直接数字化X射线摄像系统监控下肢深静脉顺行造影术患者的护理

Experience in Caring Patients Undergoing Radiography on Deep Veins of Lower Limb Monitored under Digital Radiograph

总结了257例直接数字化X射线摄像系统(DR)监控下行下肢深静脉顺行造影术的护理经验。患者取仰卧位,患肢踝关节上方5 cm扎止血带,采用9号头皮针经内踝旁侧的大隐静脉做逆心方向穿刺,注入30%～35%的造影剂30～50 ml。术前给予细致的心理护理和护理评估,对有造影禁忌证者尽量不做此项检查,合并高血压、冠心病等高危因素者予积极处理后再行检查;术中做好患者的体位护理,保持舒适并防止坠床,注意患者X射线防护,严格掌握造影剂注射用量30～50 ml、速度1 ml/s、浓度30%～50%,密切观察并预见性处理患者对造影剂的各种反应,如过敏、局部肢体反应和肾毒性。本组244例顺利完成造影检查,13例在造影过程中或术后出现不良反应,造影过程中3例出现恶心、呕吐,1例心慌胸闷,7例诉肢体疼痛,经适当处理后,症状缓解,继续完成造影;1例发生过敏性休克而终止造影;1例造影4 h后出现短暂肾功能受损,经对症处理后,肾功能恢复。本组全部病例血管显影清晰,对比度良好,病变部位显示清楚。

The author summarizes the experienee in caring 257 patients undergoing radiography on deep veins of lower limb monitored under digital radiograph （DR）. The patients took supine position, the ankle of diseased limb ligated, the great saphenous vein beside inner ankle punctured with a size-9 scalp acupuncture and 30-50 ml contrast agent at 30%-50% injected into the vein. Before operation, the patients were cared mentally and nursing assessment was conducted： those allergic to the contrast agent were away from the examination and those with hypertension and coronary artery disease underwent the examination after active treatment. During operation, they were cared at body position to keep satisfactorT and prevent falling out of bed, and they were prevented from X-ray; on the other hand, the agent was injected rigidly at a volume of 30-50 ml, at a speed of 1 ml/s and at a concentration of 30%- 50%, all reactions like allergy, reaction at local limb and renal toxicity during injection were closely observed and treated with prediction. Subsequently, 244 cases completed radiography and 13 had adverse reactions at or after the operation： 3 of them had nausea and vomiting, 1 had chest distress, 7 complained about pains in limbs which were properly treated for the fulfilhnent of radiography and 1 quitted the examination because of allergic shock and 1 had his renal function damaged 4 hours after radiotherapy, which was restored after treatment. As a result, the imaging of blood vessels for all cases were sharp, with good contrast and the foci clearly demonstrated.