心理护理干预对急性心肌梗死患者心理状态及治疗效果的影响

目的:探讨急性心肌梗死患者接受心理护理干预后心理状态变化以及治疗效果的改善。方法:选取2010年4月~2013年5月收治的82例急性心肌梗死患者,将其分为两组,每组各41例。对照组患者接受一般护理,试验组患者则在对照组基础上接受系统化心理护理干预,对比分析护理前后两组患者抑郁焦虑情绪。结果:心理护理前两组患者抑郁焦虑情绪差异无统计学意义(P>0.05);心理护理方案实施后试验组患者抑郁焦虑情绪明显轻于对照组,差异有统计学意义(P<0.05)。结论:通过针对性的心理护理干预有利于缓解急性心肌梗死患者的不良情绪,从而能够保持并提高疗效。     

125例心肌梗死临床护理体会

目的：探讨护理对急性心肌梗死患者急诊行介入治疗的影响。方法：回顾2007年12月-2009年9月共125例急性心肌梗死患者在接受急诊介入治疗前后进行护理的情况。结果：本组125例均顺利完成冠状动脉造影术,成功率为100％。结论：护理能有效缩短治疗时间,为急性心肌梗死患者顺利接受经皮冠状动脉介入治疗（PCI）创造有利条件,效果显著。     

Living alone after myocardial infarction. Impact on prognosis.

OBJECTIVE--To determine if the presence of a disrupted marriage or living alone would be an independent prognostic risk factor for a subsequent major cardiac event following an initial myocardial infarction. DESIGN--Prospective evaluation in the placebo wing of a randomized, double-blind drug trial in patients with an enzyme-documented acute myocardial infarction who were admitted to a coronary care facility. Data for living alone and/or a marital disruption were entered into a Cox proportional hazards model constructed from important physiologic and nonphysiologic factors in the same database. SETTING--Multicenter trial in a mixture of community and academic hospitals in the United States and Canada. PATIENTS--All consenting patients who were 25 to 75 years of age and without other serious diseases were enrolled (placebo, N = 1234) within 3 to 15 days of the index infarction and followed for a period of 1 to 4 years (mean, 2.1 years). Nine hundred sixty-seven patients were followed for 1.1 years and 530 for 2.2 years. PRIMARY OUTCOME MEASURE--Recurrent major cardiac event (either recurrent nonfatal infarction or cardiac death). RESULTS--Living alone was an independent risk factor, with a hazard ratio of 1.54 (95% confidence interval, 1.04 to 2.29; P less than .03). Using the Kaplan-Meier statistical method for calculation, the recurrent cardiac event rate at 6 months was 15.8% in the group living alone vs 8.8% in the group not living alone. Risk remained significant throughout the follow-up period (P = .001). A disrupted marriage was not an independent risk factor. CONCLUSION--Living alone but not a disrupted marriage is an independent risk factor for prognosis after myocardial infarction when compared with all other known risk factors.     

经皮冠状动脉介入术对冠心病患者心率变异性的影响

目的: 观察冠心病患者经皮冠状动脉介入术(PCI)后心率变异性(HRV)变化,评估PCI对冠心病预后的影响。方法: 选择经冠状动脉造影证实适合PCI的患者32例,其中心绞痛组20例,心肌梗死组12例,于PCI术前、术后3个月、6个月分别测HRV时域指标和频域指标。结果: PCI术后1个月HRV中24 h正常窦性R-R间期标准差、24 h每5 min窦性R-R间期均值标准差和高频均较术前改善(P<0.05),而术后6个月HRV除正常连续窦性R-R间期差值均方根(P>0.05)外,其余指标均进一步改善(P<0.01)。结论: PCI可以改善冠心病患者的心率变异性,可能与PCI改善了患者心肌缺血及纠正神经体液因子对窦房结功能、心室肌功能的调控失衡有关。     

