O'Bryan M M, Banas J S
Department of Cardiology, Morristown Memorial Hospital and Columbia University College of Physicians and Surgeons, USA.
Am J Emerg Med. 1998 Nov;16(7):623-6. doi: 10.1016/s0735-6757(98)90160-7.
This study sought to determine the relationship between perceived and actual use of intravenous beta-blockers by cardiologists and emergency physicians for patients with acute myocardial infarction (AMI). The charts of 35 patients who presented to the emergency department of a community hospital with AMI during a 6-month period were retrospectively reviewed. Members of the departments of cardiology and emergency medicine were mailed a one-page survey pertaining to their use of intravenous beta-blockers in AMI. Of the 35 patients only 4 (11%) received an intravenous beta-blocker. Three of these 4 patients were either hypertensive or tachycardic and none had a contraindication to beta-blockade. A contraindication was present in 15 (48%) of those who did not get intravenous beta-blockade. The survey was completed by 11 (100%) of the emergency physicians and 68 (69%) of the cardiologists. Emergency physicians were significantly less likely to report using intravenous beta-blockers in AMI patients who were normotensive with normal heart rates (P=.007) and most (9 of 11) deferred the decision to the cardiologist. Although the majority of cardiologists reported giving an intravenous beta-blocker to at least 50% of AMI patients with normal blood pressure and pulse rates, the actual frequency was only 8% (1 of 13). In this institution, cardiologists overestimated the frequency of intravenous beta-blocker administration to patients with AMI. Emergency physicians usually deferred the decision on intravenous beta-blockers to cardiologists and reported a frequency of use that was much closer to actual practice.
本研究旨在确定心脏病专家和急诊医生对急性心肌梗死（AMI）患者静脉使用β受体阻滞剂的认知与实际使用情况之间的关系。回顾性分析了一家社区医院急诊科在6个月内收治的35例AMI患者的病历。向心脏病学和急诊医学科成员邮寄了一份关于他们在AMI患者中使用静脉β受体阻滞剂情况的单页调查问卷。35例患者中只有4例（11%）接受了静脉β受体阻滞剂治疗。这4例患者中有3例患有高血压或心动过速，且均无β受体阻滞剂使用禁忌证。未接受静脉β受体阻滞剂治疗的患者中有15例（48%）存在禁忌证。11名急诊医生（100%）和68名心脏病专家（69%）完成了调查问卷。对于血压正常、心率正常的AMI患者，急诊医生报告使用静脉β受体阻滞剂的可能性显著降低（P = 0.007），并且大多数（11名中的9名）将决策推迟给心脏病专家。尽管大多数心脏病专家报告至少给50%血压和脉搏率正常的AMI患者使用了静脉β受体阻滞剂，但实际频率仅为8%（13例中的1例）。在该机构中，心脏病专家高估了对AMI患者静脉使用β受体阻滞剂的频率。急诊医生通常将静脉使用β受体阻滞剂的决策推迟给心脏病专家，并且报告的使用频率更接近实际情况。
