Lau Y K, Smith J, Morrison S L, Chamberlain D A
Br Med J. 1980 Jun 21;280(6230):1489-92. doi: 10.1136/bmj.280.6230.1489.
Simple criteria were used to select a low-risk group of patients after acute myocardial infarction. The criteria depended on the presence or absence of diabetes, pulmonary oedema, serious rhythm disorders, and recurrent cardiac pain. Patients in the low-risk category with a suitable home environment were discharged from hospital after five to seven days (mean 6.2 days); they constituted 47% of the 267 hospital survivors over 18 months. Mortality in the selected patients was 2.4% at six weeks and 7% at one year. Most complications preventing early discharge were identified on the first day. Provisional selection for a short hospital stay was made after two days, and 76% of those judged suitable at 48 hours remained free of complications. Early selection of a low-risk category is justifiable and of practical value, though subsequent events will delay discharge for some patients. All patients who died in hospital or within two weeks after infarction had developed overt complications by the end of the fourth day. The results suggest that a policy of hospital discharge after four days would be justifiable for a low-risk group selected by the present criteria.
采用简单标准来挑选急性心肌梗死后的低风险患者群体。这些标准取决于是否患有糖尿病、肺水肿、严重心律失常以及是否反复出现心前区疼痛。符合条件且家庭环境适宜的低风险患者在五至七天（平均6.2天）后出院；他们占18个月内267名医院幸存者的47%。所选患者六周时的死亡率为2.4%，一年时为7%。大多数妨碍早期出院的并发症在第一天就能被识别出来。两天后进行短期住院的初步筛选，48小时时被判定适宜的患者中有76%未出现并发症。早期挑选出低风险类别是合理且具有实际价值的，不过后续情况会导致部分患者延迟出院。所有在医院死亡或梗死两周内死亡的患者在第四天结束时都出现了明显的并发症。结果表明，对于依据当前标准挑选出的低风险群体，四天后出院的政策是合理的。
