经皮冠状动脉介入治疗后股动脉假性动脉瘤行外科治疗的特点  

Characteristics of patients who received surgical treatment for pseudoaneurysm after percutaneous coronary intervention and the related nursing care strategies

作　　者：万宝艳[1] 赵丽凤[1] 谭秀利 张东凤[1] 宋现涛[1] WAN Baoyan;ZHAO Lifeng;TAN Xiuli;ZHANG Dongfeng;SONG Xiantao(Department of Cardiovascular Medicine,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung&Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心内科,100029

出　　处：《心肺血管病杂志》2020年第3期296-298,304,共4页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探讨经皮冠状动脉介入治疗(PCI)后发生股动脉假性动脉瘤并接受外科治疗的患者特点及相关护理对策。方法:回顾性纳入2016年1月至2019年1月,就诊于北京安贞医院的66例行PCI治疗术发生股动脉假性动脉瘤的患者,根据接受的治疗策略分为保守治疗组(n=44)和外科治疗组(n=22)。比较两组患者基线资料、用药情况、PCI治疗情况和下肢动脉超声检测结果。结果:与保守治疗组相比,外科治疗组患者术后低分子肝素使用率明显较高(81.8%vs.40.9%,P=0.034);两组患者的基线资料、其他用药情况、PCI治疗情况和下肢动脉超声检测结果差异无统计学意义(P>0.05)。使用Logistic回归校正年龄、性别、BMI、高血压病史、血小板数量、动脉瘤位置、缝合器使用情况、压迫时间、肢体制动时间后,术后使用低分子肝素仍然是需要外科处理假性动脉瘤的预测因素(OR=1.62,95%CI:1.13~2.63,P=0.038)。结论:在PCI治疗后发生股动脉假性动脉瘤的患者中,使用低分子肝素的患者可能更易因保守治疗效果不佳而接受外科治疗。对于病情需要术后使用低分子肝素的患者,应提前给予多方面、针对性、个体化护理,以提高保守治疗的成功率,减轻患者负担。Objective: To explore the characteristics of patients who received surgical treatment for pseudoaneurysm after percutaneous coronary intervention(PCI) and the related nursing care strategies. Methods: We retrospectively enrolled a total of sixty-six patients with femoral artery pseudoaneurysm after PCI from January 2016 to January 2019 in Beijing Anzhen Hospital. They were divided into conservative treatment group and surgical treatment group according to the strategies they received. The baseline characteristics, medication, interventional procedure and lower extremity arterial ultrasound result were compared between the two groups. Results: Compared with the conservative treatment group, the rate of low molecular weight heparin use after the interventional procedure in the surgical treatment group was significantly higher(81.8% vs. 40.9%, P=0.034). After adjusted for age, sex, BMI, history of hypertension, platelet number, pseudoaneurysm location, suture usage, compression time, limb braking time using Logistic regression analysis, the use of heparin was still the independent predictor for the use of surgical treatment for pseudoaneurysm(OR=1.62, 95%CI: 1.13-2.63, P=0.038). Conclusions: In patients with femoral artery pseudoaneurysm after PCI, those who are treated with low molecular weight heparin after the interventional procedure may be more likely to undergo surgical treatment with poor conservative outcomes. Patients who use low molecular weight heparin should be given multiple and individualized nursing care to improve the success rate of conservative treatment.

关 键 词：经皮冠状动脉介入治疗 假性动脉瘤 保守治疗 外科治疗 预测因素 护理 

分 类 号：R54[医药卫生—心血管疾病]