一例大血管术后合并消化道出血引发脑部缺血性脑卒中的术后个案护理

Postoperative Nursing Care of a Case of Cerebral Ischemic Stroke Caused by Gastrointestinal Bleeding after Large Vessel Surgery

摘要: 目的：总结一例大血管合并脑部缺血术后的临床资料和护理经验，为今后此类患者护理提供临床经验。方法：回顾性分析2024年2月29日我科收治的一例stanford A型患者的治疗和护理过程。针对患者现存主要护理问题：疼痛、血容量不足、活动无耐力，消化道出血，压力性损伤、潜在并发症等，术后采取全面心电监护、维持内环境稳定、维持水电解质及酸碱平衡、对症支持治疗、神经系统观察、镇痛镇静、积极抗炎症反应、营养支持、积极处理皮肤问题、密切关注术后并发症、尽早行心脏康复以及心理支持等个性化的治疗及护理。结果：本例患者经积极治疗和护理后患者于术后转出我科继续治疗，生活完全自理，顺利康复出院。结论：术后有针对性的一例大血管术后合并消化道出血引发脑部缺血性的术后个案护理，有临床借鉴积极意义。

Abstract: Objective: To summarize the clinical data and nursing experience of a Stanford A type patient who underwent major vascular surgery and suffered from cerebral ischemic stroke after gastrointestinal hemorrhage, in order to provide clinical experience for future nursing care of similar patients. Methods: The clinical course and nursing care of a Stanford A type patient admitted to our department on February 29, 2024 were retrospectively analyzed. Based on the main nursing problems of the patient, such as pain, insufficient blood volume, lack of activity tolerance, gastrointestinal hemorrhage, pressure ulcers, potential complications, etc., postoperative comprehensive electrocardiogram monitoring, maintenance of the internal environment, maintenance of water, electrolyte, and acid-base balance, symptomatic supportive therapy, neurological observation, analgesia and sedation, active anti-inflammatory response, nutritional support, active management of skin problems, close monitoring of postoperative complications, early cardiac rehabilitation, and psychological support were provided with individualized treatment and nursing. Results: After active treatment and nursing, the patient was transferred out of our department for further treatment and was able to live independently, recovering smoothly and discharged from the hospital. Conclusion: The case of postoperative hemorrhage due to cerebral ischemia caused by a large vessel operation with targeted care has clinical reference value.