急性心肌梗死的护理体会

目的:总结急性心肌梗死的护理经验.方法:除了做好常规的护理外,针对急性心梗患者的特殊心理特点,及时与其沟通,了解其心理状态并给予相应的心理疏导,做好家属的心理工作,严格执行探视制度,减少不良刺激,提高抢救成功率.结果:急性心肌梗死患者中,经抢救治疗和心理疏导安全度过危险期的58例,死亡4例.结论:在做好护理常规的基础上,重视患者及家属的心理疏导及加强探视制度的管理,能提高抢救成功率.     

强化心理护理对经皮冠状动脉介入治疗围手术期并发症的影响

目的 讨论24h一对一强化心理护理对经皮冠状动脉介入治疗围手术期并发症的影响.方法 将本院近年来需要行血运重建适合PCI者共217例分为2组,强化组行24h一对一强化心理护理,对照组行一般护理,观察2组并发症的发生率.结果 强化组(8.7%)并发症发生率低于对照组(23.2%),p<0.05.结论 积极的一对一强化心理护理可以减少并发症的发生,有利于病情的恢复,提高患者的依从性.     

老年急性心肌梗死的临床分析

目的:探讨老年性急性心肌梗死的治疗措施及临床特征;方法:选择2009年2月至2011年2月我院收治的老年性急性心肌梗死患者61例为观察组,选择同期我院收治的老年性急性心肌梗死患者61例为对照组,对两组的临床特征及疗效进行比较;结果:两组首发症状的胸痛、胸闷和心悸相比差异有显著性(P<0.05),两组梗塞部位的非Q波相比差异有显著性 (P<0.05),两组治疗效果相比差异有显著性(P<0.05);结论:应针对患者的不同情况进行个体化治疗,提高患者生活质量.     

急性心肌梗死患者的护理分析

目的:探讨急性心肌梗死患者的特点及护理方法.方法:回顾性分析我院2007年4月至2010年4月,收治的 200例急性心肌梗死患者的诊治、护理资料,分析急性心肌梗死患者的特点及临床护理方法要点.结果:200急性心肌梗死患者通过及时抢救及针对性的护理均得到良好的预后.结论:通过及时抢救、有效心理护理、健康教育及适当的药物治疗,可以较好的保证急性心肌梗死患者有良好的预后.     

急性心肌梗死的院前急救护理体会

急性心肌梗死(AMI)属冠心病的严重类型,每年有一半的以上心血管疾病者死于该病[1].在基层医院急诊工作中,AMI的发病率、死亡率均较高.但如果能早期处理得当,可以及时挽救濒死的心肌、缩小心肌缺血范围、防止梗死面积的扩大,就可以降低其病死率、改善预后[2].AMI的院前急救显得尤为重要.现将笔者在院前急救护理中处理的20例AMI的体会报告如下.     

急性心肌梗死溶栓治疗的护理

总结了22例急性心肌梗塞患者行溶栓治疗的护理体会,包括溶栓前准备、溶栓过程中的准确配合、溶栓后全面周密的护理.认为护理人员必须熟练掌握溶栓治疗的相关知识,加强对患者病情的动态观察,积极预防与处理并发症,对于保证溶栓治疗的顺利进行,提高治疗效果,促进患者康复有着重要的意义.     

急性心肌梗死溶栓治疗中的护理

总结了35例发病在6h内的急性心肌梗死病人,选用尿激酶进行溶栓治疗的临床观察和护理实践.包括:心理护理和溶栓前后的护理,认为对急性心肌梗死溶栓治疗的病人进行有效护理,可提高急性心肌梗死病人的治愈率,减少并发症,提高其生活质量.     

健康教育护理干预在老年急性阑尾炎护理中的应用效果

目的:探讨健康教育护理干预在老年急性阑尾炎护理中的应用效果.方法:选择我院2008年8月至2010年8月老年急性阑尾炎患者40例,本组患者在常规急性阑尾炎护理基础上实施健康教育护理干预:制定合理的健康教育计划、术前健康教育和术后健康教育.结果:本组患者平均住院时间为9天,术后发生切口感染1例,粘连性肠梗阻1例,肺部感染患者1例.其中49例患者对健康教育护理干预表现满意,满意度为98.0%.结论:健康教育护理干预能够提高急性阑尾炎老年患者对疾病的认知程度,减少术后并发症,护理效果满意,值得借鉴.     

