低中危急性冠脉综合征患者排便方式的研究

Study on defecation pattern of acute coronary syndrome patients with low to moderate risk

目的观察不同排便方式对急性冠脉综合征患者心肌耗氧量的影响,探寻急性冠脉综合征患者早期床边坐便的安全性、可行性。方法将入住CCU的GRACE危险评分为低中危急性冠脉综合征患者92例随机分为观察组和对照组各46例。患者入院排便时采用心电监护仪实时监测,观察组由护理人员协助床边排便,对照组采用卧位排便。记录两组排便前、排便时3、6、9min及排便后的心率、血压、心肌耗氧量、排便耗时、自我理解的用力程度Borg评分。结果观察组各时间段心率、收缩压、舒张压、心肌耗氧量、排便耗时与对照组比较,差异无统计学意义(均P>0.05);两组因排便不适所致排便终止发生率比较,差异无统计学意义(P>0.05);观察组Borg评分显著低于对照组(P<0.05)。结论对低中危急性冠脉综合征患者在严密监测下进行早期床边排便,并不会导致心率、血压、心肌耗氧量的增加,可改善患者排便舒适度。急性冠脉综合征患者在GRACE危险评分筛选下选择床边排便安全可行。

Objective To observe the effects of different defecation patterns on myocardial oxygen consumption of acute coronary syndrome（ACS） patients, and to explore the safety and feasibility of bedside defecation at an early period for ACS patients. Methods A total of 92 ACS patients with low to moderate risk according to GRACE risk score and admitled to CCU were randomized into an observation group and a control group, with 46 in each group. All patients were constantly monitored by ECG monitor when defeea ting during hospitalization. The observation group defecated at bedside with the help of nurses, while the control group defecated lying in bed. The heart rate, blood pressure, myocardial oxygen consumption, defecation time, self perceived Borg scores of the two groups before defecation, 3,6,9 minutes during defecation and after defecation were recorded. Results There were no significant differences in heart rate, systolic pressure, diastolic pressure, myocardial oxygen consumption and defecation time at each time point between the two groups （P〉0.05 for all）, there was no significant difference in the rate of defecation termination because of defecation discomfort （P〉0.05）,while the Borg score of the observation group was significantly lower than that of the control group （P〈0. 05）. Conclusion Early bedside defecation under closely monitoring for ACS patients with low to moderate risk, doesn＇t increase patients＇ heart rate, blood pressure, myocardial oxygen consumption, but improve defecation comfort feeling. Therefore, it is safe and feasible for ACS patients to defecate bedside at an early stage based on the risk screening of GRACE risk score.