頸動脈狹窄患者置放頸動脈支架之護理

Nursing Care of Patients With Carotid Artery Stenosis Who Receive Carotid Artery Stent

頸動脈狹窄多起因於動脈粥狀硬化，其狹窄程度與中風有高度相關，進而引發暫時性腦缺血或永久性腦部損傷。藥物治療、頸動脈內膜切除術及置放頸動脈支架為頸動脈狹窄主要治療方式，但狹窄嚴重時，則須以頸動脈內膜切除術或置放頸動脈支架來治療。頸動脈置放支架，可重建血管循環，侵入性較頸動脈內膜切除術小，成功率高，可有效治療頸動脈狹窄、降低中風及心肌梗塞、提高存活率，但此方式易發生支架內再狹窄，故臨床已引用塗藥性支架來降低此併發症，但塗藥性支架之成效仍待更多實證研究驗證。由於頸動脈置放支架後，患者仍有再次中風、再度血管狹窄、死亡風險，故術後照護非常重要，因此，本文建議臨床醫護人員，術後需持續評估及監測患者以預防合併症，並妥善指導返家後自我照顧知識，如傷口照護、按時追蹤支架暢通度、規則服藥、戒菸、控制血糖、血壓、規律運動、減輕體重、健康飲食，經由積極控制動脈粥狀硬化的危險因子以避免合併症及血管再阻塞。 Atherosclerosis, a major cause of carotid artery stenosis, has a high correlation to stroke, which may induce transient ischemic attack (TIA) and/or permanent brain damage. The main treatment of carotid artery stenosis includes medication, carotid endarterectomy (CEA), and carotid artery stenting (CAS). However, when artery stenosis becomes severe, CEA or CAS is the most-often recommended intervention. CAS, a type of revascularization, is considered less invasive than CEA and is associated with a higher successful rate. CAS not only treats carotid stenosis effectively and reduces the incidence of stroke and myocardial infarction but also may increase the survival rate. Because CAS may lead to in-stent restenosis, an eluting stent has been developed to prevent this adverse event. However, the effectiveness of the eluting stent has yet to be adequately verified. As patients who receive CAS remain at risk of recurrent stroke, intravascular restenosis, TIA, and mortality, post-procedure medical and nursing care for this population must be appropriately applied in order to maximize the rate of long-term success. Therefore, we recommend that clinical physicians and nurses regularly evaluate and monitor post-CAS patients in order to prevent complications. Moreover, they should educate patients before discharge on post-CAS wound care and medicine-taking regimens as well as on the importance of smoking cessation, controlling blood sugar and blood pressure, exercising regularly, reducing body weight, maintaining a healthy diet, and controlling the risk factors of atherosclerosis in order to prevent the recurrence of complications.