Mulley A G, Thibault G E, Hughes R A, Barnett G O, Reder V A, Sherman E L
N Engl J Med. 1980 Apr 24;302(17):943-8. doi: 10.1056/NEJM198004243021704.
The hospital course of all patients admitted to a medical intensive-care unit (ICU) with suspected myocardial infarction was reviewed to test the feasibility of identifying patients suitable for earlier transfer from the ICU. Three hundred sixty patients admitted after presentation with uncomplicated chest pain could be stratified into three risk groups within 24 hours of admission to the ICU. One hundred sixty-eight patients (47 per cent), who were without major complications, elevation of total serum creatine phosphokinase, or electrocardiographic evidence of transmural infarction during the first day, could be designated "low-risk" patients. Three per cent of the low-risk patients subsequently met clinical criteria for infarction, 2 percent had late complications in the ICU, and none died. Rates of infarction, late complications in the ICU, and mortality in the hospital were significantly higher for patients at intermediate and high risk. Identification of low-risk patients for whom early transfer may be routinely indicated is feasible and could reduce by 55 per cent the total number of days that such patients spend in the ICU.
对所有因疑似心肌梗死入住医疗重症监护病房（ICU）的患者的住院过程进行了回顾，以测试识别适合从ICU更早转出的患者的可行性。360例因单纯胸痛就诊后入院的患者在入住ICU后24小时内可分为三个风险组。168例患者（47%）在第一天没有严重并发症、血清总肌酸磷酸激酶升高或透壁梗死的心电图证据，可被指定为“低风险”患者。3%的低风险患者随后符合梗死的临床标准，2%在ICU出现晚期并发症，无一死亡。中高风险患者的梗死发生率、ICU晚期并发症发生率和医院死亡率明显更高。识别可能常规需要早期转出的低风险患者是可行的，并且可以将这些患者在ICU的总天数减少55%。
