Handberg E, Keith T, Rucinski P
University of Florida, Gainesville.
JEMS. 1992 Apr;17(4):74-5, 77-80, 83.
The importance of early identification and treatment of patients experiencing an AMI is clearly beneficial. Studies have shown that the time from pain onset to hospital administration of thrombolytic therapy can be reduced simply by early identification of patient eligibility by paramedics and notification of the receiving hospitals--as well as more efficient patient management after arrival at the ED. The limitations of thrombolytic therapy also may be related, in part, to patient denial of symptoms and reluctance to seek emergency assistance. To widen the net of patients who can receive thrombolytic therapy, extensive research has been and is being conducted to integrate the prehospital phase into the treatment window. The practicality of upgrading all EMS systems to provide thrombolytic therapy depends on many factors. EMS directors must accept the responsibility for the prehospital care delivered. Although the diagnostic accuracy is high and complications are relatively low when compared to the risk, the current legal environment in the United States may limit the willingness of some directors to promote a prehospital thrombolytic program. Additionally, the low yield of patients may not justify the significant capital outlay required to adequately train personnel and outfit ambulances with required telemetry systems. At a minimum, however, EMS programs can improve their ability to rapidly identify those patients who may be eligible for thrombolytic therapy.
对急性心肌梗死（AMI）患者进行早期识别和治疗显然是有益的。研究表明，通过护理人员对患者资格的早期识别以及通知接收医院，再加上患者到达急诊科后更高效的管理，可缩短从疼痛发作到医院进行溶栓治疗的时间。溶栓治疗的局限性也可能部分与患者对症状的否认以及不愿寻求紧急援助有关。为了扩大能够接受溶栓治疗的患者范围，已经并正在进行广泛研究，以将院前阶段纳入治疗窗口。将所有急救医疗服务（EMS）系统升级以提供溶栓治疗的实用性取决于许多因素。EMS主管必须对所提供的院前护理负责。尽管与风险相比，诊断准确性高且并发症相对较低，但美国目前的法律环境可能会限制一些主管推广院前溶栓计划的意愿。此外，患者数量少可能无法证明为充分培训人员以及为救护车配备所需遥测系统所需的大量资本支出是合理的。然而，至少EMS计划可以提高其快速识别那些可能符合溶栓治疗条件的患者的能力。
