AMI再灌注治疗延误原因分析及对策(1)
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【摘要】 目的通过对AMI再灌注治疗时间延误原因分析及对策，减少死亡率和致残率。方法采用自制问卷调查对冠心病患者38例AMI患者进行再灌注治疗的调查， 同时对90名急诊科护士、它科护士、CCU护士进行“对AMI再灌注治疗认识程度”进行调查。结果：院前延误时间为180min-72小时(自身延误120 min或2天，交通延误60min)，院内延误146min至12小时(急诊科延误56min，他科延误60 min 至12小时，CCU延误30 min)； 38例患者和家人中仅有3例对AMI的知识有所了解。CCU护士对AMI再灌注认识程度显著高于急诊科和它科护士。结论加强对AMI患者和家人关AMI再灌注治疗有关知识的宣教，提高认识；加强对医护人员的培训；加强对“AMI临床路径”的管理，规范临床诊疗行为，专科专治，建立“绿色通道”，加强科间紧密协作，减少致死率和致残率。
【关键词】 急性心肌梗死 再灌注治疗 延误原因分析
【Abstract】 Objective for AMI reperfusion therapy time delays cause analysis and countermeasures, reducing mortality and morbidity. Methods of self-questionnaire 38 patients with coronary heart disease in patients with AMI reperfusion therapy survey, while 90 emergency department nurses, it is nurses, CCU nurses' awareness of AMI reperfusion therapy degree "investigation. Results: pre-hospital delay time was 180min --- 72 hours (120 min delay itself or 2 days, traffic delays 60min), hospital delay 146min to 12 hours (emergency department delays in 56min, 60 min delay his subjects to 12 hours, CCU delay 30 min); 38 patients and their families, only three cases of knowledge and understanding of the AMI. CCU nurses' knowledge of AMI reperfusion was significantly higher than the emergency department and its nurses. Conclusion of the AMI patients and their families to strengthen relations with the knowledge AMI reperfusion therapy in the church, to raise awareness; to strengthen the training of medical staff; strengthen the "AMI clinical pathway" management, standardize clinical practice behavior, specialists of tyranny, to establish a "green channel "to strengthen the close collaboration between the Division, to reduce mortality and morbidity.
【Keywords】 acute myocardial infarction analysis of causes of delays in reperfusion therapy
【中图分类号】 R542.2+2【文献标识码】 B【文章编号】 1007-8231(2011) 08-0638-03
再灌注治疗是治疗急性心肌梗死(AMI)的重要方法,仅适用于ST段抬高型心肌梗塞(STEMI)或新发生的左束支传导阻滞的AMI。不管采用那种再灌注治疗方案，最重要的是尽量缩短患者的总体缺血时间(自出现症状到开始再灌注治疗时间间隔)，应该将其控制在120分钟之内，最好是60分钟之内。就诊于具备急诊PCI条件的STEMI患者，应该在首次医疗接触后的90分钟直接急诊PCI 治疗。[1]如果AMI发病后6小时内不能有效地使梗死相关冠脉再通，则大面积(>40%)梗死者多会并发泵衰竭，包括心源性休克和左心功能衰竭，死亡率高，预后差。[2]为此笔者对AMI病人再灌注治疗时间延误的原因进行了调查。同时对急诊、它科、CCU护士对AMI再灌注认识程度及以及AMI患者及家属 ......
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