CAJ | 학술논문

目的探讨慢性血栓栓塞性肺动脉高压患者行肺动脉介入治疗术对并发症的预防和护理,降低病死率和致残率.方法对8例在局麻下行双侧肺动脉造影+右心导管+肺动脉介入治疗术的患者,实施手术前后一对一心理指导和健康宣教,建立预防穿刺点出血、急性肺水肿等并发症的预案.结果 8例患者在情绪稳定的状态下顺利完成介入治疗,术中未发生肺动脉破裂而造成致命性咯血、肺动脉夹层动脉瘤或假性动脉瘤等严重并发症.8例患者术后7h内血氧饱和度、收缩压、舒张压、心率的最低值与最高值差异有统计学意义(P＜0.05).2例术后1 ～2h内出现肺水肿,经及时发现及治疗后逐渐好转.8例患者随访3 ～ 24个月,心功能改善至Ⅰ级2例、Ⅱ级5例、Ⅲ级1例,6min步行试验600米以上5例、500米3例,2例患者术后返回了工作岗位,生活质量及血流动力学指标得到改善.结论术后7h内呼吸循环功能监测是防治再灌注损伤的重点,一对一的出院健康教育有利于提高患者的生存率,使患者回归社会.
목적 탐토만성혈전전새성폐동맥고압환자행폐동맥개입치료술대병발증적예방화호리,강저병사솔화치잔솔.방법 대8례재국마하행쌍측폐동맥조영+우심도관+폐동맥개입치료술적환자,실시수술전후일대일심리지도화건강선교,건립예방천자점출혈、급성폐수종등병발증적예안.결과 8례환자재정서은정적상태하순리완성개입치료,술중미발생폐동맥파렬이조성치명성각혈、폐동맥협층동맥류혹가성동맥류등엄중병발증.8례환자술후7h내혈양포화도、수축압、서장압、심솔적최저치여최고치차이유통계학의의(P＜0.05).2례술후1 ～2h내출현폐수종,경급시발현급치료후축점호전.8례환자수방3 ～ 24개월,심공능개선지Ⅰ급2례、Ⅱ급5례、Ⅲ급1례,6min보행시험600미이상5례、500미3례,2례환자술후반회료공작강위,생활질량급혈류동역학지표득도개선.결론 술후7h내호흡순배공능감측시방치재관주손상적중점,일대일적출원건강교육유리우제고환자적생존솔,사환자회귀사회.
Objective To study the prevention of postoperative complications by nursing intervention for chronic thromboembolic pulmonary hypertension (CTEPH) patients who accepted pulmonary artery interventional therapy,to reduce the mortality rate and disability rate.Methods Before and after operation,implement one-on-one psychological guidance and health education were given to 8 patients undergoing bilateral pulmonary angiography and right heart catheterization and pulmonary artery interventional therapy under local anesthesia,established plans about prevention of hemorrhage,acute pulmonary edema and other complications.Results The 8 patients completed the interventional therapy successfully in a stable mood state,pulmonary artery rupture did not occur and did not cause fatal hemoptysis of pulmonary artery dissection aneurysm,pseudoaneurysm or other surgery severe complications.In postoperative 7 hours,oxygen saturation,systolic pressure diastolic pressure,the minimum mean and the highest mean compared by paired t test,the differences were statistically significant (P＜0.05),2 cases occurred pulmonary edema after operation 1 ～ 2 hours,and gradually improved with timely detection and treatment.8 patients were followed up for 3 ～ 24 months,2 cases' heart function improved to grade Ⅰ,5 cases to grade Ⅱ,1 case to grade Ⅲ ; 6 min walking test up to 600 meters in 5 cases,500 meters in 3 patients; 2 patients returned to work,the quality of life and hemodynamic indicators improved.Conclusion Postoperative respiratory and circulatory function monitoring in 7 hours is the key for prevention of reperfusion injury mainly,one by one hospital health education is helpful to improve the survival rate of patients and help them return to society.