急诊绿色通道静脉溶栓救治急性心肌梗死的可行性研究

Emergency medical service-intravenous thrombolytic therapy for acute myocardial infarction

目的 旨在探讨急性心肌梗死 (AMI)急诊静脉溶栓绿色通道切实可行的方法。方法 将院内溶栓延迟的 4个时间段 (4D′S)前移至院前开始 ,达到院前、院内一体化 ,对院前AMI病人施行急诊静脉溶栓。结果 ①AMI病人急诊溶栓延迟时间缩短至 32 .8min ;②梗死相关血管开通率 6 5 .2 2 % ;③应用简易试管法检测凝血时间 (约 2 0min)监控小剂量肝素的使用时不良反应少。结论 ①在完善的EMSS中开通AMI急诊静脉溶栓的绿色通道可使AMI病人获得及时救治 ;②肝素的早期使用和适时监控 ,可减少再闭塞率和不良反应。

Objective To investigate effective methods of emergency medical service-intravenous thrombolytic therapy for acute myocardial infarction(AMI). Methods The four times(4D′s) -the delayed time of thrombolytic therapy in hospital were moved ahead to prehospital, and prehospital AMI patients were treated with integrative emergency intravenous thrombolytic therapy between prehospital and in-hospital. Results ①The delayed time of emergency thrombolytic therapy for AMI patients were 32.8 minutes; ② The vessel reperfusion rates of infarct-related artery was 65.2%; ③ Under the monitoring of simple clotting time, the adverse effects of lower-dose heparin was small. Conclusion ① In the perfect emergency medical services systems, the opening of emergency green channel of emergency intravenous thrombolytic therapy can benefit patients with acute myocardial infarction. ② The early use and timely monitoring of heparin can reduce the rates of reinfarction and adverse effects.