不同就诊方式ST段抬高心肌梗死患者治疗和预后的比较  

Comparison of the treatment and prognosis of patients with ST-elevated myocardial infarction by different traffic tools

作　　者：程姝娟[1] 郭路芬[1] 彭亚光[2] 

机构地区：[1]首都医科大学附属北京安贞医院28病区,北京100029 [2]北京市海淀区卫生局卫生监督所,北京100037

出　　处：《新乡医学院学报》2009年第3期268-270,共3页Journal of Xinxiang Medical University

摘　　要：目的探讨ST段抬高心肌梗死患者就诊方式的影响因素、治疗方式及影响住院期间死亡的因素。方法急性ST段抬高心肌梗死(STEM I)患者572例,根据患者就诊使用的交通工具分为观察组324例(采取急救车就诊)和对照组248例(采取其他交通工具就诊),比较2组患者一般情况、院前延误时间(PDT)、治疗方式和住院期间病死率。结果与对照组相比,入院时观察组患者心率较快(P<0.05),糖尿病患者较多(P<0.05),收缩压和舒张压明显低于对照组(P<0.05),观察组PDT明显短于对照组(P<0.05)。观察组溶栓率显著高于对照组(P<0.05),2组之间的经皮冠状动脉介入(PC I)率和再灌注治疗率差异无统计学意义(P>0.05)。观察组住院期间病死率高于对照组,但差别无统计学意义(P>0.05);糖尿病病史、入院时心率和收缩压是患者选用急救车的影响因素(P<0.05,P<0.01)。年龄、糖尿病病史和PDT是急性心肌梗死患者死亡的独立相关因素(P<0.05,P<0.01)。结论当前STEM I患者选用急救车者病情常较重,在提高急救车使用率的同时应采取及时有效的治疗。Objective To evaluate the impact of different mode of transportation on treatment and prognosis of patients with ST-elevated myocardial infarction （STEMI）. Methods According to the difference of transportation the patients used,572 cases with STEMI were divided into observation group（ n = 324 ,using ambulance） and control group（ n = 248 ,using other vehicle except ambulance）. General state of health, prehospital delay time （ PDT）, treatment way and fatality rate during the hospital stay were compared between two groups. Results Compared with control group, the heart rate was more rapid （ P 〈 0.05 ）, the number of patients with diabetes was more（ P 〈 0.05 ） ,the systolic pressure and diastolic pressure were lower（ P 〈 0.05 ） of the patients in observation group on admission. In observation group, the PDT was shorter（ P 〈 0.05 ）, but the thrombolysis rate was higher（P 〈 0. 05 ） than that of in control group. No statistical significance was found in the rate of percutanous coronary intervention and reperfusion treatment between two gronps（P 〉 0.05）. The in-hospital death rate in observation group tended to be higher but no significance was found between the two groups （ P 〉 0.05 ）. Diabetes history, heart rate and systolic blood pressure on admission were factors influencing ambulance use （ P 〈 0.05, P 〈 0.01 ）. Age, diabetes history and PDT were independent risk factors of in-hospital death rate of acute myocardial infarction （ P 〈 0.05, P 〈 0.01 ）. Conclusion Due to the lower rate of ambulance use and severity of patients, patients with STEMI have not benefited a lot from ambulance use. It suggests that not only the rate of ambulance use be promoted but also quicker and more effective treatment be given to these patients at higher risk.

关 键 词：心肌梗死 急救车 交通工具 

分 类 号：R542.2[医药卫生—心血管疾病]