急性脑梗死患者机械取栓围手术期的护理

Perioperative nursing care for patients with acute cerebral infarction undergoing mechanical tethered operation

目的 介绍急性脑梗死患者机械取栓围手术期的护理观察及要点,以提高临床护理水平。方法 回顾性总结2016年以来,在本院神经内科住院的48例急性脑梗死患者机械取栓围手术期的护理经验。结果48例患者中除2例因术中路径过度迂曲取栓未成功外,另46例患者均进行了支架取栓。取栓后经血管造影显示40例(83.33%)患者的脑血管实现再通,治疗1周后34例(70.83%)患者运动及言语功能改善明显,6例(12.50%)患者由于病情较为危重,临床疗效不明显。曾有1例术后第2 d并发脑过度灌注综合征,经治疗后治愈出院,本组病例整体治疗效果满意。结论 急性脑梗死发病急、病情重,病死率及致残率极高,运用机械取栓治疗和配合围手术期的规范护理,如严密观察病情,尽快做好术前准备,取栓后予合适体位、保持呼吸道通畅、控制血压,预防颅内出血、脑过度灌注、下肢深静脉血栓形成等,可提高血管再通率和减少取栓术后并发症,改善预后。

Objective To improve the clinical care level introducing the nursing observation points of perioperative period of mechanical thrombectomy for patients with acute cerebral infarction.Methods The perioperative nursing experience of 48 patients with acute cerebral infarction who underwent mechanical thrombectomy at our hospital since 2016 was retrospectively summarized.Results Among the 48 cases,2 cases had unsuccessful thrombectomy because of the excessive flexion in the middle of the path,and the other 46 patients underwent stent thrombectomy successfully.After thrombectomy,angiography showed that 40 patients(83.33%)were re-canalized;and after 1 week’s treatment,34 patients(70.83%) had obvious improvement in exercise and speech function,and six cases(12.50%)got no obvious clinical effect because of the severity.One patient had a brain hyperperfusion syndrome 2 days after the operation,but was cured and discharged.The overall treatment effect was satisfactory.Conclusions Acute cerebral infarction is acute and serious and has high mortality and disability rate.Mechanical thrombectomy and perioperative standard nursing,such as disease condition observation,preoperative preparation,appropriate position after thrombectomy,maintaining airway patency,blood pressure control,and prevention of intracranial hemorrhage,brain hyperperfusion,deep vein thrombosis of lower extremities,etc.,can improve re-canalization rate and prognosis and reduce complications after thrombectomy.