Hindle H, Norheim J K, Renger R
Department of Family Medicine, University of Alberta.
Can Fam Physician. 1995 Jul;41:1180-7.
To determine current practice patterns for managing acute myocardial infarction in rural Alberta, particularly to examine the availability of thrombolytic therapy.
Mailed questionnaire based on a clinical vignette.
All 104 acute care hospitals in rural Alberta with fewer than 100 beds.
The Chief of Staff at each hospital.
Proportion of hospitals providing thrombolytic therapy, choice of thrombolytic agent, rates of elective transfer after thrombolysis, and barriers preventing universal use of thrombolytic therapy.
Questionnaires were completed by 101 physicians. Three hospitals had no medical staff. Thrombolytic therapy was available in 80.8% of the hospitals. Hospitals that did not offer thrombolysis were smaller (average bed capacity 21.9 versus 37.7, P < 0.001), had fewer medical staff (average number 2.4 versus 5.5, P < 0.001), and had fewer nurses holding Advanced Cardiac Life Support certification (P = 0.015) than hospitals providing thrombolysis. Physicians identified inadequate nursing resources as the greatest barrier to providing thrombolysis. Of physicians using thrombolysis, 71.4% chose streptokinase. Half of the physicians preferred elective transfer after the procedure.
Thrombolytic therapy for acute myocardial infarction is standard practice in small hospitals in Alberta.
确定阿尔伯塔省农村地区急性心肌梗死的当前管理模式，尤其是检查溶栓治疗的可及性。
基于临床病例 vignette 的邮寄问卷调查。
阿尔伯塔省农村地区所有 104 家床位少于 100 张的急症护理医院。
每家医院的医务主任。
提供溶栓治疗的医院比例、溶栓药物的选择、溶栓后择期转运率以及阻碍溶栓治疗普遍使用的障碍。
101 位医生完成了问卷调查。有 3 家医院没有医务人员。80.8%的医院可提供溶栓治疗。未提供溶栓治疗的医院规模较小（平均床位容量 21.9 对 37.7，P < 0.001），医务人员较少（平均人数 2.4 对 5.5，P < 0.001），且持有高级心脏生命支持认证的护士人数也少于提供溶栓治疗的医院（P = 0.015）。医生们认为护理资源不足是提供溶栓治疗的最大障碍。在使用溶栓治疗的医生中，71.4%选择了链激酶。一半的医生倾向于在治疗后进行择期转运。
急性心肌梗死的溶栓治疗在阿尔伯塔省的小医院是标准治疗方法。
