无锡地区急性ST段抬高型心肌梗死治疗现状调查——一项多中心调查研究报告  

Therapeutic status of patients with acute ST-segment elevation myocardial infarction in Wuxi City,China——a multicenter research

作　　者：王强[1] 郭素峡[1] 羊镇宇[1] 吴丁烨[1] 杨承健[2] 陶以嘉[3] 陈风[4] 苏伟[5] 郑若龙[6] 杨松 李旭东 陈景开 

机构地区：[1]无锡市人民医院心内科,江苏无锡214023 [2]无锡市第二人民医院心内科,江苏无锡214000 [3]无锡市第三人民医院心内科,江苏无锡214000 [4]无锡市第四人民医院心内科,江苏无锡214000 [5]无锡市中医院心内科,江苏无锡214000 [6]无锡市江阴人民医院心内科,江苏无锡214000 [7]无锡市宜兴人民医院心内科,江苏无锡214000 [8]无锡市锡山人民医院心内科,江苏无锡214000 [9]无锡市101医院心内科,江苏无锡214000

出　　处：《岭南心血管病杂志》2014年第4期442-447,共6页South China Journal of Cardiovascular Diseases

摘　　要：目的 分析中国江苏省无锡地区急性ST段抬高型心肌梗死（ST-segment elevation myocardial infarction, STEMI）患者的基线特征及治疗现状.方法 2011年1月至2012年12月我们通过网络直报,入选无锡九家医院STEMI患者共1 410例,分析其基线特征及治疗现状.结果 院内发生患者诊治延迟时间（发病至就诊、发病至第一份心电图、发病至接受专科治疗时间）耗时最少,其次为呼叫“120”急救车入院患者,自行入院者耗时最多.“120”急救车入院患者发病至溶栓时间、就诊至溶栓时间短于自行入院患者.在直接经皮冠状动脉介入（percutaneous coronary intervention,PCI）治疗患者中,“120”急救车入院患者发病至球囊扩张时间、就诊至球囊扩张时间短于自行入院患者.在再灌注治疗患者中,就诊至溶栓、就诊至球囊扩张、发病至溶栓,发病至球囊扩张时间均短于自行入院患者.发病至就诊时间＜3 h组、3～6 h组、6～12 h组和≥12 h组的院内全因病死率（4.23％ vs.10.54％vs.18.67％vs.23.67％,x2=83.372,P＜0.01）和主要心血管事件发生率（4.47％ vs.13.24％ vs.18.98％ vs.34.63％,x2=116.325,P＜0.01）比较,差异有统计学意义.直接PCI治疗组、溶栓组及早期药物保守治疗组的院内全因病死率（1.50％ vs.10.00％ vs.18.20％,x2=50.896,P＜0.01）和主要心血管事件发生率（5.76％ vs.12.27％vs.20.86％,x239.934,P＜0.01）比较,差异有统计学意义.结论 无锡地区急性STEMI患者合并原发性高血压（高血压）最多;药物治疗基本规范化;再灌注治疗（PCI治疗和静脉溶栓）患者比例偏低;就诊后30 min内溶栓,90 min内球囊扩张患者比例偏低.PCI治疗院内全因病死率和主要心血管事件发生率最低,溶栓其次,早期保守治疗最高.院内发病患者的院前延迟时间最短,“120”急救车入院患者其次,自行入院患者最长.就诊时间延迟大于12 h后就诊,院内病死率和主要心血管Objectives To study the characteristics and therapies of patients with acute ST-segment elevation myocardial infarction （STEMI） in Wuxi,China.Methods Through network,we analyzed the baseline characteristics and therapies of 1 410 patients with STEMI admitted to the nine designated hospitals in Wuxi from January 2011 to December 2012.Results The onset-to-door time,onset-to-first electrocardiogram time and onset-to-specialized treatment time were the shortest in patients found STEMI in hospital,longer in patients admitted by 120 ambulances,and the longest in patients admitted by themselves.The onset-to-thrombolysis time and door-to-thrombolysis time in patients admitted by 120 ambulances were shorter than those in patients admitted by themselves.Among patients receiving percutaneous coronary intervention （PCI）,the onset-to-balloon dilatation time and door-to-balloon dilatation time in patients admitted by 120 ambulances were shorter than those in patients admitted by themselves.Among patients receiving reperfusion,the onsetto thrombolysis time,door-to-thrombolysis time,onset-to-balloon dilatation time and door-to-balloon dilatation time in patients admitted by 120 ambulances were shorter than those in patients admitted by themselves.In-hospital all-cause mortality and incidence of major adverse cardiovascular events （MACE） were significantly different among different onsetto-door time groups （〈3 h group vs.3-6 h group vs.6-12 h group vs.≥ 12 h group：4.23% vs.10.54% vs.18.67% vs.23.67%,x2=83.372,P〈0.01 ; 4.47% vs.13.24% vs.18.98% vs.34.63%,x2=116.325,P〈0.01）.In-hospital all-cause mortality and incidence of MACE among primary PCI group,thrombolysis group and early conservative treatment group were obviously different （1.50% vs.10.00% vs.18.20%,x2=50.896,P〈0.01; 5.76% vs.12.27% vs.20.86%,x2=39.934,P〈0.01）.Conclusions Patients with acute STEMI combined hypertension are most common in Wuxi,China.Drug treatments of STEMI have been canonically given according to the guide.A lower proporti

关 键 词：心肌梗死 再灌注治疗 延迟治疗时间 院内全因病死率 主要心血管事件 

分 类 号：R542.2[医药卫生—心血管疾病]