区域协同救治模式对急性ST段抬高型心肌梗死治疗的影响  

Impact of new regional cooperative rescue model on first medical contact to balloon time and outcome in patients with ST-elevation myocardial infarction

作　　者：杨宁[1] 司定然[1] 王恒亮[1] 任付先[1] 商惠萍[1] 

机构地区：[1]河南省濮阳市油田总医院心血管内科,457001

出　　处：《国际心血管病杂志》2015年第5期356-359,共4页International Journal of Cardiovascular Disease

摘　　要：目的:探讨区域协同救治模式对急性ST段抬高型心肌梗死(STEMI)治疗及预后的影响。方法:选取2011年8月至2014年10月在我院行急诊经皮冠状动脉介入(PCI)、非本院首诊、发病时间在24 h内的360例急性STEMI患者,分为采取区域协同救治模式的研究组(n=200)和采取常规模式的对照组(n=160)。比较两组患者首次医疗接触至球囊扩张(FMC-to-B)时间、进门至球囊扩张(D-to-B)时间、心功能、平均住院日、住院费用及随访6个月主要不良心血管事件(MACE)的发生率。结果:研究组左室射血分数(LVEF)明显高于对照组(54.8%±8.5%对48.5%±7.9%,P<0.05);研究组左室舒张末期内径(LVEDd)低于对照组[(47.5±4.8)mm对(51.4±5.6)mm,P<0.05];研究组FMC-to-B、D-to-B时间分别为(118.3±45.6)min和(74.5±33.4)min,均低于对照组的(145.6±61.5)min和(110.8±40.9)min(P均<0.05);研究组患者住院时间和住院费用分别为(7.0±2.5)d和(46 856±1 395)元,均低于对照组的(11.6±4.5)d和(53 562±1 455)元(P均<0.05);随访6个月内,研究组发生心源性猝死4例、再发心肌梗死8例,均低于对照组的10例和21例(P均<0.05)。结论:区域协同救治模式可缩短FMC-to-B及D-to-B时间,改善患者心功能,减少患者住院时间、住院费用及MACE,可有效提高区域内STEMI救治水平。Objective：To explore the impact of new regional cooperative rescue model on first medical contact to balloon time and outcome in patients with ST-elevation myocardial infarction（STEMI）. Methods：A total of 360 patients with STEMI,who underwent emergency percutaneous coronary intervention（PCI）within 24 hfrom the onset of attack between August 2011 and October 2014 in our hospital were divided into the observation group（n=200）adopting regional cooperative mode therapy and the control group（n=160）adopting non-regional cooperative mode therapy.First medical contact to balloon dilatation（FMC-to-B）time,the door to balloon dilatation（D-to-B）time,heart function,average length of stay,hospitalization cost and major adverse cardiac events（MACE）during a follow-up period of 6months were compared between the two groups. Results：Left ventricular ejection fraction（LVEF）in observation group（54.8%±8.5%）was higher than that in control group（48.5%±7.9%）（P0.05）;left ventricular end-diastolic diameter（LVEDd）in the observation group was lower than that in control group[（47.5±4.8）mm vs.（51.4±5.6）mm,P0.05].Compared with control group,FMC-to-B time[（118.3±45.6）min vs.（145.6±61.5）min],D-to-B time[（74.5±33.4）minvs.（110.8±40.9）min],hospitalization time[（7.0±2.5）d vs.（11.6±4.5）d]and costs[（53 562±1 455）yuan vs.（53 562±1 455）yuan]in observation group were all lower（all P0.05）.During six months of follow-up,4cases of sudden cardiac death,8cases of myocardial infarction recurrence were observed in observation group;while 10 cases of sudden cardiac death,21 cases of myocardial infarction recurrence were observed in control group（all P0.05）. Conclusion：New regional cooperative mode therapy can significantly shorten FMC-to-B and D-to-B time,improve cardiac function and reduce hospitalization time,costs and MACE.

关 键 词：区域协同 心肌梗死 急救医疗服务 血管成形术 

分 类 号：R542.22[医药卫生—心血管疾病]