Martens U, Lange-Braun P, Langer R, Hochrein H
Dtsch Med Wochenschr. 1987 Jun 5;112(23):910-4. doi: 10.1055/s-2008-1068164.
Short-term systemic thrombolytic treatment was undertaken in 84 patients--within the first three hours after onset of pain; with typical ECG signs of acute transmural myocardial infarction; refractory to nitroglycerin--either in an intensive care unit (n = 40) or in a medically-staffed ambulance (n = 44). Coronary angiography was undertaken in patients of both groups, after obtaining informed consent, at the earliest possible moments, combined with percutaneous transluminal coronary angioplasty (PTCA), if indicated. Thrombolytic treatment in the ambulance was primarily more effective (72%, n = 32) than in the ICU patients (47.5%; n = 19), and the pain-thrombolysis interval shorter by 30 min. The higher recurrent infarction rate in the former meant that the success rate at the end of the hospital stay did not significantly differ between the two groups (54.5% and 47.5%, respectively). Only when early systemic thrombolysis was combined with PTCA within the first three hours (n = 26) was there a markedly greater effectiveness after four weeks (77%) than without PTCA (40%). Early thrombolytic treatment by doctors in the ambulance during transfer to hospital is sensible only if it can be followed at once by coronary angiography with PTCA or operation soon after admission. Only in this way will the effectiveness of treatment be increased and maintained after discharge from hospital.
84例患者在疼痛发作后的最初3小时内接受了短期全身溶栓治疗；这些患者具有急性透壁性心肌梗死的典型心电图表现；对硝酸甘油治疗无效；其中40例在重症监护病房接受治疗，44例在配备医护人员的救护车上接受治疗。两组患者在获得知情同意后，尽早进行冠状动脉造影，如有指征则联合经皮冠状动脉腔内血管成形术（PTCA）。救护车上的溶栓治疗效果主要（72%，n = 32）优于重症监护病房的患者（47.5%；n = 19），且疼痛至溶栓的间隔时间短30分钟。前者较高的再梗死率意味着两组患者住院期末的成功率无显著差异（分别为54.5%和47.5%）。只有在最初3小时内将早期全身溶栓与PTCA联合应用（n = 26）时，四周后的疗效（77%）才明显高于未行PTCA的情况（40%）。只有在转运至医院期间由救护车上的医生进行早期溶栓治疗后，能够立即进行冠状动脉造影并在入院后不久进行PTCA或手术，这种治疗才是明智的。只有这样，出院后治疗效果才能得到提高并维持。
