BACKGROUND: Timely reperfusion in ST-segment elevation myocardial infarction(STEMI)improves outcomes. System delay is that between first medical contact and reperfusion therapy,comprising prehospital and hospital comp...BACKGROUND: Timely reperfusion in ST-segment elevation myocardial infarction(STEMI)improves outcomes. System delay is that between first medical contact and reperfusion therapy,comprising prehospital and hospital components. This study aimed to characterize prehospital system delay in Singapore.METHODS: A retrospective chart review was performed for 462 consecutive STEMI patients presenting to a tertiary hospital from December 2006 to April 2008. Patients with cardiac arrest secondarily presented were excluded. For those who received emergency medical services(EMS),ambulance records were reviewed. Time intervals in the hospital were collected prospectively. The patients were divided into two equal groups of high/low prehospital system delay using visual binning technique.RESULTS: Of 462 patients, 76 received EMS and 52 of the 76 patients were analyzed. The median system delay was 125.5 minutes and the median prehospital system delay was 33.5minutes(interquartile range [IQR]=27.0, 42.0). Delay between call-received-by-ambulance and ambulance-dispatched was 2.48 minutes(IQR=1.47, 16.55); between ambulance-dispatch and arrival-at-patient-location was 8.07 minutes(IQR=1.30, 22.13); between arrival-at- and departurefrom-patient-location was 13.12 minutes(IQR=3.12, 32.2); and between leaving-patient-location to ED-registration was 9.90 minutes(IQR=1.62, 32.92). Comparing patients with prehospital system delay of less than 35.5 minutes versus more showed that the median delay between ambulancedispatch and arrival-at-patient-location was shorter(5.75 vs. 9.37 minutes, P<0.01). The median delay between arrival-at-patient-location and leaving-patient-location was also shorter(10.78 vs.14.37 minutes, P<0.01).CONCLUSION: Prehospital system delay in our patients was suboptimal. This is the first attempt at characterizing prehospital system delay in Singapore and forms the basis for improving efficiency of STEMI care.展开更多
[目的]探讨应用自制胸痛就诊流程看图对话工具对不稳定型心绞痛病人再入院时相关因素的影响。[方法]采用方便抽样法选取2017年1月—2018年5月在某三级甲等医院就诊的不稳定型心绞痛病人480例为研究对象,根据是否运用看图对话工具进行健...[目的]探讨应用自制胸痛就诊流程看图对话工具对不稳定型心绞痛病人再入院时相关因素的影响。[方法]采用方便抽样法选取2017年1月—2018年5月在某三级甲等医院就诊的不稳定型心绞痛病人480例为研究对象,根据是否运用看图对话工具进行健康教育分为对照组和观察组各240例,对照组采用常规健康宣教,观察组采用看图对话工具进行健康宣教,查证分析两组病人在6个月内再入院的临床资料,筛选出60例作为研究对象,对照组28例,观察组32例。比较两组病人首次医疗接触(first medical contact,FMC)时间、入院时焦虑程度、胸痛缓解率、心肌梗死并发症及死亡率。[结果]观察组病人FMC时间(48.28±10.05)min,短于对照组的(115.71±12.82)min,焦虑自评量表(SAS)评分为(41.78±2.11)分,低于对照组的(55.25±6.58)分,胸痛缓解率为93.75%,高于对照组的71.42%,心肌梗死并发症少于对照组(P<0.05);两组病人死亡率比较,差异无统计学意义(P>0.05)。[结论]运用自制胸痛再发就诊流程看图对话工具进行健康教育使不稳定型心绞痛病人得到及时就诊救治,可以减少心肌梗死并发症,提升胸痛缓解疗效,提高病人生存质量。展开更多
文摘BACKGROUND: Timely reperfusion in ST-segment elevation myocardial infarction(STEMI)improves outcomes. System delay is that between first medical contact and reperfusion therapy,comprising prehospital and hospital components. This study aimed to characterize prehospital system delay in Singapore.METHODS: A retrospective chart review was performed for 462 consecutive STEMI patients presenting to a tertiary hospital from December 2006 to April 2008. Patients with cardiac arrest secondarily presented were excluded. For those who received emergency medical services(EMS),ambulance records were reviewed. Time intervals in the hospital were collected prospectively. The patients were divided into two equal groups of high/low prehospital system delay using visual binning technique.RESULTS: Of 462 patients, 76 received EMS and 52 of the 76 patients were analyzed. The median system delay was 125.5 minutes and the median prehospital system delay was 33.5minutes(interquartile range [IQR]=27.0, 42.0). Delay between call-received-by-ambulance and ambulance-dispatched was 2.48 minutes(IQR=1.47, 16.55); between ambulance-dispatch and arrival-at-patient-location was 8.07 minutes(IQR=1.30, 22.13); between arrival-at- and departurefrom-patient-location was 13.12 minutes(IQR=3.12, 32.2); and between leaving-patient-location to ED-registration was 9.90 minutes(IQR=1.62, 32.92). Comparing patients with prehospital system delay of less than 35.5 minutes versus more showed that the median delay between ambulancedispatch and arrival-at-patient-location was shorter(5.75 vs. 9.37 minutes, P<0.01). The median delay between arrival-at-patient-location and leaving-patient-location was also shorter(10.78 vs.14.37 minutes, P<0.01).CONCLUSION: Prehospital system delay in our patients was suboptimal. This is the first attempt at characterizing prehospital system delay in Singapore and forms the basis for improving efficiency of STEMI care.
文摘[目的]探讨应用自制胸痛就诊流程看图对话工具对不稳定型心绞痛病人再入院时相关因素的影响。[方法]采用方便抽样法选取2017年1月—2018年5月在某三级甲等医院就诊的不稳定型心绞痛病人480例为研究对象,根据是否运用看图对话工具进行健康教育分为对照组和观察组各240例,对照组采用常规健康宣教,观察组采用看图对话工具进行健康宣教,查证分析两组病人在6个月内再入院的临床资料,筛选出60例作为研究对象,对照组28例,观察组32例。比较两组病人首次医疗接触(first medical contact,FMC)时间、入院时焦虑程度、胸痛缓解率、心肌梗死并发症及死亡率。[结果]观察组病人FMC时间(48.28±10.05)min,短于对照组的(115.71±12.82)min,焦虑自评量表(SAS)评分为(41.78±2.11)分,低于对照组的(55.25±6.58)分,胸痛缓解率为93.75%,高于对照组的71.42%,心肌梗死并发症少于对照组(P<0.05);两组病人死亡率比较,差异无统计学意义(P>0.05)。[结论]运用自制胸痛再发就诊流程看图对话工具进行健康教育使不稳定型心绞痛病人得到及时就诊救治,可以减少心肌梗死并发症,提升胸痛缓解疗效,提高病人生存质量。
