120-CCU模式对急性心肌梗死院前溶栓治疗的初步研究报告  

Prehospital thrombolytic therapy by emergency medical personnel in acute myocardial infarction

作　　者：李强 李成祥[2] 贾国良[2] 

机构地区：[1]西安市急救中心,陕西西安710004 [2]第四军医大学西京医院心内科,710032

出　　处：《中国急救医学》2000年第3期148-150,共3页Chinese Journal of Critical Care Medicine

摘　　要：目的　探讨急性心肌梗死 (AMI) 12 0 -CCU模式院前溶栓治疗的安全性、可行性和优越性。方法　 12 0现场诊断的可疑AMI无溶栓禁忌症患者 ,按患者意愿或就地溶栓治疗后送至西京医院CCU(A组 ) ,或送至就近医院急诊室治疗 (B组 )。记录转运途中并发症、发病到溶栓时间 ,以及住院期间死亡率。结果　入选 47例可疑AMI患者 ,A组 2 6例 ,B组 2 1例。现场诊断AMI的总体准确率为 91 4%。A、B两组转运途中并发症 (室速、室颤、Ⅲ 房室传导阻滞、死亡 )发生率分别为 17 4%和 10 % (P >0 0 5 )。确诊为AMI患者 ,A、B组接受溶栓治疗的比例分别为 10 0 %和 40 % (P <0 0 5 )。A组就诊到溶栓时间较B组缩短 10 8min(42± 30minvs 15 0± 114min ,P <0 0 1)。发病到溶栓时间缩短 90min(198± 177minvs 2 88± 12 3min ,P <0 0 1)。A、B两组住院期间死亡率分别为 4 3%和 35 % (P <0 0 5 )。结论　AMI12 0 -CCU模式院前溶栓治疗安全可行 ,与院内溶栓相比 ,显著缩短发病到溶栓时间 ,提高溶栓比例 ,降低死亡率。Objective To assess the safety,feasibility,and advantage of prehospital thrombolytic the-rapy by emergency medical personnel in acute myocardial infarction(AMI) Methods patients who presented to 120 unit with suspected AMI without contraindications to thrombolysis were allocated to begin thrombolytic therapy by emergency medical personnel at home(group A)or to be administered in hospital(group B)as they liked.The clinical outcomes were compared between the twe groups.Results Of 47 eligible patients with suspected AMI, 26 were in group A,and 21 in group B.The total diagnostic accuracy rate was 91 4%.The incidence rate of severe complications(ventri-cular tachycardia or fibrillation,Ⅲ AVB,and death )before admission was similar in group A and B(17 4%vs 10%, P >0 05).The percentage of thrombolytic therapy for patients with confirmed AMI in group A and B were 100% and 40%,respectively( P <0 05).The interval from presentation to thrombolysis in group A was 108 min shorter than in group B(42±30 min vs 150±114 min, P <0 01).The interval from symptom onset to thrombolysis in group A was 90 min shorter than in group B(198±177 min va 288±123 min,p<0 01),The inhospital mortality rate in group A and B was 4 3% and 35%,respectively( P <0 05).Conclusion Compared to inhospital initiated thrombolytic therapy,prehospital initiated thrombolytic therapy by emergency medical personnel enhanced the percentage of thrombolysis,shortened the time delay from symptom onset to thromblysis,and thus reduced mortality in patients with AMI. [

关 键 词：心肌梗塞 院前溶栓 急救 120-CCU模式 

分 类 号：R542.22[医药卫生—心血管疾病]