Dale J
Medisinsk avdeling Aker sykehus, Oslo.
Tidsskr Nor Laegeforen. 1993 May 20;113(13):1581-2.
Mortality from acute myocardial infarction is high. The pre-hospital phase is particularly important, because it involves a high risk for the patient. Cardiac arrest is not uncommon. Other arrhythmias may arise, or reduced left ventricular function may induce pulmonary oedema or cardiogenic shock. The patient should therefore be transported to hospital as soon as possible, and should be given morphine and oxygen. Several therapeutic principles reduce mortality from acute myocardial infarction. Nitrates and acetylsalicylic acid can be administered before transport to hospital. Nitrates, intravenous diuretics, morphine and oxygen are important for treating pulmonary oedema, and should be administered as soon as possible. If equipment and expertise are available, a diagnosis of ventricular fibrillation or tachycardia can be verified and defibrillation performed. Intravenous atropine should be tried in cases of bradycardia. Thrombolytic therapy represents a challenge, because early start of the treatment is essential in order to salvage threatened myocardium. Optimal treatment depends on quick transport to hospital, information to the hospital, and effective routines i hospital itself.
急性心肌梗死的死亡率很高。院前阶段尤为重要，因为患者在此阶段面临的风险很高。心脏骤停并不罕见。还可能出现其他心律失常，或者左心室功能降低可能诱发肺水肿或心源性休克。因此，应尽快将患者送往医院，并给予吗啡和氧气。有几种治疗原则可降低急性心肌梗死的死亡率。在送往医院之前可使用硝酸盐和乙酰水杨酸。硝酸盐、静脉利尿剂、吗啡和氧气对于治疗肺水肿很重要，应尽快给予。如果有设备和专业技术人员，可确诊心室颤动或心动过速并进行除颤。对于心动过缓的情况，应尝试静脉注射阿托品。溶栓治疗是一项挑战，因为为挽救濒危心肌，必须尽早开始治疗。最佳治疗取决于迅速送往医院、向医院提供信息以及医院自身有效的常规流程。
