建立规范化胸痛中心对直接经皮冠状动脉介入治疗患者进门-球囊扩张时间及预后的影响  

Impacts of establishment of chest pain center on the door-to-balloon time and the short-term outcome after primary percutaneous coronary intervention of patients with ST segment elevated myocardial infarction

作　　者：向定成[1] 段天兵[1] 秦伟毅[1] 罗望胜[1] 张金霞[1] 易绍东[1] 阮云军[1] 肖华[1] 

机构地区：[1]广州军区广州总医院心血管内科,510010

出　　处：《中华心血管病杂志》2013年第7期568-571,共4页Chinese Journal of Cardiology

基　　金：基金项目：广州市科技计划专项（穗科信字2011-179号,2012J4300107）;广东省科技计划重点项目（2011A011304002）;广东省科技计划重大项目（2012A080104020）

摘　　要：目的探讨规范化胸痛中心模式对急性sT段抬高型心肌梗死（STEMI）患者直接经皮冠状动脉介入治疗（PPCI）的进门至球囊扩张（D—to-B）时间和预后的影响。方法通过院前传输12导联心电图作为院前诊断STEMI的技术手段建立规范化胸痛中心，使PPCI患者实现绕行急诊室方案直达导管室。以胸痛中心建立前1年接受PPCI的STEMI患者作为A组（93例），胸痛中心建立后1年接受PPCI的STEMI患者作为B组（149例），比较两组的D—to-B时间、住院病死率、心力衰竭发生率、住院时间和校正的人均住院费用。结果B组年平均D—to—B时间显著短于A组[（72-i-23）min比（127±79）min，P〈0．01]；最短月平均D—to-B时间亦显著短于A组[（56±11）min比（73±14）min，P〈0．01]；年D—to—B时间达标率A组和B组分别为62．4％（58／93）和91．9％（137／149）（P〈0．05）；住院病死率A组和B组分别为6．5％（6／93）和3．4％（5／149）（P〉0．05）；住院期间心力衰竭发生率A组和B组分别为24．7％（23／93）和14．1％（21／149）（P〈0．05）；住院时间A组和B组分别为（8．98±4．89）d和（7．79±5．43）d（P〉0．05）；B组校正的人均住院费用比A组低9．4％（P〈0．05）。结论规范化胸痛中心模式可以显著缩短STEMI患者PPCI的D—to—B时间、改善预后并节省住院费用。Objective To investigate the impact of the establishment of chest pain center （ CPC ） model based on the pre-hospital real-time tele-12-1ead electrocardiogram on the door-to-balloon （D-to-B） time and short-term outcome after primary percutaneous coronary intervention （PPCI） of patients with ST- segment elevated myocardial infarction （STEMI）. Methods A regular CPC was established with pre- hospital transmitted real-time 12-lead electrocardiogram system for pre-hospital diagnosis of STEMI and enabled the STEMI patients to bypass the emergency room and directly treated in the catheter lab to shorten the D-to-B time. The mean D-to-B time, the short-term outcome and medical costs were compared in PPCI patients before （93 cases, group A） and after （ 149 cases, group B） the establishment of CPC. Results After the establishment of CPC, the annual mean D-to-B time was significantly shortened [ （127 ± 79） min in group A vs. （ 72 ± 23 ） min in group B, P 〈 0.01 ] , the shortest monthly mean D-to-B time was remarkably reduced in group B than in group A [ （56 ± 11 ） min vs. （73 ± 14） min, P 〈 0. 01 ]. The annual ratio of D-to-B below 90 minutes was significantly increased from 62.4% （58/93） in group A to 91.9% （137/149） in group B （P 〈0. 05）. The in-hospital mortality rate tended to be lower and the incidence of heart failure during hospitalization was significantly reduced in group B compared with group A [ 3.4% （5/149） vs. 6.5%（6/93）, P〉0.05; 14. 1%（21/149） vs. 24.7% （23/93）,P 〈0.05].The length ofhospital stay was slightly shortened from （8. 98 ± 4. 89） days to （7.79 ± 5.43 ） days （P 〉 0. 05 ）. Corrected mean medical cost went down by 9.4% （ P 〈 0. 05 ） . Conclusion The establishment of CPC may significantly shorten the D-to-B time, improve the short-term outcome and reduce the hospitalization cost for PPCI patients with STEMI.

关 键 词：心肌梗死 血管成形术 经腔 经皮冠状动脉 医师诊疗模式 

分 类 号：R542.22[医药卫生—心血管疾病]