院前心电图中非 ST 段抬高损伤模式的频率。
Frequency of non-ST-segment elevation injury patterns on prehospital electrocardiograms.
机构信息
Department of Emergency Medicine, UC Davis Medical Center, Sacramento, California 95817, USA.
出版信息
Prehosp Emerg Care. 2010 Jan-Mar;14(1):1-5. doi: 10.3109/10903120903144924.
INTRODUCTION
Prehospital electrocardiograms (ECGs) have been recommended to facilitate early diagnosis of ST-segment elevation myocardial infarction (STEMI). However, prehospital ECGs can also be used to triage patients with non-ST-segment elevation acute coronary syndromes, who comprise a majority of patients with ischemic events presenting by ambulance to overcrowded emergency departments.
OBJECTIVE
We assessed the frequency of non-ST-segment elevation injury patterns on prehospital ECGs in patients with a chief complaint of chest pain evaluated by the emergency medical services (EMS) system.
METHODS
We analyzed prehospital ECGs of patients with the chief complaint of chest pain during a nine-month period. The ECGs were divided into three categories: injury pattern; no injury pattern; and technically uninterpretable. Injury pattern criteria were as follows: 1) regional ST depression >or=1.0 mm; 2) regional T-wave inversion (TWI) >or=3 mm; 3) left bundle branch block (LBBB); and 4) regional ST-segment elevation >or=1.0 mm. Descriptive statistics with 95% confidence intervals (CIs) are presented.
RESULTS
Prehospital ECGs were obtained for 322 of 340 chest pain patients: 72% were men; the average age was 60 years (range 18-96 years). Seventy-seven ECGs (24%, 95% CI 19.3-28.9%) met the criteria for injury pattern, 230 (71%) did not show injury, and 15 (5%) were uninterpretable. Of the 77 ECGs that exhibited an injury pattern, 39 (51%) showed ST depression, seven (9%) TWI, seven (9%) LBBB, and 24 (31%) ST-segment elevation. Thus, non-ST-segment elevation injury patterns (ST depression/TWI/LBBB) accounted for 53 (17%, 95% CI 12.6-20.9) of the total 322 prehospital ECGs.
CONCLUSION
Our findings demonstrate a relatively high frequency (17%) of non-ST-segment elevation injury patterns on prehospital ECGs of patients who summon EMS because of chest pain. These results suggest the potential of prehospital ECGs to facilitate early triage in these high-risk chest pain patients who present to overcrowded emergency departments.
介绍
院前心电图（ECG）已被推荐用于促进 ST 段抬高型心肌梗死（STEMI）的早期诊断。然而，院前 ECG 也可用于分诊非 ST 段抬高型急性冠状动脉综合征患者，这些患者构成了因缺血事件而通过救护车送往人满为患的急诊科的大多数患者。
目的
我们评估了在由紧急医疗服务（EMS）系统评估的以胸痛为主诉的患者中，院前 ECG 上出现非 ST 段抬高损伤模式的频率。
方法
我们分析了在九个月期间以胸痛为主诉的患者的院前 ECG。ECG 分为三类：损伤模式；无损伤模式；以及技术上无法解释。损伤模式标准如下：1）区域性 ST 段压低≥1.0mm；2）区域性 T 波倒置（TWI）≥3mm；3）左束支传导阻滞（LBBB）；4）区域性 ST 段抬高≥1.0mm。呈现了描述性统计数据和 95%置信区间（CI）。
结果
340 例胸痛患者中获得了 322 例院前 ECG：72%为男性；平均年龄为 60 岁（18-96 岁）。77 例 ECG（24%，95%CI 19.3-28.9%）符合损伤模式标准，230 例（71%）未显示损伤，15 例（5%）无法解释。在显示损伤模式的 77 例 ECG 中，39 例（51%）显示 ST 段压低，7 例（9%）TWI，7 例（9%）LBBB，24 例（31%）ST 段抬高。因此，非 ST 段抬高的损伤模式（ST 段压低/TWI/LBBB）占 322 例院前 ECG 的 53 例（17%，95%CI 12.6-20.9）。
结论
我们的发现表明，在因胸痛而召唤 EMS 的患者中，院前 ECG 上非 ST 段抬高损伤模式的出现频率相对较高（17%）。这些结果表明，院前 ECG 有可能在分诊这些因缺血事件而被送往人满为患的急诊科的高危胸痛患者中发挥作用。
Zotero 插件