左束支传导阻滞是临床上常见的一种心律失常,一般多认为是病理性的,当合并急性心肌梗死时,由于室间隔起始除极向量方向发生改变及以R波为主导联ST-T发生继发性改变,会掩盖心肌梗死的心电图改变,导致临床心电图诊断复杂化.

目的 探讨急性心肌梗死女性患者初次发作时患病经历的真实感受,旨在为医护人员从女性患者的角度提高优质的医疗和护理服务提供科学依据.方法 采用目的抽样法选取泰安市某三级甲等医院 18名急性心肌梗死初次发作女性患者,以半结构深入访谈法对其进行访谈,采用Colaizzi分析法对资料进行分析、整理、归纳主题.结果 急性心肌梗死女性初次发作患者的感受主要有:①我生病了吗?②我是个病人!③我还是原来的我!结论 女性患者在急性心肌梗死初次发作时有其特殊性,应从女性患者的角度满足其生理、心理和社会方面的需求.

患者女，72岁，以持续性胸痛3天为主诉入院，胸痛伴恶心、呕吐和出汗，在当地检查 CK - MB 90 U/ L，诊断为“急性冠脉综合征”，予肠溶阿斯匹林、氢氯吡格雷、辛伐他汀口服，静脉点滴“血塞通”、“红花注射.液”等，因无病情无明显好转而来我院，经门诊检查以“急性心肌梗死”收入院。查体：体温36.5℃，脉搏47次/ min，呼吸18次/ min，血压150/90 mmHg，双肺呼吸音清，未闻及干湿罗音。心浊音界无扩大，心率47次/ min，律齐，未闻及杂音和附加音。腹部平软，无压痛和反跳痛，余无显著异常。心电图诊断：窦性心动过缓，一度房室传导阻滞，急性心肌梗死（下壁和后壁）。入院诊断：冠心病急性心肌梗死（下壁和后壁），心功能 Killip 1级；心律失常：窦性心动过缓，一度房室传导阻滞。入院后检查：肌酸激酶229 U/ L ，CK - MB23 U/ L。超敏肌钙蛋白 I 1.62μg / L，B 型钠尿肽前体1056 pg /ml；冠脉造影：冠脉显示清晰，左主干短小，无明显狭窄，内膜光整；前降支近端狭窄40~50%，内膜粗糙，对角支、间隔支正常。左旋支内膜粗糙，远端狭窄40~50%血流正常，钝缘支正常，血流正常。左房支正常。右冠状动脉狭窄99%，自中段完全闭塞。未见冠脉侧支灌注、冠脉畸形、动脉瘤和夹层、肌桥等异常。

Objective:To analysize the related risk factors of nosocomial infection and put forward relevant nursing strat-egy in coronary care unit. Methods:362 cases of hospitalized patients in coronary care unit in our hospital were surveyed to analysize the related risk factors of nosocomial infection and put forward relevant nursing strategy. Results:The average hos-pital infection rate was 3. 32%. The patients with nosocomial infection suffered mainly from acute myocardial infarction,es-pecially in the elderly patients. Infection sites focused in the lower respiratory tract and the pathogens were mainly Gram -negative bacteria;Nosocomial infection was closely related to the hospitalization duration and concurrence of several risk fac-tors could increased the rates of nosocomial infection. Conclusions:Age,the hospitalization days,invasive operation,mal-nutrition and diabetis are risk factors for nosocomial infection. To deal with the above mentioned risk factors,it is necessary to strengthen the observation of illness process and the cough,sputum properties and temperature. At the same time,abi-dence by aseptic technique in indwelling catheter and enhancement of disinfection - isolation are the useful methods to pre-vent and control for the nosocomial infections.