急性脑梗死溶栓治疗时间延误的调查与分析

目的了解急性脑梗死患者溶栓治疗时间延误情况及护士和患者对急性脑梗死溶栓治疗的认知情况。方法自行设计调查问卷,对47例脑梗死患者溶栓治疗延误情况进行调查,同时对患者或家属进行急性脑梗死知识的认知调查,对30名急诊科和神经内科护士进行急性脑梗死溶栓治疗认知调查。结果47例患者溶栓治疗院前延误时间(145±85)min,其中患者自身延误时间(89±42)min,交通延误时间(56±20)min;院内延误时间(117±39)min,其中诊断前延误时间(73±27)min,诊断后延误时间(44±24)min;溶栓有效率随着时间延误延长呈下降趋势;47例患者及家属中32例不知晓脑脑梗死初始症状,无一例知晓溶栓知识;急诊室护士对脑梗死溶栓知识的掌握程度不如神经内科护士。结论急性脑梗死患者溶栓治疗前存在时间延误情况。     

急性心肌梗死溶栓治疗前时间延误分析及护理对策

分析了６８例急性心机梗死患者静脉溶栓治疗前的时间延误，调查５０名护士对急性心肌梗死治疗的认识程度，探讨溶栓治疗前延误的护理因素。结果显示，溶栓治疗院外延误２０ｈ，院内延误３１ｈ，显著长于院外延误（Ｐ＜０．０１）。其中急诊室延误１７ｈ，ＣＣＵ延误１４ｈ；随着溶栓时间延误的延长，冠脉再通率下降；急诊科护士对溶栓治疗适应证、禁忌证等认识程度低于心血管内科护士；护士在急性心肌梗死治疗中缺少主动性。认为护士能够缩短溶栓前院内延误。提出对全体护士应加强急性心肌梗死溶栓治疗的教育和培养训练，使其认识到缩短溶栓治疗前时间的意义，提高护士的主观能动性     

急性心肌梗死再灌注治疗时间延误的临床分析

目的探讨急性心肌梗死患者再灌注治疗时间延误情况及护士和患者、家属对急性心肌梗死再灌注治疗的认知情况。方法自行设计调查问卷,对2017年4-10月我院64例心肌梗死患者再灌注治疗延误情况进行调查。同时,对患者或家属进行急性心肌梗死知识的认知调查,对40名急诊科、心血管内科及其他临床科室护士进行急性心肌梗死再灌注治疗认知调查。结果 64例再灌注延误患者进门—球囊扩张时间为(145.1±61.6)min;进门—心电图时间为(8.2±5.0)min;再灌注决定延迟时间为(47.3±26.0)min;64例患者及家属中,47例不知晓心肌梗死初始症状,无1例知晓再灌注治疗有时间依赖性,仅9例接受过急性心梗相关知识宣教。临床其他科室护士对心肌梗死再灌注治疗知识的掌握程度不如急诊室及心血管内科护士。结论急性心肌梗死患者再灌注治疗前存在时间延误情况。应加强对护士的知识培训及患者家属的健康宣教。     

急性心肌梗塞溶栓治疗前时间延误的护理因素及对策

通过分析68例急性心肌梗塞患静脉溶栓治疗前的时间延误，调查50名护士对急性肌梗塞治疗的认识程度，探讨溶栓治疗前延误的护理因素。结果显示，溶栓治疗院外延误2．0h，院内延误3．1h，院内延误显长于院外延误(P<0.01)。其中急诊室延误的延长，冠脉再通率下降；急诊科护士对溶栓治疗适应证、禁忌症等认识程度低于心血管内科护士；护士在急性心肌梗塞治疗中缺少主动性。认为护士能够缩短溶栓前院内延误。提出对全体护士应加强急性心肌梗塞溶桂治疗的教育和培养训练，使其认识到缩短溶栓治疗前时间的意义，提高护士的主观能动性。     

