Juran N B
The Cleveland Clinic Foundation, OH 44195, USA.
Am Heart J. 1999 Oct;138(4 Pt 2):297-306. doi: 10.1053/hj.1999.v138.a100462.
Percutaneous coronary intervention in patients with coronary artery disease can lead to thrombotic occlusion of the artery and to subsequent ischemic complications. Patients undergoing these procedures have been treated with aspirin, heparin, or both as a means of preventing thrombosis. The arsenal of antithrombotic agents has recently been augmented by the addition of a new class of drugs the platelet receptor glycoprotein (GP) IIb-IIIa inhibitors, which include abciximab, eptifibatide, and tirofiban. Unlike aspirin or heparin, which inhibit some but not all pathways leading to thrombosis, GP IIb-IIIa inhibitors block the final common pathway of platelet aggregation. When used in conjunction with aspirin and heparin, GP IIb-IIIa inhibitors have yielded favorable clinical outcomes, reducing the incidence of death, myocardial infarction, and urgent intervention. However, GP IIb-IIIa inhibitors also have been associated with an increased risk of bleeding complications, especially at the femoral access site. This presents new challenges for nurses charged with the care of patients treated with these agents. The goal of nursing care for this population is to ensure the optimal benefits of GP IIb-IIIa inhibitor therapy while simultaneously preventing or minimizing groin bleeding in patients undergoing percutaneous coronary procedures.
冠心病患者的经皮冠状动脉介入治疗可导致动脉血栓形成闭塞，并引发随后的缺血性并发症。接受这些手术的患者已接受阿司匹林、肝素或两者联合治疗，作为预防血栓形成的手段。最近，一类新型药物——血小板受体糖蛋白（GP）IIb-IIIa抑制剂的加入，扩充了抗血栓药物的种类，这类抑制剂包括阿昔单抗、依替巴肽和替罗非班。与阿司匹林或肝素不同，后者抑制部分而非全部导致血栓形成的途径，而GP IIb-IIIa抑制剂阻断血小板聚集的最终共同途径。当与阿司匹林和肝素联合使用时，GP IIb-IIIa抑制剂产生了良好的临床效果，降低了死亡、心肌梗死和紧急干预的发生率。然而，GP IIb-IIIa抑制剂也与出血并发症风险增加有关，尤其是在股动脉穿刺部位。这给负责护理接受这些药物治疗患者的护士带来了新的挑战。对这一人群的护理目标是确保GP IIb-IIIa抑制剂治疗的最佳益处，同时预防或尽量减少接受经皮冠状动脉手术患者的腹股沟出血。
