急性心肌梗死急诊介入治疗时心电图监测护理的临床意义

Clinical nursing significance of electrocardiographic monitor in primary interventional therapy of acute myocardial infarction

目的观察急性心肌梗死患者急诊介入治疗前后心电图的变化与梗死相关血管再灌注的关系及其临床护理意义。方法分析急性心肌梗死急诊介入治疗患者介入治疗前后心电图变化,包括出现不同类型的心律失常及不同ST段回落程度与冠状动脉血流、心肌灌注程度的关系。结果在468例急性心肌梗死患者中,介入治疗术前存在室性心律失常142例。介入治疗术后出现室性加速性心率失常285例,一过性室性心动过速或R-on-T 203例,心室颤动行非同步电复律62例,出现新的Ⅱ度或Ⅲ度房室传导阻滞24例,窦性心动过缓或窦性停搏45例,原房室传导阻滞消失10例。介入治疗后ST段明显回落即ST段回落>50%为301例,ST段部分回落即ST段回落<50%为57例,ST段无变化29例。结论梗死相关血管(IRA)再灌注血流恢复正常时常可出现心律失常,有时是致命性室性心律失常,通过严密监测、及早发现和处理均可转危为安;当开通梗死相关血管冠状动脉血流较好时,ST段回落较多;而冠状动脉血流缓慢或冠状动脉血管在术中、术后再次闭塞,ST段回落较差,可伴有血压下降甚至出现心源性休克。因此急诊介入治疗时心电图监测护理十分重要,是保证介入手术顺利进行的关键。

Objective To study the clinical nursing significance of ECG monitor in primary PCI for AMI patients and the relation of changes in ECG and the reperfusion of infarction related artery. Methods Regressional analysis was made in ECG changes including different types of arrthymia, degree of ST sequent regression, and their relation between the reperfusion of infarction related artery before and after interventional therapy in AMI patients. Results In 468 AMI patients, 142 patients had ventricular arrhythmia before therapy. After interrentional therapy, 285 patients were co-morbid with accelerated ventricular tachycardia, 203 patients with transient ventricular tachycardia or R-on-T phenomenon, 62 patients with ventricular fibrillation and received asynchronous electriacal cardioversion. Twenty four patients had new onsent of Ⅱ -Ⅲ degree atrio-ventricular block and 45 patients had bradycardia or sinus arrest. The atrio-ventricular blonk in 10 patients before PCI disappeared after the operation. There are 301 patients with apparent ST segment regression （ST segment regressed ≥50%, 57 patients with partial ST segment regression, and 29 patients without ST segment changes. Conchusion Arrhythmias always accompanied with IRA reperfusion. Careful monitoring of ECG is essential for patients＇ safety after AMI. Obvious ST segment is observed in sufficient IRA reperfusion. However, poor regression of ST segment as well as haemodynamics disorder and cardiogenic shock is observed in patients with poor reperfusion or subacute occlusion of IRA.