非正常工作时间对急性心肌梗死患者院内再灌注延迟的影响  

The Effect of Off Hours on Door-to-Reperfusion Times in Patients with ST-segment Elevation Myocardial Infarction in Beijing

作　　者：刘书山[1] 胡大一[2] 杨进刚[1] 孙艺红[2] 宋莉[1] 王冉冉[1] 张清潭[1] 杜兰芳[1] 李超[1] 赵薇[1] 袁彦菊[1] 

机构地区：[1]首都医科大学附属北京同仁医院心血管诊疗中心,北京100730 [2]北京大学人民医院心脏中心,北京100044

出　　处：《中国医药导刊》2007年第3期176-178,共3页Chinese Journal of Medicinal Guide

基　　金：首都紧急医学救援(5分钟)科技工程建设资助编号[京科技发(2005)593]

摘　　要：目的:多中心、前瞻性观察非正常工作时间对急性ST段抬高心肌梗死(STEMI)患者院内再灌注延迟的影响。方法:连续入选自2005年11月至2006年7月,在北京市19个医疗中心至急诊室就诊并接受再灌注的STEMI患者共297例。分为正常工作时间(A时间)和非正常工作时间(B时间)再灌注治疗组。分析与A时间再灌注治疗相比,B时间对进门-再灌注延迟的影响。结果:297例患者中,A时间再灌注治疗组120例(40．4%),其中38例患者接受溶栓治疗,82例患者接受急诊经皮冠状动脉介入治疗(PCI);B时间再灌注治疗组177例(59．6%),其中49例患者接受溶栓治疗,128例患者接受PCI治疗。在校正患者的其他临床因素后,B时间再灌注治疗组的进门-球囊扩张时间(D2B)中位数显著长于A时间再灌注治疗组(174．3min[95%可信区间(CI):172．8～176．2]比138．3min[95% CI:136．1～140．2];P＜0．01),B时间再灌注治疗组的进门-溶栓时间(D2N)中位数和A时间再灌注治疗组无显著差别(62．7min[95% CI:61．8～64．5]比59．8min[95% CI: 58．1～61．3];P=0．07)。结论:北京市在B时间接受PCI治疗的STEMI患者D2B时间延迟增加。Objective： The aim of this study was to evaluate the effect of off hours on door - to - reperfusion times in patients with ST - segment - elevation myocardial infarction （STEMI）. Methods： Using data from the Registry of ST-segment-elevation Myocardial Infarction in Beijing, from November 2005 to July 2006, we studied 297 patients with STEM/who received acute reperfusion, including 120 patients [fibrinolytic therapy 38, percutaneous coronary intervention（PCI） 82] in routine duty hours and 177 patients （fibrinolytic therapy 49, PCI 128） patients in off hours. We evaluated the association between off hours and door - to - reperfusion times. Results： In off hours, 59.6% patients received acute reperfusion. After adjusting for patient characteristics, compared with routine duty hours, off hours was associated with a significantly longer median door - to - balloon time（ 174.3min [95% confidence interval（CI） ： 172.8 - 176.2 vs. 138.3 m/n [95% CI： 136.1 - 140.21 ; P 〈 0.01）, but there was no significandy difference in median door - to - needle time between off hours and routine duty hours （59.8 min [ 95% CI： 58.1 - 61.3 ] vs. 62.7 min [ 95% CI： 61.8 - 64.5] ; P = 0.07） . Conclusion： Off hours was an important factor associated with a significantly longer time to door - to - balloon time in Beijing.

关 键 词：急性ST段抬高心肌梗死 进门-再灌注时间 非正常工作时间 正常工作时间 

分 类 号：R542.22[医药卫生—心血管疾病]