44例症状性椎动脉闭塞复合再通手术的护理配合

Nursing cooperation in 44 cases of recanalization of symptomatic vertebral artery occlusion

目的探索椎动脉闭塞复合再通手术的护理配合方法,为临床提供切实可行的借鉴依据.方法首都医科大学宣武医院在国际上较早开展椎动脉闭塞复合再通术,本研究根据椎动脉位置深、周围组织血管丰富的解剖特点对2014年10月—2019年2月44例椎动脉复合手术配合进行总结.症状性椎动脉闭塞复合再通术中护理配合的要点包括:护士术前与医生沟通,熟悉知晓手术方案和整个流程做好护理预案;根据数字减影血管造影(DSA)结果备好术中特殊用物及深部手术器械;术中抗凝与血栓的护理;手术室所用仪器布局合理,避免反复移动;手术团队的流畅配合是保证椎动脉开通手术的安全起到至关重要的作用.结果44例椎动脉再通均成功,其中26例采用椎动脉内膜剥脱联合支架植入,18例单纯造影,1例单纯球囊扩张,椎动脉转位联合支架植入2例.结论手术护士灵活、高效、全面的配合是保证椎动脉闭塞复合再通手术顺利进行的重要环节.

Objective To explore the methods of nursing coordination in recanalization operations for vertebral artery occlusion and provide feasible reference for clinical practice. Methods Xuanwu Hospital of Capital Medical University had carried out recanalization of vertebral artery occlusion earlier than most hospitals world-widely. This study summarized 44 cases of recanalization of vertebral artery occlusion from October 2014 to February 2019 according to the anatomical characteristics of the deep position of vertebral arteries and abundant blood vessels in surrounding tissues. The key points of nursing cooperation during recanalization of symptomatic vertebral artery occlusion included: communication with doctors before operation, familiarity with the operation plan and nursing plan preparation for the whole process;preparation of special intraoperative instruments and deep surgical instruments according to the results of digital subtraction angiography (DSA);anticoagulation and thrombus nursing during operation;appropriate arrangement of the instruments in the operating room and avoidance of repeated moving as well as the smooth cooperation between members of the surgical team are the key factors to ensure the safety of the recanalization operation for vertebral artery occlusion. Results All the 44 cases of vertebral artery recanalization were successful, including 26 cases of vertebral artery endarterectomy combined with stent implantation, 18 cases of simple angiography, 1 case of simple balloon dilation, and 2 cases of vertebral artery transposition combined with stent implantation. Conclusions The flexible, efficient and comprehensive cooperation of surgical nurses is the key step of the successful operation of recanalization of vertebral artery occlusion.