Avtor/Urednik		Remškar, Mojca; Jazbec, Anja; Horvat, Matija; Noč, Marko
Naslov		Zdravljenje bolnikov z akutnim srčnomišičnim infarktom
Prevedeni naslov		Treatment of patients with acute myocardial infarction
Tip		članek
Vir		Zdrav Vestn
Vol. in št.		Letnik 70, št. 3
Leto izdaje		2001
Obseg		str. 133-7
Jezik		slo
Abstrakt		Background. Since early recognition of symptoms and adequate initial management are crucial for the survival of patients with acute myocardial infarction, we examined pre-hospital treatment and corresponding time delays in Ljubljana, Slovenia. Methods. We performed a one-year prospective study. Patients diagnosed with acute myocardial infarction were enrolled into the study. We followed pre-hospital treatment and the total pre-hospital time delay (time from onset of chest pain to the initiation of treatment), the patient time delay (time from onset of chest pain to entry) into the emergency medical sustem) and the transportation time delay (time from entry into the emergency medical system to admission to the Department for emergency internal medicine). Results. Our study demonstarted that less than 25% of patients received pre-hospital treatment with acetylsalicylic acid, nitroglycerine and morphine. Oxygen was administered in 35% of patients. The total pre-hospital time delay was significantly shorter in reperfusion-eligible patients (3.04 vs. 9.16 hours). These differences were accounted for by both shorter patient time (1.50 vs. 6.00 hours) and shorter transport time (1.08 vs. 2.24 hours). Regardless of the clinical presentation of acute myocardial infarction, the pre-hospital time delay was less in patients transported by Mobile emergency unit, predominantly due to shorter transport time (0.66 vs 1.70 hours). The median door-to-needle time was 0.67 hours and the median door-to-balloon time was 1.41 hours. Conclusions. A long patient time delay requires a wide public educational campaign regarding the early recognition of symptoms and proper notification of the emergency medical service. Both transport time and pre-hospital treatment could be significantly improved if patients with acute myocardial infarction would enter the pre-hospital medical system by Mobile emergency unit.
Izvleček		Izhodišča. Zgodnje spoznavanje simptomov in pravilno ter hitro začetno zdravljenje so zelo pomembni za bolnike z akutnim srčnomišičnim infarktom (AMI). Zato smo raziskali predbolnišnično zdravljenje bolnikov z AMI ter predbolnišnične časovne intervale na področju ljubljanske občine. Metode. Opravili smo prospektivno raziskavo, v katero smo vključili bolnike z diagnozo AMI. Spremljali smo predbolnišnično ter bolnišnično zdravljenje ter merili celokupni časovni interval (čas od nastopa prsne bolečine do pričetka reperfuzijskega zdravljenja), od bolnika odvisen časovni interval (čas od nastopa prsne bolečine do prvega stika z urgentni mmedicinskim sistemom) ter transportni časovni interval (čas od prvega stika z urgentnim medicinskim sistemom do sprejema na Internistično prvo pomoč). Rezultati. Manj kot 25% bolnikov je pred sprejemom v bolnišnico prejelo zdravljenje z acetilsalicilno kislino, nitroglicerinom ter morfijem. Kisik je prejelo le 35% bolnikov. Celokupni predbolnišnični časovni interval je bil občutno krajši pri bolnikih, ki so potrebovali takojšnje reperfuzijsko zdravljenje (3,04 proti 9,16 ure). Ta razlika je bila posledica krajšega, od bolnika odvisnega časovnega intervala (1,5 proti 6,0 ure) ter krajšega transportnega časovnega intervala (1,08 proti 2,24 ure). Ne glede na klinično sliko AMI je bil celokupni predbolnišnični časovni interval krajši pri bolnikih, ki jih je Internistično prvo pomoč pripeljala Mobilna reševalna enota, predvsem na račun krajšega transportnega časovnega intervala (0,66 proti 1,7 ure). Srednji časovni interval vrata-igla (door-to-needle) je bil 0,67 ure in srednji časovni interval vrata-balon (door-to-balloon) je bil 1,41 ure. Zaključki. Dolg, od bolnika odvisen časovni interval zahteva nacionalno izobraževalno akcijo, ki bo javnost poučila o pomembnosti zgodnje prepoznave simptomov AMI ter o pravilnem načinu postopanja v tem primeru. (Izvleček prekinjen pri 2000 znakih).
Deskriptorji		MYOCARDIAL INFARCTION EMERGENCY MEDICAL SERVICES TRANSPORTATION OF PATIENTS AMBULANCES THROMBOLYTIC THERAPY ANGIOPLASTY, TRANSLUMINAL, PERCUTANEOUS CORONARY TIME FACTORS ACUTE DISEASE