急性心肌梗死介入治疗术的急诊临床路径优化与效果评价  

High-quality of emergency clinical pathway and therapeutic effect evaluation for PCI in AMI patients

作　　者：王子超[1] 刘静 郝毅[1] 张文祥[1] 李延红[1] 孙刚[1] 

机构地区：[1]包头医学院第二附属医院急救中心,内蒙古包头014030

出　　处：《心血管康复医学杂志》2017年第5期511-515,共5页Chinese Journal of Cardiovascular Rehabilitation Medicine

基　　金：2015年度包头市医药卫生科技计划项目(BK2015001)~~

摘　　要：目的:探讨急性ST段抬高性心肌梗死(STEAMI)患者冠脉介入治疗术(PCI)的急诊临床路径优化并系统评价其临床效果。方法:入选2008年3月至2016年9月间成功实施急诊PCI术的627例STEAMI患者,根据入院顺序分为传统路径组(298例)和优化路径组(329例,接受本研究制定的新临床路径策略)。统计分析两组梗死相关血管(IRA)再灌注时间和水平、术后死亡率、出院时的健康调查简表(SF-36)评分、术后1个月的NYHA分级和左室射血分数(LVEF)。结果:与传统路径组比较,优化路径组院内门-球囊时间[(86.3±22.4)min比(65.9±17.8)min]、发病-球囊时间[(189.5±30.2)min比(154.6±27.2)min]显著缩短,IRA的PCI术前TIMI≥I级比例(5.0%比25.5%)显著较高(P均<0.01),而术后两组TIM I III级的IRA比例无显著差异(P=0.393)。与传统路径组比较,优化路径组出院时SF-36总分[(66.1±11.2)分比(75.9±12.8)分]和术后1个月LVEF[(49.3±11.2)%比(54.1±13.6)%]显著升高,术后1个月NYHA分级[(1.97±0.65)级比(1.68±0.51)级]显著降低(P<0.05或<0.01),而两组术后死亡率无显著差异(P=0.803)。结论:急性ST段抬高性心肌梗死介入治疗术的急诊临床路径优化有助于梗死相关血管的早期再灌注及缩短门-球囊时间,显著改善其临床预后,值得推广。Objective：To explore high-quality of emergency clinical pathway of percutaneous coronary intervention （PCI）in patients with acute ST elevation myocardial infarction （STEAMI）,and systematically evaluate its clinical effect.Methods：A total of 627 STEAMI patients,who received successful emergency PCI from Mar 2008 to Sep 2016,were selected.According to hospitalization sequence,they were divided into traditional pathway group （n=298）and high-quality pathway group （n=329,received new clinical pathway strategy formulated by present study）. Reperfusion time and level of infarct related artery （IRA）,postoperative mortality,the 36-item short-form heath survey （SF-36）score at discharge,NYHA class and left ventricular ejection fraction （LVEF）on one month after PCI were counted and analyzed in two groups.Results：Compared with traditional pathway group,there were signif-icant reductions in door-to-balloon time [（86.3 ± 22.4）min vs.（65.9 ± 17.8）min]and onset-to-balloon time [（189.5±30.2）min vs.（154.6±27.2）min],and significant rise in percentage of TIMI ≥grade I of IRA before PCI （5.0% vs.25.5%）in high-quality pathway group （P 〈0.01 all）,but there was no significant difference in per-centage of TIMI grade III of IRA after PCI between two groups,P =0.393. Compared with traditional pathway group,there were significant rise in total SF-36 score [（66.1±11.2）scores vs.（75.9±12.8）scores]at discharge and LVEF [（49.3±11.2）% vs.（54.1 ±13.6）%]on one month after PCI,and significant reduction in NYHA class [（1.97±0.65）classes vs.（1.68±0.51）classes]on one month after PCI in high-quality pathway group （P 〈0.05 or 〈0.01 ）.There was no significant difference in postoperative mortality between two groups,P =0.803. Conclusion：High-quality emergency clinical pathway of PCI in STEAMI patients contributes to early reperfusion of IRA,shortens door-to-balloon time,significantly improves their clinical prognosis,which is worth extending.

关 键 词：心肌梗死 临床路径 急诊医疗服务 

分 类 号：R542.22[医药卫生—心血管疾病]