急性心肌梗死患者低钙血症情况分析

目的 探讨急性心肌梗死患者低钙血症的发生及其与预后的关系. 方法 对2003年1月至2006年12月哈尔滨医科大学附属第一医院CCU病房收治的1274例急性心肌梗死患者进行回顾性分析,常规方法测定血浆钙离子浓度,依据最低值进行分组,A组Ca2+≥2.20 mmol/L,B组Ca2+(2.00～2.19)mmol/L,C组Ca2+(1.90～1.99)mmol/L,D组Ca2+<1.90 mmol/L组,比较各组间病死率,并分析可能与之相关的因素.于入院后2～3 d内行床旁超声心动图检查. 结果 A组Ca2+≥2.20mmol/L,共668例(52.4%);B组(2.00～2.19)mmol/L,共476例(37.4%);C组(1.90～1.99)nnnol/L,共73例(5.7%);D组Ca2+<1.90 mmol/L,共45例(3.5%).A、B、C、D各组的死亡情况分别为17(2.5%)、37(7.8%)、15(20.5%)、8(17.8%),差异具有统计学意义(P<0.001);对急性心肌梗死后30 d住院期间死亡危险因素进行Logistic回归分析,血钙浓度是否低于2.2 mmol/L的OR值为0.501(P=0.044). 结论 低钙血症的发生是急性心肌梗死后30 d病死率的独立预测因子.     

Sleep apnea in patients with acute myocardial infarction

OBJECTIVE: To document sleep apnea in the acute phase of myocardial infarction. If apnea occurs in patients with myocardial infarction, hypoxemia induced by apnea might exaggerate insufficiency of oxygen supplied to the damaged myocardium. DESIGN: Prospective controlled study. SETTING: Critical care unit of a teaching hospital. PATIENTS: Forty-nine patients, average age 64 yrs (range 49 to 91). MEASUREMENTS AND MAIN RESULTS: Patient measurements were recorded on a polygraph using an apnea-monitor, pulse oximeter, pulmonary artery pressure monitor, and an ECG. All of the patients observed showed frequent apneic episodes. The apnea was especially frequent when the cardiac index was low. Capillary oxygen saturation of less than 90% (suggesting systemic hypoxia) was observed in 21 patients concomitantly with apnea. Occasionally, arrhythmias followed these episodes (premature supraventricular contractions [n = 10], premature ventricular contraction [n = 4], and ventricular tachycardia [n = 2]). CONCLUSIONS: This study suggests that sleep apnea is common in the setting of acute myocardial infarction. It may be a factor predisposing to, or even causing, sudden death in patients with acute phase of myocardial infarction.     

结肠癌术后突发急性广泛前壁心肌梗死合并室颤致心搏呼吸骤停成功救治一例

急性心肌梗死(myocardial infarction)即急性心肌缺血性坏死,大多是在冠脉血供急剧减少或中断,相应心肌出现严重而持久的急性缺血导致心肌坏死,美国35～ 84岁人群发病率男性为71‰,女性为22‰,每年约有150万人发生急性心肌梗死[1-2].随着我国老龄化的加重,外科围手术期出现急性心肌梗死的情况越来越多见[3],但出现反复心室颤动致心搏呼吸骤停而获得抢救成功病案较少[4],结肠癌根治术后出现急性广泛前壁心肌梗死并发室颤抢救成功的案例更是罕见.     

Sexuality in acute myocardial infarction patients

We as nurses in the Coronary Unit we do not see the sexuality of the patients sufficiently addressed neither by us nor by the patients themselves. In this article we are trying to analize the reasons and to emphasize the need to include this subject in our Nursing Problem List.In it we explaine the fears and the wrong ideas that we have identified in our patients. The sexual function is not affected by a myocardial infarction but psychological factors, age, drugs and other associated diseases might be a reason.A quiet enviroment, a fit training plan and looking for personalise proper alternatives may help the patient to start a satisfactory sexual life again.     

Prevalence of right ventricular myocardial infarction in patients with acute inferior wall myocardial infarction

The objective was to evaluate the prevalence of right ventricular myocardial infarction (RVMI) in patients with acute inferior wall myocardial infarction (IWMI) admitted to the National Institute of Cardiovascular Diseases, Karachi, Pakistan. Between August 2000 and May 2001, a total of 100 patients with acute IWMI were enrolled. History of all patients was taken, and thorough clinical examination was performed to asses the presence of signs of right ventricular infarction. Standard 12-lead electrocardiogram was recorded immediately on arrival of patients along with right precordial leads. All patients were considered for thrombolytic therapy in the absence of any contraindication and were managed with standard treatment strategies. Complications arising during the course of admission were recorded and compared between the two groups. There were 86 (86%) males and 14 (14%) females. Mean age was 56.3 +/- 13.13 years (range 33-83 years). The prevalence of RVMI in IWMI was 34%. Smoking and diabetes were more prevalent in RVMI group, while hypertension and family history of ischemic heart disease were more common in isolated IWMI. Ninety per cent of patients received thrombolytic therapy. In-hospital mortality (23.5%) was higher in RVMI group than isolated IWMI (18.1%). Other major complications were also higher in RVMI group than isolated IWMI. Right ventricular infarction was found in approximately one-third of IWMI. Right ventricular infarction was associated with considerable morbidity and mortality, and its presence defines a higher risk subgroup of patients with inferior wall left ventricular infarction.     

