Quale J, Kimmelstiel C, Lipschik G, Schrem S
Department of Medicine, State University of New York, Downstate Medical Center, Kings County Hospital, Brooklyn.
Arch Intern Med. 1988 Jun;148(6):1277-9.
Patients presenting to the emergency room with unstable angina are a challenge to physicians whose responsibility it is to ration access to coronary care unit beds, a resource that is often in short supply. In this study, initial cardiac enzyme analysis was not helpful in identifying patients having an acute myocardial infarction. However, using two enzyme determinations, performed at least six hours apart, we were able to identify a large percentage of our patients with unstable angina who were at low risk for myocardial infarction. Patients with two consecutive normal creatinine kinase levels had only a 2% chance of having an acute myocardial infarction. We believe these data can assist physicians where monitored beds are in short supply to make judicious use of this limited resource; the subsequent reduction in critical care unit admissions and duration of stay could result in substantial monetary savings.
对于负责合理分配冠心病监护病房床位（这一常常供不应求的资源）的医生而言，因不稳定型心绞痛前往急诊室就诊的患者是一项挑战。在本研究中，初始心肌酶分析对识别急性心肌梗死患者并无帮助。然而，通过间隔至少6小时进行两次酶测定，我们能够识别出很大一部分不稳定型心绞痛且心肌梗死风险较低的患者。连续两次肌酸激酶水平正常的患者发生急性心肌梗死的几率仅为2%。我们认为这些数据可帮助在监护床位短缺地区的医生明智地利用这一有限资源；随后重症监护病房入院人数的减少和住院时间的缩短可带来可观的资金节省。
