经皮冠状动脉介入治疗患者使用股动脉压迫止血器的不良反应及护理

The Adverse Reactions of Femoral Artery Oppression Hemostat on Patients Undergoing Percutaneous Coronary Interventional Therapy and the Nursing Strategy

回顾性总结分析了63例经皮冠状动脉介入治疗患者使用股动脉压迫止血器的不良反应:2例出现迷走神经反射,6例出现穿刺点出血、血肿或假性动脉瘤,11例出现穿刺点疼痛,19例出现腰背酸痛,15例出现皮肤损害。对出现迷走神经反射者拔鞘前向患者讲明拔管的目的、步骤及拔管后的注意事项,拔管整个过程与患者交谈,分散注意力;对疼痛敏感的患者可使用利多卡因麻醉穿刺口周围皮肤,两侧股动脉同时有伤口时不同时拔管。对穿刺点出血及血肿者,使用股动脉压迫止血器前需擦干皮肤上的血迹、汗迹、消毒液,防止因胶布不粘帖未有效止血而引起出血;护士分析了解每位患者潜在的出血因素,有针对性、有目的地进行观察和护理。对穿刺点疼痛者,在使用止血器时注意加压力度,避免穿刺部位压迫过紧,影响下肢血运。对腰背疼痛者术前加强健康教育、心理护理,训练床上翻身、大小便等,术后严密观察,由护士协助患者变动体位。对皮肤损害者使用股动脉压迫止血器前仔细询问患者有无胶布过敏史,备皮要干净、彻底,去除胶布时先用温盐水浸湿后再以180°角平着皮肤轻柔缓慢揭去胶布,防止牵扯体毛引起皮肤疼痛。

The author retrospectively summarizes and analyzes the adverse reactions of femoral artery oppression hemostat on 63 patients undergoing percutaneous coronary interventional therapy and the nursing strategy. 2 of them had vasovagal reflex, 6 had hemorrhage at puncturing point, hematoma and pseudoaneurysm, 11 had pains at the puncturing point, 19 had backache and 15 had skin damage. For those with vasovagal reflex, the patients were educated about the aim, step and notable points after withdrawing the tubes; the nurses kept talking to them all through withdrawing tubes to distracting their attention. For those with sense of pains, lidocaine was used to anesthetize the skin around the puncturing point and the tubes were forbidden to withdraw when there were wounds at the femoral arteries in both sides at the same time. For those with bleeding at the puncturing point and hematoma, bloodstain, sweat stain and disinfectant should be wiped out before use of femoral artery oppression hemostat to prevent bleeding due to non-stickiness of adhesive tape. The nurses should analyze the bleeding factors of every patient and render care to them. For those with pains at the puncturing point, the pressing should be appropriate lest it was too strong and affect the blood circulation in the lower extremities. For those with backache, health education, mental care, on-bed exercises of overturning and pissing should be enhanced and the nurses should assist them to alter body position. For those with skin damage, the nurses should inquire them if they were allergic to adhesive. The skin should be cleanly and thoroughly prepared. At removing the adhesive, it should be humidified with saline and slowly removed at an angle of 180° to prevent skin ache.