上肢动脉栓塞取栓术后护理1例

Postoperative Care Following Upper Limb Arterial Embolism Thrombectomy: A Case Report

摘要: 本文报道一例80岁女性病例，患者因突发左侧肢体无力伴房颤病史，外院溶栓无效后转入，诊断为右侧大脑中动脉栓塞合并出血转化。入院8小时后出现右上肢典型“6P”征，超声及造影证实肱动脉栓塞，急诊取栓后血管再通。术后4小时出现骨筋膜室综合征，经甘露醇脱水、激素抗炎及冰敷后症状缓解，5日后肌红蛋白恢复正常。护理要点包括：1) 早期识别：房颤患者溶栓后需警惕外周栓塞，肢体突发“6P”征需即刻评估；2) 术后监测：重点观察再灌注损伤征象(“6P”征)，及时处理骨筋膜室综合征；3) 综合护理：介入术后穿刺点加压制动，动态评估肢体血流(皮温、脉搏)及全身指标(肌红蛋白、肌酐)，配合康复锻炼。本例提示，对高危患者的多系统评估、栓塞征象的快速识别及再灌注损伤的预见性护理是改善预后的关键。

Abstract: This article reports a case of an 80-year-old female patient who presented with sudden weakness in the left limb and a history of atrial fibrillation. After ineffective thrombolysis at an outside hospital, she was transferred and diagnosed with right middle cerebral artery embolism with hemorrhagic transformation. Eight hours after admission, she developed the typical “6P” signs in the right upper limb. Ultrasound and angiography confirmed brachial artery embolism, and emergency thrombectomy was performed, resulting in vessel recanalization. Four hours postoperatively, compartment syndrome developed, which was alleviated after treatment with mannitol dehydration, corticosteroid anti-inflammatory therapy, and ice packs. Myoglobin levels returned to normal 5 days later. Key nursing points include: 1) Early recognition: Patients with atrial fibrillation who have undergone thrombolysis should be vigilant for peripheral embolism. The sudden onset of “6P” signs in the limbs requires immediate assessment. 2) Postoperative monitoring: Focus on observing signs of reperfusion injury (“6P” signs) and promptly manage compartment syndrome. 3) Comprehensive nursing: Apply pressure dressing and immobilization to the puncture site after interventional surgery. Dynamically assess limb blood flow (skin temperature, pulse) and systemic indicators (myoglobin, creatinine). Coordinate with rehabilitation exercises. This case highlights that for high-risk patients, a multi-system assessment, rapid recognition of embolic signs, and anticipatory nursing for reperfusion injury are key to improving outcomes.