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目的分析老年患者经皮冠状动脉介入术(PCI)术后诱发房颤(AF)的危险因素及护理措施。方法选取2008年1月至2010年5月接受PCI术的老年患者86例,术前均无AF,术后按是否发生AF分为研究组40例(发生AF)和对照组46例(未发生AF)。比较两组年龄、血压值、左房直径(LAD)、左室射血分数(LVEF)、心胸比(CTR)、血钾与血镁水平、甲状腺激素(TT4)、脑钠肽(BNP)及C反应蛋白(CRP)差异;分析上述临床因素与接受PCI术的老年患者发生AF危险程度。结果治疗前两组的各项临床疗效指标差异无统计学意义(P>0.05)。治疗后,研究组的LVEF、血钾与血镁水平较对照组降低,而研究组的年龄、血压值、LAD、CTR、TT4、BNP及CRP增加(P<0.05)。对照组治疗前后的各项临床疗效指标差异无统计学意义(P>0.05);研究组治疗前后的各项临床疗效指标差异有统计学意义(P<0.05)。Logistic回归分析显示左房扩大、低钾血症及高BNP水平是发生AF的危险因素(P<0.05)。结论对合并有左房扩大、低钾血症及高BNP水平的PCI术老年患者临床护理应予以针对性干预措施,降低AF发生。
Objective To analyze the risk factors and nursing measures of atrial fibrillation (AF) after percutaneous coronary intervention (PCI) in elderly patients. Methods A total of 86 elderly patients undergoing PCI from January 2008 to May 2010 were enrolled in this study. All patients were divided into study group (AF) 40 cases and control group (AF group) AF). Blood pressure, left atrium diameter (LAD), left ventricular ejection fraction (LVEF), cardiothoracic ratio (CTR), serum potassium and serum magnesium levels, thyroid hormone (TT4), brain natriuretic peptide (BNP) C-reactive protein (CRP) differences; analysis of the above clinical factors and the risk of AF in elderly patients undergoing PCI. Results Before treatment, there was no significant difference in clinical efficacy between the two groups (P> 0.05). After treatment, LVEF, serum potassium and magnesium levels in the study group decreased compared with those in the control group, while the study group had an increased age, blood pressure value, LAD, CTR, TT4, BNP and CRP (P <0.05). There was no significant difference in the clinical curative indexes before and after treatment in the control group (P> 0.05). The clinical curative effect indexes of the study group before and after treatment had significant difference (P <0.05). Logistic regression analysis showed that left atrium enlargement, hypokalemia and high BNP level were the risk factors of AF (P <0.05). Conclusions The clinical nursing of elderly patients with PCI complicated with left atrium enlargement, hypokalemia and high BNP level should be targeted to reduce the occurrence of AF.