Is aortic dissection serious? What should I pay attention to during bed rest during an acute attack?

Author: Zhao Hongxia, deputy chief nurse, Beijing Anzhen Hospital, Capital Medical University

Reviewer: Zhi Xiuyi, Chief Physician, Xuanwu Hospital, Capital Medical University

Aortic dissection is relatively rare in clinical practice, but the condition is dangerous, progresses rapidly, and has a high mortality rate, about 50% within 48 hours. For every additional hour of untreated acute aortic dissection, the mortality rate increases by 1%. If it is discovered early, diagnosed and treated in time, the patient's survival rate will be significantly improved.

There are many causes of aortic dissection, such as poorly controlled hypertension, which accounts for about 75%; in addition, connective tissue diseases such as atherosclerosis, Marfan syndrome, trauma, pregnancy, drug abuse, etc. can all cause aortic dissection.

In terms of gender, the incidence rate in men is twice that in women, and the age of onset is approximately between 40 and 60 years old.

The most prominent symptom of aortic dissection is sudden pain in the chest, back and abdomen. This pain is described as tearing or knife-like pain, often with a feeling of impending death.

Figure 1 Original copyright image, no permission to reprint

If you experience unexplained chest pain, difficulty breathing, or even fainting at home, you should immediately go to bed and rest. The patient or family members should immediately call 120, wait for emergency personnel to come to your home, and send you to a nearby hospital for diagnosis and treatment.

It should be emphasized that at this time, do not randomly perform pressure, medication, patting, hot compress, etc. on the patient. Without finding out the cause, these operations will not only fail to solve the problem, but will also threaten the patient's life.

Chest pain caused by angina pectoris can be relieved in about 15 minutes, and taking nitrate drugs is effective. However, chest pain caused by aortic dissection can last for more than a few hours, and general painkillers are ineffective. Only lowering blood pressure and giving strong analgesics such as morphine and pethidine will be effective.

So when this happens, what the patient can do is seek medical attention immediately and let the doctor diagnose whether it is coronary heart disease, aortic dissection, etc.

If aortic dissection occurs, the acute phase lasts for two weeks and the patient should absolutely stay in bed.

Patients who stay in bed for a long time should pay attention to preventing the formation of lower extremity venous thrombosis, such as pumping ankle exercises, and properly moving the ankle, knee, wrist, elbow, and shoulder joints. However, it should be noted that large exercises are not recommended, and attention should be paid to avoiding or reducing coughing, sneezing and other actions to avoid increasing chest and abdominal pressure.

For patients who have just been admitted to the hospital, if the oxygen saturation is low, oxygen therapy is still needed. When oxygen is inhaled, pay attention to the patient's oxygen saturation. If the oxygen saturation is lower than 93%, increase the oxygen flow or use dual-channel oxygen inhalation.

For example, if the patient feels dryness in the nasal cavity, he or she can communicate with the nurse in time and change the nasal oxygen tube to mask oxygen inhalation, and humidify the oxygen to alleviate the discomfort symptoms.

For patients and their families, do not adjust the oxygen flow by themselves, because when the oxygen flow is too high, it will cause dryness in the nasal cavity, which is not good for the patient.

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In addition, during oxygen inhalation, if the patient feels short of breath or uncomfortable, he or she should promptly report it to the medical staff, who will also monitor the patient's oxygen saturation in real time.

Patients with aortic dissection need to defecate in bed during acute bed rest, and constipation is also a common problem.

Patients should pay attention to eating more crude fiber vegetables and fruits. If their heart function is not damaged, it is recommended to drink more water. They can also eat more foods that are easy to defecate, such as sweet potatoes.

For patients with severe constipation, doctors give them some laxatives, such as lactulose, laxatives, etc. In clinical practice, lactulose has a better effect in promoting excretion. At the same time, it should be noted that enema is not recommended because it increases abdominal pressure and easily causes aortic dissection.

Some patients may have difficulty urinating because they are not used to defecating in bed. At this time, you can let the patient listen to the sound of water, apply hot compress on the lower abdomen, listen to music to relax, and if it still doesn't work, place a urinary catheter to urinate.

Therefore, patients do not need to worry too much. If they are unable to urinate or defecate, medical staff will help them take appropriate measures.