前壁心肌梗死急诊介入术后患者微循环障碍的影响因素  

Influencing Factors of Microcirculation Disturbance in the Patients with Anterior Wall Myocardial Infarction after Emergency Interventional Therapy

作　　者：李晓彤[1] 张勤[1] 胡林婕[1] 张建秋[1] 何胜虎[2] 徐日新[2] 徐冰[2] Li Xiaotong ,Zhang Qin ,Hu Linjie ,Zhang Jianqiu ,He Shenghu2 ,Xu Rixin2 ,Xu Bing2(1. Interventional Therapy Center, Northern Jiangsu People＇ s Hospital, Yangzhou 225001, Jiangsu Province, China; 2. Department of Vasculocardiology De partment,Northern J iangsu People＇s Hospita)

机构地区：[1]江苏省苏北人民医院介入治疗中心,江苏扬州225001 [2]江苏省苏北人民医院心血管内科,江苏扬州225001

出　　处：《解放军护理杂志》2018年第10期33-36,共4页Nursing Journal of Chinese People's Liberation Army

基　　金：苏北人民医院院级科研基金项目(yzucms201728)

摘　　要：目的探讨前壁心肌梗死急诊介入治疗术后患者微循环障碍的影响因素。方法 2015年6月至2017年11月,便利抽样法选取在江苏省苏北人民医院介入治疗的前壁心肌梗死患者123例为研究对象,所有患者术后即刻评估微循环阻力指数(indexof microcirculatory resistance,IMR)。将术中测量IMR≥25的患者设为观察组,IMR<25的患者设为对照组。比较两组患者在术前及术中临床资料的差异。在单因素分析的基础上应用Logistic回归多因素分析,评价微循环障碍的独立的危险因素。结果本组患者术后发生微循环障碍71例,发生率为57.7%。两组患者在术前资料上及术中资料上的差异均有统计学意义(均P<0.05)。回归多因素分析提示,糖尿病、高血压病、吸烟史、肌钙蛋白I(troponin I,TNI)峰值、肌酸激酶同工酶MB(creatin kinase-MB,CK-MB)、入院时血糖水平、冠状动脉慢血流是引起微循环障碍的危险因素;而梗死前心绞痛是微循环障碍的保护因子,术中应用抽吸导管、应用替罗非班、应用硝普钠,可改善微循环障碍(均P<0.05)。结论在前壁心肌梗死急诊介入治疗术中,护士要识别并重视高危风险因素,加强病情观察,做好用药护理,从而使患者安全渡过手术期。Objective To explore the influencing factors of microcirculation disturbance in the patients with anterior wall myocardial infarction after emergency interventional therapy.Methods From June 2015 to November 2017,123 patients with acute anterior myocardial infarction undergoing emergency interventional therapy were selected by using convenience sampling method,and the index of microcirculatory resistance（IMR）was evaluated immediately after the operation.The patients with intraoperative measurement of IMR≥25 was classified as the observation group,while those with IMR25 was selected as the control group.The preoperative and the intraoperative clinical data were compared by single factor analysis,based on which the independent risk factors of microcirculatory disturbance were identified by multiple factor analysis of logistic regression.Results A total of 71 cases manifested microcirculatory disturbance after emergency interventional therapy for anterior myocardial infarction,withtheincidenceof57.7%.Thedifferencesof preoprative data and intraoperative data between two groups were statistically significant（all P〈0.05）.The results of multiple factor analysis of logistic regression showed that diabetes mellitus,hypertension,smoking history,troporin I（TNI）peak,creatin kinase-MB（CK-MB）peak,blood glucose on admission and slow coronary flow were the risk factors,while preinfarction angina was the protective factor.The use of suction catheter,tirofiban and sodium nitroprusside can improve the microcirculation disturbance（all P〈0.05）.Conclusions Nurses should recognize and pay attention to high-risk factors,strengthen the observation of patient＇s condition and nursing care of medication,so that patients can get through the operation safely.

关 键 词：急性心肌梗死 经皮冠状动脉介入术 冠状动脉 微循环障碍 

分 类 号：R815[医药卫生—放射医学]