Fuchs R, Scheidt S
JAMA. 1981 Nov 6;246(18):2037-41.
Patients requiring specialized cardiac care unit interventions (CCUIs) were identified from 414 consecutive admissions with known or suspected myocardial infarction (Ml). Cardiac care unit interventions included administration of lidocaine hydrochloride, atropine sulfate, sodium nitroprusside, or vasopressors; Swan-Ganz or arterial catheterization; insertion of temporary pacemaker; and electroshock. Almost all interventions occurred in a high-risk group that had one or more of three findings: (1) ongoing chest pain, (2) pulmonary rales, or (3) one or more ventricular premature contractions (VPCs) on 12-lead ECG. Of 306 high-risk patients, 41% received at least one CCUI, and 4% died in the CCU. In contrast, of the 108 low-risk patients with none of the three criteria, only 6% received any CCUI, and none died in the CCU. This study suggests that patients who do not have ongoing pain, congestive heart failure, of VPCs when first evaluated have a very low risk of early complications and may not require intensive care.
从414例已知或疑似心肌梗死（MI）的连续入院患者中识别出需要心脏重症监护病房干预（CCUIs）的患者。心脏重症监护病房干预措施包括给予盐酸利多卡因、硫酸阿托品、硝普钠或血管加压药；放置 Swan-Ganz 导管或动脉导管；插入临时起搏器；以及电击。几乎所有干预措施都发生在一个高危组中，该组有以下三项发现中的一项或多项：（1）持续胸痛，（2）肺部啰音，或（3）12导联心电图上有一个或多个室性早搏（VPCs）。在306例高危患者中，41%接受了至少一次CCUI，4%在心脏重症监护病房死亡。相比之下，在108例不符合这三项标准的低危患者中，只有6%接受了任何CCUI，且无人在心脏重症监护病房死亡。这项研究表明，首次评估时没有持续疼痛、充血性心力衰竭或室性早搏的患者早期并发症风险非常低，可能不需要重症监护。
