冠状动脉慢性完全闭塞病变介入治疗并发症的预防及护理

Prevention and Nursing of Perioperative Complications of Percutaneous Coronary Intervention for Coronary Artery Chronic Total Occlusion

目的探讨冠状动脉慢性完全闭塞病变(chronic total occlusion,CTO)介入治疗(percutaneous coronary intervention,PCI)围术期的护理重点,以降低并发症的发生率和提高患者的长期生存率。方法回顾性总结2003年1月至2010年2月行PCI治疗的824例冠状动脉CTO患者的临床资料及治疗护理措施,重点分析并发症的发生情况及预防、护理对策。结果 824例患者共处理冠状动脉CTO病变875处,成功开通731处,成功率为83.5%(731/875);并发症发生情况:冠状动脉穿孔8例,心脏压塞5例,急性心肌梗死4例,心力衰竭发生或加重7例,术中严重心律失常53例,术后2d因脑出血死亡1例。结论对冠状动脉CTO患者PCI围术期容易出现的严重并发症进行重点护理和预防,是减少并发症发生率、减轻并发症严重程度的有效措施,是提高PCI治疗效果的重要环节。

Objective To investigate the perioperative nursing points of patients with coronary artery chronic total occlusion（CTO） who underwent percutaneous coronary intervention（PCI） therapy so as to reduce the incident of complications and increase the long-term survival rate.Methods From January 2003 to February 2010,824 CTO patients confirmed by coronary angiography（CAG） received PCI,routine treatment and nursing.The patients’ clinical data and treatment and nursing procedures were summarized retrospectively with a selective analysis on the incidence of complications and preventive and nursing strategies.Results Of the 824 patients,CTO lesions were treated by 875 and successful opening were achieved in 731.The success rate was 83.5%（731/875）.Concerning the complications,coronary perforation occurred in 8 patients,pericardial tamponade in 5,acute myocardial infarction in 4,heart failure or worse in 7,serious arrhythmia surgery in 53 and death due to cerebral hemorrhage 2 days after opeartion in 1.Conclusion Intensive nursing and prevention of CTO patients who underwent PCI is effective in reducing the rates of severe complications and improving therapeutic effect of PCI treatment.