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目的探讨新型Pipeline血流导向装置治疗颅内复杂动脉瘤围术期护理方法。方法回顾性分析2015年6月至2016年8月在南京大学医学院附属鼓楼医院神经外科行Pipeline血流导向装置治疗的23例颅内复杂动脉瘤患者的临床资料,总结围术期护理体会,包括重视术前、术中、术后护理及出院指导:术前控制血压预防动脉瘤破裂,CYP2C19基因检测预测氯吡格雷治疗效果,监测凝血功能;术中密切配合手术,保证输液通畅,控制液体量及输液速度,做好管路护理;术后做好穿刺部位及肢体护理,预防脑缺血、脑出血、疼痛等并发症的护理;术后做好用药指导,定期监测凝血功能及随访。结果共植入25枚新型血流导向装置Pipeline支架,均成功输送并释放,技术成功率100%,其中1例患者于术后1周出现支架内血栓,经紧急溶栓3 d后功能恢复正常,其余均无相关性出血和缺血性并发症。结论术前防止动脉瘤破裂出血、做好心理支持、药物指导及基因检测,术中做好观察、保证安全,术后密切监测及预防并发症,是保证手术成功以及患者预后良好的关键。
Objective To investigate the perioperative nursing of complex intracranial aneurysms with the new type of Pipeline flow guiding device. Methods The clinical data of 23 patients with intracranial complex aneurysms treated with the Pipeline blood flow guiding device at Department of Neurosurgery, Drum Tower Hospital, Nanjing University Medical College from June 2015 to August 2016 were retrospectively analyzed. The nursing experiences, Including attention to preoperative, intraoperative and postoperative care and discharge guidance: preoperative blood pressure control aneurysm rupture, CYP2C19 gene prediction to predict the effect of clopidogrel to monitor the coagulation function; surgery in close cooperation with surgery to ensure smooth infusion, control of the liquid Volume and infusion speed, good pipeline care; postoperative puncture site and limb care, prevention of cerebral ischemia, cerebral hemorrhage, pain and other complications of care; good medication guidance after surgery, regular monitoring of coagulation and follow-up. Results A total of 25 new Pipeline stents were implanted successfully. The successful rate was 100%. One patient had stent thrombosis at 1 week after operation, and the function returned to normal after 3 days of emergency thrombolysis , The rest were no related bleeding and ischemic complications. Conclusion Preoperative prevention of aneurysm rupture bleeding, good psychological support, drug guidance and genetic testing, intraoperative observation, to ensure safety, close monitoring and prevention of complications after surgery is to ensure the success of the operation and the prognosis of patients with good key.