96 Nursing Care of EVAR Dolinger & Strider, Walker et al., 2010 Trimarchi et al., 2006 Dolinger & Strider, thoracic aortic a

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1 95 血管腔內主動脈瘤修復手術 (EVAR) 的護理 * 1 護理 2 3 護理護理護理護理 4 摘要 : 年 endovascular aneurysm repair, EVAR stent-graft 年年護理期護理護護理護關鍵詞 : 護理 Svensson et al., 2008 stent-graft endovascular aneurysm repair, EVAR a 2013b EVAR minimally invasive surgery abdominal aortic aneurysm, AAA; Parodi, Palmaz, & Barone, 1991 thoracic aortic aneurysm, TAA A B type A & type B aortic dissection aortic aneurysm and aneurysm rupture penetrating aortic ulcer traumatic aortic injury Cao, Bannon, Shee, & Yan, % 6% Nordon, Hinchliffe, Loftus, Morgan, & Thompson, 2011 Jonker 2010 thoracic endovasular aortic repair, TEVAR; n = 143 n = 81 19% 33% 4.1% 10.2%paraplegia 3.1% 5.5% TEVAR Mastroroberto, Onorati, Zofrea, Renzulli, & Indolfi, 2010 Blankensteijn, De Bruin, & Baas, * jung@ms2.mmh.org.tw doi: /jn 護理雜誌 61 卷 2 期中華民國 103 年 4 月

2 96 Nursing Care of EVAR Dolinger & Strider, Walker et al., 2010 Trimarchi et al., 2006 Dolinger & Strider, thoracic aortic aneurysm or thoracoabdominal aortic aneurysm penetrating aortic ulcer, PAU 3. aortic dissection complicated type B dissection 6 hybrid type A surgery 4. coarctation or aberrant artery from aorta5. traumatic aortic rupture; 2013a b 60 Walker et al., 2010 β- mean arterial pressure Kwolek & Blazick, 2010; Latessa, U heparin 100~150U/Kg/each 50 mins Dolinger & Strider, 2010 Xcarm X ray % neck 2 C- arm Dolinger & Strider, 2010; Latessa, 2002 C- arm The Journal of Nursing Vol. 61, No. 2, April 2014

3 97 95% Dolinger & Strider, 2010 Dake et al., Latessa, 2002 endoleak Latessa, 2002 type Itype II type III 5 type III type IV Walker et al., 2010 type Vendotension Ricotta, 2010 type I type III type II type IV type V Cao, De Rango, Verzini, & Parlani, Latessa, 2002 puncture coil embolization Cao et al., Latessa, 2002; Pitton, 2006 Pitton, 2006; Ricotta, Latessa, 2002 Dolinger & Strider, 2010 embolism X 24 Dolinger & Strider, 2010 Latessa, mmhg 70 mmhg Dolinger & Strider, 2010 X Baril, Cho, Chaer, & Makaroun, X Latessa, 2002 護理雜誌 61 卷 2 期中華民國 103 年 4 月

4 98 Nursing Care of EVAR Baril et al., 2010 cerebrospinal fluid, CSF cmh 2 O 10 cmh 2 O cmh 2 O Diethrich, Dolinger & Strider, 2010; Latessa, 2002 Kwolek & Blazick, 2010 Dolinger & Strider, Kwolek & Blazick, [Shih, C. C. (2007). New era of mini-invasive treatment of abdominal aortic aneurysm. VGH Nursing, 24(1), 1 7.] 2013a Webdata/18302_2_.pdf [Ministry of Health and Welfare, Taiwan, ROC. (2013a). Indications of thoracic aortic aneurysm endovascular repair. Retrieved from b (990401).doc [Ministry of Health and Welfare, Taiwan, ROC. (2013b). Indications of abdominal aortic aneurysm endovascular repair. Retrieved from (990401).doc] Baril, D. T., Cho, J. S., Chaer, R. A., & Makaroun, M. S. (2010). Thoracic aortic aneurysms and dissections: Endovascular treatment. Mount Sinai Journal of Medicine, 77(3), doi: /msj Blankensteijn, J. D., De Bruin, J. L., & Baas, A. F. (2012). Decision making in AAA repair in 2012: Open or endo? The Journal of Cardiovascular Surgery, 53(1, Suppl.), Cao, C. Q., Bannon, P. G., Shee, R., & Yan, T. D. (2011). Thoracic endovascular aortic repair--indications and evidence. The Journal of Nursing Vol. 61, No. 2, April 2014

