Acute myocardial infarction, abbreviated as AMI, is a sudden disease. Patients are often accompanied by hypotension, which can be life-threatening in severe cases. In these patients, some of the causes of basal blood pressure are caused by reversible factors, and the hypotensive state can be reversed by correcting the reversible factors. Strategy This paper takes 75 patients as an example to analyze, among which 23 cases have hypotension, and these 23 cases are divided into two situations: ① hypotension caused by cardiogenic shock (14 cases) and ② non-cardiogenic factors (9 cases). Results 16 cases survived and 7 cases died. Conclusion Hypotension is the main cause of death in patients with acute myocardial infarction. The main strategies to rescue patients in time and improve their condition are: timely diagnosis, proper nursing, inducement treatment, continuous ECG monitoring, rational use of vasodilators and diuretics, and correction of hypotension.
Keywords: May; Hypotension; nurse
According to foreign experts, hypotension may lead to cerebral infarction and myocardial infarction. After severe orthostatic hypotension, the patient's blood pressure may drop rapidly every time he changes his position, leading to syncope, forcing him to stay in bed, and inducing cerebral infarction and myocardial ischemia. The mortality rate of acute myocardial infarction is relatively high, and hypotension is the cause of death in some patients. Once hypotension occurs, it should be treated in time. If it is caused by reversible factors, it can be reversed. This paper reports 75 cases of AMI complicated with hypotension, of which 14 cases were hypotension caused by cardiogenic shock; The other 9 cases were caused by non-cardiogenic factors; Of the 23 patients, 7 died and 6 survived/kloc-0. Due to the high mortality rate of hypotension after AMI, timely diagnosis and treatment incentives and timely nursing are important factors affecting the prognosis of the disease. Report the nursing experience as follows.
1, data and policy
1. 1 general data 23 patients with AMI hypotension were composed of 16 males and 7 females, aged 47-89 years, with the average age of males being 69 years. The average age of women is 7 1 year.
1.2 sphygmomanometer adopts imported advanced equipment, and commonly used is the bedside SOLAR8000 bedside and central station monitor produced by American General Company, which automatically measures blood pressure. Main parameters of the equipment: cuff length 50 cm, width 14.5 cm. The nursing care of patients after hospitalization strictly implements the relevant medical standards, all of which are supine or 30? In the low oblique position, the cuff should be placed on the brachial artery 1 ~ 2 cm, and it should be tight enough to fit two fingers. Set the timing measurement time to measure every 5 ~ 30 minutes 1 time.
1.3 Diagnostic criteria for hypotension When the patient's blood pressure is lower than 90/60 mmHg or the patient's basal blood pressure drops by 20%.
2. Results
2. 1 patients with cardiogenic shock 14 cases, including extensive anterior myocardial infarction in 6 cases, anterior and inferior myocardial infarction in 3 cases, anterior and inferior myocardial infarction 1 case, inferior myocardial infarction in 2 cases and inferior myocardial infarction in 3 cases. According to statistics, 6 patients died.
2.2 9 cases of non-cardiogenic hypotension, including 5 cases using vasodilators, 2 cases using diuretics, 2 cases with insufficient body fluid intake and blood volume, 1 case died. It can be seen from the above analysis results that the main cause of cardiogenic shock is the occurrence of large-scale myocardial infarction, and the use of vasodilators is the main cause of non-cardiogenic hypotension [1].
Step 3 discuss
3. 1 Cardiogenic shock accounted for 60.86% of hypotensive cases in this group, and the mortality rate was as high as 42.85%. The sharp decline of cardiac pumping function caused by AMI is the main cause of cardiogenic shock. When myocardial necrosis occurs in 30% ~ 40% of the left ventricular area, the cardiac output is
3.2 Attention should be paid to drug-controlled hypotension caused by non-cardiogenic shock after AMI. Among 9 cases of non-cardiogenic hypotension, 5 cases were caused by vasodilators and 2 cases by diuretics, accounting for 77.77% of the total. It can be seen that improper medication is another common cause of hypotension. Vasodilators are the first choice for myocardial infarction, because drugs can lead to vasodilation and resistance reduction through different antihypertensive links, thus lowering blood pressure. Therefore, the condition and blood pressure should be closely observed when using vasodilators. In this group, patients with 1 anterior wall+inferior wall+right ventricular AMI were given nitroglycerin 10 mg for the first time before admission, and 500 mL glucose solution was added for intravenous drip. After 1 h, their blood pressure dropped to 70/48 mmHg. Nitroglycerin was reduced to 3 mg after admission, dopamine 40 mg was instilled slowly, and blood volume was supplemented appropriately. After 1 h, the blood pressure rose to 90/60 mmHg, and after 3 days, the blood pressure stabilized at 90 ~ 105/60 ~ 70 mmHg. Because the effective concentration of drugs varies greatly among individuals, especially the elderly, when using vasodilators, the speed and concentration of drugs should be adjusted at any time according to the changes of blood pressure, and the first dose should be small. For example, intravenous drip of nitroglycerin, the initial dose is 5 ug/min, and then it will increase by 3 ~ 5 ug every 3 ~ 5 min, and the average maximum dripping speed is 50 ug/min, which needs the control of infusion pump [3]. If the patient complains of palpitation, dizziness and other symptoms during the drip, he should pay close attention to the changes of blood pressure and report to the doctor to adjust the treatment plan in time.
3.3 Pay attention to low blood pressure caused by insufficient intake and insufficient blood volume. In the case of insufficient blood volume, hypotension is not easy to correct. Accurately record the 24-hour fluid volume, observe whether patients with vomiting, sweating and poor appetite have dehydration symptoms, and pay attention to their skin elasticity, pulse and blood pressure in elderly patients. In the process of intravenous fluid replacement, it should be handled according to the patient's age, cardiac function, urine volume and drug properties. The infusion speed of elderly patients with AMI and cardiac insufficiency should be 20 ~ 30 drops/minute, so as not to aggravate the symptoms of heart failure.
To sum up, the mortality rate of patients with hypotension caused by AMI is high, but with the close cooperation of medical care, close monitoring, careful observation, correct evaluation, timely detection of disease changes, reporting to doctors and actively cooperating with rescue, the survival rate of patients has been improved.
References:
[1] Zhang Shiduo. Analysis of 407 cases of acute myocardial infarction and experience of integrated traditional Chinese and western medicine treatment [A]. Abstract of the World Conference on Integrated Traditional Chinese and Western Medicine [C]. 1997.
[2] Wang Xiaobing. Correlation between first-order serum lipoprotein profile analysis of acute myocardial infarction and spleen deficiency syndrome [D]. First Military Medical University; 2000.
Liao Zhicong. Study on revascularization after intravenous thrombolysis in acute myocardial infarction [D]. Jinan University, 2003.