by aortic dissection is relatively rare in clinical practice.This case is the first in Southern China to achieve"four preservations"in a pregnant patient with aortic dissection.By analyzing the nursing care of this case,we comprehensively explored various aspects of postoperative care for the patient,summarized clinical experience,and aimed to guide clinical practice.[S Chin J Cardiol 2023;24(2):79-84]