经桡动脉 PCI 术后冠状动脉痉挛的原因分析及护理对策

Reason analysis and nursing strategy of coronarospasm after percutaneous coronary intervention

目的：探讨 PCI 术后发生冠状动脉痉挛的原因及最佳护理对策。方法选择2012年1月—2013年6月行 PCI 术的冠心病患者1064例,根据随机数字表法分为4组,每组266例。4组患者穿刺桡动脉成功,置入桡动脉鞘后,经鞘内注入相应药物。 A 组经鞘管给予硝酸甘油200μg ＋维拉帕米1 mg；B 组给予硝酸甘油200μg；C 组给予维拉帕米1 mg；对照组给予0.9%氯化钠溶液5~10 ml。比较各组桡动脉痉挛发生率。结果桡动脉痉挛发生率 A 组为0.75%,B 组为1.5%,C 组为4.4%,对照组为5.64%,A 组、B 组与对照组比较差异均有统计学意义（χ2值分别为6.3868,6.6043；P ＆lt;0.05）；32例PCI 术后冠状动脉痉挛患者全部抢救成功。结论应用预防桡动脉痉挛、冠状动脉痉挛药物,充分应用全程精细化优质护理,可减少 PCI 术后冠状动脉痉挛的发生。

Objective To explore the reason and nursing strategy of coronarospasm after percutaneous coronary intervention（PCI）. Methods A total of 1 064 patients with coronary heart disease, who were given PCI from January 2012 to June 2013 in our department, were randomly divided into groups A, B, C and D, 266 cases for each. All patients were successfully punctured radial artery and given corresponding medicines through tubes in radial artery sheaths. Patients in the group A was given 200 μg nitroglycerin and 1 mg verapamil, patients of the group B with 200 μg nitroglycerin, patients with 1 mg verapamil in the group C, while patients in the group D served as control group and was given 5 - 10 ml normal saline. The incidences of patients with spasms in each group were compared. Results Radial artery spasm were 0. 75% in the group A, 1. 5% in the group B, 4. 4% in the group C, and 5. 64% in the control group, and the result of control group had statistical significance with that of group A and B （ χ2 = 6. 386 8,6. 604 3; P ＆lt; 0. 05）. A total of 32 cases with coronarospasm after PCI all had been rescued. Conclusions Application of medicines for preventing radial and coronary artery spasms and careful nursing can effectively decrease the rate of artery spasms.