急性心肌梗死溶栓延迟时间分布及原因分析

111例急性心肌梗死（AMI）发病到溶栓时间为232．5±124．0min，其中发病到来院时间144．2±119．2min，来院到溶栓时间（DNT）87．6±52．3min。79例溶栓血管再通患者之DNT短于32例未溶通者（77．4±47．9比112．8±53．6min，P＜0．002）；DNT中，就诊到入院时间未通组长于溶通组（87．0±48．9比55．1±43．8min，P＜0．002）。溶栓延迟原因有：在院外患者对病情认识不足或就诊不便；院内办手续和住院缓慢以及急诊留观等。DNT≤45min的26例AMI中，18例（69．2％）系在急诊室溶栓。     

急性心肌梗死患者院前延误状况及原因分析

目的：了解急性心肌梗死（AMI）患者院前延误状况并分析影响因素,以便采取有效干预措施,减少院前延误时间,提高救治率。方法：使用自行设计的调查问卷对某三级甲等医院心内监护室（CCU）收治的69例急性心肌梗死患者的院前延误时间及相关影响因素进行调查与分析。结果：患者院前延误中位时间为4h,在发病1h、2h、6h内就医者分别为5.8%、18.8%、76.8%;就诊时间〉6h者为23.2%。多元Logistic回归分析显示：症状归因、首诊医院情况、症状出现后患者的处理方式、患者感知疾病的严重性与院前延误时间显著相关。结论：医务人员应做好患者健康教育,加强患者及家属对AMI相关知识的学习,缩短院前延误时间,提高救治率。     

不同性别急性心肌梗死患者临床症状和院前延误的对比研究

目的：探讨不同性别急性心肌梗死（AMI）患者的临床发病特点和院前延误时间的差异。方法：采用自行设计的调查问卷对我院心内监护室（CCU）收治的100例急性心肌梗死患者的院前延误时间及临床资料进行收集,并依据性别不同将患者纳入两组。结果：与同期入院的男性患者相比,女性患者年龄偏大,糖尿病患病率高,疼痛症状和非疼痛症状较少,疼痛程度较低,两组比较差异有统计学意义（P〈0.05）,院前延误时间的差异无统计学意义（P〉0.05）。结论：女性AMI患者临床症状不典型,应给予女性患者更多的关注,加强健康教育针对性。     

急性心肌梗死发病至就诊时间与预后的相关性研究

目的分析610例急性心肌梗死（AMI）患者院前延误时间分布及心肌梗死后不同时间段的死亡情况。方法回顾性分析2005年1月至2009年10月枣庄市立三院心内科收治的AMI患者610例,其中男性450例,女性160例。将记录的就诊时间与发病时间的时间差作为院前延误时间（PDT）。根据PDT不同分为7个时间段：即1～30min,31—60min,61～120min,121～240min,241—360min,361～720rain,〉720min。统计PDT分布,计算各时间段心室颤动（室颤）发生率、复苏成功率、病死率。结果610例AMI患者PDT中位数时间为130min。接受溶栓治疗128例（21．0％）,急诊PCI279例（45．7％）,其他药物对症治疗203例（33．3％）;比较三组PDT,溶栓组[（104．4±2．4）min]和PCI组[（119．2±2．4）min]均低于其他药物治疗组[（291．9±3．5）min,P〈0．05]。发生室颤47例（7．7％）,其中PDT≤30rain23．4％（11／47）,31～60min7．3％（8／109）,61～120min10．5％（15／143）,121-240min6．3％（8／127）,241—360min1．7％（1／57）,361—720min3．1％（2／64）,〉720min3．2％（2／63）;复苏成功率72．3％（34／47）。结论对患者进行宣传教育,缩短PDT,挽救濒死心肌,对预防室颤、猝死发生,降低病死率至关重要。     

急诊室溶栓治疗ST段拾高心肌梗死病人的护理

为了缩短急性心肌梗死（AMI）病人就诊至开始溶栓治疗的时间，尽可能地挽救濒临坏死的心肌，提高AMI的存活率．2003年1月-2006年1月我院急诊室对22例ST段抬高心肌梗死（STEMI）病人进行了静脉溶栓治疗。由于护理配合对溶栓治疗至关重要，故将其护理体会报告如下。     

