冠狀動(dòng)脈造影術(shù)圍術(shù)期護(hù)理

冠狀動(dòng)脈造影術(shù)+支架植入術(shù).查房目的：一、掌握冠狀動(dòng)脈造影術(shù)適應(yīng)癥；二、掌握冠狀動(dòng)脈造影術(shù)護(hù)理。.

陳金花女60歲漢族，主因“陣發(fā)性胸痛十天”為主訴，入院于2014-08-0816:50，步入病房，診斷：冠心病不穩(wěn)定型心絞痛心功能Ⅱ級(jí)；高血壓?。?級(jí)極高危）(住院期間確診2型糖尿?。┎±攸c(diǎn)：患者近十天開始出現(xiàn)胸骨后疼痛，伴胸悶氣短及大汗憋氣，后背部疼痛，持續(xù)數(shù)分鐘即可緩解，于活動(dòng)時(shí)及休息時(shí)均可發(fā)作，未予正規(guī)診治，上述癥狀仍發(fā)作頻繁，遂于2014-08-08日就診入院。診療計(jì)劃：抗栓調(diào)脂、改善循環(huán)。病例：

.病例：

輔助檢查：心電圖示竇性心律，V2-V6導(dǎo)聯(lián)T波低平。.實(shí)驗(yàn)室檢查.病例：于2014-08-1311:00在局麻下行冠狀動(dòng)脈造影術(shù)+支架植入術(shù)14:00安返病房，植入支架2枚，回病房后患者仍感后背部不適，并有惡心、嘔吐，嘔吐物為胃內(nèi)容物，量約10ml,遵醫(yī)囑肌肉注射甲氧氯普胺10mg，靜點(diǎn)泮托拉唑40mg，于17:00病人感惡心緩解，仍感后背部不適。回病房房后泵入替羅非班300ml,7ml/h。08-1408:00病人后背部不適緩解，于2014-08-1909:00好轉(zhuǎn)出院。.問(wèn)題？問(wèn)題一：為什么患者支架術(shù)后仍會(huì)感覺后背部不適感？問(wèn)題二：患者術(shù)后的護(hù)理問(wèn)題是什么？術(shù)前術(shù)后冠狀動(dòng)脈造影術(shù)的適應(yīng)癥對(duì)藥物治療中心絞痛仍較重者，明確動(dòng)脈病變情況以及考慮介入性治療或旁路移植手術(shù)。1胸痛似心絞痛而不能確診者。2中老年病人心臟增大、心力衰竭、心律失常，疑有冠心病而無(wú)創(chuàng)性檢查未能確診者。3心肌梗死后再發(fā)心絞痛或運(yùn)動(dòng)試驗(yàn)陽(yáng)性者。4急性冠脈綜合征擬行急診手術(shù)者。5.評(píng)定冠狀動(dòng)脈狹窄程度的分級(jí)標(biāo)準(zhǔn)：TIMI試驗(yàn)Ⅲ級(jí)冠狀動(dòng)脈遠(yuǎn)端造影劑完全而且迅速充盈和消除，同正常冠狀動(dòng)脈血管Ⅱ級(jí)冠狀動(dòng)脈下狹窄遠(yuǎn)端可完全充盈，但顯影慢，造影劑消除也慢Ⅰ級(jí)造影劑部分通過(guò)，冠狀動(dòng)脈狹窄遠(yuǎn)端不能完全充盈0級(jí)無(wú)血流灌注，閉塞血管遠(yuǎn)端無(wú)血流..經(jīng)皮冠狀動(dòng)脈介入治療冠狀動(dòng)脈冠狀動(dòng)脈右冠狀動(dòng)脈前降肢回旋支左主干左右左右經(jīng)皮冠狀動(dòng)脈介入治療（PCI）經(jīng)皮冠狀動(dòng)脈介入治療：醫(yī)生經(jīng)皮膚穿刺動(dòng)脈，在X線下通過(guò)導(dǎo)管等器械，對(duì)冠狀動(dòng)脈狹窄或閉塞位治療，使血管管腔恢復(fù)，血流重新通暢。通常用的是球囊擴(kuò)張術(shù)和支架植入術(shù)。閉塞的血管球囊成形術(shù)－－擴(kuò)張血管支架術(shù)－－放入支架護(hù)理呼吸、閉氣、咳嗽訓(xùn)練術(shù)前指導(dǎo)術(shù)前晚飯后口服阿司匹林+氯吡格雷；行急診PCI或術(shù)前6小時(shí)內(nèi)給藥—負(fù)荷量?？鼓幮g(shù)前停用三天，并使INR<1.8服華法林者術(shù)前行Allen試驗(yàn)；非術(shù)側(cè)上肢留置靜脈套管針。橈動(dòng)脈穿刺者術(shù)前護(hù)理.護(hù)理術(shù)后護(hù)理術(shù)后鼓勵(lì)病人多飲水；抗凝劑的使用；心電、血壓監(jiān)護(hù)24小時(shí)；心電圖與術(shù)前對(duì)比。術(shù)后負(fù)效應(yīng)的觀察與護(hù)理經(jīng)股動(dòng)脈穿刺者動(dòng)脈造影術(shù)后，可即刻拔出鞘管，常規(guī)壓迫30分鐘后，加壓包扎，患肢制動(dòng)24小時(shí)。.術(shù)后負(fù)效應(yīng)的觀察與護(hù)理造影劑反應(yīng)心肌梗死尿潴留低血壓穿刺血管損傷的并發(fā)癥腰酸、腹脹.術(shù)區(qū)出血或血腫

