Objective To explore the nursing measures of early intravenous thrombolysis in patients with acute myocardial infarction within 6 hours. Methods The clinical data of 32 patients with acute myocardial infarction were analyzed retrospectively. Nursing measures mainly include preparation before thrombolysis, nursing during thrombolysis, rehabilitation guidance and health education after thrombolysis. Results After timely treatment and nursing measures, 26 of the 32 patients in this group met the criteria of coronary artery recanalization, and the recanalization rate was 865,438 0.25% (26/32). Five patients failed to meet the recanalization criteria, and 65,438+0 patients died of acute left heart failure. Conclusion Early intravenous thrombolysis in time for patients with acute myocardial infarction and close and comprehensive nursing cooperation before, during and after thrombolysis can significantly improve the treatment rate and effect of myocardial infarction and reduce the incidence of complications and mortality.
Thrombolysis; Acute myocardial infarction; nurse
Acute myocardial infarction is one of the most common acute cardiovascular diseases in clinic. According to statistics, about 50% patients with AMI often die within 1 h after onset [1]. The disease has an acute onset and a high mortality rate, which seriously threatens the lives of patients. The main cause of acute myocardial infarction is the rupture of coronary atherosclerotic plaque, which leads to acute coronary occlusion and severe and persistent acute myocardial ischemia, leading to myocardial necrosis. Early treatment is the key to improve the treatment rate of this disease. Early thrombolytic therapy can save dying myocardial cells in time, narrow the infarct area, recanalize the blocked coronary artery, realize myocardial blood perfusion, improve the recanalization rate of coronary artery, improve the cardiac function of patients and improve the survival rate.
1 data and methods
General data of 1 1 for retrospective analysis. From 20 1 1 to 20 14, 1, 32 patients with acute myocardial infarction were admitted to our hospital, including 20 males and 2 females 12, aged 46-70 years. 4.4 years old. All 32 patients were admitted to hospital within 6 hours after onset. Through analysis and judgment, clinical symptoms, electrocardiogram, myocardial enzymes and other tests were confirmed, which met the diagnostic criteria of acute myocardial infarction of coronary heart disease and there was no contraindication to thrombolysis [2]. Anterior septal myocardial infarction 15 cases, extensive anterior myocardial infarction 15 cases, inferior myocardial infarction in 5 cases, inferior and lateral myocardial infarction in 2 cases.
1.2 treatment methods 32 patients with acute myocardial infarction were examined for blood sugar, myocardial enzymes, troponin and electrolytes. Venous access was established quickly. Oral enteric-coated aspirin 300 mg, intravenous recombinant tissue plasminogen activator (RT-PA)8mg and heparin 5000 U were injected within 5 minutes. At the same time, the intravenous drip of 42 mg rt-PA was completed within 65438±0.5h, and heparin was continuously pumped at a micro amount of 65438 0,000 U/h. The specific dose of heparin was adjusted according to the activated partial thrombin time (APTT), and the ARTT time was maintained for about 70 s. After the intravenous micropump stopped for 24 h, heparin was injected subcutaneously for 6 days.
1.3 Nursing
1.3. Before thrombolysis 1 Nursing patients are sent to the emergency intensive care unit (EICU) after admission, and ECG monitoring is carried out to ensure that the patients are absolutely in bed rest, and the ward must be quiet. Continue to give oxygen for 3 ~ 5 L/min to keep the patient's respiratory tract unobstructed, so as to help the patient gradually improve the symptoms of myocardial hypoxia and ischemia. Closely monitor the changes of various physiological indexes and vital signs of patients, such as blood pressure, pulse, body temperature, breathing, etc. To quickly establish two venous passages for patients, in order to avoid repeated puncture, indwelling needle can be used for infusion, and thicker blood vessels in forearm can be selected for easier fixation. Strictly master the indications and contraindications of thrombolytic therapy.
