慢性血栓栓塞性肺动脉高压患者介入术预防并发症的研究

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。

Study on prevention of postoperative complications by nursing intervention to chronic thromboembolic pulmonaryhypertension patients

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 fight 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 fimction improved to grade Ⅰ , 5 cases to grade Ⅱ ,Ⅰ case to grade m ; 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.