Grim P S, Feldman T, Childers R W
Department of Medicine, University of Chicago Hospital, Illinois 60637.
Ann Emerg Med. 1989 May;18(5):483-8. doi: 10.1016/s0196-0644(89)80829-7.
Maximum benefit from thrombolytic therapy in acute myocardial infarction is obtained with early therapy. The earliest possible time to treat is during the initial evaluation of the patient in the home or ambulance, which requires accurate diagnosis of acute myocardial infarction in the prehospital setting. In our study, paramedics evaluated patients who had chest pain with a 12-lead ECG transmitted by cellular telephone and a checklist for inclusion and exclusion criteria for thrombolytic therapy. This information was transmitted to a hospital-based telemetry physician who diagnosed or excluded acute myocardial infarction and made a mock decision to withhold or administer a thrombolytic agent. Forty-eight patients with chest pain were evaluated. Six were diagnosed as having overt acute myocardial infarction by the hospital-based telemetry physician. All six patients had the diagnosis substantiated by both ECG and enzyme studies on hospital admission. Based on the data supplied by paramedics, two of these six patients were considered eligible for thrombolytic therapy by the physician. Hospital evaluation confirmed the prehospital decision to treat with a thrombolytic agent. In addition, all other patients were appropriately diagnosed as ineligible. Prehospital ECG diagnosis resulted in two patients going directly to the catheterization lab, thereby bypassing the emergency department. Overt acute myocardial infarction can be accurately identified by a prehospital-acquired 12-lead ECG transmitted to a hospital-based physician. Our study demonstrates that in conjunction with specially trained paramedics, the hospital physician can decide whether to administer thrombolytic therapy to such patients in the prehospital setting.
急性心肌梗死溶栓治疗的最大益处是通过早期治疗获得的。最早的治疗时机是在患者在家中或救护车上进行初始评估时，这需要在院前环境中准确诊断急性心肌梗死。在我们的研究中，护理人员对有胸痛的患者进行评估，通过手机传输12导联心电图，并使用溶栓治疗的纳入和排除标准清单。这些信息被传输给一名医院遥测医生，该医生诊断或排除急性心肌梗死，并做出是否给予溶栓药物的模拟决定。对48例胸痛患者进行了评估。医院遥测医生诊断出6例为明显急性心肌梗死。所有6例患者入院时的心电图和酶学检查均证实了诊断。根据护理人员提供的数据，这6例患者中有2例被医生认为符合溶栓治疗条件。医院评估证实了院前给予溶栓药物治疗的决定。此外，所有其他患者均被正确诊断为不符合条件。院前心电图诊断使2例患者直接进入导管室，从而绕过了急诊科。通过传输给医院医生的院前12导联心电图可以准确识别明显急性心肌梗死。我们的研究表明，与经过专门培训的护理人员协作，医院医生可以在院前环境中决定是否对这类患者给予溶栓治疗。
