Roth A, Barbash G I, Hod H, Miller H I, Rath S, Modan M, Har-Zahav Y, Keren G, Bassan S, Kaplinsky E
Department of Cardiology, Tel-Aviv Medical Center, Israel.
J Am Coll Cardiol. 1990 Apr;15(5):932-6. doi: 10.1016/0735-1097(90)90219-f.
The growing recognition of the importance of early thrombolysis in evolving myocardial infarction was the basis for the present study, which evaluated the effectiveness, feasibility and safety of prehospital thrombolytic therapy. In a relatively small study, 118 patients were allocated to receive either prehospital treatment with recombinant tissue-type plasminogen activator (rt-PA) in the mobile intensive care unit (group A, 74 patients) or hospital treatment (group B, 44 patients). A total of 120 mg of rt-PA was infused over a period of 6 h. All patients were fully heparinized and underwent radionuclide left ventriculography and coronary angiography during hospitalization. Although group A was treated significantly earlier than group B after onset of symptoms (94 +/- 36 versus 137 +/- 45 min, respectively; p less than 0.001), no significant differences were observed between the groups in 1) extent of myocardial necrosis, 2) global left ventricular ejection fraction at discharge, 3) patency of infarct-related artery, 4) length of hospital stay, and 5) mortality at 60 days. However, a trend to a lower incidence of congestive heart failure at hospital discharge was observed in the prehospital-treated compared with the hospital-treated group (7% versus 16%, respectively; p = NS). No major complications occurred during transportation. It is concluded that myocardial infarction can be accurately diagnosed and thrombolytic therapy initiated relatively safely during the prehospital phase by the mobile intensive care team, thus instituting a beneficial clinical trend in favor of prehospital thrombolysis.
对早期溶栓治疗在进展性心肌梗死中的重要性的认识不断提高，是本研究的基础，该研究评估了院前溶栓治疗的有效性、可行性和安全性。在一项相对较小的研究中，118例患者被分配接受以下治疗：在移动重症监护病房接受重组组织型纤溶酶原激活剂（rt-PA）的院前治疗（A组，74例患者）或院内治疗（B组，44例患者）。在6小时内输注总量为120mg的rt-PA。所有患者均充分肝素化，并在住院期间接受放射性核素左心室造影和冠状动脉造影。尽管A组在症状发作后比B组治疗显著更早（分别为94±36分钟和137±45分钟；p<0.001），但两组在以下方面未观察到显著差异：1）心肌坏死程度，2）出院时整体左心室射血分数，3）梗死相关动脉通畅情况，4）住院时间，以及5）60天时的死亡率。然而，与院内治疗组相比，院前治疗组在出院时充血性心力衰竭的发生率有降低趋势（分别为7%和16%；p=无显著性差异）。转运过程中未发生重大并发症。结论是，移动重症监护团队可在院前阶段相对安全地准确诊断心肌梗死并启动溶栓治疗，从而形成有利于院前溶栓的有益临床趋势。
