Patton J A, Funk M
Cardiology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md., USA.
Am J Crit Care. 2001 Jan;10(1):23-32; quiz 33-4.
Although effective for assessing ongoing myocardial ischemia, ST-segment monitoring may be underused.
To determine the proportion of cardiac units in the United States that use ST-segment monitoring, hospital and unit characteristics associated with its use, how units use such monitoring with respect to research recommendations, if units that use ST-segment monitoring find it clinically useful and easy to use, and why some units are not using this type of monitoring.
A survey on ST-segment monitoring was mailed to a random sample of 500 cardiac nurse managers and clinical nurse specialists.
Of the final 192 respondents, 104 (54.2%) reported that they were using ST-segment monitoring. Monitor brand was the only characteristic associated with use of this monitoring (P = .03). On units that used ST-segment monitoring, patients were monitored if they had myocardial infarction (81%), unstable angina (79.6%), or possible myocardial infarction (78.6%) and after percutaneous transluminal coronary angioplasty (47.6%). Leads were chosen according to unit protocol (60.2%) and 12-lead electrocardiographic findings (48.5%); leads II (95.0%) and V1 (75.2%) were used most often. The majority of units that use ST-segment monitoring agreed that it is clinically useful (83%) and easy to use (56%). Among the units not using ST-segment monitoring, the most common reason was that physicians were not interested (27.1%).
ST-segment monitoring is not routinely used; when it is, research recommendations are often not followed. Increased awareness is needed among cardiac nurses and physicians of the clinical usefulness and proper use of ST-segment monitoring.
尽管ST段监测对于评估正在发生的心肌缺血有效，但可能未得到充分利用。
确定美国使用ST段监测的心脏科单位比例、与其使用相关的医院和科室特征、各单位在遵循研究建议方面如何使用此类监测、使用ST段监测的单位是否认为其在临床上有用且易于使用，以及一些单位不使用这种监测的原因。
向500名心脏科护士经理和临床护士专家的随机样本邮寄了一份关于ST段监测的调查问卷。
在最终的192名受访者中，104名（54.2%）报告他们正在使用ST段监测。监测仪品牌是与这种监测使用相关的唯一特征（P = 0.03）。在使用ST段监测的单位中，如果患者发生心肌梗死（81%）、不稳定型心绞痛（79.6%）或可能的心肌梗死（78.6%）以及经皮腔内冠状动脉成形术后（47.6%），则对其进行监测。导联根据科室方案（60.2%）和12导联心电图结果（48.5%）选择；最常使用的导联是II导联（95.0%）和V1导联（75.2%）。大多数使用ST段监测的单位认为其在临床上有用（83%）且易于使用（56%）。在未使用ST段监测的单位中，最常见的原因是医生不感兴趣（27.1%）。
ST段监测未被常规使用；即使使用，也常常不遵循研究建议。心脏科护士和医生需要提高对ST段监测临床实用性和正确使用方法的认识。
