预见性护理在急性心肌梗死患者静脉溶栓中的应用简

目的探讨预见性护理方案在急性心肌梗死患者静脉溶栓中的临床疗效，并为其临床护理提供新的方向。方法选取湘雅医院心内科于2010年5月～2012年9月收治的80例急性心肌梗死患者．利用随机数字表法进行分组，分别设为研究组和对照组，每组各40例。其中对照组实施常规护理方案，而研究组给予预见性护理。由专人记录两组患者在住院期间并发症发生情况，以率作为统计描述，采取X^2检验。由专人记录两组患者的临床疗效，采取显效、有效、无效、死亡作为等级划分，采取等级资料Wilcoxon符号秩和检验。待两组患者出院当天，分发自制的护理质量调查问卷，内容涉及人院须知、心理舒适、疾病知识和护理巡视评分，记录数据，以均数±标准差作为统计描述，采取两独立样本t检验。两组患者在溶栓治疗前1天和溶栓后第2天进行焦虑自评量表（SAS）和抑郁自评量表（SDS）调查并记录数据，以均数±标准差作为统计描述，采取两独立样本t检验。结果①研究组显效24例，有效20例，无效8例，死亡0例，对照组显效7例，有效18例，无效12例，死亡3例，两组临床疗效比较，差异有统计学意义（P〈0．05）。②研究组心律失常23例（57．5％），心源性休克22例（55．0％），心力衰竭2例（5．0％），对照组心律失常30例（75．0％），心源性休克30例（75．0％），心力衰竭7例（17．5％），两组并发症比较，差异均有统计学意义（均P〈0．05）。③研究组在人院须知、心理舒适、疾病知识和护理巡视方面的评分分别为（22．4±2．2）、（22．3±2．0）、（18．4±3．0）、（22．1±2．9）分，而对照组分别为（19．5±3．4）、（18．6±3．1）、（21．5±3．3）、（18．7±3．2）分，两组比较，差异均有统计学意义（均P〈0．05）。④两组患者在溶栓前的SDS和SAS评分差异均无统计学意义（P〉0．05）；研究组在溶栓后SDS评分为（53．2±2．3）分，对照组为（60．8±2．5）分，两组比较，差异有统计学意义（P〈0．05）；研究组在溶栓后SAS评分为（52．0±3．2）分，对照组为（60．5±2．9）分，两组比较，差异有统计学意义（P〈0．05）。结论预见性护理能够提高急性心梗患者溶栓效果，并降低并发症发生率，改善患者心理状况，取得较为满意的临床效果。

Application of predictive nursing in intravenous thrombolysis in patients with acute myocardial infarction

Objective To discuss the clinical effect of predictive nursing plan in intravenous thrombolysis in patients with acute myocardial infarction, and provide a new direction for the clinical nursing. Methods 80 cases of patients with acute myocardial infarction in Cardiology Department of Xiangya Hospital from May 2010 to September 2012, were randomly divided into two groups, each group had 40 cases. The control group received routine nursing program, and the study group were given nursing care. Specialized personnel recorded of two groups of patients in the incidence of complications during the hospitalization and thrombolysis total efficiency, X2 test was adopted. Specialized personnel recorded of two groups of patients in the clinical efficiency, Wilcoxon signed rank test was adopted. Specialized person- nel distribution of nursing quality questionnaire to the two groups of patients, involving the admission notice, psycho- logical comfort, knowledge of disease and nursing inspection scores, two independent samples t test was adopted. Two groups of patients before thrombolytic therapy of 1 d and after thrombolytic therapy of 2 d were provided for SDS and SAS questionnaire, two independent samples t test was adopted. Results ①Patients in the study group were markedly effective for 24 cases, effective for 20 cases, invalid for 8 cases, death for 0 case; patients in the control group were markedly effective for 7 cases, effective for 18 cases, invalid for 12 cases, death for 3 cases, there was significant dif- ference between the two groups （P 〈 0.05）. ②The study group had 23 cases （57.5%） of arrhythmia, 22 cases （55.0%） of cardiogenic shock, 2 cases （5.0%） of heart failure, the control group had 30 cases （75.0%） of arrhythmia, 30 cases （75.0%） of cardiogenic shock, 7 cases （17.5%） of heart failure, there were significant differences between the two groups （all P 〈 0.05）. ③the study groups in the scores of admission notice, psychological comfort, knowledge of disease and nursing inspection were （22.4±2.2）, （22.3±2.0）, （18.4±3.0）, （22.1±2.9） scores, while the control group were （19.5±3.4）, （18.6±3.1）, （21.5±3.3）, （18.7±3.2） scores, the difference between the two groups were statistically significant （P 〈 0.05）. ④Two groups of patients before thrombolysis in the SDS and SAS scores were not significant （P 〉 0.05） study group after thrombolysis in SDS scores were （53.2±2.3） scores, control group were （60.8±2.5） scores, the differ ence between the two groups was statistically significant （P 〈 0.05）; study group after thrombolysis in SAS scores were （52.0±3.2） scores, control group were （60.5±2.9） scores, the difference between the two groups was statistically significant （P 〈 0.05）. Conclusion Nursing care can improve the effect of thrombolysis in patients with acute myocardial infarction, and reduce the incidence of complications.