Effect of Atropine Injection Combined with Nursing Intervention on Interventional Treatment of Patients with ST Segment Elevation Myocardial Infarction

1. Data and methods

1.1. General Information

A total of 60 patients with ST-segment elevation myocardial infarction treated in our hospital from January 2022 to January 2023 were selected as the research objects. According to different nursing methods, they were divided into routine group (n = 30) and systematic group (n = 30), routine group (n = 20 males and n = 10 females). The average age was (65.17±12.55) years. The lesion locations were left anterior descending branch in 10 cases, right coronary branch in 8 cases and left circumflex branch in 13 cases. The mean time from onset to percutaneous coronary intervention (PCI) was (5.32±2.85)h (1-10h). In system group, there were 22 males and 8 females. The average age was (66.50±9.07) years. The lesion locations were left anterior descending branch in 11 cases, right coronary branch in 6 cases and left circumflex branch in 14 cases. The mean time from onset to percutaneous coronary intervention (PCI) was (5.25±2.69)h (1-10h). The above data conform to the principle of balanced comparability (P > 0.05). See Table 1.

1.2. Inclusion and exclusion criteria

Inclusion criteria: 1. It met the diagnostic criteria of clinical ST-segment elevation acute myocardial infarction; 2. 2. Coronary angiography was performed; 3. Persistent chest pain that cannot be relieved by nitrates; 4. Sign informed consent. Exclusion criteria :1. Patients with combined malignant tumor; 2. Patients with severe liver and kidney dysfunction; 3. Patients with poor compliance and unable to cooperate.

1.3. methods

Both groups were treated with anticoagulation before percutaneous coronary intervention and intravenous injection of ordinary heparin of 100~120IU/kg. Tirofiban was administered intravenously for 24-36 hours at 0.15μg/(kg·min). The patients were placed in supine position after entering the operating room. After anesthesia, the radial artery or femoral artery was punctured by Sedinger puncture method under digital subtraction angiography. In the conventional group, radial artery puncture was performed in 28 cases and femoral artery puncture in 3 cases. In system group, radial artery puncture was performed in 30 cases and femoral artery puncture in 1 case. Coronary artery stenosis 70% or greater implanted 6 f scabbard, conventional coronary angiography, determine after infarction, vascular, menstruation bellows in coronary angioplasty (PTCA), and appropriate stents, stents implanted 78, residual stenosis < 20%, any imaging showed TIMI the flow within the Ⅲ level, patient condition and hemodynamic stability, the operation is a success. Clopidogrel (75mg/d)+ aspirin (100mg/d) was given postoperative follow-up treatment.On the basis of above the system group add atropine sulfate injection 0.9% sodium chloride 4ml+Atropine sulfate 0.5mg intravenous injection drug batch number 2203305

1.4. Atropine injection combined with nursing intervention

The routine group received routine nursing, including preoperative disinfection, skin preparation, close observation of patients' vital signs, etc., and the occurrence of intraoperative complications were handled by doctors.

On the basis of routine nursing, systematic nursing cooperation was given in the system group. The details are as follows: ① Preoperative preparation: When receiving the notification of percutaneous coronary intervention (PCI), the personnel on duty should be in position as soon as possible. Understand the patient's basic condition and examination indicators, prepare first-aid drugs and conventional coronary angiography and PCI materials, and check whether the instrument is in standby state. The adverse events that are easy to happen during the operation should be prevented and dealt with in advance. After entering the operating room, the patient should do three checks and eight pairs to confirm the operation site and skin preparation. Communicate with the patient, guide the patient how to cooperate with the doctor, explain the possible situation during the operation, calm the patient's emotions. Assist the patient to take the supine position, give the patient oxygen inhalation and ecg monitoring, pay attention to avoid the defibrillation site when connecting the ECG monitoring electrode, so as not to affect the image collection and rescue as the principle. Do a good job of ecg and multifunctional monitoring, to ensure the patient's vein patency. ② Cooperation in interventional surgery: timely delivery of instruments according to the needs of intraoperative physicians to ensure smooth operation. Assist the doctor to complete the puncture. Double check with the doctor after unpacking the balloon stents. Perform all treatments accurately according to condition and doctor's advice. ③ Prevention of intraoperative complications: Arrhythmia: intraoperative possible malignant arrhythmia and thus endanger the patient lives, to closely observe the patient's breathing, heart rate, heart rate, blood pressure, blood oxygen saturation, once found abnormal situation will promptly report to the doctor, when necessary intravenous push note 0.5 ~ 1 mg of atropine or application of temporary pacemaker, immediately came to nurse electric defibrillation, care nurse is responsible for the rescue medication; Amiodarone hydrochloride should be given in the case of ventricular tachycardia. 2. Observation and nursing of precardiac pain: When the coronary artery stent is implanted, the balloon is filled, the coronary artery blood flow is temporarily interrupted, and vascular spasm is easy to occur. Psychological nursing of patients is strengthened, and patients are often asked whether there is chest pain, chest tightness, etc., and informed that this is a normal reaction. For patients with obvious intraoperative pain in the precardiac area filled with balloon, the patient should be asked about the nature of pain, given the relevant explanation of pain and psychological comfort, to eliminate the patient's fear and tension, and given morphine analgesia when necessary. 3. Acute coronary artery occlusion: when acute coronary artery occlusion occurs in timI 0-2 level of anterior coronary artery flow, immediate intravenous administration of antihypertensive drugs, positive inotropic drugs and coronary artery injection of tirofiban hydrochloride, and implantation of stents to cover the damaged intima for patients who cannot be relieved after medication. 4. Vagus reflex: The vagus reflex usually occurs in vascular puncture and postoperative sheath tube removal, and the general clinical manifestations are pallor, nausea and vomiting, dizziness, chest tightness, sweating, decreased blood pressure, slow heart rate, etc. If vomiting occurs, tilt the head to one side and remove foreign bodies in the mouth and nose to prevent suffocation caused by vomit. 1mg atropine was injected intravenously to speed up dripping. For those whose blood pressure could not be raised in time or dropped too much, symptomatic treatment such as hydroxyamine or dopamine was given.

