,*,Click To Edit Title Style,*,*,Click To Edit Title Style,Click To Edit Title Style,*,Click To Edit Title Style,冠状动脉造影术,+,支架植入术,查房目的：,一、掌握冠状动脉造影术适应症；,二、掌握冠状动脉造影术护理。,陈金花 女,60,岁 汉族，主因,“,阵发性胸痛十天,”,为主诉，入院于,2014-08-08 16:50,，步入病房，诊断：冠心病 不稳定型心绞痛 心功能,级；高血压病（,3,级极高危）,(,住院期间确诊,2,型糖尿病）,病例特点：患者近十天开始出现胸骨后疼痛，伴胸闷气短及大汗憋气，后背部疼痛，持续数分钟即可缓解，于活动时及休息时均可发作，未予正规诊治，上述症状仍发作频繁，遂于,2014-08-08,日就诊入院。诊疗计划：抗栓调脂、改善循环。,病例：,病例：,辅助检查：心电图示窦性心律，,V2-V6,导联,T,波低平。,实验室检查,病例：,于,2014-08-13 11:00,在局麻下行冠状动脉造影术,+,支架植入术,14:00,安返病房，植入支架,2,枚，回病房后患者仍感后背部不适，并有恶心、呕吐，呕吐物为胃内容物，量约,10ml,遵医嘱肌肉注射甲氧氯普胺,10mg,，静点泮托拉唑,40mg,，于,17:00,病人感恶心缓解，仍感后背部不适。回病房房后泵入替罗非班,300ml,7ml/h,。,08-14 08:00,病人后背部不适缓解，于,2014-08-19 09:00,好转出院。,问题,？,问题一：为什么患者支架术后仍会感觉后背部不适感？,问题二：患者术后的护理问题是什么？,术前,术后,冠状动脉造影术的适应症,对药物治疗中心绞痛仍较重者，明确动脉病变情况以及考虑介入性治疗或旁路移植手术。,1,胸痛似心绞痛而不能确诊者,。,2,中老年病人心脏增大、心力衰竭、心律失常，疑有,冠心病而无创性检查未能确诊者。,3,心肌梗死后再发心绞痛或运动试验阳性者,。,4,急性冠脉综合征拟行急诊手术者,。,5,评定冠状动脉狭窄程度的分级标准：,TIMI,试验,级,冠状动脉远端造影剂完全,而且迅速充盈和消除，同,正常冠状动脉血管,级,冠状动脉下狭窄远端可完全充盈，,但显影慢，造影剂消除也慢,级,造影剂部分通过，冠状动,脉狭窄远端不能完全充盈,0,级,无血流灌注，闭塞血管远端无血流,经皮冠状动脉介入治疗,冠状动脉,冠状动脉,右冠状动脉,前降肢,回旋支,左主干,左,右,左,右,经皮冠状动脉介入治疗（PCI）,经皮冠状动脉介入治疗：医生经皮肤穿刺动脉，在X线下通过导管等器械，对冠状动脉狭窄或闭塞位治疗，使血管管腔恢复，血流重新通畅。通常用的是球囊扩张术和支架植入术。,闭塞的血管,球囊成形术扩张血管,支架术放入支架,护理,呼吸、闭气、咳嗽训练,术前指导,术前晚饭后口服阿司匹林,+,氯吡格雷；,行急诊,PCI,或术前,6,小时内给药,负荷量。,抗凝药,术前停用三天，并使,INR1.8,服华法林者,术前行,Allen,试验；非术侧上肢留置,静脉套管针。,桡动脉穿刺者,术,前,护,理,护理,术后护理,术后鼓励病人多饮水；抗凝剂的使用；,心电、血压监护,24,小时；,心电图与术前对比。,术后负效应的观察与护理,经股动脉穿刺者动脉造影术后，可即刻拔出鞘管，常规压迫,30,分钟后，加压包扎，患肢制动,24,小时,。,术后负效应的观察与护理,造影剂反应,心肌梗死,尿潴留,低血压,穿刺血管损伤的并发症,腰酸、腹胀,术区出血或血肿,腹膜后出血或血肿,假性动脉瘤和动,-,静脉瘘,穿刺动脉血栓形成或栓塞,骨筋膜室综合征,穿刺血管损伤的并发症,出院指导,遵医嘱,降压,降糖,危险因素,调脂,抗凝药,冠心病放上支架后就万事大吉？,支架是冠心病病人的福音。急性心梗病人，如及时放入支架，就可以将死亡率降低到,5%6%,；非急、重症的心绞痛患者，如放入支架也能缓解症状，并提高体力活动能力。但放支架毕竟只能算是一种急救治疗手段，而不是,“,保命符,”,。对于已经获救的心梗病人，最重要的是二级预防,防复发。,控制高血压、糖尿病,高血压,、糖尿病,是一种常见疾病,虽然很少引起症状，却是冠心病,的主要危险因素,，严格控制血,压、糖尿病。,改变生活方式,定期运动,减轻生活压力,注意体重,戒烟限酒,健康饮食,低,胆固醇、低脂,低,盐,低,糖,多吃,谷类,水果、蔬菜,家禽、鱼,少吃,猪肉、牛肉,油炸食物,定期坚持门诊随访、术后复查,1、出院后1-6月内每月复查一次，6个月后可延长至每3个月复查一次坚持定期门诊随防。,2、有条件者最好9-12个月后再次进行冠状动脉造影术检查，以便及早发现血管有无再狭窄情况，从而及时给予治疗。,3、有症状应随时到医院复查,THANK YOU,Click To Edit Title Style,Premium,Design,Diversity,of Culture,Immense,Visual Appeal,Visual,Appealing,Immense,Visual Appeal,Sleek Diagram&Chart,Immense visual appeal Premade PowerPoint Templates,Professional quality templates in a couple of clicks away,!,Eye-Catching Visual,Feel the touch of art-PowerPoint Templates,PPT Slides,PPT Diagrams For Your Presentation,Ready to Use,Subscription offers you all designs youll ever need to make your PowerPoint,Click To Edit Title Style,Stylish Design,Its