非ST段抬高急性冠状动脉综合征心电图变化及早期有创干预

目的探讨非ST段抬高急性冠状动脉综合征(ACS)的心电图变化及早期有创干预的价值。方法2001年10月至2003年10月连续入院的非ST段抬高的ACS患者共545例,分成早期保守治疗组与早期有创干预组,随访患者30d与6个月的复合心血管事件(包括心脏性死亡、非致命性心肌梗死、非致命性心力衰竭、因反复缺血性心绞痛发作住院),评价心电图不同变化以及不同干预策略对患者预后的影响。结果随访545例患者中ST段压低者的单项心血管事件与复合事件均较其他心电图改变者明显增多,ST段压低变量是患者6个月复合心血管事件危险性增加的独立预测因素之一(OR3·864,95%CI:1·668~9·451,P<0·001)。与早期保守治疗组比较,早期有创干预组随访30d时反复心绞痛发作住院事件减少,随访30d与6个月时复合心血管事件也减少(均P<0·05);亚组分析示ST段压低患者早期有创干预能明显降低30d及6个月复合心血管事件(均P<0·01),无ST段压低患者并无类似获益。结论ST段压低是预测患者能从早期有创干预中获益的有效指标;早期有创干预较早期保守治疗能明显降低ST段压低的ACS患者的心血管事件。     

The use of HMG Co-A reductase inhibitors following acute myocardial infarction in hospital practice

Treatment with a HMG-CoA reductase inhibitor (statin) following a myocardial infarction has been shown to reduce the incidence of subsequent coronary revascularisation, myocardial infarction and cardiovascular death. The majority (89%) of patients admitted to the coronary care unit of our hospital received a fasting cholesterol check as part of a routine coronary care unit protocol. However, our survey shows that only 26% of patients surviving an acute myocardial infarction were on treatment with a statin at follow-up. Furthermore, those receiving statins were given smaller doses than those used in clinical trials. One way to ensure patients receive adequate treatment with statins, may be to include it as part of a coronary care unit protocol.     

循证护理在急性心肌梗死后心律失常患者中的应用

目的探讨循证护理在急性心肌梗死后心律失常患者中的应用效果,以期促进患者尽快康复。方法选取2010年10月～2011年10月本院住院的符合WHO急性心肌梗死后心律失常标准的患者120例,将其随机分为循证护理组和常规护理组,各60例,常规护理组实施常规护理,循证护理组在常规护理的基础上实施循证护理措施,包括对急性心肌梗死后心律失常的时相分布特征、可控因素、心理干预措施、健康宣教等方面的偱证,用以指导临床护理。比较两组患者心律失常发生率、心功能分级、平均住院时间、平均卧床时间、平均医疗费用、患者健康知识达标率、患者满意度。结果常规护理组心率失常发生率为66.67%,明显高于循证护理组的13.33%,两组比较差异有高度统计学意义（P〈0.01）;常规护理组健康知识达标率为71.67%,循证护理组为96.67%,两组比较差异有统计学意义（χ^2=7.43,P〈0.05）。两组患者心功能分级比较差异有统计学意义（P〈0.05）。循证护理组患者平均住院时间为（11.02±1.01）d、平均住院费用为（5 174.95±612.30）元,均显著低于常规护理组,差异有高度统计学意义（t=13.98、16.12,P〈0.01）;循证护理组平均卧床时间为（2.96±0.73）d,与常规护理组比较差异有统计学意义（t=7.14,P〈0.05）。循证护理组患者满意度为96.67%,高于常规护理组的70.00%,两组比较差异有统计学意义（χ^2=7.06,P〈0.05）。结论循证护理可有效降低急性心肌梗死后心律失常的发生,提高患者满意度,促进患者尽快康复。     

