宋莉,颜红兵,程姝娟,王健,赵汉军,李世英,李庆祥,郑斌,迟云鹏,吴铮

• 1:首都医科大学附属北京安贞医院心内科28病区

摘要(Abstract)：

目的比较不同转运方式对ST段抬高心肌梗死(STEMI)患者再灌注治疗延迟的影响。方法单中心现况调查。入选2006年1月1日至2007年4月30日期间,于发病24h内就诊于北京安贞医院抢救中心的232例STEMI患者。根据转运方式分为救护车组和自行转运组,比较两组各时间间隔:(1)决定就医-首次医疗接触;(2)决定就医-进门;(3)决定就医-球囊扩张;(4)进门-球囊扩张;(5)发病-球囊扩张。结果 105例(45.3%)STEMI患者通过救护车转运到达医院,其余127例(54.7%)为自行转运。自行转运组决定就医-进门时间显著短于救护车组(中位数,35min比50min,P<0.001)。而救护车组的决定就医-首次医疗接触(中位数,15min比35min,P<0.001)、决定就医-球囊扩张(中位数,173min比193min,P=0.049)、进门-球囊扩张(中位数,102min比125min,P<0.001)以及发病-球囊扩张时间(中位数,223min比300min,P<0.001)均显著短于自行转运组。结论尽管自行转运可更快到达医院,但是救护车转运可更快获得再灌注治疗。

关键词(KeyWords)： 心肌梗死;救护车;病人转送;再灌注

Abstract:

Keywords:

基金项目(Foundation): 首都紧急医学救援(5分钟)科技工程建设研究项目组子课题之一[京科技发(2005)593]的部分资助

作者(Author): 宋莉,颜红兵,程姝娟,王健,赵汉军,李世英,李庆祥,郑斌,迟云鹏,吴铮

参考文献(References)：

• [1]Chambless L,Keil U,Dobson A,et al.Population versus clinical view of case fatality from acute coronary heart disease:results from the WHO MONICA Project1985-1990.Multinational MO-NItoring of Trends and Determinants in CArdiovascular Disease.Circulation,1997,96:3849-3859.
• [2]Indications for fibrinolytic therapy in suspected acute myocardial infarction:collaborative overview of early mortality and major morbidity results from all randomised trials of more than1000pa-tients.Fibrinolytic Therapy Trialists'(FTT)CollaborativeGroup.Lancet,1994,343:311-322.
• [3]Cannon CP,Gibson CM,Lambrew CT,et al.Relationship of symptom-onset-to-balloon time and door-to-balloon time with mortality in patients undergoing angioplasty for acute myocardial infarction.JAMA,2000,283:2941-2947.
• [4]Canto JG,Zalenski RJ,Ornato JP,et al.Use of emergency medi-cal services in acute myocardial infarction and subsequent quality of care:observations from the National Registry of Myocardial In-farction2.Circulation,2002,106:3018-3023.
• [5]Cabrita B,Bouyer-Dalloz F,L'Huillier I,et al.Beneficial effects of direct call to emergency medical services in acute myocardial infarction.Eur J Emerg Med,2004,11:12-18.
• [6]Hedges JR,Feldman HA,Bittner V,et al.Impact of community intervention to reduce patient delay time on use of reperfusion therapy for acute myocardial infarction:Rapid Early Action for Coronary Treatment(REACT)trial:REACTStudy Group.Acad Emerg Med,2000,7:862-872.
• [7]Johansson I,Stromberg A,Swahn E.Ambulance use in patients with acute myocardial infarction.J Cardiovasc Nurs,2004,19:5-12.
• [8]Kerr D,Holden D,Smith J,et al.Predictors of ambulance use in patients with acute myocardial infarction in Australia.Emerg Med J,2006,23:948-952.
• [9]Yan HB,Song L,Chen H,et al.Factors influencing ambulanceuse in patients with ST-elevation myocardial infarction in Beijing,China.Chin Med J(Engl),2009,122:272-278.
• [10]Thuresson M,Jarl-v MB,Lindahl B,et al.Factors that influ-ence the use of ambulance in acute coronarysyndrome.Am Heart J,2008,156:170-176.
• [11]Hutchings CB,Mann NC,Daya M,et al.Patients with chest pain calling9-1-1or self-transporting to reach definitive care:which mode is quicker-Am Heart J,2004,147:35-41.
• [12]Antman EM,Hand M,Armstrong PW,et al.2007Focused Up-date of the ACC/AHA2004Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction:a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.Circulation,2008,117:296-329.
• [13]Song L,Hu DY,Yan HB,et al.Influence of ambulance use on early reperfusion therapies for acute myocardial infarction.Chin Med J(Engl),2008,121:771-775.
• [14]郭金成,华琦,刘东霞,等.影响急性ST段抬高心肌梗死患者应用急救医疗服务的因素.中国急救医学,2006.26:181-183.
• [15]van de Loo A,Saurbier B,Kalbhenn J,et al.Primary percutane-ous coronary intervention in acute myocardial infarction:direct transportation to catheterization laboratory by emergency teams re-duces door-to-balloon time.Clin Cardiol,2006.29:112-116.