急性大面积肺栓塞静脉溶栓患者的观察与护理

目的探讨静脉溶栓治疗急性大面积肺栓塞患者的护理方法。方法回顾性分析2015年同济大学附属上海市肺科医院心肺循环科治疗的36例急性大面积肺栓塞患者的临床资料。所有患者均给予微量注射泵静脉注射注射用阿替普酶治疗,在溶栓前、中、后均实施对症护理及肺血管病专科护理,严密观察患者的生命体征及穿刺处皮肤等情况,并进行血常规、出凝血时间等实验室检查,及时发现出血等并发症。结果34例患者胸闷、胸痛、气促、呼吸困难等症状缓解,其中:1例患者在腹部皮下注射处出现1 cm×2 cm的血肿;2例患者桡动脉穿刺处出现1 cm×1 cm的血肿,经纱布填塞1 h后,血肿均未见增大,7 d后逐渐吸收;3例患者出现鼻出血,量约30 ml,经纱布填塞后停止出血;2例患者血压为75~80/50~55 mmHg(1 mmHg=0.133 kPa),经升压等急救和护理后均好转;2例患者病死。结论急性大面积肺栓塞患者静脉溶栓治疗期间,及时发现病情变化及出血等不良反应,积极配合抢救,可提高抢救成功率。

Observation and Nursing of Patients with Acute Massive Pulmonary Embolism Treated by Intra-venous Thrombolytic Therapy

Objective To discuss the nursing methods for patients with acute massive pulmonary embolism treated by intravenous thrombolytic therapy.Methods Clinical data of 3 6 cases were analyzed retrospec-tively.All patients were given microinj ection pump intravenous inj ection with alteplase,and before,during and after thrombolytic therapy,patients also received targeted nursing care and pulmonary vascular specialty nursing.The vital signs and puncture site skin status were observed,the blood and coagulation time were examined,and bleeding and other complications were timely discovered.Results The symptoms of chest tightness,chest pain,and shortness of breath and dyspnea of 34 cases were alleviated.There was 1 case of 1 cm ×2 cm hematoma at abdominal subcutaneous inj ection site.Two cases of 1 cm ×1 cm hema-toma at radial artery puncture site.After 1 hour pressing,the hematoma was not increasing,absorbed grad-ually after 7 days.Three cases had nose bleeding for about 30ml,and stopped after pressing.The blood pres-sure of two cases was 75~80/50~55 mmHg (1 mmHg=0.133 kPa).After rise in blood pressure treat-ment and nursing,patients’symptoms were improved and discharged.Two cases died.Conclusions During the intravenous thrombolytic treatment for patients with acute massive pulmonary embolism,the close observation of the disease changes and bleeding and other adverse reactions,and actively cooperation can improve the success rate of rescue.