The Hemodynamic Influence And Clinical Significance Of Early Nursing Intervention In Patients With AMI And Emergency PCI

Objective1. To explore the hemodynamic influence of early postoperative rehabilitation nursing procedure in patients with acute myocardial infarction and percutaneous coronary intervention.2. By observing the effect and clinical significance of early rehabilitation nursing on cardiac function, degree of comfort and the incidence of vascular complications in patients with AMI and PCI, to provide evidence for improving perioperative nursing program.MethodsEighty patients with acute myocardial infarction (no serious complications) and PCI were recruited from A Third-level First-class central Hospital ICU from January,2009 to May,2010.They were randomly divided into the early rehabilitation group(43 cases)and the control group(37 cases).All patients conformed to the diagnostic criteria for AMI.Two groups in gender, age, cardiac function killip grading and coronary artery Pathological change count and other general information had no significant difference (P>0.05),and they were comparable.The control group in PCI postoperative on the basis of routine therapy received routine care and guidance, while the rehabilitation group in the PCI postoperative on the basis of routine therapy received rehabilitation nursing including rehabilitation exercise and health education. Rehabilitation nursing procedure was developed according to age, cardiopulmonary function, referring to the first phase of three-stage rehabilitation exercise program (CCU period) recommended by American heart association (AHA) and the rehabilitation procedure formulated in China. The rehabilitation guidance was also combined with nurses' practical experience in our hospital. Hemodynamic parameters were measured daily using the United States Bioz Com noninvasive hemodynamic monitor, and then compared between two groups a day before operation and after 1 to 3 days to evaluate cardiac function. The influence of early rehabilitation nursing training on patients' cardiac function after PCI was analyzed, and the condition of bed rest, abdominal distension, back pain, dysuria and the incidence of vascular complications were observed and compared between two groups. Data analysis was completed using statistical software SPSS 13.0. Measurement data was displayed as mean±standard deviation (x±s), and analyzed using the t test, count data was analyzed using Chi-square (X2) test.Results1. Comparison of hemodynamic parameters1.1 Hemodynamic parameters comparison between the rehabilitation group and the control group before PCI. There was no significant difference in hemodynamic parameters between two groups before PCI (P> 0.05).1.2 Hemodynamic parameters comparison between the rehabilitation group and the control group after 1,2 days of the PCI. In the rehabilitation group and the control group the 1,2 days after PCI, HR(/min), SBP(mmHg), DBP(mmHg), MAP(mmHg), PEP(ms), STR, SVR(D.S×Cm-5), SVRI(D.S×Cm-5×m-2) were significantly decreased than that of before PCI, but the difference had no statistical significance between two groups (P> 0.05); CO(L/min-1), CI[L/(min-1·m2)], SV(mL/B), SI[mL/(B·m2)], VI(/1000s), ACI(/100s2), LVET(ms), LCW(kgxm), LCWI(kgxmx×m-2) were significantly increased than that of before PCI, but the difference had no statistical significance between two groups (P> 0.05).1.3 Hemodynamic parameters comparison between the rehabilitation group and the control group after 3 days of the PCI. In the rehabilitation group and the control group in the 3 days after PCI, HR(/min), SBP(mmHg), DBP(mmHg), PEP(ms), STR, SVR(D.S×cm-5), SVRI(D.S×cm-5×m-2) were significantly decreased than that of before PCI, but the difference had no statistical significance between two groups (P>0.05); CI[L/(min-1·m2)], SV(mL/B), SI[mL/(B-m2)], VI(/1000s), ACI(/100s2), LVET(ms), LCW(kgxm), LCWI(kgxmxm-2) were significantly increased than that of before PCI, but the difference had no statistical significance between two groups (P>0.05). After rehabilitation nursing, patients'cardiac output increased significantly and the difference had statistical significance between two groups (P<0.05); mean arterial pressure decreased significantly and the difference had statistical significance between two groups (P<0.05).2. Comparison of the comfort degree and complications occurrence between the rehabilitation group and the control group after PCI.There was no significant difference in the incidence of postoperative vascular complications between two groups (P> 0.05). The bed coordination and urinate in the rehabilitation group was significantly better than that in the control group (P< 0.01). Abdominal distension discomfort was significantly relieved in the rehabilitation group compared that with the control group (P< 0.05), Back pain was more significantly relieved in the rehabilitation group compared that with the control group (P<0.01).Conclusions1. Under the closely monitoring of non-invasive hemodynamic, the early rehabilitation nursing do not affected the cardiac function of patients with acute myocardial infarction (no serious complications) and PCI, indicating that the early rehabilitation nursing after PCI is safe.2. The early rehabilitative nursing can help patients with AMI and PCI not only improve the cardiac function and cardiovascular efficiency, but also relieve the back pain and other discomfort symptoms.