1827例急性心肌梗死患者梗死部位的相关分析

目的　调查不同部位急性心肌梗死患者梗死的发病特点。方法　通过回顾病史 ,将符合诊断标准的住院患者按照不同发病部位分组 ,分别记录发病特点 ,了解不同发病部位的构成比 ,不同发病部位的男女构成比以及发病部位与病死率的关系。结果　符合条件的病例共 182 7例 ,前壁急性心肌梗死 (前壁、前间壁和广泛前壁 )占总发病的 4 5 8% ,其次是下壁急性心肌梗死组占 2 6 7%。在所有部位急性心肌梗死病例中 ,男性发病比例 (6 4 0 %～ 88 3% )与女性 (11 7%～ 36 0 % )相比均有很大差别 (P <0 0 5 )。各部位急性心肌梗死的病死率为 8 7%～ 2 0 6 %。除急性前壁合并下壁组心肌梗死病例病死率差异有显著性外 (P <0 0 5 ) ,其他部位急性心肌梗死患者的病死率与急性心肌梗死平均住院病死率相比差异未见显著性(P >0 0 5 )。结论　急性心肌梗死以前壁或下壁为主 ,男性仍是发生急性心肌梗死的主要人群 ,急性前壁和合并下壁心肌梗死的病死率显著高于急性心肌梗死平均病死率。     

Newer fibrinolytic agents in patients with acute myocardial infarction

Summary Fibrinolytic agents with higher specificity for fibrin in the thrombi and little systemic activation of the fibrinolytic system have been developed and tested in preliminary clinical trials of patients with acute myocardial infarction. The largest published experience available has been with recombinant tissue plasminogen activator, which seems to be more effective than streptokinase in lysing coronary thrombi. The acylated streptokinase-plasminogen complex BRL 26921 and pro-urokinase also gave promising preliminary results. All these agents, however, were accompanied by unexpectedly high incidence of systemic activation of the fibrinolytic system and by hemorrhagic complications with frequencies similar to those accompanying streptokinase. Hence, their superior clinical efficacy must be clearly proven before they are substituted for a more widely available and less expensive drug, such as streptokinase.     

Disopyramide kinetics in patients with acute myocardial infarction.

The kinetic behavior of disopyramide was studied in 20 patients with suspected myocardial infarction: in 13 of these, the diagnosis was subsequently confirmed. All received a 400-mg oral loading dose of disopyramide base followed by an oral maintenance regimen of either 100 or 200 mg 4 times daily. The elimination half-life (t1/2beta) was longer (p less than 0.05) in patients with confirmed infarction than in patients with unconfirmed infarction [38.0 +/- 3.7 hr (mean +/- SEM) compared to 24.3 +/- 0.8 hr, and 21.2 +/- 2.1 hr compared to 7.2 +/- 2.4 hr for the 100- and 200-mg maintenance dose regimens, respectively]. The t1/2beta was dose dependent for infarct and noninfarct patients. Two of the patients with confirmed infarction failed to reach trough plasma levels equal to or exceeding the lower end of the manufacturer's recommended therapeutic range (3.3 mug/ml) during the study. For the remaining 11 patients the time taken to achieve trough plasma levels of 3.3 mug/ml varied from 18 to 170 hr; hence plasma disopyramide concentration in these patients was suboptimal at a time when the risk of arrhythmias is high. Modification of existing oral loading dose regimens is therefore required for optimization of oral disopyramide therapy.     

急性心肌梗死合并急性胰腺炎患者的观察及护理

目的总结急性心肌梗死(acute myocardial infarction,AMI)合并急性胰腺炎AP(acute pancreatitis,AP)患者的观察及护理的要点。方法 2010年6月～2011年10月对12例AMI合并AP患者进行治疗,其中重组组织型纤维蛋白溶酶原激活剂(recombinant tissuetype plasminogen activator,rt-PA)溶栓治疗2例,冠状动脉介入治疗3例,内科保守治疗7例;并配合做好护理工作。结果 10例患者经治疗治愈,2例死亡。结论 AMI合并AP,病情凶险,预后差、死亡率高。护理方面做好患者病情观察,积极抗休克,做好溶栓前后及冠状动脉介入(percutaneous coronary intervention,PCI)治疗的护理等,其是治疗成功的重要措施。     

Early identification of patients with acute myocardial infarction

In conclusion, early identification of AMI requires the utilization of three main criteria: (1) History and physical examination; (2) 12-lead electrocardiography, and (3) serum protein markers of myocardial cell death. The history may indicate admission for AMI exclusion or unstable angina, although these data remain largely subjective. The physical examination provides few clues in subtle presentations of myocardial cell death, and instead identifies patients with left ventricular dysfunction, often with failure. The 12-lead ECG is an insensitive early indicator of AMI, often identifying 50% or fewer of these patients. Currently, thrombolytic therapy or invasive catheterization techniques such as PTCA are based on 12-lead depictions of acute injury patterns. Finally, serum markers of AMI, particularly myoglobin, CPK-MM isoforms, and new monoclonal antibody assays for CPK-MB may allow early identification of patients with AMI with nondiagnostic ECGs.     