家庭溶栓抢救急性心肌梗死患者的方法及护理

为缩短急性心肌梗死（AMI）患者发病至溶栓治疗前迟滞时间，对26例冠心病、心绞痛患者（观察组）开展AMI症状及就医急迫性教育、并填写医患联系卡。当有AMI症状时，医护人员到其家中进行救护、溶栓与转送。对照组选择急诊住入我科的AMI患者24例。结果显示观察组住院前时间为16±12h，对照组52±34h（P<0.005）；医护人员决定时间和处置时间均短于对照组（P<0.05，P<0.01）。家庭溶栓为抢救AMI患者赢的了有效时间，是抢救AMI患者和护士实行家庭救护的较好途径。     

Thrombolysis in acute myocardial infarction: the safety and efficiency of treatment in the accident and emergency department.

OBJECTIVES: To assess the safety and efficiency with which the accident and emergency (A&E) department provides thrombolytic treatment for patients with acute myocardial infarction (AMI). METHODS: A prospective observational study based in a teaching hospital for one year. All patients who presented with the clinical and electrocardiographic indications for thrombolytic treatment were studied. Patients were grouped according to route of admission. After logarithmic transformation, the "door to needle times" of the groups were compared using a two tailed Student's t test. Arrhythmias and complications after thrombolytic treatment were noted. The appropriateness of the treatment was assessed retrospectively by review of the clinical records and electrocardiograms, judged against locally agreed eligibility criteria. RESULTS: Data from 153 patients were analysed; 138/153 (90%) patients were admitted via the A&E department. The shortest door to needle times were seen in those patients thrombolysed by A&E staff within the A&E department (mean 43.8 minutes). The transfer of A&E patients to the coronary care unit (CCU) was associated with a significant increase in the door to needle time (mean 58.8 minutes, p = 0.004). Only one malignant arrhythmia occurred during the administration of thrombolysis in the A&E department, and this was managed effectively. No arrhythmias occurred during transfer of thrombolysed patients to the CCU. In every case, the decision to administer thrombolysis was retrospectively judged to have been appropriate. CONCLUSIONS: The A&E department provides appropriate, safe, and timely thrombolytic treatment for patients with AMI. Transferring A&E patients to the CCU before thrombolysis is associated with an unnecessary treatment delay.     

Prehospital recognition of AMI using independent nurse/paramedic 12-lead ECG evaluation: Impact on in-hospital times to thrombolysis in a rural community hospital

Because the benefits from thrombolytic therapy in acute myocardial infarction (AMI) are time dependent, multiple strategies have been devised to speed therapy. This study sought to determine whether hospital-based nurse and paramedic advanced life support (ALS) providers could be trained to independently evaluate (sight read) a prehospital 12-lead electrocardiogram (ECG) for the presence of AMI as part of a protocol designed to speed in-hospital administration of thrombolytic agents. Providers were required to determine on the basis of a protocol (1) whether or not AMI was present, and (2) whether or not thrombolytic therapy was indicated. Providers then radioed their impression to the emergency department (ED) and initiated a protocol to prepare identified candidates for thrombolysis. The final decision to initiate thrombolytic therapy was made by the ED physician after patient arrival at the hospital. One hundred fifty-five patients with chest pain were studied. Twenty-one (13.5%) were ultimately proven in-hospital to have AMI. Providers were able to recognize AMI in 17 of 21. Four of 21 did not meet ECG criteria for AMI on the field ECG, but were categorized as having a high index of suspicion for AMI by providers. There were no false-positive diagnoses. Fourteen patients (9%) received thrombolytic therapy. In-hospital times to administration of thrombolytic therapy decreased to an average of 22 ± 13.8 minutes in the studied group compared with a historical control group average of 51 ± 50 minutes. It is concluded that hospital-based paramedics and nurses can successfully be taught to evaluate (ie, sight read) a prehospital ECG for the presence of AMI with accuracy. A prehospital chest pain protocol using a field ECG can speed in-hospital administration of thrombolytic therapy to the extent that field administration of thrombolytic agents may not significantly improve times to administration of therapy when transport times are similar to those of this study.     

