关键词: 心脏瓣膜置换, 异常出血, 并发症, 再次手术, 影响因素, 护理干预

Abstract: Objective To explore the diagnosis and management of abnormal bleeding in patients after heart valve replacement surgery. Methods Thirty patients with abnormal bleeding after heart valve replacement surgery admitted to the First Affiliated Hospital of Guangzhou Medical University from January 2020 to May 2024 were retrospectively analyzed and divided into an observation group．In addition,200 patients who did not experience abnormal bleeding after heart valve replacement surgery admitted during the same period were selected as the control group．Prognosis of two groups of patients were compared,and the related indicators of diastolic blood pressure,systolic blood pressure,heart rate,and abnormal bleeding related to drainage flow within 3 hours after surgery were evaluated．Finally,the logistic regression model was used to analyze the influencing factors of abnormal bleeding in patients after heart valve replacement．Results The length of hospital stay and left ventricular ejection fraction in the observation group were higher than those in the control group,and the left ventricular end diastolic diameter was lower in the observation group than in the control group,and the incidence of postoperative infection,arrhythmia,and low cardiac output syndrome was significantly higher in the observation group than in the control group（P<0.05）．The postoperative diastolic blood pressure,systolic blood pressure,heart rate,and drainage volume within 3 hours in the observation group were significantly higher than those in the control group（P<0.05）．The smoking history,diabetes,and anticoagulation compliance were different between the observation and control groups（P<0.05）．A history of smoking and adherence to anticoagulation were independent influencing factors for abnormal bleeding in patients after heart valve replacement（P<0.05）．Conclusions The occurrence of abnormal bleeding in patients after heart valve replacement can greartly affect the patient's prognosis,increase the incidence of complications,and affect cardiac function recovery．Reference opinions can be provided for the diagnosis of abnormal bleeding based on diastolic blood pressure,systolic blood pressure,heart rate,and postoperative drainage volume within three hours．In addition,a history of smoking and adherence to anticoagulation are independent influencing factors for abnormal bleeding in patients after heart valve replacement．Therefore,while routine treatment is performed on patients with abnormal bleeding,close monitoring of patient risk factors is necessary,scientific nursing interventions should be implemented to improve patient adherence to anticoagulation and reduce the incidence of abnormal bleeding．

Key words: heart valve replacement, abnormal bleeding, complications, reoperation, influencing factors, nursing interventions