影响ST段抬高心肌梗死患者再灌注决定延迟的因素  

Factors associated with delay of reperfusion-decision for patients with ST-segment elevation myocardial infarction

作　　者：宋莉[1] 颜红兵[1] 杨进刚[3] 孙艺红[4] 刘书山[5] 李超[5] 胡大一[4] 无 

机构地区：[1]首都医科大学附属北京安贞医院28病区,100029 [2]代表心肌梗死紧急救治系统研究协作组 [3]中国医院科学院阜外心血管病医院 [4]北京大学人民医院心脏中心 [5]首都医科大学附属北京同仁医院心血管中心

出　　处：《中华心血管病杂志》2010年第4期301-305,共5页Chinese Journal of Cardiology

基　　金：首都紧急医学救援（5分钟）科技工程建设研究项目[京科技发（2005）593]

摘　　要：目的调查急性ST段抬高心肌梗死（STEMI）患者的再灌注决定延迟程度并分析其影响因素。方法本研究为多中心现况调查。入选2006年1月1日至12月31日期间就诊于北京市19所医院并接受心肌再灌注治疗的635例急性STEMI患者。入院1周内，通过与患者进行结构式访谈及查阅病例记录收集资料。再灌注决定延迟定义为院内完成首份心电图至患者或家属签署治疗同意书的时间间隔。根据再灌注决定延迟时间分为早决定组（≤30min）和晚决定组（〉30min），采用单因素和多因素分析识别影响再灌注决定延迟的相关因素。结果接受溶栓者129例（20．3％），接受直接PCI者506例（79．7％）。中位再灌注决定延迟时间为47min，中位进门-溶栓时间为82min．中位进门-球囊扩张时间为135min。多元logistic回归分析显示，了解再灌注治疗（OR=1．723，95％CI：1．156～3．212，P=0．040）、有院前心电图（OR=1．566，95％CI：1．018—2．409，P=0．036）、入院时心功能Killip分级1〉2（OR=1．579，95％CI：1．00d～2．483，P=0．021）以及就诊于心血管专科医院（OR=5．075，95％CI：1．380～18．655，P：0．014）是再灌注决定延迟≤30min的独立预测因素。早决定组的中位进门一溶栓时间（47min比103min，P〈0．001）和中位进门．球囊扩张时间（100min比154min，P〈0．001）明显短于晚决定组。结论STEMI的再灌注决定延迟时间偏长，是院内延迟的主要部分。普及再灌注治疗知识以及通过救护车转运增加院前心电图完成率可能缩短院内延迟。Objective To determine lengths and factors associated with delay of reperfusiondecision in patients with acute ST-segment elevation myocardial infarction （STEMI）. Methods This crosssectional and multicenter survey was conducted in 19 hospitals from Beijing between 1 January and 31 December, 2006 and included STEMI patients receiving thrombolysis or primary percutaneous coronary intervention （PCI）. Data were collected by structured interviews and medical records review within 1 week after admission. Reperfusion-decision delay was defined as time interval from the initial ECG after admission to sign of the thrombolysis or operation approval. Patients were categorized into an early decision group and a late decision group based on the 30 min cut-off time. Results Of the 635 STEMI patients interviewed, 129 （20. 3% ） received thrombolysis, and the remaining 506 （79. 7% ） received primary PCI. The median reperfusion-decision delay was 47 rain. The median door-to-needle time was 82 rain, and the median door-to- balloon time was 135 min. Multivariate logistic analysis showed that awareness of the time-dependent nature of reperfusion therapy （ OR = 1. 723,95% CI： 1. 156-3. 212, P = 0. 040） , pre-hospital electrocardiogram （ OR = 1. 566,95% CI： 1. 018-2. 409, P = 0. 036）, cardiac function of Killip ≥2 at admission （ OR = 1. 579, 95% CI： 1. 004-2. 483 ,P = 0. 021 ） and presenting to cardiovascular specialty hospital （ OR = 5. 075,95% CI：1. 380-18. 655,P = 0. 014）were independent predictors early reperfusion-decision delay. Patients in early decision group had significantly shorter median door-to-needle （47 vs. 103 min, P 〈 0. 001 ） and door-to- balloon （ 100 vs. 154 min, P 〈 0. 001 ） times compared to patients in late decision group. Conclusions The main reason of the in-hospital delay of reperfusion therapy of STEMI patients is reperfusion-decision delay. New public health strategies should be developed to educate patients and their family members to increase their awar

关 键 词：心肌梗死 心肌再灌注 流行病因素 

分 类 号：R542.22[医药卫生—心血管疾病]