农村社区院前溶栓的潜在用途。

Doherty Donna Tedstone, Dowling John, Wright Peter, Murphy Andrew W, Bury Gerard, Bannan Liam

Public Health Department, NWHB, Ballyshannon, Donegal, Ireland.

Resuscitation. 2004 Jun;61(3):303-7. doi: 10.1016/j.resuscitation.2004.01.022.

BACKGROUND

It is recommended that eligible patients receive thrombolytic treatment within 90 min of alerting medical or ambulance services. The Donegal Area Rapid Treatment Study (DARTS) showed that pre-hospital thrombolysis reduces "call to needle" times for patients living remote from the hospital base [Donegal Area Rapid Treatment Study (DARTS): Final Report. North Western Health Board].

AIM

To review DARTS data to describe the potential impact of pre-hospital thrombolysis on a defined population.

METHOD

Data from the DARTS project was reviewed to describe cases where thrombolysis was not administered, cases where thrombolysis was administered in hospital but not in the community, and to extrapolate these findings to other rural regions in the area to identify the potential for additional pre-hospital thrombolysis.

RESULTS

Eighty-four patients from DARTS practices presented to the district hospital with AMI during the study period with 35% (29/84) receiving thrombolysis. Of the 29 who received thrombolysis, 87% (25) were referred from the general practitioner. Of these, 32% (8/25) were administered thrombolysis by the general practitioner. Of the general practitioner referrals that did not receive pre-hospital thrombolysis (n = 17), 65% (11/17) were not thrombolysed in the community for appropriate clinical reasons and 35% (6/17) could have been potentially eligible for pre-hospital thrombolysis. Inclusion of these patients suggests a potential pre-hospital thrombolysis rate in the region of 56%. For the rural Donegal areas this would result in a potential 17 cases per year being eligible for pre-hospital thrombolysis.

CONCLUSIONS

Currently, 35% of the 240 AMIs that occur annually in the region receive thrombolysis. Broad implementation of DARTS in the region would provide pre-hospital thrombolysis to approximately an additional 25 patients each year, with a potential for further gains. For this to become a reality, support and encouragement must be provided to all rural general practitioners, the ambulance services, receiving hospitals and policy makers to implement a pre-hospital thrombolysis policy.

背景

建议符合条件的患者在呼叫医疗或急救服务后90分钟内接受溶栓治疗。多尼戈尔地区快速治疗研究（DARTS）表明，对于居住在远离医院基地的患者，院前溶栓可缩短“呼叫至穿刺”时间[多尼戈尔地区快速治疗研究（DARTS）：最终报告。西北卫生委员会]。

目的

回顾DARTS数据，以描述院前溶栓对特定人群的潜在影响。

方法

回顾DARTS项目的数据，描述未进行溶栓治疗的病例、在医院而非社区进行溶栓治疗的病例，并将这些结果外推至该地区的其他农村地区，以确定额外进行院前溶栓的可能性。

结果

在研究期间，来自DARTS医疗机构的84例急性心肌梗死患者被送往地区医院，其中35%（29/84）接受了溶栓治疗。在接受溶栓治疗的29例患者中，87%（25例）由全科医生转诊。其中，32%（8/25）由全科医生进行溶栓治疗。在未接受院前溶栓治疗的全科医生转诊患者（n = 17）中，65%（11/17）因适当的临床原因未在社区接受溶栓治疗，35%（6/17）可能有资格接受院前溶栓治疗。纳入这些患者表明该地区院前溶栓率可能达到56%。对于多尼戈尔农村地区而言，这将导致每年约有17例患者有资格接受院前溶栓治疗。