急性ST段抬高型心梗患者直接冠状动脉介入救治时间布局分析  

Time layout for primary percutaneous coronary intervention in patients with acute ST elevated myocardial infarction

作　　者：王守力[1] 赵蓓[1] 刘佩林[1] 冯雪瑶[1] 刘莉[1] 赵京涛[1] 刘利峰[1] 刘瑛琪[1] 宋洪勇[1] 毛帅[1] 周莉[1] 夏会会 

机构地区：[1]解放军306医院心内科,北京100101

出　　处：《解放军医学杂志》2015年第3期231-235,共5页Medical Journal of Chinese People's Liberation Army

摘　　要：目的分析急性ST段抬高心肌梗死(STEMI)并接受直接冠状动脉介入(PCI)治疗的患者从症状发作至再灌注治疗各个环节的时间分布。方法本研究为单中心现况调查。纳入2013年1月-2014年7月解放军306医院连续急诊收住入院且发病小于12h的STEMI患者211例。按照患者发病-治疗顺序分别记录以下时间:发病-呼叫急救车-急救车到达现场-医院急诊-同意手术签字-进入导管室-首次球囊扩张,并与新指南对照,分析原因。结果 150例(71%)患者通过急救车转运至医院,61例(29%)患者为自行转院。入门-球囊(DTB时间)的中位值为105min,与指南对照,DTB时间未达标(应<90min)。此外,在整个救治时间中,发病-呼叫急救车的中位时间(62min)以及急诊-同意手术签字的中位时间(50min)须要缩短。结论患者自身的延迟是院前延迟的主要原因,获取知情同意时间过长严重影响患者及时治疗,主要原因是患者对急性心梗及再灌注治疗的重要性认知不足。Objective To analyze the treatment time layout in different phases and related factors in patients with acute ST elevated myocardial infarction （STEMI） undergoing primary percutaneous coronary intervention （PCI）. Methods The study was a cross-sectional and single center registry. Data of 211 patients with STEMI admitted within 12 hours of onset to the Emergency Department of the 306 Hospital of PLA between January 1, 2013 and July 31, 2014 were collected. The following median times were recorded and compared with that in 2013 ACC/AHA guideline： symptom onset-summoning the ambulance services- ambulance arrival-ambulance arriving at emergency department （ED）-consent to primary PCI-arriving at catheterization laboratory- first balloon dilatation. Results Of the 211 patients with STEMI, 150 （71%） were transported to the 306 Hospital of PLA by ambulance, and the remaining 61 （29%） arrived at hospital by themselves. Through it all 3 time slots delayed： the median time of door to balloon （DTB） was 105min, did not reach the standard according to 2013 ACC/AHA guideline （〈90min）; from symptom onset to summoning an ambulance was 62min, and from arriving at the hospital to consent to primary PCI was 50min. Conclusions The patient＇s own delay is the main cause of pre-hospital delay, the time of obtaining an informed consent plays an important role in treatment delay. Many patients are not aware of the importance for early reperfusion therapy.

关 键 词：心肌梗死 血管成形术 气囊 冠状动脉 时间 入门-球囊时间 

分 类 号：R542.22[医药卫生—心血管疾病]