周凌丽　　赵明　　冯建矩　　徐龙彪

[摘要] 目的 探讨循证护理在降低颈动脉狭窄患者支架成形术后脑高灌注的应用。 方法 选取2014年1月至2019年1月在我院行颈动脉狭窄患者支架成形的86例患者，术后所有患者均进行统一治疗方式，根据护理方式的不同，将其随机分为研究组45例和对照组41例，其中对照组接受常规护理干预，研究组接受循证护理，对比两组患者术后脑高灌注的发生率。 结果 研究组发生CHS率为4.44%（2/45），明显低于对照组的19.51%（8/41），差异有统计学意义（P<0.05）。研究组CAS术后发生不良事件发生率为2.22%（1/45），明显低于对照组的19.51%（8/41），差异有统计学意义（χ2=6.832，P=0.012<0.05）。 结论 循证护理在颈动脉狭窄患者支架成形术后可降低脑高灌注的发生率。

[关键词] 临床护理;颈动脉狭窄;支架植入术;脑高灌注

[中圖分类号] R473.74          [文献标识码] B          [文章编号] 1673-9701（2021）16-0164-04

Application of evidence-based nursing in reducing cerebral hyperperfusion in patients with carotid artery stenosis after carotid stenting

ZHOU Lingli   ZHAO Ming   FENG Jianju   XU Longbiao

Department of Surgery， the People's Hospital of Zhuji City in Zhejiang Province， Zhuji   311800， China

[Abstract] Objective To explore how to carry out targeted nursing to reduce the occurrence of cerebral hyperperfusion syndrome by applying evidence-based nursing in patients with carotid artery stenosis after stenting. Methods Eighty-six patients with carotid artery stenosis who underwent carotid stenting in our hospital from January 2014 to January 2019 were selected. All patients underwent a unified treatment method after the operation. According to different nursing methods， all patients were randomly divided into the study group （n=45） and the control group （n=41）. The control group was received routine nursing intervention， and the study group was received evidence-based nursing. The incidence of postoperative cerebral hyperperfusion was compared between the two groups. Results The incidence of CHS in the study group was 4.44% （2/45）， which was lower than that of 19.51%（8/41） in the control group， and the difference between the groups was statistically significant （P<0.05）. The adverse event occurrence rate in the study group was 2.22%（1/45）， which was significantly higher than that of （19.51%[8/41]）in the control group， with significantly difference（χ2=6.832， P=0.012<0.05） Conclusion Evidence-based nursing can reduce the incidence of cerebral hyperperfusion in patients with carotid artery stenosis after stenting.

[Key words] Clinical nursing; Carotid artery stenosis; Stent implantation; Cerebral hyperperfusion

随着老龄化和城市进程的不断加快，脑卒中发病率急剧上升，当下已是我国国民第一位死亡病因。做为脑卒中的主要类型——缺血性脑血管病，已引起了社会和众多临床医生的关注和重视[1]，在治疗过程中通过利用颈内手术将重点前移，即中风的预防，已有众多患者从中受益。伴随介入器械与技术的不断进步，颈动脉支架成形术（Carotid angioplasty andstenting，CAS）在临床上开展也越来越广泛[2-3]。

但CAS后的并发症是当前临床上的难点和主要关注点，尤其是脑高灌注综合征（Cerebral hyperperfusion syndrome，CHS）这一严重并发症，给医护人员提出了严峻的挑战，引起了的高度重视[4]。目前临床在CHS的治疗上，仍缺乏一种对于CEA后CHS治疗绝对有效的治疗方法，主要通过严密监测血流动力学，严格控制血压预防CHS的发作，预防性的使用自由基清除剂，故术后对患者的临床观察和护理显得尤为重要[5-6]。护理人员通过获取证据，将科学研究结论与临床经验及患者的意愿相结合从而实现循证护理，对决策过程提供仔细、清晰、明智的依据。……