冠心病患者经皮腔内冠状动脉成形术后1周内心功能改变及护理对策

Change of Heart Function after Percutaneous Transluminal Coronary Angioplasty(PTCA) in Patients with Coronary Heart Disease and Nursing Strategy

目的 评估冠心病患者经皮冠状动脉成形术 (percutanueoustransluminalcoronaryangioplasty,PTCA )术后 1周内心功能的改变 ,为完善PTCA围手术期护理方案提供理论依据和参考。方法 对 6 0例成功行PTCA及PTCA +支架术的冠心病患者 ,于术前 1d、术后 1～ 7d每日定时测定血流动力学参数。结果 两组患者的每搏血量 (SV)、心输出量 (CO)、心脏指数 (CI)、每搏功指数 (SWI)、心肌收缩力 (MCF)、左室总泵力 (TPF)、左室射血分数 (LVEF)及心肌耗氧量 (MVO)在术后均有一定程度的降低 ,术后第 3天最低 ,至术后第 5天或第 7天恢复至术前水平。反映心脏舒张功能的指标术后各天未见明显改变 ,均与术前无显著差异 (P >0 .0 5 )。结论 血流动力学指标的改变显示 ,PTCA术后 1周内心功能经历了从减退到逐渐恢复的过程 ,提示患者仍存在着潜在的心肌缺血的可能。PTCA术后护理应针对患者心功能的变化特征 。

Objective To provide a theoretic foundation for improving perioperative nursing programs for PTCA patients by observing related parameters reflecting changes of heart function within a week after PTCA.Methods In 60 patients with successful PTCA and stent PTCA, some hemodynamic parameters were measured at a given time 1 d before operation and daily 7 d after operation.Results Hemodynamic parameters measured after operation were lower than those before operation to some degree, including SV, CO, CI, SWI, MCF, TPF, LVEF and MVO, which reached the lowest levels on d 3 and restored to normal on d 5 or 7 after operation. In addition, the parameters reflecting cardiac diastolic function changed insignificantly after operation.Conclusions Pre and postoperative changes of hemodynamic parameters showed that heart function within a week after PTCA undergoes a process from dropping to recovering, suggesting that patients are still at risk for potential myocardial ischemia. Postoperative nursing interventions should focus on monitoring heart function at appropriate time according to the changing characteristics of heart function of the patients.