心脏介入并发心脏压塞的早期识别与急救护理

Early Identification and Emergency Nursing of Cardiac Tamponade during Cardiac Catheterization and Surgical Intervention

目的探讨心血管病介入性诊治围手术期并发急性心脏压塞早期表现、急救治疗及护理。方法总结分析心血管病介入性诊疗围手术期患者发生急性心脏压塞时的早期临床表现,所采取的积极有效治疗及护理措施。结果12例患者中,8例以胸闷、气促为首发症状,6例患者伴心率增快,2例心率减慢,5例出现恶心,10例出现血压不同程度下降而提示发生了急性心脏压塞,10例患者发生于术中,2例患者发生于术后1.5 h后已回病房;抢救急性心脏压塞的关键在于快速心包穿刺并置管引流,PCI术中发生者,还应尽快封堵冠脉破裂口。12例患者均因术中及术后仔细观察病情,早期识别和积极有效的治疗及护理而抢救成功,无1例死亡。结论导管室及心血管病房护士应掌握急性心脏压塞的早期表现,特别是胸闷、气促及心悸等患者在术中的主诉,术中及术后应认真临床观察患者的心率、血压等病情变化,熟练心包穿刺引流操作及护理配合,对早期识别和赢得宝贵的抢救时间尤为重要。

Objective To explore the early presentations, emergency treatment and nursing care of the perioperative cardiac tamponade during cardiac catheterization and surgical intervention for cardiovascular diseases. Methods The early clinical mani-festation,treatment and nursing care of 12 patients with the perioperative cardiac tamponade during cardiac catheterization and surgical intervention for cardiovascular diseases were summarized and analyzed retrospectively. Results Among 12 cases of car-diac tamponade,the first symptoms in 8 cases were chest stuffy and anhelation,6 cases were with tachycardia,2 cases with brady-cardia,5 cases with the symptom of sicchasia,and 10 cases with various degree of decreased blood pressure which suggest an a-cute cardiac tamponade had happened. The onset of cardiac tamponade in 10 patients were in the process of catheterization, in 2 eases were 1.5 h after the surgical intervention. The key to emergency treatment of acute cardiac tamponade was prompt pericar-diocentesis and perieardial catheter drainage. For the cardiac tamponade in PCI, incision of coronary artery should be closed im-mediately. All 12 cases were successfully saved and none died. Conclusion Nurses in cardiac catheterization laboratory and car-diovascular ward should master the early clinical manifestation of the acute cardiac tamponade, especially the patients＇ complaint such as chest stuffy, anhelation and palpitation in the process of catheterization ; carefully observe patients＇ condition change such as heart rate and blood pressure, and be proficient at pericardiocentesis and perieardial catheter drainage operation and nursing cooperation, which play important roles in the early identification and emergency treatment of cardiac tamponade.