二级医院对急性心肌梗死急诊溶栓的可行性探讨

The Practice of Thrombolysis Administering in Emergency Department of Community Hospital for AMI

目的:分析影响急性心肌梗死(AMI)溶栓治疗的相关因素,观察急诊溶栓治疗的诊断―用药时间的改善情况及溶栓疗效。方法:分别从发病时间(溶栓时间窗)、年龄和疾病严重程度等因素探讨对溶栓治疗的影响,结合诊断―用药时间分析我院溶栓治疗的再通率情况。结果:影响溶栓治疗的最主要因素依次为时间窗、年龄、心功能(KillipⅢ级)、non-STE、心源性休克等;急诊科诊断―用药时间为101.9min;溶栓再通率为83.3%。结论:急诊科开始溶栓所需要的时间明显缩短,再通率也明显增加,影响溶栓最主要的因素为发病时间窗、年龄及疾病严重程度等,提示在二级医院急诊溶栓治疗可能是首选措施。

Objective：To analyze the most important factors of influencing thrombelitic therapy for AMI, at same time we observed the effectiveness of improving the ＇Time of diagnose to thrombolysis beginning time＇ by performing emergency thrombolysis. Method：We studied the factors including the time after occurrence of AMI, age, severity of disease with AMI, non-STE and others respectively on the influence of thrombolysis, assessing the ＇ Time of diagnose to thrombolysis beginning time＇ and reperfusion rate. Results：The factors on deciding administering thrombolysis for AMI were occurrence time.age.heart failure （Killip Ⅲ级）.non-STE.cardiogenic shock. The time of diagnose to thrombelysis was 101.9 min averagely, the reperfusion rate was 83.3%. Conclusion：The time of diagnose to thrombolysis administering was obviously shorter than before, the reperfusion rate was also increasing, the most important factors influencing thrombolysis was occurrence time, age and severity of disease with AMI. It means that thrombolysis in emergency department is likely to be the primary option for AMI in community hospital.