循環器救急輪番制による急性心筋梗塞患者の病院収容時間に関する検討
急性心筋梗塞に対する再灌流療法の有用性は明確に梗塞発症からの時間に依存している. 一方, 再灌流療法施行率はいまだに低く, 米国では30-40%である. 急性梗塞患者の早期病院収容を推進するには単一医療機関では不可能であり, 本研究では地域全体で循環器救急輪番制を開始し, 収容時間が短縮するかを検討した. 輪番制開始前後で比較すると, 救急隊直接搬送は10%から34%に有意に増加し, 一次救急医療センター経由例は40%から10.6%に有意に軽減した. しかし, 梗塞発症後2時間以内の病院収容は37.5%と36.2%, 収容時間の中央値は3.1時間と3.5時間で差を認めなかった. 収容に6時間以...
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| Published in | 医療 Vol. 57; no. 4; pp. 242 - 246 |
|---|---|
| Main Authors | , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
一般社団法人 国立医療学会
2003
国立医療学会 |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0021-1699 1884-8729 |
| DOI | 10.11261/iryo1946.57.242 |
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| Abstract | 急性心筋梗塞に対する再灌流療法の有用性は明確に梗塞発症からの時間に依存している. 一方, 再灌流療法施行率はいまだに低く, 米国では30-40%である. 急性梗塞患者の早期病院収容を推進するには単一医療機関では不可能であり, 本研究では地域全体で循環器救急輪番制を開始し, 収容時間が短縮するかを検討した. 輪番制開始前後で比較すると, 救急隊直接搬送は10%から34%に有意に増加し, 一次救急医療センター経由例は40%から10.6%に有意に軽減した. しかし, 梗塞発症後2時間以内の病院収容は37.5%と36.2%, 収容時間の中央値は3.1時間と3.5時間で差を認めなかった. 収容に6時間以上要した遅延収容例の理由は, 患者判断による遅れが63.4%と高率であった. 今後は, 急性心筋梗塞発症時の早期救急隊要請と専門病院収容を目指し地域全体での市民啓発活動を検討している. |
|---|---|
| AbstractList | 急性心筋梗塞に対する再灌流療法の有用性は明確に梗塞発症からの時間に依存している. 一方, 再灌流療法施行率はいまだに低く, 米国では30-40%である. 急性梗塞患者の早期病院収容を推進するには単一医療機関では不可能であり, 本研究では地域全体で循環器救急輪番制を開始し, 収容時間が短縮するかを検討した. 輪番制開始前後で比較すると, 救急隊直接搬送は10%から34%に有意に増加し, 一次救急医療センター経由例は40%から10.6%に有意に軽減した. しかし, 梗塞発症後2時間以内の病院収容は37.5%と36.2%, 収容時間の中央値は3.1時間と3.5時間で差を認めなかった. 収容に6時間以上要した遅延収容例の理由は, 患者判断による遅れが63.4%と高率であった. 今後は, 急性心筋梗塞発症時の早期救急隊要請と専門病院収容を目指し地域全体での市民啓発活動を検討している. |
| Author | 田邊, 潤 高山, 英男 小嶋, 俊一 上村, 竜太 小川, 晃生 横山, 広行 山科, 育子 黒田, 重臣 時田, 祐吉 |
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| References | 3) Fibrinolytic Therapy Trials' (FTT) Collaborative Group: Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients. Lancet 343: 311-322, 1994 2) GUSTO investigators: An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. N Engl J Med 329: 673-682, 1993 1) Randomized trial of intravenous streptokinase, oral aspirin, both, or neither among 17187 cases of suspected acute myocardial infarction: ISIS-2. ISIS-2 (Second International Study of Infarct Survival) Collaborative Group Lancet 2 (8607): 349-350, 1998 5) WHO MONICA project: Myocardial infarction and coronary deaths in the world health organization MONICA project: Registration procedures, event rates, and case-fatality rates in 38 populations from 21 countries in four continents. Circulation 90: 583-612, 1994 9) Hirvonen TP, Halinen MO, Kala RA et al: Delays in thrombolytic therapy for myocardial infarction in Finland: Results of a national thrombolytic therapy delay study. Finnish Hospitals' Thrombolysis Survey Group. Eur Heart J 19: 885-892, 1998 13) Chareonthaitawee P, Gibbons RJ, Roberts RS et al: The impact of time to thrombolytic treatment on outcome in patients with acute myocardial infarction. For the CORE investigators. Heart 84: 142-148, 2000 8) Rustige J, Schiele R, Burczyk et al: The 60 minutes myocardial infarction project: Treatment and clinical outcome of patients with acute myocardial infarction in Germany. Eur Heart J 18: 1438-1446, 1997 11) Rogers WJ, Canto JG, Barron HV et al: Treatment and outcome of myocardial infarction in hospitals with and without invasive capability. J Am Coil Cardiol 35: 371-379, 2000 12) Liem AL, van't Hof AW, Hoorntje JC et al: Influence of