急性心肌梗死急诊介入治疗时心电图监测护理的临床意义Clinical nursing significance of electrocardiographic monitor in primary interventional therapy of acute myocardial infarction
邱月红,翟莹,谭源,杜敏,王伟民
摘要(Abstract)：
目的观察急性心肌梗死患者急诊介入治疗前后心电图的变化与梗死相关血管再灌注的关系及其临床护理意义。方法分析急性心肌梗死急诊介入治疗患者介入治疗前后心电图变化,包括出现不同类型的心律失常及不同ST段回落程度与冠状动脉血流、心肌灌注程度的关系。结果在468例急性心肌梗死患者中,介入治疗术前存在室性心律失常142例。介入治疗术后出现室性加速性心率失常285例,一过性室性心动过速或R-on-T 203例,心室颤动行非同步电复律62例,出现新的Ⅱ度或Ⅲ度房室传导阻滞24例,窦性心动过缓或窦性停搏45例,原房室传导阻滞消失10例。介入治疗后ST段明显回落即ST段回落>50%为301例,ST段部分回落即ST段回落<50%为57例,ST段无变化29例。结论梗死相关血管(IRA)再灌注血流恢复正常时常可出现心律失常,有时是致命性室性心律失常,通过严密监测、及早发现和处理均可转危为安;当开通梗死相关血管冠状动脉血流较好时,ST段回落较多;而冠状动脉血流缓慢或冠状动脉血管在术中、术后再次闭塞,ST段回落较差,可伴有血压下降甚至出现心源性休克。因此急诊介入治疗时心电图监测护理十分重要,是保证介入手术顺利进行的关键。
关键词(KeyWords)： 心肌梗死;血管成形术,经腔,经皮冠状动脉;心电描记术
基金项目(Foundation):
作者(Author): 邱月红,翟莹,谭源,杜敏,王伟民
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