急性心肌梗死患者溶栓治疗的护理体会

急性心肌梗死是指在冠状动脉病变的基础上发生冠状动脉供血急剧减少或中断,导致心肌严重而持久的急性缺血性坏死,是内科常见症状,其早期死亡率最高.因此,一旦确诊,应紧急处理.而早期进行溶栓治疗,使闭塞的冠状动脉再通,可挽救部分濒死的心肌、缩小梗死面积,改善预后.现将我院心内科2010年1～12月收治的53例急性心肌梗死患者治疗溶栓的护理体会介绍如下.     

37例老年急性心力衰竭的急救护理体会

总结37例老年急性心力衰竭病人的病情观察和护理.认为针对老年急性心力衰竭的病人的病因及诱因加强护理,可以提高治疗效果,降低死亡率.     

Effect of percutaneous transluminal coronary angioplasty on exercise in patients with and without previous myocardial infarction

Improvement in exercise capacity is an important clinical effect of percutaneous transluminal coronary angioplasty (PTCA), and was assessed in patients with and without previous myocardial infarction (MI) undergoing PTCA. We prospectively followed patients with exercise testing before and 2 weeks after angioplasty in 415 patients, 170 (41%) of whom had a previous MI. A third exercise test was performed 20 +/- 2 weeks after PTCA in 403 patients. From left ventricular angiography obtained before PTCA, regional dyskinesia was classified into anterior or posterior locations. Both patients with and without previous MI had a significant increase in exercise capacity from before to 2 and 20 weeks after PTCA (previous MI: 31.9% and 29.3%; no MI: 50.7% and 38.2%; p <0.0001 [analysis of variance]). In patients with MI and anterior dyskinesia, in whom lesions on the left anterior descending artery were dilated or posterior dyskinesia in whom lesions on the right coronary artery were dilated, exercise capacity increased significantly from before to 2 and 20 weeks after PTCA (left anterior descending artery: 53.1% and 39.7%, p <0.0001; right coronary artery: 16.9% and 27.6%, p = 0.01 [analysis of variance]). Multivariate regression analysis revealed that male sex, no previous MI, and dilation of left anterior descending artery were significantly associated with increased exercise capacity after angioplasty adjusted for age and smoking habits, whereas left ventricular ejection fraction and end-diastolic pressure were not associated with increased exercise capacity.     

Intravascular ultrasound assessment of direct percutaneous transluminal coronary angioplasty in patients with acute myocardial infarction

BACKGROUND: Acute myocardial infarction is caused by sudden thrombotic occlusion of the coronary artery due to a previous rupture of atherosclerotic plaque. OBJECTIVE: To use intracoronary ultrasound measurements to evaluate lumen and plaque changes in patients with acute myocardial infarction. METHODS: Patients (n = 103) with acute myocardial infarction who had been scheduled to undergo primary percutaneous transluminal coronary angioplasty (PTCA) were selected. Both before and after successful coronary angioplasty, intracoronary 30 MHz ultrasound studies were performed using a 3.5F monorail catheter. The ultrasound catheter was successfully advanced into the occluded vessel segment without major complications prior to PTCA in 79 of 103 (76.7%) patients and after PTCA in 88 of 103 (85.3%) patients. RESULTS: The plaques were eccentric in 66 patients (83.5%). The plaque morphology was purely low echogenic in 14 (17.7%), highly echogenic in six (7.6%) and mixed in 59 (74.7%) patients. Partial (59 of 79, 74.7%) or ring-like calcification (3 of 79, 3.8%) was observed in 62 patients (78.5%). Plaque fissuring or dissection was detected prior to PTCA in 25 patients (31.7%). Coronary angioplasty successfully enlarged the inner luminal area from 2.1 +/- 0.7 to 7.4 +/- 1.9 mm2 (P < 0.01), whereas the plaque-thrombus area decreased significantly (13.8 +/- 1.7 mm2 before and 9.0 +/- 1.9 mm2 after PTCA; P < 0.01). The total vessel area remained virtually constant (15.9 +/- 1.9 mm2 before and 16.4 +/- 2.5 mm2 after PTCA, NS). PTCA-induced plaque rupture or dissection was observed in only 13 (16.5%) patients. CONCLUSION: Intracoronary ultrasound imaging can be performed safely and successfully prior and subsequent to PTCA in selected patients with acute myocardial infarction. Early reperfusion via PTCA seems to be attributable to a significant reduction in the amount of low-echogenic plaque and thrombus material, whereas factors like balloon-induced dissection and stretching of vessels play only a minor role.     

