主动脉夹层患者37例观察及急救护理.docVIP

主动脉夹层患者37例观察及急救护理 　　[摘要] 目的 总结37例主动脉夹层患者的观察及急救护理经验。 方法 对37例主动脉夹层患者的急救护理进行分析，做好急救抢救准备，监测生命体征，对疼痛的性质部位程度的观察，控制好血压和心率，仔细观察压迫症状，防止瘤体破裂，做好患者及家属的心理护理等。结果 患者转科手术治疗24例，保守治疗4例，死亡9例，死亡率32.1%。结论 主动脉夹层患者病死率高，在手术前急诊科观察和急救工作护理十分重要，作为急诊护理人员，应对该病特征要有充分的认识，把每项护理工作做好，尽快转入后续治疗。 　　[关键词] 主动脉夹层；急救护理 　　[中图分类号] R473.5 [文献标识码] B [文章编号] 2095-0616（2013）22-116-02 　　Observation and emergency nursing of 37 patients with aortic dissection 　　ZHANG Xiaowei 　　The General Hospital of Shenyang Military Region，Shenyang 110840，China 　　[Abstract] Objective To Summarize observation and emergency nursing experience on of 37 patients with aortic dissection. Methods The emergency nursing of 37 patients with aortic dissection were analyzed，about emergency rescue preparation，monitoring of vital signs，observation on the nature and location and degree of pain，blood pressure and heart rate testing，carefully observing the compression symptoms，preventing aneurysm rupture，and psychological care of patients and their families. Results 24 patients were transferred operation treatment. 4 patients were treated conservatively，and 1 patient died. The mortality rate was 32.1%. Conclusion Aortic dissection aortic dissection has high fatality. Observation and Emergency nursing of patients with aortic dissection is very important before the operation. The emergency nursing staff need to fully understand the characteristics of this disease，do each nursing work，transfer patients to the follow-up treatment as soon as possible. 　　[Key words] Aortic dissection；Emergency nursing 　　主动脉夹层（aortic dissection，AD）是主动脉内膜撕裂，循环中的血液通过裂口进入主动脉肌壁内，导致血管壁的分层。由于动脉壁中层组织坏死，血液经血管内膜裂口渗入主动脉壁并分开中层而形成的血肿，该病是一种起病急骤，发展较迅速的心血管极危重症[1]。2009年5月～2012年11月我科收治了37例主动脉夹层患者，将急救护理体会报道如下。 　　1 临床资料 　　37例主动脉夹层患者中，男23例，女14例，年龄35～87岁，均有高血压病史。按Debakey分型：Ⅰ型13例，Ⅱ型7例，Ⅲ型17例。在急诊抢救室因夹层破裂死亡9例，24例经急救处理后分别转入心血管内科、心血管外科住院治疗，4例回家保守治疗。 　　2 观察及急救护理 　　2.1 病情观察及监测 　　主动脉夹层病情凶险，进展快，当医生诊断为主动脉夹层时，立即引起高度重视，给予脉搏、血压、血氧饱和度监测，吸氧5～6L/min，严格卧床休息，保持情绪稳定。迅速建立静脉通道，备好药物如止痛药吗啡或派替定、降压药硝普钠、常规抢救药肾上腺素、阿托品、