标题：基于信息不对称理论的护理指导对急性心肌梗塞合并心衰患者应激反应、不良事件发生率的影响

      作者：李世杰，岳珍珍，裴欣    郑州大学第一附属医院郑东院区心脏重症监护病区，河南 郑州 450000

      卷次： 2023年34卷23期

      【摘要】 目的 探讨基于信息不对称理论的护理指导在急性心肌梗塞(AMI)合并心衰患者中的应用价值。方法 选取 2021年5月至2023年2月郑州大学第一附属医院郑东院区就诊的128例AMI合并心衰患者作为研究对象。所有患者均采用经皮冠状动脉介入术(PCI)治疗，按随机数表法将患者分为研究组和常规组各64例，常规组患者采用常规护理干预，研究组患者在常规组基础上联合基于信息不对称理论的护理指导，比较两组患者干预前、出院当天(干预后)的心功能[左心室收缩末期内径(LVESD)、左室射血分数(LVEF)、左心室舒张末期内径(LVEDD)]，入院当天、入手术室时、术后1 d和干预后的应激反应(舒张压、收缩压)和负性情绪[焦虑自评量表(SAS)、抑郁自评量表(SDS)]，以及不良事件发生率、护理满意度。结果 研究组患者入手术室时、术后1 d的收缩压分别为(107.25±7.38) mmHg、(102.14±6.95) mmHg，明显低于常规组的(124.11±7.52) mmHg、(113.77±7.12) mmHg，舒张压分别为(72.36±5.03) mmHg、(67.52±4.11) mmHg，明显低于常规组的(83.65±5.27) mmHg、(71.86±4.28) mmHg，差异均有统计学意义(P<0.05)；干预后，研究组患者的LVESD、LVEDD分别为(45.14±2.63) mm、(44.26±1.83) mm，明显低于常规组的(50.32±3.89) mm、(49.07±2.96) mm，LVEF为(49.97±2.79)%，明显高于常规组的(43.06±1.08)%，差异均有统计学意义(P<0.05)；入手术室时、术后1 d研究组患者的SAS分别为(54.14±5.78)分、(50.32±5.62)分，明显低于常规组的(63.42±6.12)分、(58.77±6.08)分，SDS分别为(53.74±7.36)分、(47.13±6.58)分，明显低于常规组的(65.87±7.61)分、(53.25±6.80)分，差异均有统计学意义(P<0.05)；研究组患者的不良事件发生率3.13%，明显低于常规组的15.63%，患者对护理的满意度为95.31%，明显高于常规组的79.69%，差异均有统计学意义(P<0.05)。结论 基于信息不对称理论的护理指导不仅可减轻AMI合并心衰患者生理、心理应激反应，提升患者心功能，降低不良事件发生率，还可提高患者对护理的满意度。
      【关键词】 急性心肌梗塞；经皮冠状动脉介入术；信息不对称理论；应激反应；不良事件
      【中图分类号】 R473.5 【文献标识码】 A 【文章编号】 1003—6350（2023）23—3486—06

Effects of nursing guidance based on information asymmetry theory on stress response and incidence of adverseevents in patients with acute myocardial infarction complicated with heart failure.
LI Shi-jie, YUE Zhen-zhen, PEIXin. Cardiac Intensive Care Unit, Zhengdong Hospital of the First Affiliated Hospital of Zhengzhou University, Zhengzhou450000, Henan, CHINA
【Abstract】 Objective To explore the application value of nursing guidance based on information asymmetrytheory in patients with acute myocardial infarction (AMI) complicated with heart failure. Methods A total of 128 pa-tients with AMI and heart failure who were treated at Zhengdong Hospital of the First Affiliated Hospital of ZhengzhouUniversity from May 2021 to February 2023 were selected as the research subjects. All the patients were treated withpercutaneous coronary intervention (PCI) and were randomly divided into a study group and a conventional group, with64 patients in each group. The patients in the conventional group received conventional nursing intervention, while thepatients in the study group received nursing guidance based on information asymmetry theory in addition to convention-al nursing intervention. The cardiac function [left ventricular end-systolic diameter (LVESD), left ventricular ejectionfraction (LVEF), left ventricular end-diastolic diameter (LVEDD)] of the two groups before intervention and on the day ofdischarge (after intervention) was compared. The stress response (diastolic pressure, systolic pressure) and negative emo-tions [Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS)] of the two groups on the day of admission,at the time of admission to the operating room, and on the first day after surgery were compared. The incidence of adverseevents and satisfaction with care were also compared between the two groups. Results The systolic blood pressure ofthe study group was (107.25±7.38) mmHg and (102.14±6.95) mmHg at the time of admission to the operating room and1 day after surgery, respectively, which was significantly lower than (124.11±7.52) mmHg and (113.77±7.12) mmHg ofthe conventional group; the diastolic blood pressure was (72.36±5.03) mmHg and (67.52±4.11) mmHg, respectively,which was significantly lower than (83.65±5.27) mmHg and (71.86±4.28) mmHg of the conventional group; the differ-ences were statistically significant (P<0.05). After intervention, the LVESD and LVEDD of the study group were(45.14±2.63) mm and (44.26±1.83) mm, respectively, which were significantly lower than (50.32±3.89) mm and (49.07±2.96) mm of the conventional group; LVEF was (49.97±2.79)%, which was significantly higher than (43.06±1.08)% ofthe conventional group; the differences were statistically significant (P<0.05). The SAS scores of the study group atthe time of admission to the operating room and 1 day after surgery were (54.14±5.78) points and (50.32±5.62) points,respectively, which were significantly lower than (63.42±6.12) points and (58.77±6.08) points of the conventional group;the SDS scores were (53.74±7.36) points and (47.13±6.58) points, respectively, which were significantly lower than(65.87±7.61) points and (53.25±6.80) points of the conventional group; the differences were statistically significant (P<0.05). The incidence of adverse events in the study group was 3.13%, which was significantly lower than 15.63% of theconventional group; the satisfaction rate of patients with nursing was 95.31% , which was significantly higher than79.69% of the conventional group; the differences were statistically significant (P<0.05). Conclusion Nursing guid-ance based on the theory of information asymmetry can alleviate the physiological and psychological stress responses ofAMI patients with heart failure, improve the cardiac function of patients, reduce the incidence of adverse events, and im-prove the nursing satisfaction of patients.
      【Key words】 Acute myocardial infarction; Percutaneous coronary intervention; Asymmetric information theory;Stress response; Adverse events