Leizorovicz A, Haugh M C, Mercier C, Boissel J P
Service de Pharmacologie Clinique, Lyon, France.
Eur Heart J. 1997 Feb;18(2):248-53. doi: 10.1093/oxfordjournals.eurheartj.a015227.
To compare the components of the time delay involved in pre-hospital and hospital thrombolytic therapy in patients presenting with suspected acute myocardial infarction.
From October 1988 to January 1992 a total of 198 mobile emergency units in 15 European countries and Canada randomized 5469 patients to receive either pre-hospital thrombolytic treatment, followed by placebo in hospital (pre-hospital group), or pre-hospital (hospital group) in the European Myocardial Infarction Project trial. We performed a post hoc analysis of these data to correlate components of the interval between symptom onset and treatment with baseline patient characteristics.
The delay between onset of symptoms and calling for an ambulance was significantly longer for female patients (P = 0.0001), older patients (> 65 years old; P = 0.0001), those who had experienced pain within the previous 24 h (P = 0.0001), and those with pulmonary oedema (P = 0.04). This delay was significantly shorter in patients with previous myocardial infarction (P = 0.02), those with ventricular fibrillation (P = 0.0001), and those in shock (P = 0.0001). The delay between the two injections was significantly longer for older patients (> 65 years old; P = 0.02), those with previous myocardial infarction (P = 0.03), and those in shock (P = 0.003).
Action undertaken to reduce delays between symptom onset and treatment should focus on modifiable factors such as patients who are likely to be late callers i.e. women and those over 65 years of age.
比较疑似急性心肌梗死患者在院前和院内溶栓治疗中所涉及的时间延迟的构成因素。
在1988年10月至1992年1月期间，欧洲15个国家和加拿大的198个移动急救单元将5469例患者随机分为两组，一组接受院前溶栓治疗，随后在院内接受安慰剂治疗（院前组），另一组在欧洲心肌梗死项目试验中接受院前（院内组）治疗。我们对这些数据进行了事后分析，以将症状发作至治疗的时间间隔的构成因素与患者基线特征相关联。
女性患者（P = 0.0001）、老年患者（>65岁；P = 0.0001）、在过去24小时内经历过疼痛的患者（P = 0.0001）以及患有肺水肿的患者（P = 0.04），其症状发作至呼叫救护车之间的延迟明显更长。有既往心肌梗死病史的患者（P = 0.02）、发生心室颤动的患者（P = 0.0001）以及休克患者（P = 0.0001），这一延迟明显更短。年龄较大患者（>65岁；P = 0.02）、有既往心肌梗死病史的患者（P = 0.03）以及休克患者（P = 0.003），两次注射之间的延迟明显更长。
为减少症状发作至治疗之间的延迟而采取的行动应侧重于可改变的因素，例如可能较晚呼叫的患者，即女性和65岁以上的人群。
