危重STEMI患者床旁紧急行IABP的护理及预后观察

Nursing and Clinical Prognosis of Emergency Bedside IABP for Severe STEMI Patients

目的探讨危重急性大面积ST段抬高型心肌梗死(STEMI)在CCU病房紧急应用床旁主动脉内球囊反搏泵(IABP)治疗的护理及临床预后。方法 2014年3月至2016年10月,选取发病12~72 h,不能急诊血运重建、血压≤100/60 mm Hg的危重STEMI患者82例,随机分为2组,观察组40例,对照组42例。两组入院后均给予规范的药物治疗,按危重患者标准化护理,观察组在规范药物治疗的基础上床旁应用IABP,加强IABP术后护理,严密观察病情变化及并发症的发生。两组均于10~14 d冠状动脉造影,必要时经皮冠脉介入治疗术(PCI),评价梗死相关血管PCI术前及术后冠状动脉急性心肌梗死溶栓试验(TIMI)血流分级,观察IABP的并发症及术后4周心功能、主要不良心血管事件的发生情况。结果两组PCI术前TIMI血流、PCI术后4周主要不良心血管事件的发生率、左心室射血分数差异有统计学意义(均P<0.05),IABP相关并发症经及时处理均好转。结论对于危重STEMI患者床旁应用IABP能改善梗死相关血管的TIMI血流,改善心功能,减少主要不良心脏事件的发生,加强护理配合与严密观察能减少及预防并发症的发生。

Objective To study nursing and clinical prognosis of emergency bedside intra-aortic balloon pump （IABP） in patients with acute ST-segment elevation myocardial infarction （STEMI）. Methods From March 2014 to October 2016, 82 severe STEMI patients were selected with onset time of 12 -72 hours, and blood pressure ≤ 100/60 mmHg without emergency revascularization. They were randomly divide into two groups： 40 patients in observation group and 42 in control group. All the individuals were given standardized drug treatment and nursing care, and performed coronary arterion graphy or percutaneous coronary intervention （PCI） after 10 to 14 days. In IABP group, nurse closely observed the changes and complications to strengthen the postoperative nursing. The thrombolysis in acute myocardial infarction （TIMI） grade was evaluated before and after PCI. The major adverse cardiac events and heart function were observed at 4 weeks after operation. Results The TIMI grade before PCI, incidence of the major adverse cardiac events at 4 weeks after operation and left ventricular ejection fraction had significant difference between the two groups （ all P 〈 0.05） , while complications of IABP were improved and treated timely. Conclusion Early emergency application of IABP on bedside for patients with STEMI could reduce the major adverse cardiac events, improve the TIMI blood flow of infarction related vessels and upgrade heart function. It was proved that strengthening nursing care and closely observing the patients could reduce the occurrence of complications.