冠心病介入围术期舒适护理对患者心理状态及预后的影响

目的:探讨冠心病介入治疗(PCI)围术期心理结合行为护理的舒适护理对患者心理状态及预后的影响。方法:120例拟行PCI患者行术前空腹血糖、血脂检查,所有患者按随机化分组表随机分入对照组和干预组。对照组按PCI术前和术后护理常规进行;护理干预组除按PCI术前和术后护理常规进行外给予心理及行为护理的舒适护理干预措施。对患者焦虑自评量表(SAS)和抑郁自评量表(SDS)评估进行术前1天在护理前和拔动脉鞘管后12小时进行,并同时检测血清促肾上腺皮质激素(ACTH)、血浆皮质醇(Cor)、血糖及血C反应蛋白(CRP)。所有人选患者均采用门诊或电话随访,随访终点为12个月内的不良血管事件(MACE),包括全因死亡、非致死性心肌梗死(MI)和靶病变血运重建(TLR)。结果:对照组术后的SDS评分、SAS评分、ACTH、Cor和CRP均比术前显著升高(P<0.01),干预组术后SDS评分、ACTH、Cor和CRP均比术前显著升高(P<0.01),但干预组术后SDS评分、ACTH及Cor均比对照组术后的降低(P<0.05)。干预组12个月总MACE比对照组减少(χ2=11.04,P<0.05)。经Logistic多因素回归分析围术期抑郁是影响PCI术后12个月MACE的独立影响因素(OR=1.559,95.0%CI 1.06².29,P=0.023),护理干预是负影响PCI术后12个月MACE的独立影响因素(OR=0.114,95.0%CI 0.022.29,P=0.023),护理干预是负影响PCI术后12个月MACE的独立影响因素(OR=0.114,95.0%CI 0.02⁰.84,P=0.033),护理干预是减少PCI术后12个月MACE的影响因素。结论:冠心病介入治疗围术期可引起患者抑郁的心理应激反应升高,而抑郁是冠心病介入治疗术后不良血管事件的独立影响因素,心理护理结合行为护理的舒适护理干预可减轻围术期的抑郁负性心理反应及减少术后12个月总的不良血管事件。     

主动脉球囊反搏治疗25例急性重症心肌梗死患者的疗效观察

目的观察主动脉球囊反搏术(IABP)支持下急性重症心肌梗死患者行状动脉介入治疗的效果。方法对25例行介入治疗的急性重症心肌梗死患者应用IABP治疗1～9 d,平均(3.28±2.31)d,观察治疗前后血压和心率的改变。结果本组25例患者应用IABP治疗后血压均明显增高(P<0.05),心率明显减慢(P<0.05)。结论急性重症心肌梗死患者在IABP支持下行急诊冠状动脉介入治疗可增加治疗的安全性,降低病死率,减少血管再闭塞率及提高手术成功率。     

Long-term cardiac prognosis following noncardiac surgery. The Study of Perioperative Ischemia Research Group.

OBJECTIVE--To determine the long-term (2-year) cardiac prognosis of high-risk patients undergoing noncardiac surgery and to determine the predictors of long-term adverse cardiac outcome. DESIGN--Prospective cohort study. Historical, clinical, and laboratory data were collected during the in-hospital period, and at 6 months, 1 year, and 2 years following surgery. Data were analyzed using proportional hazards models. SETTING--University-affiliated Veterans Affairs medical center. POPULATION--A consecutive sample of 444 patients with or at high risk for coronary artery disease who had undergone elective noncardiac surgery and were discharged from the hospital in stable condition. MAIN OUTCOME MEASURES--Cardiac death, myocardial infarction, unstable angina, progressive angina requiring coronary artery bypass graft surgery or coronary angioplasty, and new unstable angina requiring hospitalization. RESULTS--Forty-seven patients (11%) had major cardiovascular complications during a 728-day (median) follow-up period: 24 had cardiac death; 11, nonfatal myocardial infarction; six, progressive angina requiring coronary artery bypass graft surgery or coronary angioplasty; and six, new unstable angina requiring hospitalization. Thirty percent of outcomes occurred within 6 months of surgery and 64% within 1 year. Five independent predictors of long-term outcome were identified. Three predictors reflected the preexisting chronic disease state: (1) the presence of known vascular disease (hazard ratio, 6.1; 95% confidence interval [CI], 2.5 to 15.0; P less than .0001); (2) a history of congestive heart failure (hazard ratio, 5.0; 95% CI, 2.0 to 12.0; P less than .0005); and (3) known coronary artery disease (hazard ratio, 3.7; 95% CI, 1.7 to 8.0; P less than .0007). Two predictors reflected acute postoperative ischemic events: (1) myocardial infarction/unstable angina (hazard ratio, 20; 95% CI, 7.5 to 53.0; P less than .0001) and (2) myocardial ischemia (hazard ratio, 2.2; 95% CI, 1.1 to 4.3; P less than .03). Patients surviving a postoperative in-hospital myocardial infarction had a 28-fold increase in the rate of subsequent cardiac complications within 6 months following surgery, a 15-fold increase within 1 year, and a 14-fold increase within 2 years (95% CI, 5.8 to 32; P less than .00001). Seventy percent of all long-term adverse outcomes were preceded by in-hospital postoperative ischemia that occurred at least 30 days (median, 282 days) before the long-term event. The development of congestive heart failure or ventricular tachycardia (without ischemia) during hospitalization was not associated with adverse long-term outcome. CONCLUSIONS--The incidence of long-term adverse cardiac outcomes following noncardiac surgery is substantial. At increased risk are patients with chronic cardiovascular disease; at highest risk are patients with acute perioperative ischemic events. We conclude that survivors of in-hospital perioperative ischemic events, specifically myocardial infarction, unstable angina, and postoperative ischemia, warrant more aggressive long-term follow-up and treatment than is currently practiced.     

