河南省不同级别医院急性ST段抬高型心肌梗死患者早期再灌注治疗现状调查  

Survey on the early reperfusion therapy status in patients with ST-segment elevation myocardial infarction hospitalized in tertiary and secondary hospitals in Henan province

作　　者：张优[1,2,3] 高传玉[2,3] 段广才[1] 刘馨允 张华[2,3] 张彩丽[2,3] 胡大一[4] 

机构地区：[1]郑州大学公共卫生学院流行病学教研室,450001 [2]河南省人民医院 [3]郑州大学人民医院心内科 [4]北京大学人民医院心脏中心

出　　处：《中华心血管病杂志》2015年第10期858-862,共5页Chinese Journal of Cardiology

基　　金：河南省科技厅重点攻关项目（132102310080）

摘　　要：目的 了解河南省不同级别医院急性ST段抬高型心肌梗死（STEMI）患者的早期再灌注治疗现状.方法 采用统一调查表,对2011年6月至2012年6月河南省17家医院（8家三级医院,9家二级医院）的STEMI患者进行登记,收集基线资料、早期再灌注治疗情况和住院病死率等资料.结果 共入选1 686例STEMI患者,其中886例患者来自三级医院,800例患者来自二级医院.654例患者接受早期再灌注治疗,其中83.0％（543/654）患者接受溶栓治疗,17.0％（111/654）患者接受直接经皮冠状动脉介入治疗（PCI）.三级和二级医院STEMI患者的早期再灌注比例差异无统计学意义[40.1％ （355/886）比37.4％ （299/800）,P=0.257].发病-接诊、入门-溶栓和入门-球囊扩张时间中位数分别为132、18和60 min.三级医院STEMI患者的发病-接诊（150 min比120 min,P=0.001）、入门-溶栓（30 min比18 min,P=0.003）及发病-溶栓（3.5h比2.7h,P=0.001）时间中位数均长于二级医院,而不同级别医院患者的入门-球囊扩张、发病-直接PCI和发病-择期PCI时间差异均无统计学意义（P均＞ 0.05）.三级医院入门-溶栓时间≤30 min的比例低于二级医院[46.4％（84/181）比62.2％ （153/246）,P=0.001],两者入门-球囊扩张时间≤90 min的比例差异无统计学意义[58.8％ （60/102）比57.1％ （4/7）,P=1.000].三级和二级医院STEMI患者的住院病死率差异无统计学意义[5.8％ （51/886）比5.5％ （44/800）,P=0.820].结论 河南省STEMI住院患者早期再灌注比例较低,溶栓是主要的早期再灌注方式;三级医院没有发挥其介入治疗的优势;二、三级医院在早期再灌注治疗上有很大的提高空间.Objective To observe the early reperfusion therapy status for patients with ST elevation acute myocardial infarction （STEMI） hospitalized in tertiary and secondary hospitals in Henan province.Methods Baseline data, early reperfusion treatment and in-hospital mortality of STEMI patients hospitalized in 17 hospitals in Henan province （8 tertiary hospitals, 9 secondary hospitals） from June 2011 to June 2012 were obtained using a uniformed questionnaire.Results One thousand six hundred and eighty six patients were enrolled, of which 886 patients were hospitalized in tertiary hospitals and 880 patients were early hospitalized in secondary hospitals.Six hundred and fifty four patients （38.8%, 654/1 686） underwent early reperfusion therapy （543 with thrombolysis and 111 with primary percutaneous coronary intervention （PCI））.There was no difference in the proportion of early reperfusion therapy between tertiary and secondary hospitals （40.1% （355/886） vs.37.4% （299/800）, P =0.257）.The median time from symptom onset to first medical contact, door-to-needle and door-to-balloon was 132 min, 18 min and 60 min, respectively.The median time from symptom onset to first medical contact （150 min vs.120 min, P =0.001）, door-to-needle （30 min vs.18 min, P =0.003） and symptom onset-to-thrombolysis （3.5 h vs.2.7 h, P =0.001） were significantly longer in tertiary hospitals than in secondary hospitals.No difference was found in median time of door-to-balloon, symptom onset-to-primary PCI or symptom onset-to-elected PCI between tertiary and secondary hospitals （all P 〉0.05）.The proportion of door-to-needle≤30 min was lower in tertiary hospitals than in secondary hospitals （46.4% （84/181） vs.62.2% （153/246）, P =0.001）.However, there was no difference in the proportion of door-to-balloon ≤90 min between tertiary and secondary hospitals （58.8% （60/102） vs.57.1% （4/7）, P =1.000）.In-hospital mortality was also similar between tertiary and secondary hospitals （5.8

关 键 词：心肌梗死 心肌再灌注 数据收集 

分 类 号：R542.22[医药卫生—心血管疾病]