Long-term beneficial effect of late reperfusion for acute anterior myocardial infarction with percutaneous transluminal coronary angioplasty

BACKGROUND: Although the short-term and long-term beneficial effects of early coronary revascularization by primary PTCA or thrombolytic therapy have been established for acute myocardial infarction, thrombolytic therapy >24 hours after the onset of acute myocardial infarction has not been shown to improve clinical outcome. The purpose of this study was to assess the effect of late revascularization by primary PTCA over a 5-year period. METHODS AND RESULTS: Eighty-three patients with initial Q-wave anterior myocardial infarction >24 hours after onset were randomized into a PTCA group (n=44) and a no-PTCA group (n=39). Long-term follow-up was conducted with regard to end points, which included cardiac death, nonfatal recurrence of myocardial infarction, and development of congestive heart failure. Left ventricular ejection fraction and regional wall motion at 6 months after myocardial infarction were similar in the 2 groups. Left ventricular end-diastolic and end-systolic volume indexes were significantly smaller in the PTCA group than in the no-PTCA group (P<0.0001). With cardiac events as end points, a 5-year Kaplan-Meier event-free survival analysis revealed that the no-PTCA group had a worse prognosis than the PTCA group (P<0.0001). Patency of the infarct-related artery, left ventricular ejection fraction, end-diastolic volume index, and end-systolic volume index were significantly associated with cardiac events by a Cox proportional hazards analysis (hazard ratios 0.120, 0.845, 1.065, and 1.164, respectively). CONCLUSIONS: In initial Q-wave anterior myocardial infarction, we conclude that even with late reperfusion, PTCA had beneficial effects on cardiac events over the 5-year period after myocardial infarction, with the prevention of left ventricular dilation after myocardial infarction being a possible mechanism.     

Randomised trial of home-based psychosocial nursing intervention for patients recovering from myocardial infarction

BACKGROUND: Increases in life stress have been linked to poor prognosis, after myocardial infarction (MI). Previous research suggested that a programme of monthly screening for psychological distress, combined with supportive and educational home nursing interventions for distressed patients, may improve post-MI survival among men. Our study assessed this approach for both men and women. We aimed to find out whether the programme would reduce 1-year cardiac mortality for women and men. METHODS: We carried out a randomised, controlled trial of 1376 post-MI patients (903 men, 473 women) assigned to the intervention programme (n = 692) or usual care (n = 684) for 1 year. All patients completed a baseline interview that included assessment of depression and anxiety. Survivors were also interviewed at 1 year. FINDINGS: The programme had no overall survival impact. Preplanned analyses showed higher cardiac (9.4 vs 5.0%, p = 0.064) and all-cause mortality (10.3 vs 5.4%, p = 0.051) among women in the intervention group. There was no evidence of either benefit or harm among men (cardiac mortality 2.4 vs 2.5%, p = 0.94; all-cause mortality 3.1 vs 3.1%, p = 0.93). The programme's impact on depression and anxiety among survivors was small. INTERPRETATION: Our results do not warrant the routine implementation of programmes that involve psychological-distress screening and home nursing intervention for patients recovering from MI. The poorer overall outcome for women, and the possible harmful impact of the intervention on women, underline the need for further research and the inclusion of adequate numbers of women in future post-MI trials.     

One-year outcomes of diabetic versus nondiabetic patients with non-Q-wave acute myocardial infarction treated with percutaneous transluminal coronary angioplasty

Risk factors and outcomes associated with non-Q-wave myocardial infarction (MI) in diabetics and nondiabetics were analyzed for 376 consecutive patients, 77 with diabetes (20%) and 299 nondiabetics (80%), who had non-Q-wave MI and had percutaneous transluminal coronary angioplasty (PTCA) performed before discharge from hospital during the period from January 1992 to February 1996. Diabetics were slightly older (64 +/- 10 years vs 61 +/- 12 years, p <0.053), had more prior coronary artery bypass grafting (CABG) surgery (27% vs 12%, p <0.001), and hypertension (77% vs 49%, p <0.001). There was no significant difference in unstable angina, saphenous vein graft PTCA, single versus multiple vessel disease, or history of MI. PTCA success rates for diabetics versus nondiabetics were similar (96% vs 97%, p = NS). In-hospital complications such CABG, recurrent MI, repeat PTCA, stroke, and death were not statistically significant between the 2 groups. At 1-year follow-up, survival in diabetics (92%) was similar to nondiabetics (94%, p = NS), although event-free survival (PTCA, CABG, MI, death) was worse in diabetics (55% vs 67% for nondiabetics, p <0.05). Although diabetic patients with non-Q-wave MI represent a cohort with more risk factors for poor outcome, aggressive in-hospital revascularization with PTCA results in an excellent short-term outcome as well as 1-year survival similar to the nondiabetic patients. However, total events at 1-year follow-up are more common in the diabetic patients, suggesting that more aggressive screening and therapy in follow-up may be warranted, and that a diabetic with non-Q-wave MI will require increased utilization of cardiovascular resources in the first year after the event.