Cagán S, Pavlovic M, Stefanovic R, Murín J, Wimmerová S, Besedová I, Trnovec T
Ustav preventívnej a klinickej medicíny, Bratislava.
Vnitr Lek. 2000 Feb;46(2):67-79.
Better management of patients with acute myocardial infarction during the prehospital phase is at present a challenge not only for health workers but for society as a whole. The authors pay attention to knowledge of the complex problem of the prehospital phase in patients with acute myocardial infarction which is a prerequisite for finding possible solutions for a favourable effect on their management. The authors analyzed 3,040 patients who were admitted to hospital alive within 96 hours after the development of complaints with suspicion of a first or repeated acute myocardial infarction. They focused attention in particular on prehospital time delay. They found that within a satisfactory time interval (within 2 hours) 29.8% patients were delivered and within a yet acceptable interval of 4 hours 51.6% patients (with respect to effectiveness of thrombolytic treatment). Similarly undesirable are also data on the patient time delay. Within the optimal first hour after development of complaints following the decision of the patient (subjects present) to ask for or seek medical assistance was the decision of 34% patients, during the first two hours 47.5% and within 4 hours 61.2% patients with acute myocardial infarction. The ratio of time delay of the patient in the total prehospital delay is 45.5% even in patients who were admitted during the first hour after development of acute myocardial infarction. In patients who were admitted 4 hours after development of complaints it is 79.5%. The patient is admitted to hospital most quickly if he calls the medical emergency service and latest when he decides to see a doctor. Physicians and other health workers contributed only in 16.4-20.9% patients with acute myocardial infarction to their early decision to seek medical assistance. Patients with an early decision (within one hour) call most frequently the medical emergency service and are taken to hospital by this service. The time delay due to transport is shortest in these patients. The late hospital admission of patients with acute myocardial infarction in Slovakia calls for reduction of the time interval from the development of complaints to hospital admission (total prehospital delay), in particular the time taken by the patient to make up his mind (patient time delay). Early calling of the emergency medical service and transport of the maximum possible number of patients with acute myocardial infarction to hospital by the emergency medical service will greatly improve the management of patients with acute myocardial infarction. Comprehensive implementation of the survival chain (24), the most comprehensive implementation of recommendations of the European Society of Cardiology and the European Resuscitation Council for in the management of patients with acute heart attacks during the prehospital phase (21) and early effective treatment which begins already in the prehospital phase has a favourable impact on the condition of patients with acute myocardial infarction and on their prognosis. Along with early and effective treatment of patients with acute myocardial infarction in hospital and their stratification these are the most important approaches to the development and control of sudden cardiac death. Knowledge of the complex problem of the prehospital phase in patients with acute myocardial infarction is the prerequisite for the elaboration of high standard prehospital management of patients with acute myocardial infarction.
目前，对急性心肌梗死患者进行更好的院前阶段管理不仅对医护人员，而且对整个社会来说都是一项挑战。作者关注急性心肌梗死患者院前阶段这一复杂问题的相关知识，这是找到对其治疗产生有利效果的可能解决方案的先决条件。作者分析了3040例在出现疑似首次或再次急性心肌梗死症状后96小时内入院的存活患者。他们特别关注院前时间延迟。他们发现，在令人满意的时间间隔（2小时内）内，29.8%的患者被送达医院，在尚可接受的4小时间隔内，51.6%的患者被送达医院（就溶栓治疗效果而言）。患者时间延迟的数据同样不理想。在患者决定（在场者）寻求医疗帮助后的最佳首小时内，34%的急性心肌梗死患者做出了决定，在前两小时内这一比例为47.5%，在4小时内为61.2%。即使是在急性心肌梗死发病后首小时内入院的患者，患者时间延迟在总院前延迟中的比例也为45.5%。在出现症状后4小时入院的患者中，这一比例为79.5%。患者若呼叫医疗急救服务则入院最快，若决定去看医生则入院最晚。医生和其他医护人员仅促使16.4% - 20.9%的急性心肌梗死患者尽早决定寻求医疗帮助。早期做出决定（1小时内）的患者最常呼叫医疗急救服务，并由该服务送往医院。这些患者因转运导致的时间延迟最短。斯洛伐克急性心肌梗死患者入院延迟的情况要求缩短从出现症状到入院的时间间隔（总院前延迟），尤其是患者做出决定所花费的时间（患者时间延迟）。尽早呼叫紧急医疗服务并由紧急医疗服务将尽可能多的急性心肌梗死患者送往医院，将极大地改善急性心肌梗死患者的治疗。全面实施生存链（24）、最全面地实施欧洲心脏病学会和欧洲复苏委员会关于院前阶段急性心脏病发作患者管理的建议（21）以及早在院前阶段就开始的早期有效治疗，对急性心肌梗死患者的病情及其预后有有利影响。除了在医院对急性心肌梗死患者进行早期有效治疗及其分层外，这些是发展和控制心源性猝死的最重要方法。了解急性心肌梗死患者院前阶段的复杂问题是制定高标准急性心肌梗死患者院前管理的先决条件。
