Study On The Cardiac Function Of Patients With Acute Myocardial Infarction In The Early Stage During Defecation

Objectives To clear the effect of defecation to the cardiac function in the different periods, times and positions. By comparing the purgative effect of two alvi dejection ways, kaiselu intranus injection and castor oil oral administration, to provide the guide for the defecation nursing of AMI patients. Methods In the first part, using multi-functional electrocardiogram monitor and dynamic electrocardiograph to acquire the parameters, including heart rate, blood pressure, myocardial oxygen consumption(MVO2), QT dispersion(QTd), heart rate variability(HRV), ST segment depression and R-waves amplitude. 25 defecations of AMI patients in the early stage were observed. The parameters mentioned above were compared in the different periods of defecation and were used to analyze the similarities and differences between the first defecation in hospital and other defecations. In the second part, to compare the change of the parameters mentioned above with different positions during defecating. In the third part, AMI patients who need to take purgative measure were divided into two groups randomly, Kaiselu group and Castor oil group. The change of the parametes mentioned above were observed in different periods of defecations. resulte1. During AMI patients keeping in bed, the interval time from the last defecation to the first time in hospital was 80.88±26.0 hours, being longer significantly than normal, which was 38.11 ±20.88 hours (p=0.0001).2. In the process of defecation, blood pressure and MVO2 in the initial stage of defecation increase significantly (P<0.05) than that in peace. QTcd and the sum of ST segment depression both raised obviously (p=0.025, p=0.047) during defecating. Other parameters had no significant change.3. The blood pressure of first defecation was lower than that of the non-firstdefecation in hospital. However, since the heart rate of the first defecation was faster than that of non-first defecation, the change of MVO2 between them tends to be same. SDNN of the first defecation in 30 minutes after defecation was lower significantly (P= 0.032) than that of the non-first defecation.4. There was no statistically evident differences (P=0.581) in the change of parameters — heart rate, blood pressure, MVO2, HRV and ST segment depression—when AMI patients defecated with different positions. But on the increasing amplitude during the periods of the initial stage and the later stage of defecation, QTcd of supine position (20.99 ±11.89, 19.29 ±16.07) was higher significantly than that of semi-reclining position (7.68+15.29, 3.40± 10.93), statistical difference existing (P = 0.034, P=0.010).5. Kaiselu group and Castor oil group have no statistical difference in satisfaction, availability, defecation time and self-feeling. But at the periods of after purging, the heart rate and the MVO2 of kaiselu group were higher obviously (P=0.029, P=0.019) than those of Castor oil group. No obvious difference in other parameters was observed between two groups.Conclusions1. A large percentage of AMI patients in the early stage feel hard during defecating. The process of defecation have negative effects on MVO2, heart autorhythmicity and myocardial ischemia level of AMI patients in the early stage. The danger of the non-first defecation is the same as the first defection.2. During defecating, there are the same effects on the cardiac function when patients take the supine or semi-reclining position defecation. So the semi-reclining position is also a realizable way for AMI patients in early stage.3. MVO2 of patients after taking Kaiselu intranus injection increased more obviously than that of taking castor oil oral administration, so it is inadvisable to prolong the time of waiting for defecatione after Kaiselu intranus injection.