120-ICU模式急诊溶栓治疗急性心肌梗死的初步研究

Acute thrombolytic therapy by emergency medical personnel in acute myocardial infarction

目的 探讨急性心肌梗死 (AMI) 12 0 ICU模式急诊溶栓治疗的安全性、可行性和优越性。方法 12 0现场诊断的可疑AMI无溶栓禁忌证患者 ,按患者意愿直接送至韶关市人民医院急救中心重症监护病房 (ICU)接受溶栓治疗 (A组 ) ,或送至急救中心再辗转至心内科冠心病监护病房 (CCU)治疗 (B组 )。记录转运途中并发症、发病到溶栓时间 ,再通率、以及住院期间严重并发症发生率、病死率。结果 入选 89例可疑AMI患者 ,A组 4 0例 ,B组 4 9例。现场诊断AMI的总体准确率为 96 .6 %。两组转运途中并发症 (室速、室颤、Ⅲ度房室传导阻滞 )发生率为 11.6 %。确诊为AMI患者A、B组接受溶栓治疗比例分别为 97.3%和 30 .6 % (P <0 .0 1)。A组就诊到溶栓时间较B组缩短 10 1min[(44 .4± 17.3)min与 (14 6± 5 9)min],P <0 .0 1。A组发病到溶栓时间较B组缩短 99min[(195± 171.4 )min与(2 94± 83.6 )min],P <0 .0 1。A、B两组血管再通率分别为 72 .2 %和 33.3% (P <0 .0 1) ,两组住院期间严重并发症发生率分别为 18.9%和 4 6 .9% (P <0 .0 1) ,病死率分别为 5 .4 %和 2 2 .4 % (P <0 .0 5 )。结论 12 0 ICU模式急诊溶栓治疗AMI安全可行。与入院后溶栓相比 ,显著缩短发病到溶栓时间 ,提高溶栓比例 ,降低病死率。是我国中小?

Objective To assess the safety,feasibility,and advantage of acute thrombolytic therapy by the 120 ICU type in acute myocardial infarction (AMI).Methods Patients who were diagnosed for the presence of suspected AMI without contraindications to thrombolysis were allocated to begin thrombolytic therapy by emergency medical personnel at Emergency Center (group A) or to be administered in hospital(group B) as they liked.The clinical outcomes were compared between the two groups. Results Of 89 eligible patients with suspected AMI,40 were in group A, and 49 were in group B,the total diagnostic accuracy rate was 96.6 %. The incidence rate of severe complications(Ventricular tachycardia or fibrillation,Ⅲ AVB) was 11.6 %. The percentage of thrombolytic therapy for patients with confirmed AMI in group A and B was 97.3 % and 30.6 %,respectively(P< 0.01 ).The interval from presentation to thrombolysis in group A was 101 min shorter than that of group B( 44.4 ± 17.3 min vs 146±59 min,P 0.01 ). The interval from symptom onset to thrombolysis in group A was 99 min shorter than that of group B(195± 171.4 min vs 294± 83.6 min,P< 0.01 ).The patency rates in group A and B were 72.2 % and 33.3 % respectively(P< 0.01 ). The in hospital incidence rate of severe complications in group A and B was 18.9 % and 46.9 %, respectively (P< 0.01 ).The in hospital mortality rare in group A and B was 5.4 % and 22.4 %,respectively (P< 0.05 ).Conclusion Compared to in hospital initiated thrombolytic therapy,acute thrombolytic therapy by 120 ICU type shortened the time from symptom onset to thromblysis, enhanced the percentage of thrombolysis,and thus reduced mortality in patients with AMI.It indicates that acute thrombolytic threapy by 120 ICU type for AMI is an advanced way and worth spreading in middle small cities.