Elective percutaneous intervention for unprotected left main coronary artery stenosis complicated with left anterior descending artery chronic total occlusive lesions

Background The patients with unprotected left main coronary artery （ULMCA） stenosis and chronic total occlusion （CTO） lesions at the left anterior descending （LAD） artery are often recommended for bypass surgery. However, some of these patients are deemed inoperable or are at high risk for surgery. In this study, we explored strategies and evaluated the efficacy of percutaneous coronary intervention for the treatment of ULMCA stenosis complicated by LAD CTO. Methods From November 2001 to July 2009, 78 patients with ULMCA stenosis and LAD CTO lesions were selectively treated with stenting. Six patients （7.7%） refused surgery due to their young age （S40 years）, and the other 72 patients （92.3%） were unsuitable for surgery. Reasons for poor surgical candidacy included advanced age （〉80 years）, chronic obstructive pulmonary, unsuitable distal target vessels for bypass, EuroSCORE ≥6, and so on. Four different strategies were applied based on the degree of left main stenosis and the ostial diameter and involvement of the left circumflex. Results Total procedural success was achieved in 94.9%, there were no deaths or thromboses. Five patients （6.4%） experienced non-Q-wave myocardial infarction in hospital. At long-term follow-up （（52±28） months）, there were 3 cardiac deaths （3.8%） and 4 （5.1%） nonfatal myocardial infarctions. Angiographic follow-up was performed in 50 patients （64.1%）, and target vessel revascularizations were required in 10 patients （12.8%）, among which 4 nonfatal myocardial infarction patients included. The rate of major adverse cardiac events was 16.7% （13/78）.Conclusions This study indicates that percutaneous intervention can be performed safely in high risk surgical patients with ULMCA and LAD CTO lesions based on individual therapeutic strategies. It may be feasible to apply this technique in selected patients mentioned above.     

Surgical treatment of impending myocardial infarction: Report of two cases

Two men, aged 29 and 44, presented with clinical and electrocardiographic evidence suggesting impending myocardial infarction. Selective coronary angiography revealed serious obstructive coronary atherosclerosis including gross stenosis of the main left coronary artery in both. Emergency surgical operations were performed, a double aorto-coronary venous bypass in one and a single venous bypass combined with a Vineberg operation in the other. Neither patient sustained myocardial infarction. Both patients are very well more than six months after operation. Clinical, electrocardiographic and angiographic evidence of the effectiveness of these operations is presented.     

非ST段抬高型心肌梗死急诊介入治疗的随访研究

目的：总结非ST段抬高性心肌梗死（NSTEMI）患者行急诊介入治疗（PCI）的临床疗效及随访结果.方法：2000年2月～2005年2月间,共收治142例NSTEMI患者,年龄36～82岁;其中6例行外科搭桥（CABG）治疗,136例行急诊PCI;发病到急诊PCI时间为1.5～11h.结果：136例行PCI者,131例成功,成功率96.3%.共治疗133处病变,置入支架177枚,4例患者仅行球囊扩张术.2例死亡,1例死于心源性休克,1例死于颅内出血.2例术后1周内支架内亚急性血栓形成.住院期间无其他严重心血管事件发生.129例患者门诊随访12个月,无不良心血管事件发生,86例PCI患者术后6～12个月行冠脉造影检查,再狭窄10例,8例金属裸支架者（16%）、2例药物洗脱支架者（5.6%）.结论：非ST段抬高型心肌梗死急诊介入治疗安全有效,能明显改善临床症状.药物洗脱支架可降低再狭窄发生率.     

