一例IABP辅助急诊PCI治疗高危急性心梗患者的护理关键时间窗管理经验总结

Summary of Nursing Experience during the Critical Time Window of Emergency PCI for a High-Risk Acute Myocardial Infarction Patient Assisted by IABP

摘要: 目的：针对传统主动脉内球囊反搏(IABP)在高危急性心肌梗死(AMI)患者急诊经皮冠状动脉介入治疗(PCI)中应用时机偏晚、陷于被动补救的困境，提出并验证“IABP精准前移”策略及其配套的护理关键时间窗管理模型的有效性与应用价值。方法：通过报告一例急性前壁心肌梗死极高危患者的救治过程，系统阐述“IABP精准前移”策略(即主动将循环支持时机从血流动力学失代偿后前移至失代偿临界点前)的决策逻辑与实践路径。基于循证依据与策略内核，构建并详细阐述结构化的“护理关键时间窗管理”模型，该模型将护理流程系统划分为窗前期、窗启动期、窗内期及窗后期四个时序衔接的阶段。结果：病例成功践行了“精准前移”策略，在IABP支持下顺利完成急诊PCI，术中及术后血流动力学保持稳定。所构建的护理模型明确了各阶段护理的核心任务与要点，实现了护理角色从被动执行者向风险识别者、决策启动者及协同领导者的主动转型。该模型以预见性评估为起点，以多学科快速通道为保障，为优化急诊救治流程提供了时序化管理框架。结论：本病例报告显示，对于具有高危特征的AMI患者，早期识别预警征象并前移IABP支持时机，有助于为急诊PCI创造稳定的血流动力学条件。围绕此策略实施的阶段性护理时间窗管理，为本例的成功提供了重要保障，该护理经验可为处理类似复杂病例提供参考。

Abstract: Objective: To address the dilemma of traditional intra-aortic balloon pump (IABP) being applied too late and trapped in passive rescue during emergency percutaneous coronary intervention (PCI) in high-risk acute myocardial infarction (AMI) patients, we propose and verify the effectiveness and application value of the “IABP Precision Advancement” strategy and its supporting critical time window management model for nursing. Methods: By reporting the treatment process of an extremely high-risk patient with acute anterior myocardial infarction, we systematically elaborate on the decision-making logic and practical path of the “IABP Precision Advancement” strategy (i.e., proactively advancing the timing of circulatory support from after hemodynamic decompensation to before the critical point of decompensation). Based on evidence-based principles and the core of the strategy, we construct and elaborate on a structured “critical time window management for nursing” model, which systematically divides the nursing process into four temporally connected stages: pre-window, window initiation, intra-window, and post-window. Results: The case successfully implemented the “Precision Advancement” strategy, successfully completing emergency PCI with IABP support, maintaining stable hemodynamics during and after the procedure. The constructed nursing model clarifies the core tasks and key points for each stage of nursing, achieving an active transformation of the nursing role from a passive executor to a risk identifier, decision initiator, and collaborative leader. Starting with predictive assessment and supported by a multidisciplinary fast track, this model provides a temporally managed framework for optimizing emergency treatment processes. Conclusion: This case report shows that for AMI patients with high-risk characteristics, early identification of early warning signs and advancing the timing of IABP support can help create stable hemodynamic conditions for emergency PCI. The staged time window management for nursing implemented around this strategy provides an important guarantee for the success of this case, and this nursing experience can serve as a reference for handling similar complex cases.