胸痛中心模式下急性ST段抬高型心肌梗死救治现状研究

刘璇; 李树仁; 杨国慧

doi:10.13201/j.issn.1001-1439.2019.05.008

胸痛中心模式下急性ST段抬高型心肌梗死救治现状研究

- 1. 河北医科大学研究生学院(石家庄, 050017);
- 2. 河北省人民医院心血管内科

详细信息

通讯作者: 李树仁,E-mail:lsr64@126.com

中图分类号: R541.4

收稿日期: 2018-12-23

Treatment of patients with ST-segment elevation myocardial infarction in chest pain center mode: Current status

- 1. Graduate School of Hebei Medical University, Shijiazhuang, 050017, China;
- 2. Department of Cardiology, Hebei General Hospital

More Information

Corresponding author: LI Shuren, E-mail: lsr64@126.com

Received Date: 23 December 2018

摘要

摘要: 目的：了解现有胸痛中心模式下急性ST段抬高型心肌梗死（STEMI）的救治情况和患者预后，为胸痛中心建设提供循证依据，进一步完善救治策略。方法：入选2016-09-2018-09来我院行急诊经皮冠状动脉介入治疗（PCI）的STEMI患者458例，根据入院时间将患者分为A、B、C、D组，比较各组发病-球囊扩张（S2B）时间、发病-首次医疗接触（S2FMC）时间、首次医疗接触-球囊扩张（FMC2B）时间、入门-球囊扩张（D2B）时间、心功能>Ⅱ级、院内病死率及院内不良心脑血管事件（MACCE）发生率。分析S2FMC时间、FMC2B时间与S2B时间的相关性。结果：所有入选患者中位S2B时间、S2FMC时间、D2B时间、FMC2B时间分别为206、87、54、93 min。通过胸痛中心认证后，中位D2B时间明显缩短（64 min：51 min，P<0.01）。两年间中位S2B、S2FMC、FMC2B时间变化不显著（P>0.05）。心功能>Ⅱ级7.2%，院内病死率5.9%，院内MACCE发生率7.0%，两年间院内病死率及MACCE发生率均有下降趋势（P>0.05）。相关性分析显示，与FMC2B时间相比，S2FMC时间与S2B时间相关性更强（r：0.810：0.477，P<0.001）；进一步分析发现，自行来院、呼叫120及网络医院转运患者S2FMC时间与S2B时间均存在更强相关性（P<0.001）。结论：胸痛中心模式的运行缩短了D2B时间，但未明显减少患者S2B、S2FMC、FMC2B时间以及院内事件发生。因此缩短总缺血时间尤其是患者延误时间是改进的方向。
- 急性心肌梗死 /
- 胸痛中心 /
- 经皮冠状动脉介入治疗 /
- 院内预后
Abstract: Objective: To investigate the treatment and prognosis status of patients with acute ST segment elevation myocardial infarction (STEMI) under chest pain center mode, providing a evidence-based basis for the chest pain center construction to improve treatment strategies.Method: From September 2016 to September 2018, 458 patients with STEMI undergoing emergency PCI in our hospital were enrolled and divided into four groups according to the admission time.Symptom-to-balloon (S2B) time, symptom-to-first medical contact (S2FMC) time, first medical contact-to-balloon (FMC2B) time, door-to-balloon (D2B) time, cardiac function grade >Ⅱ, in-hospital mortality and major adverse cardiac-cerebral event (MACCE) were compared among four groups.The correlation between S2FMC time, FMC2B time and S2B time were analyzed.Result: The median S2B time, S2FMC time, D2B time and FMC2B time were 206, 87, 54 and 93 min, respectively.The median D2B time was significantly shortened after chest pain accreditation (64 min vs.51 min, P<0.01).There was no significant change in median S2B, FMC2B and S2FMC time in two years (P>0.05).Cardiac function grade >Ⅱ was 7.2%, in-hospital mortality was 5.9% and MACCE was 7.0% in all patients.The mortality and MACCE decreased in two years (P>0.05).Correlation analysis showed that the correlation between S2FMC time and S2B time was stronger than that of FMC2B time (r:0.810 vs.0.477, P<0.001).There was a stronger correlation between S2FMC time and S2B time even in different patients' referral (P<0.001).Conclusion: The chest pain center model could shorten D2B time, but doesn't significantly reduce S2B, S2FMC, FMC2B time and in-hospital events.Therefore, shortening the total ischemic time especially patient delay is the further work.
- myocardial infarction /
- chest pain center /
- percutaneous coronary intervention /
- in-hospital outcomes

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