Ornato J P
Internal Medicine Section of Emergency Medical Services, Medical College of Virginia, Richmond 23218.
Clin Cardiol. 1990 Mar;Suppl 5:V48-52; discussion V67-72.
Delay from the onset of acute myocardial infarction (AMI) symptoms to initiation of thrombolytic therapy can be reduced by improving patient recognition of AMI symptoms and encouraging speedier action in seeking medical assistance and improving the time it takes for medical personnel to evaluate the patient's symptoms and initiate appropriate therapy. Attempts to improve patient response to AMI symptoms have met with limited success. Prehospital administration of thrombolytic drugs may be of value, but many AMI patients are not transported by the emergency medical services system. As the hospital entry point for both ambulance patients and walk-ins, the emergency department (ED) is a major focal point for influencing the timing of thrombolytic therapy. Unfortunately, much of what is known about the time sequence of ED thrombolytic therapy in the United States comes from organized trials in a small number of centers. Little is known about how often non-ED physicians participate in the decision-making process (either in person or by phone consultation), or how many delays are potentially avoidable. Current evidence suggests that preestablished ED treatment plans and protocols can reduce the time delay for many patients who present with AMI, especially if paramedics can transmit diagnostic quality ECGs to the hospital.
通过提高患者对急性心肌梗死（AMI）症状的识别能力、鼓励患者更快地寻求医疗救助以及缩短医务人员评估患者症状并启动适当治疗所需的时间，可以减少从急性心肌梗死症状发作到开始溶栓治疗的延迟。改善患者对AMI症状反应的尝试取得的成功有限。院前给予溶栓药物可能有价值，但许多AMI患者并非由紧急医疗服务系统运送。作为救护车患者和自行就诊患者进入医院的入口，急诊科（ED）是影响溶栓治疗时机的主要焦点。不幸的是，在美国，关于急诊科溶栓治疗时间顺序的很多信息都来自少数中心的有组织试验。对于非急诊科医生参与决策过程的频率（无论是亲自参与还是通过电话咨询），以及有多少延迟可能是可以避免的，人们了解得很少。目前的证据表明，预先制定的急诊科治疗计划和方案可以减少许多AMI患者的时间延迟，尤其是如果护理人员能够将诊断质量的心电图传输到医院的话。
