Trebouet E, Fradin P, Orion L, Dimet J
Samu, SMUR, urgences, CHD Les Oudairies, boulevard Stéphane-Moreau, 85925 La Roche-Sur-Yon cedex 09, France.
Ann Cardiol Angeiol (Paris). 2010 Aug;59(4):209-13. doi: 10.1016/j.ancard.2010.06.003. Epub 2010 Jul 23.
Estimating the quality of care of the patients presenting an ST-elevation myocardial infarction in Vendee.
Prospective observational study carried out over the year 2008. Included patients presenting a myocardial infarction for less than 24 hours, they were alive when emergency team arrived, and were taken care of by the SMUR, the emergencies or the cardiology of the hospital of La Roche-sur-Yon.
Two hundred and seventeen patients were included, 163 men and 54 women, average age: 65 years. Fifty-six percent of the patients called initially the emergency medical service, half of those within an hour after pain began. Seventy-two percent of them were looked after by a SMUR. Twenty-six percent consulted initially a general practitioner, and one third of those were redirected towards the emergency medical service. Thirty percent of all patients followed the ideal procedure defined by succession of chest pain, emergency medical service call, SMUR, angioplasty or fibrinolysis. The average time between the ECG and the fibrinolysis is 36 minutes, or of the arrival in coronarography room is 105 minutes. The balloon is inflated 42 minutes later. Eighty-six percent of the patients taken care of in the acute phase benefited from a strategy of reperfusion, primary angioplasty (63%) or fibrinolysis (21%). Ninety percent of revascularisations were successful.
In the case of the chest pain, the emergency medical service is under-used. The number of revascularised patients is satisfactory, but the whole procedure takes too much time, especially when the treatment is the angioplasty.
评估法国滨海夏朗德省ST段抬高型心肌梗死患者的护理质量。
2008年开展的前瞻性观察性研究。纳入发病时间小于24小时的心肌梗死患者，急救团队到达时患者存活，且由法国紧急医疗救援服务（SMUR）、急诊或滨海拉罗什医院的心脏病科进行治疗。
共纳入217例患者，其中男性163例，女性54例，平均年龄65岁。56%的患者最初呼叫了紧急医疗服务，其中一半在疼痛开始后1小时内呼叫。72%的患者由法国紧急医疗救援服务进行护理。26%的患者最初咨询了全科医生，其中三分之一被转诊至紧急医疗服务。所有患者中有30%遵循了由胸痛、紧急医疗服务呼叫、法国紧急医疗救援服务、血管成形术或纤维蛋白溶解术构成的理想流程。心电图检查至纤维蛋白溶解术的平均时间为36分钟，或至冠状动脉造影室的平均时间为105分钟。球囊在42分钟后充气。急性期接受治疗的患者中有86%受益于再灌注策略，主要是直接冠状动脉介入治疗（63%）或纤维蛋白溶解术（21%）。90%的血运重建成功。
对于胸痛患者，紧急医疗服务的使用不足。血运重建患者的数量令人满意，但整个过程耗时过长，尤其是在采用血管成形术治疗时。
