NURSING STRATEGY FOR CARDIAC ISCHEMIA MONITORING

急性心肌梗死和不稳定型心绞痛的诊断 急诊科(ED)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，静脉注射肝素治疗不稳定型患者 心绞痛。除了缺血心肌的早期再灌注外， 梗死区动脉的持续通畅是 急性心肌梗死患者的存活率。因此，即使在早期治疗干扰素时 ED初步成功地实现了再灌注，随后 入院后再闭塞梗塞动脉可能 否定这些早期治疗的全部有益效果。 因此，必须找到更好的方法来监测患者的病情 急诊室以及患者住院期间的缺血 重症监护和“降级”遥测单元。报道称， 标准12导联心电图连续ST段监测可能会有所改善 检测缺血；然而，这种监测很难实现 因为它需要在干扰位置放置多个电极 在病人护理下，这会产生身体运动的噪音信号。这个 本研究的目的是测试连续ST段监测是否 使用简单的导联系统(导出的12导联心电图)可与 目前被接受的“黄金标准”导联系统(标准12导联心电图) 检测缺血和心肌梗死。实验方法包括 从记录的3个基本信号数学推导出121个导联 病人。一个前瞻性的、可比较的、“主体内”的设计将是 其中685名急性心肌梗死或不稳定型心绞痛患者将接受 实验和标准的连续12导联ST段监测 心电信号自抵达急症室至出院为止 医院。实验方法和标准的心电方法将进行比较 诊断准确性--无心肌梗死，梗死部位， 缺血程度(“总缺血负荷”)，检测延迟 最初非诊断性心电图中的首发缺血和复发性缺血 因心肌梗塞或不稳定型心绞痛住院期间。心肌酶， 超声心动图、心血管造影术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。 统计分析将包括计算灵敏度， 实验方法的特异性和预测准确性，其中 将其与标准的心电方法进行比较。

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.