120-CCU溶栓模式治疗急性心肌梗死69例临床分析

目的：探讨采用120-CCU溶栓模式治疗急性心肌梗死（AMI）的临床疗效。方法：2003年1月至2007年10月采用120-CCU模式救治AMI患者69例，分为溶栓组（n=51）和非溶栓组（n=18）；溶栓组使用尿激酶150万U，于30min内静脉滴入，12h后给于肝素钠6250U皮下注射，每12h1次，连续5～7d，每天口服阿斯匹林300mg，3d后改服每天150mg，1周后改为每天50mg，并静脉滴入硝酸甘油7～10d。非溶栓组除不使用尿激酶外，其它治疗方法同溶栓组。结果：69例中溶栓组51例的总溶栓再通率为74%；在4h内获溶栓治疗者35例；溶栓延迟时间为3.1±2.0h；4h内溶栓再通率的80%（28/35）明显高于4～6h内的44%（7/16），P〈0.05；溶栓组的住院病死率12%（6/51）显著低于28%（5/18），P〈0.05。结论：120-CCU溶栓模式治疗急性心肌梗死可尽早实施溶栓治疗，显著提高溶栓再通率和降低住院病死率。     

Thrombolysis in acute myocardial infarction: the safety and efficiency of treatment in the accident and emergency department.

OBJECTIVES: To assess the safety and efficiency with which the accident and emergency (A&E) department provides thrombolytic treatment for patients with acute myocardial infarction (AMI). METHODS: A prospective observational study based in a teaching hospital for one year. All patients who presented with the clinical and electrocardiographic indications for thrombolytic treatment were studied. Patients were grouped according to route of admission. After logarithmic transformation, the "door to needle times" of the groups were compared using a two tailed Student's t test. Arrhythmias and complications after thrombolytic treatment were noted. The appropriateness of the treatment was assessed retrospectively by review of the clinical records and electrocardiograms, judged against locally agreed eligibility criteria. RESULTS: Data from 153 patients were analysed; 138/153 (90%) patients were admitted via the A&E department. The shortest door to needle times were seen in those patients thrombolysed by A&E staff within the A&E department (mean 43.8 minutes). The transfer of A&E patients to the coronary care unit (CCU) was associated with a significant increase in the door to needle time (mean 58.8 minutes, p = 0.004). Only one malignant arrhythmia occurred during the administration of thrombolysis in the A&E department, and this was managed effectively. No arrhythmias occurred during transfer of thrombolysed patients to the CCU. In every case, the decision to administer thrombolysis was retrospectively judged to have been appropriate. CONCLUSIONS: The A&E department provides appropriate, safe, and timely thrombolytic treatment for patients with AMI. Transferring A&E patients to the CCU before thrombolysis is associated with an unnecessary treatment delay.     

Measurement of care time in patients with acute myocardial infarction admitted to a general ICU: evaluation and improvement

Acute myocardial infarction (AMI) requires early and safe nursing care, particularly with respect to initiating and following up thrombolytic treatment, the most effective therapy according to the literature. Time is decisive. Recommended door-to-needle time should not exceed 35 minutes (from patient's arrival to injection of the thrombolytic agent in the ICU). This quality of care study centered on the measurement of four partial times and their sum. These times corresponded to different phases a patient with AMI undergoes from arrival at the hospital emergency room center to thrombolysis in the ICU. The intrahospital delay in patient care was examined. Times were recorded on a specific register of all patients with priority I AMI (clear criteria for fibrinolysis) who were seen at our center. Total time to fibrinolysis in the ICU was 60 minutes (excessive intrahospital delay). A corrective intervention plan was designed and implemented, which reduced the delay to an acceptable 30 minutes. This improved the quality of care of AMI patients at our center.     

