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目的:总结对急性ST段抬高型心肌梗死实行急诊绿色通道诊治的经验并分析影响其运行的主要因素。方法:回顾性总结2009-01-12期间对136例急性ST段抬高型心肌梗死的诊断现状及实行急诊绿色通道给予急诊介入,静脉溶栓或药物保守治疗等情况以及患者的院内预后情况;并对急诊绿色通道的影响因素进行分析。结果:136例患者中,从症状发作-入院时间平均为112 min;128例(94%)能得到及时准确的诊断,8例被漏诊;入急诊室到完成首份心电图时间平均为2.8 min;103例实施经皮冠状动脉介入术,入院到球囊扩张时间为(85±14)min;6例实行急诊溶栓治疗,从入院至溶栓时间为(35±8)min;27例实行药物保守治疗,其中8例因患者家属签字拒绝急诊介入或溶栓。127例病情好转出院,9例院内死亡。结论:绝大多数急性ST段抬高型心肌梗死患者能够得到及时准确的诊断并通过急诊绿色通道得到及时的再灌注治疗,影响绿色通道运行的主要因素包括:患者及家属对急性心肌梗死的发病特点和治疗方法认识不足及急诊医师或心血管医师的漏诊。
OBJECTIVE: To summarize the experience of emergency diagnosis and treatment of acute green tract infarction with ST-segment elevation myocardial infarction and to analyze the main factors influencing its operation. Methods: The diagnostic status of 136 cases of acute ST - segment elevation myocardial infarction and the emergency intervention, intravenous thrombolysis and conservative treatment of the emergency green channel during the period of 2009-01-12 were retrospectively summarized, and the prognosis of the patients was evaluated. The influencing factors of emergency green passage were analyzed. RESULTS: Among the 136 patients, the average onset time from symptom onset to admission was 112 min. 128 (94%) patients were diagnosed in time and correctly, and 8 patients were missed. The mean time between entering the emergency room and completing the first electrocardiogram was 2.8 min. 103 cases underwent percutaneous coronary intervention, the time from admission to balloon dilatation was (85 ± 14) min; 6 cases received emergency thrombolytic therapy, the time from admission to thrombolysis was (35 ± 8) min; 27 cases were administered drugs Conservative treatment, of which 8 patients refused to emergency intervention or thrombolysis due to family members. 127 cases improved condition, 9 cases died in the hospital. Conclusions: The vast majority of patients with acute ST-segment elevation myocardial infarction can get timely and accurate diagnosis and timely reperfusion treatment through emergency green channel. The main factors that affect the operation of green channel include: the incidence of acute myocardial infarction in patients and their families Lack of knowledge of features and treatments, and missed visits by emergency physicians or cardiologists.