疑似急性心肌梗死的纤溶治疗——临床实践中的应用与风险

Fibrinolytic treatment in suspected acute myocardial infarction--use and risks in clinical practice.

作者信息

Beermann B, von Bahr C, Sundström A

机构信息

Department of Drug Epidemiology, Information and Inspection, Medical Products Agency, Uppsala, Sweden.

出版信息

Eur J Clin Pharmacol. 1997;52(3):179-82. doi: 10.1007/s002280050271.

DOI:10.1007/s002280050271

PMID:9218923

Abstract

OBJECTIVES

To study the adherence to guidelines concerning fibrinolytic treatment of patients with suspected myocardial infarction and to obtain information on severe events in clinical practice.

METHODS

Prospective reporting of all patients admitted for suspected acute myocardial infarction during 4 months in 1994 from 69 (73.4% of all) Swedish coronary care units.

RESULTS

The study covers 10,652 admissions, representing 9726 patients. The mean percentage treated with fibrinolytic drugs of patients with a positive ECG (ST-elevation and/or bundle branch block), a delay < 12 h and no contraindications was 56%. The interhospital range was 18.1-94.1%. Fibrinolytic drugs were given with a delay time > 24 h in 12.5% of women and 15.7% of men, and 36.1% of patients with verified acute myocardial infarction were given fibrinolytic drugs. Streptokinase was used in 82.7% and alteplase in 15.5% of the patients, respectively (interhospital range 0-53.3%).

CONCLUSIONS

Fibrinolytic therapy seems to be used in a non-rational way at several hospitals. Local quality systems may be a way to assure better care.

摘要

目的

研究疑似心肌梗死患者对纤维蛋白溶解治疗指南的遵循情况，并获取临床实践中严重事件的相关信息。

方法

前瞻性报告1994年4个月期间瑞典69个（占总数的73.4%）冠心病监护病房收治的所有疑似急性心肌梗死患者。

结果

该研究涵盖10652例入院病例，代表9726名患者。心电图阳性（ST段抬高和/或束支传导阻滞）、延迟时间<12小时且无禁忌症的患者中，接受纤维蛋白溶解药物治疗的平均比例为56%。医院间范围为18.1%-94.1%。12.5%的女性和15.7%的男性使用纤维蛋白溶解药物的延迟时间>24小时，36.1%经证实为急性心肌梗死的患者接受了纤维蛋白溶解药物治疗。分别有82.7%的患者使用链激酶和15.5%的患者使用阿替普酶（医院间范围为0%-53.3%）。