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经肱动脉行冠状动脉介入治疗术后患者舒适的护理

作者:丁美幸 郭向华 李 云

所属单位:河南理工大学第一附属医院,焦作市第二人民医院心血管内科 (河南 焦作 454000)

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摘要

目的 探讨舒适护理模式应用于经肱动脉冠状动脉介入术后患者的效果。方法 选取2014-2016年经肱动脉冠状动脉 介入术的50例病人,分为对照组和实验组各25例, 对照组术前常规护理,术后拔出鞘管,压迫穿刺处止血,然后用 绷带环形加压包扎穿刺点,肘关节制动8小时,8小时后拆除绷带。实验组术前除外对照组的术前护理外,护士指导 患者反复练习保持上肢伸直肘部不能弯曲状况下如何变换各种体位及上肢如何放置最佳位置等,术后同样方法加压 包扎穿刺点后,将患者穿刺侧上肢以肘关节为中心置入制动支具内,根据患者臂围调节支具的松紧度,8小时后拆 除支具和绷带。结果 两组的舒适度有明显的统计学差异(P<0.05)。结论 舒适护理模式应用于经肱动脉冠状动脉 介入术后患者,提高了患者的舒适度,增强了患者的遵医行为,减少了术后并发症发生。

Objective To explore the effect of comfort care model in patients with brachial artery coronary intervention. Methods A total of 50 cases of 2014-2016 patients by brachial artery coronary intervention, divided into control group and experimental group with 25 cases in each group, the control group received routine preoperative nursing, postoperative sheath tube, puncture and compression hemostasis, bandage ring compression bandage puncture point, elbow braking for 8 hours, 8 hours after the demolition bandage. The experimental group except the control group before surgery, preoperative nursing, nurse patients with repeated practice can not bend and straighten elbows keep the upper conditions how to transform a variety of positions and how to place the optimal position of the upper limb after the operation, the same method of pressurized bandaging the puncture point after the puncture on the side limb from the elbow brace in braking center placement according to the patient's arm, adjust the tightness of the brace, 8 hours after the removal of brace and bandage. Results The comfort of the two groups was statistically significant (P<0.05). Conclusion The application of comfort care model in patients with brachial artery coronary intervention improves the comfort of patients, enhances the compliance of patients, and reduces the incidence of postoperative complications.

【关键词】舒适护理;肱动脉;介入

【中图分类号】R543;R47

【文献标识码】A

【DOI】10.3969/j.issn.1009-3257.2018.02.024

前言

近年来冠状动脉介入诊疗经桡动脉途径以其微 创、并发症少、痛苦小等优点,已被用作大部分患 者的常规径路[1]。但由于桡动脉内径相对较细小,穿 刺成功率偏低且易发生痉挛[2],经股动脉途径的穿刺 部位并发症较多、术后需限制患者活动;而肱动脉途 径无需限制患者活动[1],且肱动脉较桡动脉粗大,穿 刺相对容易,穿刺成功率高,因此,桡动脉穿刺失败 后,经肱动脉途径为更好入路。由于经皮肱动脉冠状 动脉介入术后,常采用绷带加压止血法对穿刺处进行 止血.需要上肢伸直肘部制动不能弯曲,并受压8小时,患者处于过度紧张、焦虑状态,舒适度明显降 低。舒适是人最基本的需求,提高患者舒适度是护理 的最终目标[3]。舒适护理是通过对护理活动的舒适干 预,使人在心理、生理、社会交往等方面达到愉快的 状态或降低不愉快的程度[4],舒适护理的最终目的是 让患者心身处于最佳状态,更好地配合治疗,减少并 发症,促进患者早日康复[5]。我科自2015年起,将舒 适护理模式应用于经肱动脉冠状动脉介入术后患者, 增加了患者的舒适度,提高了患者的配合度,减少了 术后并发症的发生,总结如下。