踝臂指数对冠心病患者冠状动脉粥样硬化及心血管事件的预测价值

目的：观察踝臂指数测量值（ABI）对国人冠状动脉狭窄程度及冠心病病人的预测价值。方法：选取112例行冠状动脉造影的患者进行ABI测量、病史收集、生化检查和统计学处理,观察ABI、临床指标与冠状动脉造影结果的相关性。并随访13.4±2.3月,观察ABI与心血管事件（心源性死亡、非致死性心肌梗死、不稳定性心绞痛、冠状动脉旁路移植术）的相关性。结果：冠状动脉造影严重病变组和非严重病变级间ABI有显著差异;ABI降低与ABI正常组间心血管事件发生率先有显著差异。结论：ABI〈0.9对冠状动脉严重病变（三支和左主干病变）及冠心病患者的预后有预测价值。     

Surgical standby for coronary balloon angioplasty.

OBJECTIVE--To assess the predictability of need for emergency surgery after coronary balloon angioplasty. DESIGN-- Nonrandomized intervention study. SETTING--Nonprofit university hospital. PATIENTS--Prior to balloon angioplasty, 1000 consecutive patients were assigned to either the "standby" group (189 patients [19%]) or the "no-standby" group (811 patients [81%]). Patients in the standby group (intervention coordinated with cardiac surgery) included all operable patients undergoing angioplasty of their largest coronary arteries that were not currently or previously totally occluded or collateralized; the no-standby group consisted of the remainder of patients. INTERVENTION--Allocation to coronary angioplasty with or without surgical standby. MAIN OUTCOME MEASURES--Need for bypass surgery, occurrence of myocardial infarction, and mortality from complications of angioplasty. RESULTS--Bypass surgery immediately after angioplasty was done in one patient in each group (standby, 0.5%, vs no-standby, 0.1%). The frequency of infarction was 5% vs 4%, respectively. All eight deaths occurred in the no-standby group (1.0%), but none of them were consequences of a lack of surgical standby. They occurred in situations in which bypass surgery would not have changed the outcome (two cardiac failures late after technically successful angioplasty for postinfarct cardiogenic shock, one in-laboratory rupture of an unrecognized ventricular pseudoaneurysm, and one protamine reaction), secondary to acute problems late after successful angioplasty (two sudden deaths and one vessel occlusion in an inoperable patient), or despite surgery (one patient with left main stem dissection). CONCLUSIONS--Performing roughly 80% of coronary angioplasties without surgical standby did not increase patient risk. Coronary angioplasty without surgical backup, albeit not an ideal setting, appears ethically feasible in selected patients if dictated by logistic considerations.     

经皮冠状动脉介入联合主动脉球囊反搏的护理

目的探讨经皮冠状动脉介入（PCI）联合主动脉球囊反搏术（IABP）治疗急性心肌梗死（AMI）合并心源性休克的护理。方法急性心肌梗死（AMI）合并心源性休克患者56例,所有患者在24h内均使用经皮冠状动脉介入（PCI）联合主动脉球囊反搏术（IABP）治疗,通过加强护理及监护,降低病死率。结果经皮冠状动脉介入（PCI）联合主动脉球囊反搏术（IABP）治疗急性心肌梗死（AMI）合并心源性休克,可提高PCI成功率,减少并发症,降低手术风险。56例患者中,54例患者抢救成功,成功率96%。结论 PCI联合IABP对治疗心肌梗死合并心源性休克有较好的疗效,护理中要求护理人员熟练掌握PCI的护理配合和IABP的工作原理及机械操作,确保PCI及IABP有效、安全实施,加强病情观察,防止并发症的发生和发展,可有效提高手术治疗的成功率,降低病死率。     

急诊PCI对急性ST段抬高型心肌梗死患者左心室功能的影响

目的:探讨急诊冠状动脉介入治疗(PCI)对急性ST段抬高型心肌梗死患者左心室功能的影响.方法:入选病例为接受冠状动脉介入治疗的首次急性ST段抬高型心肌梗死的患者,65例,其中急诊PCI组35例,择期PCI组(对照组)30例.术后7 d、6个月所有患者行超声心动图检查,测量左心室射血分数、二尖瓣血流频谱以评价左心室收缩、...     

