摘要
目的总结主动脉内球囊反搏联合体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)支持下老年高危冠心病患者行经皮冠状动脉介入术的围术期护理经验。方法对2019年1月—2020年1月本院收治采用主动脉内球囊反搏联合ECMO支持下行经皮冠状动脉介入术9例老年高危冠心病患者,在围术期实施如下护理措施:术前做好物品准备和患者准备;在主动脉内球囊反搏术中,实施制动护理、穿刺部位护理、停机及拔管护理及反搏效果观察;ECMO中,严密观察血流动力学、出入液量及体温、凝血酶原时间的监测及预防并发症的发生;经皮冠状动脉介入术中,做好穿刺侧肢体疼痛护理和血流动力学的观察及护理等。结果患者手术均获得成功,手术时间(4.0±0.7)h。1例行经皮冠状动脉介入术中发生心血管链崩溃,2例穿刺部位发生血肿,1例术后发生尖端性扭转室速和室颤,经处理以上症状均得到缓解。结论术前做对好物品准备和患者准备是手术顺利完成的基础;做好主动脉内球囊反搏术护理配合及ECMO循环支持的护理是保证经皮冠状动脉介入术成功的保证。
Objective To summarize the perioperative nursing experience of percutaneous coronary intervention(PCI)in elderly patients with high-risk coronary heart disease supported by intra-aortic balloon counter-pulsation(IABP)combined extracorporeal membrane oxygenation(EMO).Methods From January 2019 to January 2020,9 patients with high-risk coronary heart disease were enrolled in our hospital.They underwent percutaneous coronary intervention with the support of IABP and ECMO.In ECMO,the hemodynamics,fluid volume,body temperature,and prothrombin time were carefully observed,and complications were prevented.In IABP,physical restrction,nursing of puncture side,stopping work of IABP,extubation and couter-pulsation effect were well observed and nursed.Results All operation was successful.The operation time was(4.0±0.7)h.One case had hemodynamic collapse during the percutaneous coronary intervention.Two cases had hematoma at the puncture site.One case had ventricular fibrillation.All of the above symptoms were relieved after treatment.Conclusions For high-risk PCI patients who are not suitable for cardiac surgery,it is feasible and safe to combine ECMO with IABP to support HRPCI.There are many devices used in operation,and the difficulty of nursing in operation is increased.
作者
杨华
程湘琦
刘聪聪
何玉腊
高好考
贺媛
张亚敏
Yang Hua;Cheng Xiangqi;Liu Congcong;He Yula;Gao Haokao;He Yuan;Zhang Yamin(The First Affiliated Hospital of Air Force Military Medical University,Xi'an,710032,China;Xi'an Hospital of Traditional Chinese Medicine,Xi'an,710021,China)
出处
《现代临床护理》
2020年第6期55-60,共6页
Modern Clinical Nursing
关键词
冠心病
老年
主动脉内球囊反搏
体外膜肺氧合
围术期护理
coronary heart disease,the old
intra-aortic balloon counter-pulsation
extracorporeal membrane oxygenation
nursing cooperation
