颈动脉支架成形术围手术期并发症的护理

CAROTID ANGIOPLASTY AND PERIOPERATIVE CARE

目的本研究结合我院脑血管病中心近年来颈动脉支架围手术期护理经验,探讨颈动脉狭窄血管内支架成形术围术期的护理方案。方法通过回顾性分析我科59例行颈动脉支架成形术患者围手术期出现的并发症,总结护理经验,提出合理的护理方案。结果 59例患者共置入颈内动脉支架64枚,颈动脉支架64枚全部放置成功,技术成功率100%,但有4例发生手术相关并发症(占6.2%)。1例患者出现术后血压低,心率过慢,给予持续静滴阿托品及多巴胺1 w后恢复正常;1例患者术后肢体乏力加重,复查头颅MR见多发脑梗,考虑小栓子脱落;1例患者术中支架内急性血栓形成,给予尿激酶溶栓后完全恢复正常;1例患者出现术后颅内出血,脑疝死亡。结论对颈动脉狭窄接受经皮血管内支架成形术治疗的患者在围术期进行精心护理,是提高治疗效果的重要保证。术前心理护理、充分准备是手术成功的基础,术中密切观察患者生命体征变化及心理护理安慰和医护配合是支架成功的保证,术后生命体征和神经系统功能的监测以及对患者及其家属的术后防止出现并发症的指导是预防并发症的关键。

Objective Combined with our experience in carotid stent,to discuss the carotid artery stenting reasonable perioperative care program.Methods By analyzing 59 case of carotid artery stenting patients and perioperative complications,sum up nursing experience,Propose reasonable care program.Results 59 patients implanted with 64 carotid artery stenting,and all 64 cases of carotid artery stent placement achieved success,technical success rate was 100%,but 4 patients had surgical complications,accounting for 6.2%.One case of postoperative patients with low blood pressure,heart rate too slow,being given continuous intravenous atropine and dopamine,then returned to normal after one week;one case of postoperative limb weakness increased,head MR show multiple brain stem,taking off small emboli;one case patient had acute stent thrombosis in the operating,back to normal after urokinase;one patients had intracranial hemorrhage,the patient died of cerebral hernia.Conclusion Perioperative intensive care is an important guarantee for treatment.Preoperative psychological care,adequate preparation is the basis of successful operation;In the operation,close observation of vital signs,medical and psychological care is a guarantee of stent success;Monitoring of vital signs as well as guiding for patients and their families to prevent complications after surgery is the key to preventing complications.