Hayasaki K, Kugimiya H, Takemiya S, Honda T, Kikuchi H
Jpn Circ J. 1984 Jul;48(7):729-39. doi: 10.1253/jcj.48.729.
For purposes of evaluating the clinical features in the prehospital phase of acute myocardial infarction, 22 patients presenting prehospital syncope and patients presenting in-hospital re-attack were chiefly studied. Cardiac or ventricular standstill, acute mechanical failure, ventricular fibrillation, serious block, bradycardia-hypotension syndrome, cardiogenic shock, cardiac failure and cardiac rupture may be cited as the complications likely to occur in the early phase of the onset of acute myocardial infarction. Among these complications, cardiac or ventricular standstill results from overactivity of the vagus nerve, and acute mechanical failure is a result of drastically decreased cardiac output due to extensive infarction. There is no report of either complication, and both may be considered to be the fatal complications occurring almost simultaneously with the onset of acute myocardial infarction. The time intervals from the onset of symptoms to hospital admission were perspectively analyzed on 72 patients transported by the MCCU and 139 by ordinary ambulance. The interval from the onset of symptoms to medical help and that from the examination by personal physician to the call for ambulance were the greatest of all time factors, while the interval for emergency transport of the patient was short. There was no significant difference in the interval to hospital admission between the patients transported by the MCCU and those by ordinary ambulance. However, the in-transit death rate was 1/72 patients transported by the MCCU and 8/139 by ordinary ambulance: in other words, this death rate tended to be high in the latter. Twenty-two normal volunteers were studied for changes in heart rate, blood pressure and double product with the speed of transport. The transport at a low speed caused less changes in these parameters than that at a high speed.
为评估急性心肌梗死院前阶段的临床特征，主要研究了22例出现院前晕厥的患者和住院期间再次发作的患者。心脏骤停或心室停搏、急性机械性衰竭、心室颤动、严重传导阻滞、心动过缓 - 低血压综合征、心源性休克、心力衰竭和心脏破裂可被视为急性心肌梗死发病早期可能出现的并发症。在这些并发症中，心脏骤停或心室停搏是迷走神经活动过度所致，急性机械性衰竭是广泛梗死导致心输出量急剧下降的结果。尚无这两种并发症的相关报道，二者均可被认为是几乎与急性心肌梗死发病同时出现的致命并发症。对由心肌梗死监护病房（MCCU）转运的72例患者和由普通救护车转运的139例患者从症状发作到入院的时间间隔进行了前瞻性分析。从症状发作到获得医疗救助的间隔以及从私人医生检查到呼叫救护车的间隔是所有时间因素中最长的，而患者紧急转运的间隔较短。由MCCU转运的患者和由普通救护车转运的患者入院间隔无显著差异。然而，MCCU转运的72例患者中有1例在转运途中死亡，普通救护车转运的139例患者中有8例在转运途中死亡：换句话说，后者的死亡率往往较高。对22名正常志愿者的心率、血压和双乘积随转运速度的变化进行了研究。低速转运引起的这些参数变化比高速转运时小。
