Operation room in the safe operation of the high-frequency electric knife problem The male L2 cases, female 2 cases, aged 42 to 46 years old, average age is 50.8 years old.1.2 typical cases: patient male, 49 years old, because of sudden precordial pain, pale 3H hospital. Physical examination: the BP14.3 / 9.3kPa, P607 / min, R20 /. Min.The electrocardiogram shows: II, avF sT segment elevation and T wave into a curve, III avF see Q wave and gradually deepened, 24h after serum enzymes were increased gradually. The electrocardiogram showed: acute inferior and posterior wall myocardial infarction.Give the sublingual nitroglycerin administration, and to give energy mixture, polarized liquid, compound salvia miltiorrhiza and intravenous drip after treatment of poor efficacy, meaning given nitroglycerin in 5% glucose solution in 5mg 250ml, press 20 ~ g / min speed instillation after pain relief, nitroglycerin infusion reduced gradually, 14d angina pectoris after be control, ECG improvements.
Nursing experience of 2 2.1 infusion preparation: nitroglycerin used 5% ~ 10% glucose solution preparation. The LMG or 5mg nitroglycerin adding 5% ~ 10% glucose 100ml or 250ml to slow the rate of intravenous infusion in general is not easy, in conjunction with other drugs, prepared with. More than 4 ~ 6h should not be used, should be prepared.
2.2: nitroglycerin infusion speed of fast, too fast to avoid venous transfusion.Blood pressure caused by excessive, rapid heart rate, the liquid drop speed regulator for L5 / min, and the nitroglycerin added to the liquid, starting from a small dose, infusion of slower, depending on the patient’s reaction speed, continuous observation of blood pressure during intravenous infusion of 2 ~ 3 times better, patient comfort, blood pressure fluctuations may increase dosage.
2.3 withdrawal indications and cautions: when a patient clinical remission of symptoms, angina can be controlled, the electrocardiogram has improved, stable condition, can withdraw.Withdrawal should gradually reduce dosage, slow down the liquid velocity to stop, do not suddenly stop, otherwise it will cause a rebound of side effects, exacerbate myocardial ischemia.
The 2.4 observation of blood pressure, heart rate changes: Nitroglycerin in the use of the process must be closely monitoring of blood pressure, heart rate, blood pressure can not be less than 12 / 8kPa, too low can not be used, because the coronary perfusion pressure is too low, coronary flow reduction, aggravate ischemia, it should be noted that no dosage is too large, so as to avoid excessive lowering of blood pressure and coronary artery perfusion pressure caused by the reflection of the excitement of sympathetic nerve, cause the heart rate to accelerate, leading to increased myocardial oxygen consumption, can aggravate the symptoms of angina pectoris and worse, it began to use 0. 5h to measure blood pressure, heart rate should be 1 times, to maintain the delivery should be 2H monitoring of blood pressure, heart rate 1 times.
2.5: close observation of changes in nursing staff must strengthen the inspection and monitoring, close observation of the patient’s blood pressure, heart rate, respiration and other changes, was observed in the pain location, nature and uCf ~ Q, and pay attention to the arrhythmia, will force the failure and cardiogenic shock care.
2.6: psychological nursing in clinical work, we often observed, excessive emotional tension can be induced by various types of arrhythmia, effects of nitroglycerin treatment effect, the case for AMI patients, particularly threatening. Therefore, nurses in the busy infusion, blood pressure, electrocardiogram and must not be the patient’s mental status of nursing staff, first through a variety of ways to try to stabilize the patient mood rapidly, as long as the patient on treatment with confidence, fear will disappear. Health care professionals should master the psychological status of the patients to the necessary explanations, which concerns, enhance confidence in the fight against disease, combined with our treatment.