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目的 探讨急性心肌梗死 (AMI) 12 0 -CCU模式院前溶栓治疗的安全性、可行性和优越性。方法 12 0现场诊断的可疑AMI无溶栓禁忌症患者 ,按患者意愿或就地溶栓治疗后送至西京医院CCU(A组 ) ,或送至就近医院急诊室治疗 (B组 )。记录转运途中并发症、发病到溶栓时间 ,以及住院期间死亡率。结果 入选 47例可疑AMI患者 ,A组 2 6例 ,B组 2 1例。现场诊断AMI的总体准确率为 91 4%。A、B两组转运途中并发症 (室速、室颤、Ⅲ 房室传导阻滞、死亡 )发生率分别为 17 4%和 10 % (P >0 0 5 )。确诊为AMI患者 ,A、B组接受溶栓治疗的比例分别为 10 0 %和 40 % (P <0 0 5 )。A组就诊到溶栓时间较B组缩短 10 8min(42± 30minvs 15 0± 114min ,P <0 0 1)。发病到溶栓时间缩短 90min(198± 177minvs 2 88± 12 3min ,P <0 0 1)。A、B两组住院期间死亡率分别为 4 3%和 35 % (P <0 0 5 )。结论 AMI12 0 -CCU模式院前溶栓治疗安全可行 ,与院内溶栓相比 ,显著缩短发病到溶栓时间 ,提高溶栓比例 ,降低死亡率。
Objective To investigate the safety, feasibility and superiority of pre-hospital thrombolysis in acute myocardial infarction (AMI) 12 0 -CCU. Method 12 0 Patients with suspicious AMI at the scene who have no thrombolytic contraindications are referred to Xijing Hospital CCU (Group A) or to the nearest hospital emergency room (Group B), either as intended or locally by thrombolytic therapy. Records of complications during transit, onset to thrombolytic time, and in-hospital mortality. Results 47 patients with suspected AMI were enrolled in this study. There were 26 cases in group A and 21 cases in group B. The overall accuracy of on-site diagnosis of AMI was 91 4%. The incidences of complications (VT, VF, III atrioventricular block, and death) in A and B groups during transit were 17 4% and 10%, respectively (P 0 05). Patients diagnosed with AMI had a 10% and 40% rate of thrombolytic therapy in groups A and B, respectively (P <0 05). The time of thrombolysis in group A was shorter than that in group B by 108 min (42 ± 30 min vs 150 ± 114 min, P <0.01). The onset of thrombolysis was shortened by 90 min (198 ± 177 min vs 888 ± 123 min, P <0.01). Mortality rates during hospitalization in groups A and B were 43% and 35%, respectively (P <0.05). Conclusion AMI12 0 -CCU model of pre-hospital thrombolytic therapy is safe and feasible, compared with the hospital thrombolysis, significantly shorten the onset of thrombolytic time, increase the proportion of thrombolytic and reduce mortality.