急诊科溶栓可缩短进门至穿刺时间。

Emergency department thrombolysis improves door to needle times.

作者信息

Corfield A R, Graham C A, Adams J N, Booth I, McGuffie A C

机构信息

Accident and Emergency Department, Crosshouse Hospital, Kilmarnock KA2 0BE, UK.

出版信息

Emerg Med J. 2004 Nov;21(6):676-80. doi: 10.1136/emj.2004.014449.

DOI:10.1136/emj.2004.014449

PMID:15496692

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC1726488/

Abstract

OBJECTIVE

To identify the effect on door to needle (DTN) time of moving the site of thrombolysis delivery from the coronary care unit (CCU) to the emergency department (ED). To ascertain if moving the site of thrombolysis enables appropriate use of thrombolysis.

DESIGN

Prospective cohort study.

SETTING

CCU and ED of a 450 bed Scottish district general hospital without on-site primary angioplasty.

PARTICIPANTS

Primary site for thrombolysis of patients presenting to the hospital with ST elevation MI (STEMI) moved from CCU to ED on 1 April 2000. Study patients who had a confirmed STEMI and/or received thrombolytic therapy before this date were defined as the pre-change group; those who were diagnosed as STEMI and/or received thrombolytic therapy after this date were defined as the post-change group.

STATISTICAL ANALYSIS

Mann-Whitney test was used to compare medians and chi(2) test for categorical data.

RESULTS

1349 patients were discharged from CCU with a diagnosis of STEMI or received thrombolysis in the ED or CCU between April 1998 and April 2002. There were 632 patients in the pre-change group and 654 patients in the post-change group. Sixty three patients were excluded. Median DTN time for the pre-change group (321 thrombolysed patients) was 64 minutes and median DTN time for the post-change group (324 thrombolysed patients) was 35 minutes, a median difference of 25 minutes (95% CI for difference 20 to 29 minutes, p<0.0001, Mann-Whitney U test). A total of 37 patients were thrombolysed but did not have a final diagnosis of STEMI.

CONCLUSION

A significant reduction in DTN times accompanied this change in practice in this hospital.

摘要

目的

确定将溶栓治疗地点从冠心病监护病房（CCU）转移至急诊科（ED）对门到针（DTN）时间的影响。确定转移溶栓地点是否能使溶栓得到合理应用。

设计

前瞻性队列研究。

地点

一家拥有450张床位、无现场初级血管成形术的苏格兰地区综合医院的CCU和ED。

参与者

2000年4月1日起，因ST段抬高型心肌梗死（STEMI）入院患者的溶栓主要地点从CCU转移至ED。在此日期之前确诊为STEMI和/或接受溶栓治疗的研究患者被定义为改变前组；在此日期之后被诊断为STEMI和/或接受溶栓治疗的患者被定义为改变后组。

统计分析

采用Mann-Whitney检验比较中位数，采用卡方检验分析分类数据。

结果

1998年4月至2002年4月期间，1349例患者从CCU出院，诊断为STEMI或在ED或CCU接受溶栓治疗。改变前组有632例患者，改变后组有654例患者。63例患者被排除。改变前组（321例接受溶栓治疗的患者）的DTN时间中位数为64分钟，改变后组（324例接受溶栓治疗的患者）的DTN时间中位数为35分钟，中位数差异为25分钟（差异的95%CI为20至29分钟，p<0.0001，Mann-Whitney U检验）。共有37例患者接受了溶栓治疗，但最终诊断并非STEMI。