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題名 | Delayed Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction in The Emergency Department=急性心肌硬塞病人於急診延遲接受緊急經皮冠狀動脈氣球擴張術之探討 |
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作者 | 黃世鴻; 龔嘉德; 周義; 柴漢東; 李文輝; | 書刊名 | 臺灣急診醫學會醫誌 |
卷期 | 8:2 民95.06 |
頁次 | 頁49-53 |
分類號 | 415.3161 |
關鍵詞 | 延遲皮冠狀動脈氣球擴張術; 急性心肌梗塞; 急診; Percutaneous coronary intervention; PCI; Acute myocardial infarction; Emergency department; ED; |
語文 | 英文(English) |
中文摘要 | 背景與目的:急性心肌梗塞治療目標在於使梗塞的血管儘速獲得血液的灌注,而時間上的延遲將影響病人的預後及存活率。本研究的目的在於探討急性心肌梗塞病人在急診延遲接受緊急經皮冠狀動脈氣球擴張術的原因、臨床特性以及預後情形。方法:本研究以回溯病歷方式,收集2000年1月至7月期間於某醫學中心急診接受經皮冠狀動脈氣球擴張術診療之急性心肌梗塞個案,分為延遲組與非延遲組。以原因、臨床特性以及院內死亡率來比較差異。結果:研究期間共收集196位急性心肌梗塞病人於急診接受經皮冠狀動脈氣球擴張術。151位為非延遲組於到院後90分鐘內完成血管擴張;45位為延遲組超過90分鐘後才完成血管擴張。造成延遲接受冠狀動脈氣球擴張術因素有60%為病患因素,40%為醫師因素。造成延遲最常見的原因為延誤診斷(35.6%)、穩定病人病況差時間太久(26.7%)以及家屬考慮接受治療時間太久(20%)。最後追蹤病人的住院死亡率,發現延遲組死亡率為13.3%遠高於非延遲組4.6% (13.3% vs 4.6%; p=0.04)。結論:本研究發現急性心肌梗塞病人延遲接受緊急經皮冠狀動脈氣球擴張術呈現出較高的住院死亡率。所以,加強早期正確診斷以及在短時間內有計畫有組織性的治療急性心肌梗塞病患,以期達到預防延遲接受氣球擴張術與降低死亡率的目標。 |
英文摘要 | Background & Objectives: In the treatment of acute ST-segment elevation myocardial infarction (STEMI), the time delay to achieve reperfusion of the infarction-related artery has been linked to survival rate. This study aimed to evaluate clinical characteristics, causes and effects of delayed primary percutaneous coronary intervention (PCI) for emergency department patients with STEMI. Method: Retrospective observational study with chart review included all patients suffering acute STEMI who underwent primary PCI in an urban teaching hospital from January to July 2000. Demographic data, clinical characteristics and in-hospital mortality rate of enrolled patients who had received delayed PCI were compared with patients who had received timely PCI. Result: Of 196 enrolled patients, 151 patients underwent PCI within 90 minutes and 45 patients underwent PCI after 90 minutes. Causes of delayed PCI were categorized as 60% patient-related and 40% doctor-related. The common causes of delay were delayed diagnosis (35.6%), poor patient condition with prolonged stabilization (26.7%) and prolonged decision time by family (20%). The in-hospital mortality rate for the delayed-PCI group was higher than that of the timely-PCI group (13.3% vs. 4.6%; p=0.04). Conclusion: Delayed PCI in patients with STEMI may result in poor hospital survival. Enhancing early diagnosis and having an organized approach to managing patients with acute myocardial infarction may be the most effective strategies to prevent delayed PCI. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。