Torrado González E, Ferriz Martín J A, Vera Almazán A, Alvarez Bueno M, Rodríguez García J J, González Rodríguez-Villasonte P, López Vargas C, García Paredes T
Servicio de Cuidados Críticos y Urgencias, Complejo Hospitalario Carlos Haya, Málaga.
Rev Esp Cardiol. 1997 Oct;50(10):689-95. doi: 10.1016/s0300-8932(97)73284-6.
Although the importance of the early use of thrombolytic therapy in acute myocardial infarction has been demonstrated, it is usual to detect an unacceptable delay in its administration. We measured the in-hospital delay and, when it was determined we designed a protocol to reduce it.
From January-92 to December-94 we performed a prospective analysis of the measured delay for patients with a diagnosis on admission of acute myocardial infarction or unstable angina within 24 hours of the onset of symptoms. To ensure a homogeneous population, we established a triage system: priority I, delay of the therapy not admissible and so immediate administration of thrombolytic agent (performed in the emergency department); priority II, need for a careful evaluation of the risk/benefit ratio for thrombolytic therapy and administration, when indicated, after admission to the coronary care unit, and priority III, thrombolytic therapy whether indicated or contraindicated. All data were evaluated periodically in order to detect possible failures and to correct them.
A total of 1,462 patients with a diagnosis of acute myocardial infarction (n = 1,006) or unstable angina (n = 456) were included. The administration of lytic therapy in the emergency department reduced the In-Hospital delay for thrombolysis by 54% from a median of 65 minutes (45 and 110) to 30 minutes (15 and 60) (p < 0.001) in priority I patients (40% of the patients diagnosed with AMI). For all cases with thrombolytic therapy this time was reduced from 87.5 minutes (50 and 155) to 50 minutes (25 and 110) minutes (p < 0.001).
Awareness of our in-hospital delay, establishing a triage system in the emergency department and administering thrombolytic drugs in the this area has made it possible to provide this therapy to selected patients as early as possible.
尽管已证明急性心肌梗死早期使用溶栓治疗的重要性，但在其给药过程中通常会发现不可接受的延迟。我们测量了住院延迟时间，并在确定延迟情况后设计了一项方案以减少延迟。
从1992年1月至1994年12月，我们对症状发作24小时内入院诊断为急性心肌梗死或不稳定型心绞痛的患者的测量延迟进行了前瞻性分析。为确保研究人群的同质性，我们建立了一个分诊系统：一级优先，治疗延迟不可接受，因此应立即给予溶栓剂（在急诊科进行）；二级优先，需要仔细评估溶栓治疗的风险/效益比，并在入住冠心病监护病房后根据情况给药；三级优先，无论是否有指征或禁忌均进行溶栓治疗。定期评估所有数据，以发现可能的失误并加以纠正。
共纳入1462例诊断为急性心肌梗死（n = 1006）或不稳定型心绞痛（n = 456）的患者。在急诊科进行溶栓治疗使一级优先患者（40%诊断为急性心肌梗死的患者）的溶栓住院延迟从中位数65分钟（45至110分钟）减少了54%，降至30分钟（15至60分钟）（p < 0.001）。对于所有接受溶栓治疗的病例，这一时间从87.5分钟（50至155分钟）降至50分钟（25至110分钟）（p < 0.001）。
意识到我们的住院延迟情况，在急诊科建立分诊系统并在该区域给予溶栓药物，使得有可能尽早为选定的患者提供这种治疗。
