Banerjee S, Rhoden W E
Department of Cardiology, Barnsley District General Hospital.
J R Coll Physicians Lond. 1998 Jan-Feb;32(1):36-8.
To study the effectiveness of a fast-track method of admitting patients with myocardial infarction directly to the coronary care unit (CCU).
Ambulance paramedic staff were trained and provided with a Life Pak XI Monitor/Defibrillator which can obtain a 12-lead electrocardiogram. When a diagnosis of acute myocardial infarction was made by the paramedics, the CCU was informed and the patient was directly transferred to the CCU, bypassing the accident and emergency (A&E) department. The appropriateness of admission to the CCU was assessed against set criteria. The time from call for help to the administration of thrombolytic therapy (thrombolysis time) in patients directly admitted to the CCU was compared with that in another group of patients with definite myocardial infarction who were admitted through the A&E department over the same period of time.
Twenty-five patients were fast-tracked to the CCU. Diagnosis of myocardial infarction was confirmed on admission in 14. Thirteen were treated with thrombolysis as there were no contra-indications; of the other 11 patients, seven were diagnosed as angina, one had complete heart block, one had haemodynamically significant atrial fibrillation and two had non-cardiac chest pain. The average time from call for help to thrombolysis in this group was 82 +/- 32 minutes. This was significantly shorter (p < 0.02) than in the patients who were admitted through A&E, in whom the average time from call for help to thrombolysis was 112 +/- 35 minutes. Twenty-one of 25 fast-tracked patients fulfilled the criteria for CCU admission.
The majority of fast-trackings are appropriate and will result in quicker administration of thrombolysis in hospitals where the facility for thrombolysis does not exist in the A&E department.
研究一种将心肌梗死患者直接收入冠心病监护病房（CCU）的快速通道方法的有效性。
对救护车医护人员进行培训，并为其配备可获取12导联心电图的Life Pak XI监测/除颤器。当医护人员确诊急性心肌梗死时，通知CCU并将患者直接转至CCU，绕过事故及急救（A&E）部门。根据既定标准评估收入CCU的适宜性。将直接收入CCU的患者从呼救到进行溶栓治疗的时间（溶栓时间）与同期通过A&E部门收入的另一组确诊心肌梗死患者的溶栓时间进行比较。
25例患者通过快速通道进入CCU。14例入院时心肌梗死诊断得到证实。13例因无禁忌证接受了溶栓治疗；另外11例患者中，7例诊断为心绞痛，1例有完全性心脏传导阻滞，1例有血流动力学意义的心房颤动，2例有非心源性胸痛。该组从呼救到溶栓的平均时间为82±32分钟。这明显短于（p<0.02）通过A&E部门入院的患者，后者从呼救到溶栓的平均时间为112±35分钟。25例通过快速通道入院的患者中有21例符合CCU入院标准。
大多数快速通道入院是合适的，对于A&E部门没有溶栓设施的医院，这将使溶栓治疗更快实施。
