ACT监测配合专项护理在PCI围术期的应用效果

Application effect of ACT monitor cooperated with special nursing during PCI perioperation

目的观察监测激活全血凝固时间（ACT）在PCI围术期调整肝素使用剂量及其与临床护理配合的应用效果。方法选取2014年4月-2015年4月在解放军第306医院导管室行冠状动脉造影＋PTCA＋支架置入术并同时使用肝素进行抗凝的患者327例。通过ACT监测及术前护理访视，采集患者的危险因素，做好手术预案；以10岁为1个阶段按照年龄段进行分组，共分为5组．术中密切监测ACT值，观察患者危险情况；术后进行针对性指导。结果每组均有部分患者术后ACT值不达标．需追加肝素使用量。71例术前应用欣维宁的患者，术后实时监测ACT均在靶目标值200—250S范围之内：而在术前未应用欣维宁的256例患者中有41例术后ACT监测值未达到靶目标值，需追加肝素，其中55～64岁组别的ACT值不达标发生率最高，可达到20％。术前未使用欣维宁的患者有8例在术后因股动脉鞘管穿刺部位渗血而提前拔出鞘管，但术后ACT值位于靶目标值范围内。所有患者术中和术后均无卒中、出血和支架内血栓形成等并发症发生。结论ACT监测及与护理有效配合，确保了肝素在介入手术中的安全应用。

Objective To monitor the evaluation of heparin dose in activated clotting time （ACT） during PCI perioperation, and explore its application in clinical care. Methods Totally 327 patients with coronary angiography, PTCA and stent implantation, using heparin to anticoagulating simultaneously in conduit room of the 306th Hospital of PLA from April 2014 to April 2015. By ACT monitoring and preoperative nursing visit, we collected patients＇ risk factors, and made operation plans; patients were assigned to five groups by the stage of age, and ten year-old was taken as a stage. ACT was closely observed in the operation, and the risk situation of patients was also observed; after operation, specific guidance was taken. Results There were patients with substandard ACT in each group after operation, and needed additional heparin. 71 cases of patients with preoperative application of tirofiban, their postoperative ACT were within the target range 200-250 s ; among 256 patients without preoperative application of tirofiban, there were 41 patients whose ACT value does not reach the required target value and needed additional heparin, wherein the incidence rate of substandard VCT value of 55-64 year-old group was the highest and was 20%. Eight cases without preoperative application of tirofiban, bad sheath pipe pulled out because of errhysis in femoral artery sheath pipe puncture after operation, but their VCT value was within the target range of target value. All patients had no intraoperative and postoperative stroke, bleeding and thrombosis, ere.Conclusions ACT monitoring and effective coordination of care, can ensure the safety of heparin used in interventional procedures.