替罗非班在急诊PCI患者中应用的护理措施及体会

Nursing measures and experience of using tirofiban in emergency percutaneous coronary intervention treatment L

目的探讨替罗非班在急诊经皮冠状动脉介入（PCI）术后患者中的临床疗效、护理措施及经验。方法 60例经桡动脉途径行急诊PCI的急性心肌梗死患者接受注射替罗非班,持续24-48 h。术后采取针对性临床观察及护理,总结护理经验。结果术中经冠状动脉内注射药物负荷量者有50例,所有患者替罗非班维持时间从术中至术后24-48 h,平均（30.5±8.1）h。患者药物维持过程中穿刺部位出现瘀斑10例,穿刺局部出血5例,血肿2例。自发性其他部位出血4例,其中多发性瘀斑1例,牙龈出血1例,血尿、血痰各1例。上述出血现象经过及时的发现、采取局部压迫,重新包扎或减量、停药等处理后得到了缓解,无严重颅内出血及消化道出血现象。所有患者术后胸痛缓解,心电图示ST段抬高的导联3 h下降〉50%占78%,住院期无急性血栓发生,无明显的医患矛盾。结论急性心肌梗死急诊PCI中使用替罗非班安全有效,针对性的护理对并发症防治起到重要作用。

Objective To explore clinical efficacy, nursing measures and experience of tirofiban on the emergency percutaneous coronary intervention（PCI） in patients. Methods A total of 60 patients with acute myocardial infarction and receieved primary PCI via radial artery approach were injected with tirofiban for 24-48 h. Targeted Clinical observation and nursing were applied to summarize nursing experience. Results There were 50 cases given a loaded amount of tirofiban by intracoronary way. The maintenance time of tirofiban was about 24-48 h with the average tim as（30.5±8.1）h. Ecchymosis appeared locally in 10 cases, bleeding in 5 cases, and hematoma in 2 cases. There were 4 cases of spontaneous hemorrhage from other parts of the body, including 1 case of multiple ecchymosis, 1 case of gingival bleeding, 1 case of hematuria and 1 case of blood sputum. Local compression, necessary reduction or shutdown of tirofiban and rewrapping were performed timely after the discovery of local bleeding. No severe intracranial hemorrhage or hemorrhage from digestive tract was detected. The patients with ST-segment resolution more than 50% during 3 h counted for 78%. There was no chest pain after PCI, no acute thrombosis occurred during hospitalization, and no obvious contradiction between doctors and patients. Conclusions The using of tirofiban on primary PCI of acute myocardial infarction is safe and effective, and targeted nursing plays an important role in the prevention of complications.