5 99 Annals of Thoracic and Cardiovascular Surgery: Official Journal of the Association of Thoracic and Cardiovascular Surgeons of Asia, 17(1), 1 6. doi: /atcs. ra Cao, P., De Rango, P., Verzini, F., & Parlani, G. (2010). Endoleak after endovascular aortic repair: Classification, diagnosis and management following endovascular thoracic and abdominal aortic repair. The Journal of Cardiovascular Surgery, 51(1), Dake, M. D., Miller, D. C., Semba, C. P., Mitchell, R. S., Walker, P. J., & Liddell, R. P. (1994). Transluminal placement of endovascular stent-grafts for the treatment of descending thoracic aortic aneurysms. The New England Journal of Medicine, 331(26), doi: / NEJM Diethrich, E. B. (2008). Technical tips for thoracic aortic endografting. Seminars in Vascular Surgery, 21(1), doi: /j.semvascsurg Dolinger, C., & Strider, D. V. (2010). Endovascular interventions for descending thoracic aortic aneurysms: The pivotal role of the clinical nurse in postoperative care. Journal of Vascular Nursing, 28(4), doi: /j. jvn Jonker, F. H., Trimarchi, S. T., Verhagen, H. J., Moll, F. L., Sumpio, B. E., & Muhs, B. E. (2010). Meta-analysis of open versus endovascular repair for ruptured descending thoracic aortic aneurysm. Journal of Vascular Surgery, 51(4), doi: /j.jvs Kwolek, C. J., & Blazick, E. (2010). Current management of traumatic thoracic aortic injury. Seminars in Vascular Surgery, 23(4), doi: /j.semvascsurg Latessa, V. (2002). Endovascular stent-graft repair of descending thoracic aortic aneurysms: The nursing implications for care. Journal of Vascular Nursing, 20(3), doi: /mvn Mastroroberto, P., Onorati, F., Zofrea, S., Renzulli, A., & Indolfi, C. (2010). Outcome of open and endovascular repair in acute type B aortic dissection: A retrospective and observational study. Journal of Cardiothoracic Surgery, 5(23), 1 7. doi: / Nordon, I. M., Hinchliffe, R. I., Loftus, I. M., Morgan, R. A., & Thompson, M. M. (2011). Management of acute aortic syndrome and chronic aortic dissection. Cardiovasc Intervent Radiology, 34(5), doi: /s Parodi, J., Palmaz, J., & Barone, H. (1991). Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Annals of Vascular Surgery, 5(6), doi: / BF Pitton, M. B. (2006). Diagnosis and management of endoleaks after endovascular aneurysm repair: Role of MRI. Abdominal Imaging, 31(3), doi: /s Ricotta, J. J., Jr. (2010). Endoleak management and postoperative surveillance following endovascular repair of thoracic aortic aneurysms. Journal of Vascular Surgery, 52(4, Suppl.), 91S 99S. doi: /j.jvs Svensson, L. G., Kouchoukos, N. T., Miller, D. C., Bavaria, J. E., Coselli, J. S., Curi, M. A., Wheatley, G. H., III. (2008). Expert consensus document on the treatment of descending thoracic aortic disease using endovascular stent-grafts. The Annals of Thoracic Surgery, 85(1, Suppl.), S1 S41. doi: /j.athoracsur Trimarchi, S., Nienaber, C. A., Rampoldi, V., Myrmel, T., Suzuki, T., Bossone, E., Eagle, K. A. (2006). Role and results of surgery in acute type B aortic dissection: Insights from the international registry of acute aortic dissection (IRAD). Circulation, 114(1, Suppl.), doi: /cir- CULATIONAHA Walker, T. G., Kalva, S. P., Yeddula, K., Wicky, S., Kundu, S., Drescher, P., Cardella, J. F. (2010). Clinical practice guidelines for endovascular abdominal aortic aneurysm repair: Written by the standards of practice committee for the Society of Interventional Radiology and endorsed by the Cardiovascular and Interventional Radiological Society of Europe and the Canadian Interventional Radiology Association. Journal of Vascular and Interventional Radiology, 21(11), doi: /j.jvir 護理雜誌 61 卷 2 期中華民國 103 年 4 月

6 100 Nursing Care of EVAR Nursing Care of Endovascular Aneurysm Repair Patients Ya-Fen Fan 1 Chen-Yen Chien 2 Hui-Yuan Yang 3 Jung-Mei Tsai 4 * 1 MSN, RN, Nurse Practitioner, Department of Cardiovascular Surgery, Mackay Memorial Hospital; 2 MD, Physician, Department of Cardiovascular Surgery, Mackay Memorial Hospital; 3 MSN, RN, Department of Nursing, Mackay Memorial Hospital; 4 MSN, RN, Supervisor, Department of Nursing, Mackay Memorial Hospital and Instructor, Department of Nursing, Mackay Medical College. ABSTRACT: The treatment of aortic disease previously used conventional open surgery to replace the aorta with artificial vascular prosthesis after resecting the lesioned segment. The recently developed technique of endovascular aneurysm repair (EVAR) uses a stent graft to reinforce the diseased aortic wall while allowing blood flow continuity and preventing further aortic expansion, dissection and aortic rupture. Taiwan s National Health Insurance now covers payment for authorized EVAR procedures, making treatments safer for patients who are elderly, have congestive heart failure, have multiple comorbidities, or have other high-risk factors. EVAR is gradually replacing previous methods to become the primary treatment approach for aortic disease. This article discusses the development of EVAR, indications, operative procedures, complications, postoperative risk factors, and clinical nursing problems. We hope that this article provides new information on nursing care for patients undergoing endovascular aneurysm repair surgery. Key Words: endovascular aneurysm repair, aortic stent graft, nursing. Accepted for publication: April 24, 2013 *Address correspondence to: Jung-Mei Tsai, No. 45, Minsheng Rd., Tamshui District, New Taipei City 25160, Taiwan, ROC. Tel: +886 (2) ext. 2601; jung@ms2.mmh.org.tw The Journal of Nursing Vol. 61, No. 2, April 2014

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<4D6963726F736F667420576F7264202D203035BA43A9CAB5C7B049BADCB177AACCAABAC0E7BE69B7D3C5402DB3AFBEE5AF5CA141B3AFA5C9B1D32E646F63> 慢性腎衰竭患者的營養照護陳曉珮陳玉敏 * 摘要營養不良的問題常見於慢性腎衰竭的患者, 且與心血管罹病率及死亡率有密切相關護理人員在面對此類患者逐年上升的情況下, 應具備營養照護的相關知識, 才能給予適當的營養介入, 以