treatment delay on infarct size and clinical outcome in patients with acute myocardial infarction treated with primary angioplasty. J Am Coll Cardiol 32: 629-633, 1998 6) Faxon D, Lenfant C: Timing is everything: Motivating patients to call 9-1-1 at onset of acute myocardial infarction. Circulation 104: 1210-1211, 2001 18) Leizorovicz A, Haugh MC, Mercier C et al: Pre-hospital and hospital time delays in thrombolytic treatment in patients with suspected acute myocardial infarction: Analysis of data from the EMIP study. Europeam Myocardiol Infarction Project. Eur Heart J 18: 248-253, 1997 7) Casale PN, Jones JL, Wolf FE et al: Patients treated by cardiologists have a lower in-hospital mortality for acute myocardial infaction. J Am Coll Cardiol 32: 885-889, 1998 17) Zahn R, Schiele R, Gitt AK et al: Impact of prehospital delay on mortality in patients with acute myocardial infarction treated with primary angioplasty and intravenous thrombolysis. Am Heart J 142: 105-111, 2001 4) Barron HV, Bowlby LJ, Breen T et al: Use of reperfusion therapy for acute myocardial infarction in the United States: Data from the National Registry of Myocardial Infarction 2. Circulation 97: 1150-1156, 1998 10) Brown AL, Mann NC, Daya M et al: Demographic, belief, and situational factors influencing the decision to utilize emergency medical services among chest pain patients. Circulation 102: 173-178, 2000 14) Franzosi MG, Santoro E, De Vita C et al: Ten-year follow-up of the first megatrial testing thorombolytic therapy in the patients with acute myocardial infarction: results of the Grruppo Italiano per to studio della Sopravvivenza nell' Infarto-1 Study. The GISSI Investigators. Circulation 98: 2659-2665, 1998 15) Berger PB, Ellis SG, Holmes DR Jr et al: Relationship between delay in performing direct coronary angioplasty and early clinical outcome in patients with acute myocardial infarction: results from the global use of strategies to open occluded arteries in acute coronary syndromes (GUSTO-IIb) trial. Circulation 100: 14-20, 1999 16) Weaver WD, Cerqueira M, Hallstrom AP et al: Prehospital-initiated vs hospital-initiated thrombolytic therapy for myocardial infarction. JAMA 270: 1211-1216, 1993 |
| References_xml | – reference: 10) Brown AL, Mann NC, Daya M et al: Demographic, belief, and situational factors influencing the decision to utilize emergency medical services among chest pain patients. Circulation 102: 173-178, 2000 – reference: 8) Rustige J, Schiele R, Burczyk et al: The 60 minutes myocardial infarction project: Treatment and clinical outcome of patients with acute myocardial infarction in Germany. Eur Heart J 18: 1438-1446, 1997 – reference: 12) Liem AL, van't Hof AW, Hoorntje JC et al: Influence of treatment delay on infarct size and clinical outcome in patients with acute myocardial infarction treated with primary angioplasty. J Am Coll Cardiol 32: 629-633, 1998 – reference: 1) Randomized trial of intravenous streptokinase, oral aspirin, both, or neither among 17187 cases of suspected acute myocardial infarction: ISIS-2. ISIS-2 (Second International Study of Infarct Survival) Collaborative Group Lancet 2 (8607): 349-350, 1998 – reference: 2) GUSTO investigators: An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. N Engl J Med 329: 673-682, 1993 – reference: 11) Rogers WJ, Canto JG, Barron HV et