老年急性冠脉综合征介入治疗的护理学指导

目的 观察急性冠脉综合征(ACS)病人经皮冠状动脉腔内血管成形术(PCI)的效果,观察术后血清肌酸激酶同功酶(CK-MB)、心肌肌钙蛋白I(cTnI)和超敏C-反应蛋白(HS-CRP)的变化,并分析这些变化的临床意义,制订临床护理指导原则.方法 老年ACS病例30例,在常规治疗的基础上行PCI.上述病人分别测定术前、术后12 h和术后2 w的生化项目,包括CK-MB、cTnI和HS-CRP,并观察症状体征和心电图的变化.结果 CK-MB、cTnI符合ACS的动态变化,未发现术后再次升高的病例.PCI术后12 h血清HS-CRP水平较术前升高,有统计学意义(P<0.05),但2 w后降至正常.结论 介入治疗可加剧冠脉局部炎症反应,使HS-CRP升高.随着血管开通以及他汀类药物的应用,炎症反应逐渐减轻.CK-MB、cTnI的术前术后变化在本组病例中符合ACS的一般规律.制订ACS介入治疗的临床护理指导原则是非常必要的.

Nursing guide to the old patients with ACS receiving Percutaneous Coronary Intervention (PCI)

Objective To observe the results of PCI in elderly patients with ACS,paying attention to the changes of CK-MB,cTnI and HS-CRP before and after PCI,and analyze these results upon nursing means.Afterwards we work out a nursing instruction.Methods Thirty patients' arteries were inserted and the stents were set in the lesion coronaries after routine treatment.The biochemical parameters CK-MB,cTnI and HS-CRP were checked and analyzed before PCI and twelve hours and two weeks after PCL Results CK-MB and cTnI conform with the dynamic variation of ACS.It means during onset of ACS the rising time and top time a-mong STEMI and NSTEMI patients are four to six hours and eighteen to twenty-four hours respectively.They no rerun highly after PCI.Twelve hours after PCI the HS-CRP hiked up with statistical connotation (P < 0.05) but they descend to normal values after two weeks.Conclusion PCI exasperate the local inflammation of the coronary artery and the HS-CRP exalted.The inflammation alleviates gradually following the blood vessels broken through and the statins taken orally.The dynamic variation of CK-MB and cTnI conform to ACS's general regulation,meaning they run up during onsets but go down after them and PCI.To ACS patients the clinical nursing conduct in accordance with the biochemical parameters is necessary.Nurses should know the meaning of common blood pa-rameters related to heart diseases.During nursing patients they should choose a proper blood vessel to perform in-jection.Before and after PCI a nurse must observe the life signs carefully and pay more attention to the influence of some drugs such as aspirin,ACEI or statins and examination like PCI to chemical analysis results.