持续心电监护对急性冠状动脉综合征中危患者的影响

Effect of continuous electrocardiographic monitoring on poor risk patients with acute coronary syndrome

目的 探讨持续心电监护对急性冠状动脉综合征（ACS）中危患者的影响。方法 连续入选2015年1月至2016年6月于首都医科大学附属北京安贞医院心内科住院并拟择期行介入治疗的ACS中危患者500例，全球急性冠状动脉事件注册（GRACE）评分均为109～140分，根据医生的医嘱分为心电监护组（288例）和非心电监护组（212例）。入院24～48 h后由护士发放状态焦虑问卷调查，比较2组患者的焦虑评分，并记录在此期间临床事件发生情况，包括心绞痛再发、新发心律失常和死亡。结果 2组各有1例死亡，死亡率差异无统计学意义（P＞0.05）；心电监护组患者焦虑评分和心绞痛再发比例明显高于非心电监护组［（56±12）分比（43±10）分、12.5%（36/288）比7.1%（15/212）］，差异均有统计学意义（均P＜0.05）；2组新发心律失常和总临床事件发生率比较，差异无统计学意义（P＞0.05）。结论 对入院后GRACE评分109～140分的ACS中危患者，应慎重行持续心电监护。

Objective To investigate the effect of continuous electrocardiographic monitoring on poor risk patients with acute coronary syndrome（ACS）. Methods A prospective analysis was performed in 500 patients with ACS whose Global Registry of Acute Coronary Events（GRACE） score between 109 to 140. They are divided into continuous electrocardiographic monitoring group（n=288） and non-electrocardiographic monitoring group（n=212）. The State-Trait Anxiety Inventory evaluating patient emotion status and the incidence of clinical events including recurrence of angina pectoris, arrhythmia and death were recorded in 24-48 h after admission. Results There was one death in each group. Anxiety score and recurrence rate of angina pectoris in continuous electrocardiographic monitoring group were significantly higher than those in non-electrocardiographic monitoring group[（56±12）points vs （43±10）points, 12.5%（36/288） vs 7.1%（15/212）]（P〈0.05）. There were no significant differences of arrhythmia rate and clinical event rate between groups（P〉0.05）. Conclusion Continuous electrocardiographic monitoring should be performed in poor risk ACS patients with GRACE between 109 to 140.