al: Treatment and outcome of myocardial infarction in hospitals with and without invasive capability. J Am Coil Cardiol 35: 371-379, 2000 – reference: 16) Weaver WD, Cerqueira M, Hallstrom AP et al: Prehospital-initiated vs hospital-initiated thrombolytic therapy for myocardial infarction. JAMA 270: 1211-1216, 1993 – reference: 9) Hirvonen TP, Halinen MO, Kala RA et al: Delays in thrombolytic therapy for myocardial infarction in Finland: Results of a national thrombolytic therapy delay study. Finnish Hospitals' Thrombolysis Survey Group. Eur Heart J 19: 885-892, 1998 – reference: 17) Zahn R, Schiele R, Gitt AK et al: Impact of prehospital delay on mortality in patients with acute myocardial infarction treated with primary angioplasty and intravenous thrombolysis. Am Heart J 142: 105-111, 2001 – reference: 5) WHO MONICA project: Myocardial infarction and coronary deaths in the world health organization MONICA project: Registration procedures, event rates, and case-fatality rates in 38 populations from 21 countries in four continents. Circulation 90: 583-612, 1994 – reference: 7) Casale PN, Jones JL, Wolf FE et al: Patients treated by cardiologists have a lower in-hospital mortality for acute myocardial infaction. J Am Coll Cardiol 32: 885-889, 1998 – reference: 14) Franzosi MG, Santoro E, De Vita C et al: Ten-year follow-up of the first megatrial testing thorombolytic therapy in the patients with acute myocardial infarction: results of the Grruppo Italiano per to studio della Sopravvivenza nell' Infarto-1 Study. The GISSI Investigators. Circulation 98: 2659-2665, 1998 – reference: 18) Leizorovicz A, Haugh MC, Mercier C et al: Pre-hospital and hospital time delays in thrombolytic treatment in patients with suspected acute myocardial infarction: Analysis of data from the EMIP study. Europeam Myocardiol Infarction Project. Eur Heart J 18: 248-253, 1997 – reference: 6) Faxon D, Lenfant C: Timing is everything: Motivating patients to call 9-1-1 at onset of acute myocardial infarction. Circulation 104: 1210-1211, 2001 – reference: 15) Berger PB, Ellis SG, Holmes DR Jr et al: Relationship between delay in performing direct coronary angioplasty and early clinical outcome in patients with acute myocardial infarction: results from the global use of strategies to open occluded arteries in acute coronary syndromes (GUSTO-IIb) trial. Circulation 100: 14-20, 1999 – reference: 4) Barron HV, Bowlby LJ, Breen T et al: Use of reperfusion therapy for acute myocardial infarction in the United States: Data from the National Registry of Myocardial Infarction 2. Circulation 97: 1150-1156, 1998 – reference: 13) Chareonthaitawee P, Gibbons RJ, Roberts RS et al: The impact of time to thrombolytic treatment on outcome in patients with acute myocardial infarction. For the CORE investigators. Heart 84: 142-148, 2000 – reference: 3) Fibrinolytic Therapy Trials' (FTT) Collaborative Group: Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients. Lancet 343: 311-322, 1994 |
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| Snippet | 急性心筋梗塞に対する再灌流療法の有用性は明確に梗塞発症からの時間に依存している. 一方, 再灌流療法施行率はいまだに低く, 米国では30-40%である. 急性梗塞患者の早期... |
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| SubjectTerms | 循環器救急輪番制 急性心筋梗塞 患者による遅れ 病院収容遅延 |
| Title | 循環器救急輪番制による急性心筋梗塞患者の病院収容時間に関する検討 |
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