Scherer T, Furger F, Münch U
Schweiz Rundsch Med Prax. 1989 Sep 12;78(37):993-6.
A reduction of the infarct-related mortality needs measures to diminish the extension of the infarction. A valuable approach is the thrombolysis, which proved useful in the past years. The aim of this study was to investigate the doctor's and the patient's behaviour related to the delay in hospital admission. During one year, the admission of 148 patients with suspected myocardial infarction was prospectively analysed. The median delay was 7.5 hours. 48% of the patients suffered from an acute myocardial infarction, 17% from an unstable angina, and 35% had no underlying heart disease. 38% reached the hospital within 4 hours (39% of the patients with confirmed myocardial infarction). The total delay was mainly due to the patients behaviour (median delay 3 hours) and in a lesser extent to the doctor's behaviour (median delay 1.5 hours). An immediate admission was only in 14% the first medical measure. In 40% an ECG was performed, in 6% a chest X-Ray, and in 11% laboratory investigations were undertaken. These results confirm the fact that people, especially the patients with known coronary artery disease should be better informed about the nature and the course of the illness and the efficient behaviour in case of onset of complications. The doctor's delay can be shortened by omission of useless diagnostic investigations.
降低梗死相关死亡率需要采取措施减少梗死范围。一种有价值的方法是溶栓治疗，在过去几年已证明其有用性。本研究的目的是调查医生和患者与住院延迟相关的行为。在一年时间里，对148例疑似心肌梗死患者的入院情况进行了前瞻性分析。中位延迟时间为7.5小时。48%的患者患有急性心肌梗死，17%患有不稳定型心绞痛，35%无潜在心脏病。38%的患者在4小时内到达医院（确诊心肌梗死的患者中这一比例为39%）。总延迟主要归因于患者的行为（中位延迟3小时），而医生行为导致的延迟程度较小（中位延迟1.5小时）。立即入院仅在14%的情况下是首要医疗措施。40%的患者进行了心电图检查，6%进行了胸部X光检查，11%进行了实验室检查。这些结果证实了这样一个事实，即人们，尤其是已知患有冠状动脉疾病的患者，应该更好地了解疾病的性质和病程以及并发症发作时的有效应对行为。通过省略无用的诊断检查可以缩短医生造成的延迟。
