“急救车-导管室”模式对急性心肌梗死患者开通血管时间和左室功能的影响  

Influences of mode of ambulance-catheter room on vascular-opening time and left ventricular ejection fraction in patients with acute myocardial infarction

作　　者：裘毅钢[1] 李田昌[1] 陈宇[1] 李贤峰[1] 曹毅[1] 田海涛[1] 王志国[1] 李东韬[1] 

机构地区：[1]海军总医院心脏中心,北京100048

出　　处：《中国循证心血管医学杂志》2015年第1期76-79,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的探讨"急救车-导管室"模式对急性ST段抬高型心肌梗死(STEMI)患者入门-球囊扩张时间与左室功能的影响。方法选择2011年1月至2013年12月海军总医院心脏中心行急诊经皮冠状动脉介入(PCI)治疗并完成3个月随访的STEMI患者416例,按照患者进入导管室的模式分为"急救车-导管室"组和"急救车-急诊科-导管室"两组,记录两组患者靶血管病变、心功能Killip分级,比较两组患者开通血管时间、入院和PCI术后3个月左室射血分数(LVEF)及变化值。结果两组患者间基线情况、靶血管病变、心功能killip分级等无统计学差异(P>0.05);两组症状发作-医院就诊时间无统计学差异(P>0.05),"急救车-导管室"组在平均入门-球囊扩张时间[(44.3±11.8)min vs.(82.9±12.6)min]和症状发作-开通血管时间[(511.8±219.9)min vs.(558.6±245.6)min]均低于对照组,且存在统计学差异(P<0.05)。两组患者入院时LVEF相似,但在PCI术后3个月随访时,"急救车-导管室"组在LVEF及LVEF增加值均高于对照组(P<0.05)。结论 "急救车-导管室"模式可缩短STEMI患者急诊PCI入门-球囊扩张时间、症状发作-开通血管时间及改善术后3个月时左心室功能。Objective To discuss the influences of mode of ambulance-catheter room on door-to-balloon time （DBT） and left ventricular ejection fraction （LVEF） in patients with acute ST-segment elevation myocardial infarction （STEMI）. Methods STEMI patients （n=416） with emergency percutaneous coronary intervention （PCI） and 3-month follow-up were chosen from Jan. 2011 to Dee. 2013, and divided into ambulance-catheter room group （group 1） and ambulance-emergency department-catheter room group （group 2）. The target vascular lesion and Killip grading were recorded, and vascular-opening time and changes of LVEF at hospitalization time and 3 m after PCI were compared in 2 groups. Results The baseline, target vascular lesion and Killip grading had no statistical difference （P〉0.05）, and duration of symptom attack-hospitalization had no statistical difference （P〉0.05） between 2 groups. The mean DBT [（44.3 ±11.8） min vs. （82.9± 12.6） min] and symptom attack-vascular-opening time [（511.8 ± 219.9） rain vs. （558.6 ± 245.6） min] were higher in group 1 than those in group 2 （P〈0.05）. LVEF was similar in 2 groups at hospitalization time, but after PCI for 3 m, LVEF and added value of LVEF were higher in group 1 than those in group 2 （P〈0.05）. Conclusion The mode of ambulance-catheter room can shorten DBT and symptom attack-vascular-opening time, and improve left heart function 3 m after PCI in STEMI patients with emergency PCI.

关 键 词：急性心肌梗死 经皮冠状动脉介入治疗 入门-球囊扩张时间 左室射血分数 

分 类 号：R541.4[医药卫生—心血管疾病]