about giving you the variety you need to meet the design on your mind.,We create powerpoint templates based on new visual trends thats fresh,relevant and always on the cutting edge.,More choices and,visual trends,PresenterTemplates provides the themes that surrounds you every day.We cover a wide range of subjects including business,IT,lifestyle,nature,travel,technology,school,culture and much more for you to choose from and about 200 are added every month.,A wide range of subjects,PowerPoint is a complete presentation graphics package.It gives you everything you need to produce a professional-looking presentation.PowerPoint offers word processing,outlining,drawing,graphing,and presentation management tools-all designed to be easy to use and learn.,PowerPoint Presentation,Eye-Catching,Visual,Immense Visual Appeal,Sleek Diagram&Chart,有效控制冠心病的各种危险因素,遵医嘱继续服用降压、降糖、调脂及抗凝药,出院指导,Inspiration for your fine performance,Click To Edit Title Style,01,02,03,04,05,06,07,08,09,10,11,12,13,14,15,16,17,Value 01,Value 02,Value 03,Value 04,Value 05,Value 06,Value 07,Value 08,Value 09,Value 10,Value 11,Visual Appealing,Captivate your viewing audience-PowerPoint Templates&Backgrounds,Sleek Diagram&Charts For Your Presentation,Click To Edit Title Style,0%,CONTENTS,80%,100%,60%,40%,20%,Click To Edit Title Style,PowerPoint Presentation,PowerPoint is a complete presentation graphics package.,It gives you everything you need to produce a professional-looking presentation.,PowerPoint offers word processing,outlining,drawing,graphing,and presentation management tools-all designed to be easy to use and learn.,Visual,Appealing,Captivate your viewing audience-PowerPoint Templates&Backgrounds,Sleek Diagram&Charts For Your Presentation,Immense,Visual,Appeal,Eye-,Catching Visual,Sleek,Diagram,&Chart,Click To Edit Title Style,Visual Appealing,Captivate your viewing audience-PowerPoint Templates&Backgrounds,Sleek Diagram&Charts For Your Presentation,Animation,Dynamic look to your presentation Animation PowerPoint Templates&Backgrounds for Your Impressive Presentation,Easy Search,Our easy to use and functional search engine helps you locate the right templates quickly saving you time,To offer you what you want,when you want,Clarity&,Impact,Premium,Design,Subtle,Touch,Visual,Appealing,Immense Visual Appeal,Eye-Catching Visual,Easy To Use,Universal Design,Click To Edit Title Style,North America,South America,Africa,Australia,Asia,Europe,Click To Edit Title Style,TEXT HERE,Click to add text,Click to