缺血性脑血管病支架植入联合脑动脉瘤栓塞治疗围手术期护理

Perioperative nursing care of stent implantation combined with cerebral aneurysm embolization for ischemic cerebrovascular disease

目的总结缺血性脑血管病支架植入+脑动脉瘤栓塞治疗的护理经验。方法回顾性分析2017年3月至2020年12月16例经股动脉穿刺行支架植入及弹簧圈栓塞治疗的缺血性脑动脉狭窄及动脉瘤患者的临床资料。结果16例患者中,术中发生动脉痉挛6例、颈动脉窦反应1例;术后24 h内发生脑栓塞3例,再发脑梗死3例,颈动脉窦反应、造影剂过敏、膀胱出血各1例,经精心治疗与护理,患者恢复良好,无死亡,也无脑出血、深静脉血栓等护理并发症发生。结论缺血性脑血管病支架植入联合脑动脉瘤栓塞治疗的围手术期护理重点在于:关注基础疾病及控制情况;关注重要时间节点,即术中血流重新分布时以及术后24 h内;关注手术部位尤其颈动脉;关注患者病情异常予及时处理。早期介入康复训练,全程做好患者及家属健康教育、基础护理等是降低致残致死率的重要保障。

Objective To summarize the nursing experience of stent implantation combined with cerebral aneurysm embolism treatment for the patients with ischemic cerebrovascular disease.Methods The nursing data of patients with ischemic cerebral artery stenosis and aneurysms treated with femoral artery puncture stent implantation and spring ring embolism from March 2017 to December 2020 was analyzed retrospectively.Results Among the sixteen patients,intraoperative arterial spasm occurred in six cases,and carotid sinus reaction in one case.Three cases of cerebral embolism,three cases of recurrent cerebral infarction,one case of carotid sinus reaction,one case of contrast agent allergy and one case of bladder hemorrhage occurred after 24 hours of operation.After careful treatment and nursing care,the patients recovered well.No death,cerebral hemorrhage,deep vein thrombosis and other nursing complications occurred.Conclusions The focus of ischemic cerebrovascular stent implantation in the treatment of hypothyroidism during perioperative period of surgery is to pay attention to the basic disease and situation controlling;the important time periods including the redistribution of blood flowand 24 hours after surgery;the surgical site,especially for the cervical artery as well as the abnormality of the patient's condition.Early intervention,rehabilitation training and health education are the important guarantee to reduce the fatality rate of disability.