1.5. Evaluation criteria of efficacy

Time of infarct opening and length of hospital stay: recorded by medical staff during operation. Incidence of adverse reactions during PCI: Possible adverse reactions during PCI include ventricular tachycardia, ventricular fibrillation, vagal hypotension and acute coronary artery occlusion. Death during interventional treatment: conditions for clinical declaration of death: ① Complete loss of consciousness of the patient; ② Complete respiratory and heartbeat arrest; ③ The blood pressure continued to be zero, and the above indexes could not be recovered after a period of rescue; ④ The patient has pupil dilation. Determination of treatment success: The criteria for successful treatment were no serious complications, TIMI ⅲ blood flow, stable patient condition and hemodynamics. The criteria of treatment failure were complications, blood flow did not reach TIMI ⅲ, patients' condition did not improve, and hemodynamics did not reach stability. Improvement of heart function: The standard of good improvement of heart function was the heart failure classification of ⅰ - ⅱ set by the New York Heart Association one week after surgery, and the ejection fraction of heart color ultrasound was more than 50%. The criteria for poor improvement in cardiac function were that the patients did not reach the heart failure classification ⅰ - ⅱ set by the New York Heart Association one week after surgery, and the ejection fraction of the heart showed by color ultrasound was less than 50%.

1.6. Statistical methods

SPSS20.0 was used for data analysis software, measurement data were expressed as (± S), and independent sample T test was used. The counting data were expressed as the number of cases (rate) and X² test was used. The comparison with (P < 0.05) was statistically significant. GraphPad Prism 8 was used as the mapping software.

2. Results

2.1. Comparison of the opening time of infarcted vessels

The opening time of infarct vessel in conventional group was (76.36±11.62) min. The time of infarct vessel opening in the system group was (62.83±9.77) min, which was significantly better than that in the conventional group (P < 0.05), as shown in Figure 1. (* represents the comparison of time to open infarct vessels between the conventional group and the system group t=4.962, P < 0.001)

As shown in Figure 1.

2.2. Comparison of the incidence of total adverse reactions during interventional treatment

In the conventional group, there were 1 cases of ventricular fibrillation, 3 cases of ventricular tachycardia, 2 cases of acute coronary artery occlusion, 4 cases of hypotension, and the total rate of adverse reactions was 10 cases (33%). In the systemic group, there were 0 cases of ventricular fibrillation, 1 case of ventricular tachycardia, 1 case of acute coronary artery occlusion, 1 case of hypotension, and 3 cases (10%) of total adverse reactions. The total adr rate in system group was significantly lower than that in conventional group (P < 0.05), as shown in Table 2.

2.3. Comparison of mortality during interventional treatment

In the conventional group, 4 patients died during interventional treatment, with a mortality rate of 13%. In the system group, 0 patients died during interventional treatment, and the mortality rate was 0%. The mortality of routine group was significantly higher than that of system group (P < 0.05), as shown in Figure 2. (* represents comparison of mortality between the conventional and system groups x²=4.276, P=0.039)

2.4. Comparison of treatment success rate

In the conventional group, 18 cases were successfully treated, and the success rate was 60%. In the systemic group, 26 cases were successfully treated, and the success rate was 87%. The success rate of the system group was significantly higher than that of the conventional group (P < 0.05), as shown in Figure 3. (* represents the comparison of treatment success rate between the conventional group and the system group x²=5.455, P=0.02)

2.5. Comparison of improvement of cardiac function and length of hospitalization

In the conventional group, 17 patients had good cardiac function improvement, 10 patients had poor cardiac function improvement, and the hospital stay was (7.33±1.21) d. In system group, 25 patients had good cardiac function improvement, 5 patients had poor cardiac function improvement, and the hospital stay was (6.43±1.30) d. The number of patients with improved cardiac function and length of hospital stay in the system group were significantly better than those in the conventional group (P < 0.05), as shown in Table 3.