腹膜后出血或血腫假性動(dòng)脈瘤和動(dòng)-靜脈瘺

穿刺動(dòng)脈血栓形成或栓塞

骨筋膜室綜合征穿刺血管損傷的并發(fā)癥.出院指導(dǎo)遵醫(yī)囑降壓降糖危險(xiǎn)因素調(diào)脂抗凝藥.冠心病放上支架后就萬(wàn)事大吉？

支架是冠心病病人的福音。急性心梗病人，如及時(shí)放入支架，就可以將死亡率降低到5%―6%；非急、重癥的心絞痛患者，如放入支架也能緩解癥狀，并提高體力活動(dòng)能力。但放支架畢竟只能算是一種急救治療手段，而不是“保命符”。對(duì)于已經(jīng)獲救的心梗病人，最重要的是二級(jí)預(yù)防——防復(fù)發(fā)。.控制高血壓、糖尿病高血壓、糖尿病是一種常見疾病雖然很少引起癥狀，卻是冠心病的主要危險(xiǎn)因素，嚴(yán)格控制血壓、糖尿病。

.改變生活方式定期運(yùn)動(dòng)減輕生活壓力注意體重戒煙限酒.健康飲食低膽固醇、低脂低鹽低糖多吃谷類水果、蔬菜家禽、魚少吃豬肉、牛肉油炸食物.定期堅(jiān)持門診隨訪、術(shù)后復(fù)查1、出院后1-6月內(nèi)每月復(fù)查一次，6個(gè)月后可延長(zhǎng)至每3個(gè)月復(fù)查一次堅(jiān)持定期門診隨防。2、有條件者最好9-12個(gè)月后再次進(jìn)行冠狀動(dòng)脈造影術(shù)檢查，以便及早發(fā)現(xiàn)血管有無(wú)再狹窄情況，從而及時(shí)給予治療。

3、有癥狀應(yīng)隨時(shí)到醫(yī)院復(fù)查.THANKYOU.ClickToEditTitleStylePremiumDesignDiversityofCultureImmenseVisualAppealVisualAppealingImmenseVisualAppealSleekDiagram&ChartImmensevisualappealPremadePowerPointTemplates,Professionalqualitytemplatesinacoupleofclicksaway!Eye-CatchingVisualFeelthetouchofart-PowerPointTemplates,PPTSlides,PPTDiagramsForYourPresentationReadytoUseSubscriptionoffersyoualldesignsyou'lleverneedtomakeyourPowerPoint.ClickToEditTitleStyleStylishDesignIt’saboutgivingyouthevarietyyouneedtomeetthedesignonyourmind.Wecreatepowerpointtemplatesbasedonnewvisualtrendsthat’sfresh,relevantandalwaysonthecuttingedge.MorechoicesandvisualtrendsPresenterTemplatesprovidesthethemesthatsurroundsyoueveryday.Wecoverawiderangeofsubjectsincludingbusiness,IT,lifestyle,nature,travel,technology,school,cultureandmuchmoreforyoutochoosefromandabout200areaddedeverymonth.AwiderangeofsubjectsPowerPointisacompletepresentationgraphicspackage.Itgivesyoueverythingyouneedtoproduceaprofessional-lookingpresentation.PowerPointofferswordprocessing,outlining,drawing,graphing,andpresentationmanagementtools-alldesignedtobeeasytouseandlearn.PowerPointPresentationEye-CatchingVisualImmenseVisualAppealSleekDiagram&Chart.有效控制冠心病的各種危險(xiǎn)因素遵醫(yī)囑繼續(xù)服用降壓、降糖、調(diào)脂及抗凝藥出院指導(dǎo)Inspirationforyourfineperformance.ClickToEditTitleStyle0102030405060708091011121314151617Value01Value02Value03Value04Value05Value06Value07Value08Value09Value10Value11VisualAppealingCaptivateyourviewingaudience-PowerPointTemplates&Backgrounds,SleekDiagram&ChartsForYourPresentation.ClickToEditTitleStyle0%CONTENTS80%100%60%40%20%.ClickToEditTitleStylePowerPointPresentationPowerPointisacompletepresentationgraphicspackage.Itgivesyoueverythingyouneedtoproduceaprofessional-lookingpresentation.PowerPointofferswordprocessing,outlining,drawing,graphing,andpresentationmanagementtools-alldesignedtobeeasytouseandlearn.VisualAppealingCaptivateyourviewingaudience-PowerPointTemplates&Backgrounds,SleekDiagram&ChartsForYourPresentationImmenseVisualAppealEye-CatchingVisualSleekDiagram&Chart.ClickToEditTitleStyleVisualAppealingCaptivateyourviewingaudience-PowerPointTemplates&Backgrounds,SleekDiagram&ChartsForYourPresentationAnimationDynamiclooktoyourpresentationAnimationPowerPointTemplates&BackgroundsforYourImpressivePresentationEasySearchOureasytouseandfunctionalsearchenginehelpsyoulocatetherighttemplatesquicklysavingyoutimeToofferyouwhatyouwant,whenyouwantClarity&ImpactPremiumDesignSubtleTouchVisualAppealingImmenseVisualAppealEye-CatchingVisualEasyToUseUniversalDesign.ClickToEditTitleStyleNorthAmericaSouthAmericaAfricaAustraliaAsiaEurope.ClickToEditTitleStyleTEXTHEREClicktoaddtextClicktoaddtextClicktoaddtextTEXTClicktoaddtextClic