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ST段抬高型心肌梗死患者与非ST段抬高型心肌梗死患者的电解质失衡:一项队列研究。

Electrolyte Imbalance Among Patients With and With No ST-Elevation Myocardial Infarction: A Cohort Study.

作者信息

Dreidi Mu'taz, Asmar Imad, Jaghama Maram, Alrimawi Intima, Atout Maha

机构信息

Department of Nursing, Faculty of Pharmacy, Nursing and Health Professions, Birzeit University, Birzeit, Palestine (Dr Dreidi, Mr Asmar, and Ms Jaghama); School of Nursing, Georgetown University, Washington, District of Columbia (Dr Alrimawi); and School of Nursing, Philadelphia University, Amman, Jordan (Dr Atout).

出版信息

Crit Care Nurs Q. 2023;46(2):136-144. doi: 10.1097/CNQ.0000000000000446.

Abstract

Electrolytes imbalances are highly prevalent and have shown a high impact on mortality in patients with acute myocardial infarction. These electrolytes imbalance have prognostic value in predicting mortality in patients with acute myocardial infarction. The purpose of this study was to assess the prognostic value of electrolyte imbalances in predicting 1-month mortality among patients with myocardial infarction with and with no ST-elevation. This cohort study was conducted in a referral hospital in the West Bank, Palestine. All patients with confirmed medical diagnosis of acute myocardial infarction and admitted to the medical coronary care unit in the hospital were eligible participants. A convenience sample of 186 participants was obtained. These participants were followed up for 1 month to assess their survival (alive or dead). Demographic and clinical data were recorded by reviewing their health records. The derived data were analyzed using SPSS version 19. About 36% of all patients were found to be hyponatremic, 15% of them have hypokalemia, and 9% of patients had hypocalcemia. There was a significant difference between STEMI and non-STEMI in sodium (t = 4.7, P < .001). A multivariate logistic regression analysis was performed to predict 1-month mortality for patients with myocardial infarction with and with no ST-elevation. The predictors that were found to be significant are sodium (odds ratio [OR] = 0.789, P = .010), calcium (OR = 0.221, P = .014), diastolic blood pressure (OR = 0.933, P = .047), and blood urea nitrogen (OR = 0.821, P = .005). Electrolyte imbalance was highly prevalent among patients with acute myocardial infarction. Hyponatremia and hypocalcemia were present and associated significantly with predicting 1-month mortality. Health care providers should take into consideration the electrolytes of patients with acute myocardial infarction from the first moment of admission and correct them early to maximize the clinical outcomes and survival for patients.

摘要

电解质失衡非常普遍,并且已显示出对急性心肌梗死患者的死亡率有很大影响。这些电解质失衡在预测急性心肌梗死患者的死亡率方面具有预后价值。本研究的目的是评估电解质失衡在预测有和没有ST段抬高的心肌梗死患者1个月死亡率方面的预后价值。这项队列研究在巴勒斯坦西岸的一家转诊医院进行。所有经医学确诊为急性心肌梗死并入住医院心脏监护病房的患者均为合格参与者。获得了186名参与者的便利样本。对这些参与者进行了1个月的随访,以评估他们的生存情况(存活或死亡)。通过查阅他们的健康记录来记录人口统计学和临床数据。使用SPSS 19版对得出的数据进行分析。发现所有患者中约36%为低钠血症,其中15%有低钾血症,9%的患者有低钙血症。ST段抬高型心肌梗死(STEMI)和非ST段抬高型心肌梗死(non-STEMI)在钠水平上存在显著差异(t = 4.7,P < .001)。进行了多因素逻辑回归分析,以预测有和没有ST段抬高的心肌梗死患者的1个月死亡率。发现具有显著意义的预测因素是钠(比值比[OR] = 0.789,P = .010)、钙(OR = 0.221,P = .014)、舒张压(OR = 0.933,P = .047)和血尿素氮(OR = 0.821,P = .005)。电解质失衡在急性心肌梗死患者中非常普遍。低钠血症和低钙血症存在,并且与预测1个月死亡率显著相关。医疗保健提供者应从入院的第一时间就考虑急性心肌梗死患者的电解质情况,并尽早进行纠正,以最大限度地提高患者的临床结局和生存率。

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