Consideration for primary angioplasty: impact on the door-to-drug time in AMI patients ultimately treated with thrombolytic agent

The objective of this study was to determine if consideration for percutaneous transluminal coronary angioplasty (PTCA) delays administration of thrombolytic therapy in acute myocardial infarction (AMI) patients. Retrospective medical record review of patients ultimately diagnosed with AMI who presented to the ED with chest pain and ST segment elevation on the electrocardiogram; these patients also received acute reperfusion therapy (PTCA or thrombolytic agent). AMI was diagnosed by abnormal elevations in the creatinine phosphokinase MB fraction. The study period covered 2 years (July 1, 1994 to June 30, 1996) in a university hospital ED with an annual volume of 60,000 patient-visits. The use of reperfusion therapies, time intervals, and times of presentation were recorded. Patients were divided into two groups based on cardiac catheterization laboratory (CATH) availability: (group I, CATH currently in operation, Monday to Friday, 7 am to 7 pm and group II, CATH currently not in-operation, all other times). Fifty-two patients with AMI met entry criteria. Patients were treated with thrombolytic therapy in 25 cases; PTCA in 27 cases. Patients received thrombolytic agents within statistically equivalent time intervals regardless of the period of presentation; time to thrombolytic therapy for group I patients was 38 +/- 16 minutes compared with 36 +/- 26 minutes for group II patients (P =. 891). A trend toward significance was noted in the use of PTCA compared with thrombolytic agent; Group I patients were more often treated with PTCA (19) compared with group II patients (11, P =.067). Patients were more rapidly treated with PTCA during CATH operation; the mean time to PTCA for group I patients was 73.5 minutes compared with PTCA for group II patients with 107.8 minutes (P =.033). The consideration for PTCA did not significantly delay the administration of thrombolytic therapy at the study site institution. PTCA was initiated more rapidly in patients presenting with AMI during hours of CATH operation.     

Retrospective observational case-control study comparing prehospital thrombolytic therapy for ST-elevation myocardial infarction with in-hospital thrombolytic therapy for patients from same area

Design: Retrospective observational case-control study comparing patients with suspected acute myocardial infarction (AMI) treated with thrombolytic therapy in the prehospital environment with patients treated in hospital. Setting: Wyre Forest District and Worcestershire Royal Hospital, UK. Participants: (A) All patients who received prehospital thrombolytic therapy for suspected AMI accompanied by electrocardiographic features considered diagnostic. (B) Patients who received thrombolytic therapy after arrival at hospital for the same indication, matched with group A by age, gender and postcode. Main outcome measures: 1. Call to needle time 2. Percentage of patients treated within one hour of calling for medical help 3. Appropriateness of thrombolytic therapy 4. Safety of thrombolytic therapy Results: 1. The median call to needle time for patients treated before arriving in hospital (n = 27) was 40 minutes with an inter-quartile range 25–112 (mean 43 minutes). Patients from the same area who were treated in hospital (n = 27) had a median time of 106 minutes with an inter-quartile range 50–285 (mean 126 minutes). This represents a median time saved by prehospital treatment of 66 minutes. 2. 60 minutes after medical contact, 96 % of patients treated before arrival in hospital had received thrombolytic therapy; this compares with 4% of patients from similar areas treated in hospital. 3. Myocardial infarction was confirmed in 92% (25/27) of patients who received prehospital thrombolytic therapy and similarly 92% (25/27) of those given in-hospital thrombolytic therapy. 4. No major bleeding occurred in either group. Group A suffered fewer in-hospital deaths than group B (1 versus 4). Cardiogenic shock (3 patients) and ventricular arrhythmia (5 patients) were seen only in group B. Conclusion: Paramedic-delivered thrombolytic therapy can be delivered appropriately, safely, and effectively. Time gains are substantial and can meet the national targets for early thrombolytic therapy in the majority of patients.     

急性心肌梗死静脉溶栓程序化管理

目的　探讨急性心肌梗死 (AMI)静脉溶栓程序化护理管理模式的应用价值。方法　根据AMI诊疗过程各时期对护理工作的不同要求 ,制定一套程序化护理管理模式。将连续的护理过程划分为接诊准备及接诊 -溶栓前准备及溶栓 -溶栓后观察相对独立的三个阶段 ,针对每一阶段特点制定内容详尽而又重点突出的护理计划 ;建立管理程序评价制度 ,对护理工作及时进行考评和监督。结果　此项护理管理程序的应用明显缩短了接诊到开始溶栓的时间 (doortoneedletime) ;能指导护士及时发现各种并发症 ,提高了护理工作的预见性 ;管理程序评价制度的实施 ,保证了各阶段护理程序的落实。结论　该模式实用性强 ,能有效地保证AMI静脉溶栓快速而安全地实施