急性心肌梗死病人的护理

急性心肌梗死是一种常见的危重心血管疾病,积极有效的治疗护理对提高病人的生存率和改善病人生活质量具有重大意义.随着医疗技术的不断发展,目前临床治疗手段日趋完善,随之对临床护理也提出了更高的要求.为此,总结2005年10月-2007年9月在我院住院的186例急性心肌梗死病人的护理体会如下.     

心肌梗死患者的康复治疗

心肌梗死患者的康复治疗包括循序渐进和按部就班的康复运动训练、对患者及家属的医学康复指导和对患者心脏功能及身体状况的定期评定 ,其目的是尽可能使患者恢复正常生活。实际上 ,心肌梗死的康复治疗始于发病当日 ,并且 ,由于冠心病是一个慢性和逐渐发展的过程 ,因此 ,这种康复治疗是终生的 ,大致可分为住院阶段、出院后阶段和维持阶段。1住院阶段以往认为 ,急性心肌梗死患者应强制卧床休息3— 6周 ,但这样处理常可引起长期卧床的不良后果 ,有时比心肌梗死疾病本身对患者的危害还要大。长期卧床的常见不良后果有 :1卧床 3周体力可下降2 0 %…     

急性心肌梗死病人的护理

急性心肌梗死（AMI）是急性心肌缺血坏死，大多数是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，使相应的心肌严重而持久缺血所致。原因通常是在冠状动脉粥样硬化不稳定斑块病变的基础上继发血栓形成。心肌梗死急性发作后1周内心律失常发生率较高，如室性心动过速、心室颤动等是造成心肌梗死病人死亡的常见原因，因此，心内科护士掌握一定的心电图知识，及早发现病情变化，对于降低心肌梗死病人的病死率，提高护理质量非常重要。我院自2004年1月-2006年6月共收治心肌梗死病人186例，现就186例病人发病1周内心电图表现及护理体会作一回顾性总结。     

急性心肌梗死病人的护理

急性心肌梗死(AMI)是急性心肌缺血坏死,大多数是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,使相应的心肌严重而持久缺血所致。原因通常是在冠状动脉粥样硬化不稳定斑块病变的基础上继发血栓形成[1]。心肌梗死急性发作后1周内心律失常发生率较高,如室性心动过速、     

High-dose glucose-insulin-potassium treatment reduces myocardial apoptosis in patients with acute myocardial infarction

BACKGROUND: Several clinical trials have suggested that a metabolic cocktail of glucose-insulin-potassium (GIK) decreases mortality rates in patients with acute myocardial infarction (AMI). It has also been reported that Fas-mediated apoptosis plays an important role in ischaemic/reperfusion injury in the rat model. This study was designed to evaluate the interaction of ischaemic/reperfusion and reperfusion therapy coadministered with high-dose GIK treatment on soluble Fas/APO-1 (sFas) and Fas ligand (sFasL) plasma concentration in patients with AMI. MATERIALS AND METHODS: Seventy-four patients presenting with AMI who underwent reperfusion therapy were randomized into a GIK group (n = 35) receiving high-dose GIK for 24 h or a vehicle group (n = 39). Thirty-four control subjects were also enrolled in the present study. Strepavidin-biotin ELISA was used to determine the soluble sFas and sFasL plasma concentration at baseline, 24 h (h), 3 day (d), 7 d and 14 d. RESULTS: Soluble Fas and sFas-L serum concentrations ([sFas] and [sFas-L]) of patients with AMI were significantly elevated at baseline as compared with normal controls (NCs; P < 0.01 vs. NC). The sFas in the GIK and vehicle groups markedly decreased 24 h after the GIK infusion (10.7-->5.9 ng mL(-1) and 9.7-->6.5 ng mL(-1); P < 0.01 vs. baseline) and then increased during the 3-7-d period (5.9-->12.1 ng mL(-1) and 6.5-->11.1 ng mL(-1); P < 0.01 vs. 24 h). The GIK group demonstrated reduced sFas (12.1-->5.9 ng mL(-1)) at 14 d (P < 0.01 vs. 7 d), with no concomitant changes in the vehicle group. The sFas-L in the GIK and vehicle groups was not significant different during the 14-d period. CONCLUSIONS: These results indicate that the sFas and sFasL in patients with AMI increased significantly compared with NC. Owing to the cardioprotective effects reported here and by others, a high-dose GIK infusion co-administered with the timely re-establishment of nutritive perfusion should be strongly considered as a treatment of choice for AMI. Additionally, sFas may be a valuable marker of the physiological response to ischaemic/reperfusion injury and reperfusion associated with high-dose GIK treatment.