Castaigne A, Hervé C, Duval-Moulin A M, Dubois-Randé J L, Merlet P, Hittinger L
Service de cardiologie, CHU Henri-Mondor, Créteil.
Arch Mal Coeur Vaiss. 1990 Feb;83 Spec No 1:41-5.
Too few myocardial infarctions are thrombolysed, and the thrombolytic agent is usually administered too late. This situation can conceivably be improved by educating both physicians and patients, by promoting thrombolysis in all hospitals and by performing thrombolysis before admission. We report here our experience of pre-hospital thrombolysis with Eminase in the Val-de-Marne department. This preliminary study is just a small stone added to the big heap of small series of thrombolysis at home published throughout the world. But while the feasibility of pre-admission thrombolysis has been well demonstrated, its effectiveness remains to be accurately determined. Two studies involving large groups of patients are currently in progress: one in Seattle with the left ventricular function as principal criterion of judgment, the other in Europe (The European Myocardial Infarction Project) with mortality as main criterion of judgment. We must wait for the results of these studies to know whether pre-hospital thrombolysis will become the standard treatment of myocardial infarction and if so, to implement the relevant changes required in health structures.
接受溶栓治疗的心肌梗死患者太少，而且溶栓药物的使用通常过晚。通过对医生和患者进行教育、在所有医院推广溶栓治疗以及在入院前进行溶栓治疗，这种情况有望得到改善。我们在此报告我们在马恩河谷省使用纤溶酶原激活剂（Eminase）进行院前溶栓的经验。这项初步研究只是在全球范围内发表的大量小型溶栓系列研究中的又一小项。虽然入院前溶栓的可行性已得到充分证明，但其有效性仍有待准确确定。目前有两项涉及大量患者的研究正在进行：一项在西雅图，以左心室功能作为主要判断标准；另一项在欧洲（欧洲心肌梗死项目），以死亡率作为主要判断标准。我们必须等待这些研究的结果，以了解院前溶栓是否会成为心肌梗死的标准治疗方法，如果是，还要实施卫生机构所需的相关变革。
