急救干预对急性ST段抬高型心肌梗死预后的影响  

Effect of first aid intervention on prognosis of patients with acute ST segment elevation myocardial infarction

作　　者：梁磊[1] 张彬[1] 李萍[1] 蒋文彬[1] 崔美平[1] 姜先雁[1] 常瑜[1] 王松涛[1] 

机构地区：[1]青岛阜外心血管病医院心脏中心,山东青岛266034

出　　处：《内科理论与实践》2016年第1期24-27,共4页Journal of Internal Medicine Concepts & Practice

摘　　要：目的 :探讨急救干预对ST段抬高型急性心肌梗死(AMI)预后的影响。方法 :选取经我院急诊120确诊为ST段抬高型AMI患者58例为急救组,同期自行入院确诊ST段抬高型AMI患者74例为自救组。观察2组患者间首次医疗接触(FMC)时间、发病-再灌注时间、急诊经皮冠状动脉介入治疗(PCI)及溶栓治疗的比例,住院期间血管再通率、治愈率、并发症、死亡及住院天数。随访观察1、3和6个月时2组患者心绞痛症状、射血分数(EF)、心功能不全、心律失常、再发心肌梗死、心源性休克、死亡发生率等。结果:急救组的FMC时间(19.54±8.66)min,发病-再灌注时间(113.27±10.16)min,均低于自救组[分别为(50.85±11.46)、(135.69±12.25)min,均P<0.05)];急诊PCI比例为29.3%,高于自救组的13.5%(P<0.05);急救组溶栓的比例(20.7%)与自救组(24.3%)无显著差异;急救组血管再通率及治愈率分别为77.6%和81.0%,均高于自救组60.8%和59.5%(均P<0.05);急救组住院期间并发症发生率为25.9%,平均住院日为(18±9)d,均低于自救组48.7%和(32±16)d(均P<0.05)。随访期间,1个月内心血管事件及病死率均无显著性差异。3个月心功能不全发生率、心律失常发生率急救组低于自救组(均P<0.05);而其他方面无统计学差异。6个月时心功能不全、心律失常、再发心肌梗死发生率、心源性休克发生率急救组低于自救组(均P<0.05),而在其他方面无统计学差异。结论:急救干预能够降低AMI患者并发症的发生及病死率,改善预后。Objective To study the effect of emergency intervention on the prognosis of acute ST segment elevation myocardial infarction. Methods Fifty eight patients who were diagnosed with ST segment elevation acute myocardial infarction（AMI） and transported by our hospital ambulance were categorized as the first aid group, and 74 cases who were diagnosed with ST segment elevation AMI and went to the hospital by themselves as the self-help group. The time of first medical contact（FMC）, onset to reperfusion time, ratio of emergency percutaneous coronary intervention（PCI）,ratio of thrombolytic therapy,recanalization rate of coronary artery,cure rate, complications, death and days of hospitalization were observed and compared between the two groups. Patients were followed up for 1 month, 3 months,6 months, and symptoms of angina, value of ejection fraction（EF）, heart function insufficiency, arrhythmia, recurrence of AMI, cardiogenic shock and mortality were observed and compared between the two groups. Results The time of FMC[（19.54±8.66） min] and onset-reperfusion time [（113.27±10.16） min] in first aid group were lower than that in self-help group [（50.85 ±11.46）,（135.69 ±12.25） min, respectively, P〈0.05]; PCI ratio（29.3%） in first aid group was higher than that in self-help group（13.5%, P0.05）; rate of thrombolysis in first aid group（20.7%） was not significantly different with self-help group（24.3%）; recanalization rate of coronary artery（77.6%） and cure rate（81.0%） in first aid group were higher than that in self-help group（60.8% and 59.5%, P〈0.05）; complication rate（25.9%） and average hospitalization day [（18±9） d] were lower than that in self-help group[48.7% and（32 ±16） d, P0.05]. During follow-up,there were no significant differences in cardiovascular events and mortality in the first month. At 3 month, the rate of heart failure and arrhythmia in first aid group were lower than that in self-help group（P〈0.05）; the others had no sign

关 键 词：急性心肌梗死 ST段抬高 急救 急救延误 预后 

分 类 号：R542.22[医药卫生—心血管疾病]