Drew Barbara J
Department of Physiological Nursing, University of California, San Francisco, USA.
Am J Crit Care. 2002 Jul;11(4):378-86; quiz 387-8.
The electrocardiogram continues to be the gold standard for the diagnosis of cardiac arrhythmias and acute myocardial ischemia. The treatment of arrhythmias in critical care units has become less aggressive during the past decade because research indicates that antiarrhythmic agents can be proarrhythmic, causing malignant ventricular arrhythmias such as torsade de pointes. However, during the same period, the treatment of acute myocardial ischemia has become more aggressive, with the goal of preventing or interrupting myocardial infarction by using new antithrombotic and antiplatelet agents and percutaneous coronary interventions. For this reason, critical care nurses should learn how to use ST-segment monitoring to detect acute ischemia, which is often asymptomatic, in patients with acute coronary syndromes. Because the electrocardiographic lead must be facing the localized ischemic zone of the heart to depict the telltale signs of ST-segment deviation, the challenge is to find ways to monitor patients continuously for ischemia without using an excessive number of electrodes and lead wires. The current trend is to use reduced lead set configurations in which 5 or 6 electrodes, placed at convenient places on the chest, are used to construct a full 12-lead electrocardiogram. Nurse scientists at the University of California, San Francisco, School of Nursing are at the forefront in developing and assessing the diagnostic accuracy of these reduced lead set electrocardiograms.
心电图仍然是诊断心律失常和急性心肌缺血的金标准。在过去十年中，重症监护病房中心律失常的治疗已变得不那么激进，因为研究表明抗心律失常药物可能会引发心律失常，导致如尖端扭转型室性心动过速等恶性室性心律失常。然而，在同一时期，急性心肌缺血的治疗变得更加积极，目标是通过使用新型抗血栓和抗血小板药物以及经皮冠状动脉介入治疗来预防或中断心肌梗死。因此，重症监护护士应学会如何使用ST段监测来检测急性冠状动脉综合征患者中常无症状的急性缺血。由于心电图导联必须面对心脏的局部缺血区域才能描绘出ST段偏移的特征性迹象，挑战在于找到在不使用过多电极和导联线的情况下持续监测患者缺血情况的方法。当前的趋势是使用简化导联设置，其中将5或6个电极放置在胸部方便的位置，用于构建完整的12导联心电图。加利福尼亚大学旧金山分校护理学院的护理科学家在开发和评估这些简化导联心电图的诊断准确性方面处于前沿地位。
