Door-to-needle time for administration of fibrinolytics in acute myocardial infarction in Cape Town.
Door-to-needle time for administration of fibrinolytics in acute myocardial infarction in Cape Town.
复制标题
开普敦急性心肌梗塞纤溶药物给药的门到针时间。
DOI：
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发表时间：
2012
期刊：
影响因子：
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通讯作者：
L. Wallis
中科院分区：
文献类型：
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作者：
R. Maharaj;H. Geduld;L. Wallis
目标
确定开普敦三家医院急诊中心（EC）急性心肌梗死（AMI）纤溶药物给药的当前门到针时间，并将其与美国心脏协会/美国心脏病学会（AHA/ACC）推荐的30分钟作为护理质量标志进行比较。
方法
对2008年1月至2010年7月在开普敦三家医院的EC接受溶栓治疗AMI的所有患者的病例记录进行回顾性审查。计算总的上门到针时间，并分析患者人口统计学和表现、医生资格、临床病理学和延迟溶栓给药的原因。
结果
共确定了372例急性ST段抬高型心肌梗死（STEMI）患者; 161例患者符合研究条件。达到的中位上门穿刺时间为54分钟（范围13 - 553分钟）。33例（20.5%）患者的门到针时间为30分钟或更短; 51.3%的患者乘坐救护车到达; 34%的患者有院前12导联ECG; 88.8%的患者有心肌梗死的典型症状。医务人员对44.7%的患者进行了溶栓治疗。心电图梗死部位以下壁为主（55.9%）。
结论
相当数量的患者在就诊后30分钟内没有溶栓。缺乏资深医生、难以解读ECG、不典型表现和EC系统延迟延长了本研究中的上门穿刺时间。
OBJECTIVES
To determine the current door-to-needle time for the administration of fibrinolytics for acute myocardial infarction (AMI) in emergency centres (ECs) at three hospitals in Cape Town, and to compare it with the American Heart Association/American College of Cardiology (AHA/ACC) recommendation of 30 minutes as a marker of quality of care.
METHODS
A retrospective review of case notes from January 2008 to July 2010 of all patients receiving thrombolytics for AMI in the ECs of three Cape Town hospitals. The total door-to-needle time was calculated and patient demographics and presentation, physician qualification, clinical symptomology and reasons for delays in thromobolytic administration were analysed.
RESULTS
A total of 372 patients with acute ST elevation myocardial infarction (STEMI) were identified; 161 patients were eligible for the study. The median door-to-needle time achieved was 54 minutes (range 13 - 553 mins). A door-to-needle time of 30 minutes or less was achieved in 33 (20.5%) patients; 51.3% of the patients arrived by ambulance; 34% of patients had a pre-hospital 12-lead ECG; and 88.8% had typical symptoms of myocardial infarction. Medical officers administered thrombolytics to 44.7% of the patients. The predominant infarct location on ECG was inferior (55.9%).
CONCLUSION
A significant number of patients were not thrombolysed within 30 minutes of presentation. The lack of senior doctors, difficulty interpreting ECGs, atypical presentations and EC system delays prolonged the door-to-needle time in this study.