NURSING STRATEGY FOR CARDIAC ISCHEMIA MONITORING

急性心肌梗死（MI）和不稳定型心绞痛的诊断 急诊科（艾德）很重要，因为目前的标准 护理是立即溶栓治疗或冠状动脉成形术， 急性心肌梗死患者，静脉肝素用于不稳定 心绞痛 除了缺血心肌的早期再灌注外， 梗死动脉的持续通畅是一个重要的决定因素， 急性心肌梗死患者的生存率。 因此，即使早期治疗IFN 艾德最初成功地实现再灌注，随后 入院后梗塞动脉的再闭塞可能 会抵消这些早期治疗的全部有益效果。 因此，当务之急是找到更好的方法来监测患者， 在艾德中以及在患者住院期间， 重症监护和“降压”遥测装置。 报告表明 标准12导联ECG的连续ST段监测可改善 检测局部缺血;然而，这种监测难以实现 因为它需要多个电极放置在干扰的位置， 患者护理和身体运动产生噪声信号。 的 本研究的目的是测试连续ST段监测是否 使用简单导联系统（导出的12导联ECG）与 目前公认的“金标准”导联系统（标准12导联ECG）， 检测局部缺血和心肌梗死。 实验方法包括 从记录的3个基本信号数学地导出121个ECG导联， 病人 将采用前瞻性、比较性、“受试者内”设计， 用于685例急性心肌梗死或不稳定型心绞痛患者， 连续12导联ST段监测实验和标准 从他们到达艾德到他们出院的ECG 医院 将比较实验和标准ECG方法， 存在-不存在MI、梗死位置 缺血的程度（“总缺血负荷”），延迟缺血的检测， 初始非诊断性ECG中的发作性缺血和复发性缺血 因MI或不稳定型心绞痛住院期间。 心肌酶， 超声心动图、血管造影和心肌灌注成像数据 将被用作相对于正确诊断的独立标准。 统计分析将包括灵敏度计算， 特异性和预测准确性的实验方法， 将与标准ECG方法进行比较。

Diagnosis of acute myocardial infarction (MI) and unstable angina in the emergency department (ED) is important because the current standard of care is immediate thrombolytic therapy or coronary angioplasty for patients with acute MI, and intravenous heparin for patients with unstable angina. In addition to early reperfusion of ischemic myocardium, sustained patency of the infarct artery is an important determinant of survival in patients with acute MI. Thus, even when early treatment ifn the ED is initially successful in achieving reperfusion, subsequent reocclusion of the infarct artery following admission to the hospital may negate the entire beneficial effects of these early treatments. Therefore, it is imperative to find better ways to monitor a patient for ischemia in the ED as well as throughout a patient's hospitalization in critical care and "step-down" telemetry units. Reports suggest that continuous ST segment monitoring of the standard 12-lead ECG may improve detection of ischemia; however, such monitoring is difficult to accomplish because it requires multiple electrodes placed in locations that interfere with patient care and that create a noisy signal with body movement. The goal of this research is to test whether continuous ST segment monitoring using a simple lead system (derived 12-lead ECG) is comparable to the currently-accepted "gold standard" lead system (standard 12-lead ECG) for detecting ischemia and MI. The experimental method involves mathematically deriving 121 ECG leads from 3 base signals recorded from the patient. A prospective, comparative, "within-subjects" design will be used in which 685 patients with acute MI or unstable angina will undergo continuous 12-lead ST segment monitoring of both experimental and standard ECGs from the time they arrive in the ED until they are discharged from the hospital. Experimental and standard ECG methods will be compared for diagnostic accuracy for presence-absence of MI, infarct location, magnitude of ischemia ("total ischemic burden"), detection of delayed- onset ischemia in initially non-diagnostic ECGs, and recurrent ischemia during hospitalization for MI or unstable angina. Cardiac enzymes, echocardiographic, angiographic, and myocardial perfusion imaging data will be used as an independent standard relative to a correct diagnosis. Statistical analysis will include calculation of the sensitivity, specificity, and predictive accuracy of the experimental method, which will be compared to the standard ECG method.