NURSING STRATEGY FOR CARDIAC ISCHEMIA MONITORING

心脏监护室（CCU）护士的主要职责是监测 冠状动脉成形术后的患者， 缺血可能是突发冠状动脉并发症的信号 再闭塞，随后发生急性心肌梗死。的理由 在再闭塞后重建血流的干预措施是， 发生大面积梗死的患者经常有多次反复发作， 因充血性心力衰竭和慢性衰弱而住院 症状如呼吸急促，无法执行日常 活动和疲劳。一种非侵入性的技术， 用于检测复发性心肌缺血的患者症状是 患者的12导联心电图（ECG）。由于ECG 异常是短暂的，心脏缺血往往被错过了， 患者的每日12导联ECG。拟议的研究旨在确定 连续床旁心肌缺血ST段的敏感性和准确性 与常规相比，使用“衍生”12导联“ECGD”进行监测- 用于检测复发性心脏缺血的监测双导联方法 冠状动脉成形术后第二个目的是确定 在敏感性和准确性方面存在性别差异， 这些患者中2种电极导线方法之间的差异。 416例受试者将记录球囊充盈时的12导联ECG， 在冠状动脉血管成形术期间记录患者的缺血模式 在“受控”缺血期间。信息将从 患者同时出现心肌缺血症状。 患者将作为自己的对照，并使用两种电极导线进行监测 血管成形术后CCU中的方法。将分析灵敏度 使用2因素重复测量方差分析，其中 因变量定义为真实缺血事件的比例 通过各种方法检测。为了比较2种导联方法的准确性，2 护理专家将独立确定这两种方法是否包含 相同的ST段抬高、压低或等电位ST段 与记录的患者12导联ECGD的相应导联相比 在冠状动脉成形术中。护士专家评级将被置于3 X3列联表，其中表行将包含“相同”、“相关” 和方法I的“不同”评级（双导线监测）， 表格各列将包含方法II（12导联ECGD）的评级。的 列联表将在非参数“相关” 比例”统计模型。McNemar检验的Stuart推广 将用于测试相关边际的相等性 概率

A major responsibility of cardiac care unit (CCU) nurses is to monitor patients following coronary angioplasty for signs and symptoms of cardiac ischemia which may signal the complication of sudden coronary artery reocclusion with subsequent acute myocardial infarction. The rationale for interventions to re-establish blood flow following reocclusion is that patients who develop extensive infarction often have numerous repeated hospitalizations for congestive heart failure and chronic, debilitating symptoms such as shortness of breath, inability to perform daily activities, and fatigue. A noninvasive technique more sensitive than the patient's symptoms for detecting recurrent cardiac ischemia is the patient's 12-lead electrocardiogram (ECG). However, because the ECG abnormalities are transient, cardiac ischemia is often missed by the patient's daily 12-lead ECG. The proposed study seeks to determine the sensitivity and accuracy of continuous bedside cardiac ischemia ST segment monitoring using a "derived" 12-lead "ECGD" compared to the routinely- monitored dual-lead method for detecting recurrent cardiac ischemia following coronary angioplasty. A secondary aim is to determine whether there are gender differences in the sensitivity and accuracy of differences between the 2 lead methods in these patients. 416 subjects will have 12-lead ECGDs recorded with balloon inflation, during coronary angioplasty to record the patient's ischemic pattern during "controlled" ischemia. Information will be elicited from the patient at the same time as to their symptoms of cardiac ischemia. Patients will serve as their own controls and be monitored with both lead methods in the CCU following angioplasty. The sensitivity will be analyzed using a 2-factor repeated measures analysis of variance, where the dependent variable is defined as the proportion of true ischemic events detected by each method. To compare the accuracy of the 2 lead methods, 2 nurse experts will independently determine whether both methods contain the same pattern of ST elevation, depression, or isoelectric ST segments compared to corresponding leads of the patient's 12-lead ECGD recorded during coronary angioplasty. Nurse expert ratings will be placed into a 3 X 3 contingency table, where the table rows will contain "same," "related" and "different" ratings for Method I (routinely-monitored dual leads) and table columns will contain ratings for Method II(12-lead ECGD). The contingency table will be analyzed under a non-parametric "correlated proportions" statistical model. The Stuart extension of the McNemar test will be used to test for the equality of the correlated marginal probabilities.