[麻醉医生对急性冠状动脉综合征的院前护理。与心脏病专家护理标准的前瞻性比较]
[Prehospital care of acute coronary syndrome by anaesthetists. Prospective comparison with the care standards of cardiologists].
作者信息
Breckwoldt J, Müller D, Overbeck M, Stern R, Schnitzer L, Arntz H R
机构信息
Klinik für Anästhesiologie und operative Intensivmedizin, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin.
出版信息
Anaesthesist. 2008 Feb;57(2):131-8. doi: 10.1007/s00101-007-1290-x.
BACKGROUND
Prehospital treatment of acute coronary syndrome (ACS) by anaesthetists acting in physician staffed emergency medical service (EMS) was compared with that of the gold standard of cardiologists.
METHODS
Prospectively 599 patients with assumed ACS were traced. Prehospital diagnosis and therapy were compared with re-evaluation of ECGs and diagnosis on hospital discharge.
RESULTS
In the case of ST-segment elevating myocardial infarction (STEMI) anaesthetists diagnosed 84% of cases correctly and cardiologists in 94% (p=0.048). False positive diagnoses were given in 11% by anaesthetists versus 5% by cardiologists (p=0.31). Anaesthetists accompanied all patients with instable angina versus 94% by cardiologists (p=0.06). Anaesthetists achieved 82% of patients to be pain-free versus 73% of cardiologists (p=0.01). Mortality until discharge was identical for the two groups (8.2%).
CONCLUSION
In prehospital management of ACS cardiologists showed higher diagnostic competence, whereas anaesthetists revealed a greater degree of therapeutic caution. Patient mortality was not influenced.
背景
比较了在配备医生的紧急医疗服务（EMS）中由麻醉医生进行的急性冠状动脉综合征（ACS）的院前治疗与心脏病专家这一黄金标准的治疗情况。
方法
前瞻性地追踪了599例疑似ACS患者。将院前诊断和治疗与心电图的重新评估及出院诊断进行比较。
结果
在ST段抬高型心肌梗死（STEMI）病例中，麻醉医生正确诊断出84%的病例，心脏病专家正确诊断出94%的病例（p = 0.048）。麻醉医生的假阳性诊断率为11%，而心脏病专家为5%（p = 0.31）。所有不稳定型心绞痛患者均由麻醉医生陪同，而心脏病专家陪同的比例为94%（p = 0.06）。麻醉医生使82%的患者无痛，而心脏病专家为73%（p = 0.01）。两组出院前的死亡率相同（8.2%）。
结论
在ACS的院前管理中，心脏病专家显示出更高的诊断能力，而麻醉医生表现出更大程度的治疗谨慎性。患者死亡率未受影响。
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