心脏介入围手术期的护理干预及患者焦虑情绪的管理

目的：对比心脏介入治疗前后结患者焦虑情绪的改变,探讨围手术期护理干预对减轻患者焦虑情绪,预防术后并发症疗效。方法选择我院心脏介入(PCI)合并焦虑患者118例,随机分为干预组59例和对照组59例,对照组采用常规护理方式,观察组在常规护理的基础上给予全面的心理护理干预。并评估两组手术前后焦虑(SAS)评分以及术后并发症的情况。结果心脏介入患者合并焦虑的比例为44.2%,其中焦虑评分与学历、吸烟史、冠心病家族史成正相关(P<0.05),与年龄成负相关(P<0.01);观察组术后梗死率、心绞痛发作频率、心律失常发生率也明显减少(P <0.01);观察组手术前后SAS评分明显低于对照组,差异具有统计学意义(P<0.05或0.001)。结论围手术期开展全面的护理干预可以缓解PCI手术前后患者焦虑情绪,减轻术后并发症,值得临床推广应用。     

急性心肌梗死介入术后支架内血栓形成的临床分析

目的：探讨急性心肌梗死介入术后支架内血栓形成的危险因素。方法随机选取2013年1月—2015年4月期间该院收治的急性心肌梗死行经皮冠状动脉介入治疗患者210例,其中12例患者于治疗后出现支架内血栓形成,对其临床资料进行回顾性分析。结果心功能不全(OR=2.224,95%CI=1.017~2.431,P=0.002)、前壁心肌梗死(OR=1.458,95%CI=1.432~4.775,P=0.002)、停用抗血小板药物(OR=1.105,95%CI=0.934~2.132,P=0.000)、支架长度(OR=1.527,95%CI=1.398~5.917,P=0.005)均是影响急性心肌梗死患者PCI术后发生支架内血栓形成的危险因素。结论复杂冠状动脉病变类型、抗血小板治疗依从性差是影响急性心肌梗死患者PCI术后发生支架内血栓形成的重要危险因素,应加强早期治疗和护理干预,以改善预后。     

宽心合剂对急性心肌梗死患者心肌保护作用的临床研究

目的评价宽心合剂辅助直接经皮冠状动脉介入术（PCI）治疗急性心肌梗死（AMI）的心肌保护作用。方法入选成功接受直接PCI治疗的急性前壁心肌梗死患者60例,随机分为宽心合剂组和常规PCI对照组（常规对照组）,每组30例。宽心合剂组在直接PCI及常规药物治疗基础上于再灌注治疗成功后予宽心合剂20ml/d,口服,随访3个月。于术前及术后1、8、24、48h及7d分别取静脉血3ml,测定血清肌酸激酶同工酶（CK-MB）、血清总超氧化物歧化酶（T-SOD）及血清丙二醛（MDA）水平。于术前及术后2h记录心电图,分析ST段抬高幅度与ST段恶化的发生率。并于术后2d及3个月分别行心脏超声检查以评价心功能。结果宽心合剂组较常规对照组术前心电图（ECG1）ST段抬高幅度、术后2h心电图（ECG2）ST段抬高幅度、ST段下降幅度及ST段恶化率比较,差异无统计学意义。宽心合剂组血清CK-MB水平较常规对照组术后8h明显升高,差异有统计学意义（P〈0.05）;宽心合剂组血清MDA水平较常规对照组术后1h明显升高,差异有统计学意义（P〈0.05）;宽心合剂组血清T-SOD水平较常规对照组术后8h明显降低,差异有统计学意义（P〈0.05）。心脏超声检查术后2d两组患者各指标差异均无统计学意义（P〈0.05）,术后3个月宽心合剂组患者LVEDV、LVESV较常规对照组显著减小,LVEF明显升高,差异均有统计学意义（P〈0.05）。结论宽心合剂对AMI发病早期急性缺血-再灌注损伤心肌具有心肌保护作用,减轻心肌细胞氧自由基过氧化损伤可能是其作用机制之一。