急性ST段抬高心肌梗死患者发病-治疗延迟时间分布

目的调查急性ST段抬高心肌梗死(STEMI)患者症状发作至治疗各个环节的时间。方法前瞻性调查412例STEMI患者,按患者发病-治疗顺序分别记录如下时间:患者延迟(PD)、转运延迟(TD)、院前延迟(PHD)、门-CCU时间、CCU-签字同意治疗时间以及门-针(DTN)和门-囊(DTB)时间。结果412例患者发病-治疗各环节中位数时间记录如下:PD 75 min,TD 50min,PHD 170 min,门-CCU时间30 min。252例患者入院12 h内接受了再灌注治疗,溶栓145例,急诊介入治疗107例,CCU-签字同意溶栓和介入治疗时间分别为15 min和46.5 min,DTN和DTB分别为65 min和135 min。DTN在60 min内者占48.3%(70/145)。DTB在90 min和120 min者分别为23.4%(25/107)和43.9%(47/107)。结论患者延迟在院前延迟中起关键性作用,获取知情同意时间过长严重影响患者及时治疗,院内治疗延迟仍然高于标准要求。

Time Delay Distribution from Symptom Onset to Treatment in Patients with Acute ST Elevated Myocardial Infarction

Objective To investigate the time delay in different phases from symptom onset to arrival at the hospital and time to treatment in patients with acute ST-segment elevated myocardial infarction(STEMI).Methods In this prospective,study,412 consecutive patients with confirmed STEMI were encolled in the(LuHe Hospital and Xuanwu Hospital) study from September 2003 to November 2004.The data were collected from patients' interviews and medical records.The following median times were recorded: patient's delay(PD),transportation delay(TD),prehospital delay(PHD),door to CCU(DTC),CCU to informed consent of reperfusion therapy,door to needling(DTN) and door to the first ballooning(DTB).Results A total of 412 patients with STEMI were enrolled.The following median times were recorded: PD 75 min;TD 50 min,PHD 170 min;door to CCU 30 min;252 patients received reperfusion therapy within 12 h after symptom onset,of which 145 patients received thrombolytic therapy,the remaining 107 patients performed primary angioplasty.Written informed consent in thrombolytic therapy and primary angioplasty was obtained in median times of 15 min and 46.5 min,respectively.Door to needling and door to ballooning times were 65 min and 135 min,respectively.Door to needling time of less than or equal to 60 min is achieved in 48.3% of patients,Door to ballooning time of less than 90 min and 120 min in 23.4% and 43.9%,respectively.Conclusion PD is the main cause of prehospital delay.The time of obtaining informed consent plays an important role in treatment delay.In-hospital delay is still higher than the guideline-recommended door-to-ballooning times.