Before treatment, we should introduce the treatment process and matters needing attention of thrombolytic therapy to patients and their families in detail, inform them of the necessity and importance of treatment, and obtain the understanding and cooperation of patients and their families. Because acute myocardial infarction will make patients have difficulty breathing and a sense of suffocation, fear will make patients nervous and anxious, and the heart rate will increase, which will aggravate myocardial ischemia. Therefore, it is necessary to do a good job in psychological care of patients, so that patients can try their best to eliminate fear and tension, maintain a good attitude and actively cooperate with treatment.
Before treatment, we should make full preparations, and prepare all drugs and instruments needed for treatment, such as atropine, dopamine, lidocaine and other rescue drugs, as well as blood pressure monitors, defibrillators, electrocardiographs and other rescue instruments.
1.3.2 Nursing during thrombolysis ECG monitoring was carried out, ECG was recorded as the basic value before thrombolysis, ECG was recorded immediately after thrombolysis, and 1 full-lead ECG was printed every 30 minutes for 4 times, and the exact date, time and ST-segment elevation value of ECG were recorded in detail, paying special attention to observing the evolution of ST-T, so as to judge the thrombolytic effect and find reperfusion arrhythmia in time.
Listening to the patient's chief complaint, recording the location, degree and duration of the patient's chest pain every 15 minutes during thrombolysis, and evaluating whether the chest pain quickly relieves and disappears within 2 hours after thrombolysis are effective indicators for judging coronary artery recanalization.
Closely observe vital signs, monitor blood pressure, heart rate and pulse, prevent complications, and take rescue measures in time.
1.3.3 after nursing thrombolytic therapy, there is still residual stenosis in the coronary artery, which is easy to cause secondary myocardial infarction. Patients can be given anticoagulant therapy according to the doctor's advice, oral aspirin and plavix, and subcutaneous injection of low molecular weight heparin to ensure that the recanalized coronary artery avoids blood flow occlusion [3]. During anticoagulant therapy, we should closely observe whether the patient's skin and mucosa have bleeding tendency, and monitor coagulation time and prothrombin time.
After treatment, the patient was told to stay in bed absolutely and not to do any strenuous exercise to prevent the falling embolus from flowing back. After treatment, 1 d can guide patients to get out of bed and do simple activities, and activities at this time are the best rehabilitation time [4]. However, full preparations should be made before the activity, the content of the activity should be scientific and reasonable, and it should be carried out according to the actual situation of patients. Pay attention to eat less and eat more, don't be too full, avoid irritating food, and the food should not be overheated or too rough, otherwise it will damage the digestive tract mucosa.
Patients should be given correct discharge guidance when they leave the hospital, and told to take the medicine correctly on time and return to the hospital for regular review. The drug and dosage can be adjusted in time according to the patient's recovery, and once complications are found, they can be treated in time. And teach patients and their families simple first aid measures.
Two results
After timely treatment and nursing measures, among the 32 patients in this group, 26 patients completely met the standard of coronary artery recanalization, and the recanalization rate was 865,438 0.25% (26/32). Five patients got better and were discharged from hospital. 1 patient died of acute left heart failure.
3 abstract
Through the early thrombolytic care of 32 patients with acute myocardial infarction, we realized that early thrombolytic therapy can significantly improve the recanalization rate of coronary artery and protect myocardium as soon as possible. The effect of thrombolytic therapy and the prevention and treatment of complications are closely related to the nursing measures at all stages of treatment. Relevant nursing staff must strengthen the mastery of professional knowledge and skills, master various processes, methods, indications, contraindications, precautions and complications of thrombolytic therapy, and give comprehensive and whole-course nursing cooperation at all stages of thrombolytic therapy to help improve the early thrombolytic therapy effect of patients with acute myocardial infarction, reduce the occurrence of complications, improve the survival rate of patients and improve the clinical treatment effect.
References:
Li Fengxiang. Nursing experience of early thrombolysis in acute myocardial infarction. Medical information (last issue), 201,24 (3):1316-1317.
[2] Ding Xianqiong. Nursing cooperation of early thrombolytic therapy for acute myocardial infarction. Journal of clinical rational drug use, 20 1 1, 4 (6):112-13.
[3] Zeng. 150 observation and nursing of early thrombolysis in elderly patients with acute myocardial infarction. Contemporary Nurses (Specialist Edition), 20 12 (5): 88-90.