Pressley J C, Wilson B H, Severance H W, Raney M P, McKinnis R A, Smith M W, Hindman M C, Wagner G S
J Am Coll Cardiol. 1984 Sep;4(3):487-92. doi: 10.1016/s0735-1097(84)80091-1.
This prospective study documents the natural history of the prehospital phase of 110 patients with acute myocardial infarction transported by a basic emergency medical system during a 22 month period. Ambulances in a mixed urban-rural county were staffed by basic emergency medical technicians certified in basic life support and the administration of intravenous fluids. Systolic blood pressure, pulse rate and cardiac rhythm were noted for all patients at the time of ambulance arrival and intermittently during transport. Analyses of patient data were performed to determine the relation between the occurrence of subsequent in-hospital urgent complications and death and 1) patient delay time, 2) initial pulse rate, 3) initial systolic blood pressure, and 4) initial cardiac rhythm. Twenty-three (21%) of the 110 patients died and 66 (60%) experienced at least one in-hospital urgent complication. When initial rhythm, pulse rate and blood pressure were considered, patients with hypotension had a higher mortality rate than did those who were either normotensive or hypertensive. The 10 patients with initial sinus bradycardia but no hypotension constituted a subgroup with zero mortality. These results identify high and low risk patient subgroups that may benefit from either providing or withholding interventions directed toward hemodynamic stabilization during the prehospital phase of acute myocardial infarction.
这项前瞻性研究记录了在22个月期间，由基本急救医疗系统运送的110例急性心肌梗死患者院前阶段的自然病程。在一个城乡混合的县，救护车配备了经过基本生命支持和静脉输液管理认证的基本急救医疗技术人员。在救护车到达时以及转运期间对所有患者间歇性地记录收缩压、脉搏率和心律。对患者数据进行分析，以确定随后发生的院内紧急并发症和死亡与以下因素之间的关系：1）患者延迟时间；2）初始脉搏率；3）初始收缩压；4）初始心律。110例患者中有23例（21%）死亡，66例（60%）经历了至少一种院内紧急并发症。当考虑初始心律、脉搏率和血压时，低血压患者的死亡率高于血压正常或高血压患者。10例初始窦性心动过缓但无低血压的患者构成了一个死亡率为零的亚组。这些结果确定了高风险和低风险患者亚组，它们可能会从在急性心肌梗死院前阶段提供或不提供旨在稳定血流动力学的干预措施中获益。
