NURSING STRATEGY FOR CARDIAC ISCHEMIA MONITORING

心脏监护病房(CCU)护士的主要职责是监测 冠状动脉成形术后患者心脏的体征和症状 可能预示着突然冠状动脉并发症的缺血 再闭塞继发急性心肌梗死。其基本原理是 再闭塞后重建血流的干预措施是 发展为大面积脑梗塞的患者通常有多次反复发作 因充血性心力衰竭和慢性衰弱而住院 呼吸急促、不能每天执行任务等症状 活动和疲劳。一种非侵入性技术比 患者检测复发性心肌缺血的症状是 患者的12导联心电图。然而，因为心电 异常是一过性的，心脏缺血经常被 患者每日12导联心电图。拟议的研究旨在确定 连续床边心肌缺血ST段的敏感性和准确性 使用“衍生”的12导联“ECGD”进行监测，与常规的- 监测双导联检测复发性心肌缺血 在冠状动脉血管成形术之后。第二个目标是确定是否 在敏感度和准确度上存在性别差异 两种导联方法在这些患者中的差异。 416名受试者将用气球充气记录12导联ECGD， 在冠状动脉成形术中记录患者的缺血模式 在“受控”的缺血期间。信息将从 同时观察患者的心脏缺血症状。 患者将作为他们自己的对照，并使用两个导线进行监测 方法在CCU行血管成形术。将分析敏感度 使用双因素重复测量的方差分析，其中 因变量定义为真正的缺血事件的比例 每种方法都能检测到。要比较这两种导联方法的准确性，请按2 护士专家将独立确定这两种方法是否包含 相同的ST段抬高、压低或等电性ST段 与患者记录的12导联ECGD的相应导联进行比较 在冠状动脉血管成形术期间。护士专家评级将被置于3级 X 3列联表，其中表行将包含“相同”、“相关” 和方法I(常规监测的双导联)的“不同”评级和 表列将包含方法II(12导联ECGD)的评级。这个 列联表将在非参数下进行分析 比例“统计模型--McNemar检验的Stuart推广 将用于检验相关边际的相等性 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.