实施区域化协同救治急性心肌梗死可行性  

Feasibility and efficacy of the regional cooperative ST-segment elevation myocardial infarction rescue network among the prefectural level city hospitals

作　　者：何如平[1] 叶健烽[1] 苏少辉[1] HE Ru -ping;YE Jian - feng;SU Shao - hui.(Department of Cardiology, Dongguan People＇s Hospital, Dongguan 523059, Guangdong, Chin)

机构地区：[1]东莞市人民医院心血管内科,广东东莞523059

出　　处：《广东医学》2018年第11期1659-1662,共4页Guangdong Medical Journal

基　　金：东莞市社会科技发展项目(编号:2015108101022)

摘　　要：目的探讨采取区域协同救治模式对急性心肌梗死(AMI)救治及预后的影响。方法选取行急诊经皮冠状动脉介入(PCI)、发病时间在12 h内的400例急性ST段抬高心肌梗死(STEMI)患者,分为采取区域协同救治模式的观察组(n=200)和采取常规救治模式的对照组(n=200)。比较两组患者多种诊疗时间、心功能、住院时间、住院费用及随访3个月主要不良心血管事件(MACE)的发生率。结果观察组左室射血分数(LVEF)明显高于对照组[(50.1±4.9)%vs(48.5±4.9)%,P<0.001];观察组左室舒张末期内径(LVEDd)低于对照组[(49.7±4.3)mm vs(51.2±3.6)mm,P<0.001]。观察组从首次医疗接触到首份心电图时间(8.3±3.5)min,从首次医疗接触到负荷量双抗给药时间(15.6±6.2)min,从首份心电图完成至首份心电图确诊时间(5.3±2.2)min,导管室激活时间(20.6±5.2)min,FMC-to-B时间(119.3±34.6)min、D-to-B时间(72.1±28.7)min,均低于对照组的(20.5±7.6)min、(28.3±8.5)min、(12.3±5.4)min、(35.3±4.6)min、(152.3±39.7)min和(108.2±28.1)min,差异有统计学意义(P<0.001)。观察组患者住院时间和住院费用分别为(7.2±1.4)d和(36 018.8±556.5)元,均低于对照组的(11.4±2.9)d和(45 119.6±666.0)元,差异有统计学意义(P<0.001)。随访3个月内,观察组发生心源性猝死6例、再发心肌梗死9例、心力衰竭18例、恶性心律失常10例,均低于对照组的15例、32例、47例、21例(P<0.05)。结论实施区域化协同救治STEMI网络可行性强,可明显缩短患者诊断及治疗时间,改善患者心功能,减少患者住院时间、费用及MACE发生率,是提升STEMI救治能力的有效方法。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） among the prefectural level city hospitals in China. Methods A total of 400 patients with STEMI,who underwent emergency percutaneous coronary intervention（ PCI） within 12 h from the onset of attack between July 2014 and July 2017 in our hospital were divided into the observation group（ n = 200） adapting regional cooperative mode therapy and the control group（ n = 200） adapting 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,hospital stay,hospitalization cost and major adverse cardiac events（ MACE）during a follow-up period of 3 months were compared between the two groups. Results Left ventricular ejection fraction（ LVEF） in observation group（ 50. 1 ± 4. 9%） was significantly higher than that in control group（ 48. 5 ± 4. 9%,P 0. 001）. Left ventricular end-diastolic diameter（ LVEDd） in the observation group was significantly lower than that in control group（ 49. 7 ± 4. 3 mm vs. 51. 2 ± 3. 6 mm,P 0. 001）. Compared with control group,first medical contact to the first electrocardiogram time（ 8. 3 ± 3. 5 min vs. 20. 5 ± 7. 6 min,P 0. 001）,from the first medical contact to the loading time of dual anti-platelet（ 15. 6 ± 6. 2 min vs. 28. 3 ± 8. 5 min,P 0. 001）,from the first electrocardiogram to the first ECG diagnosis time（ 15. 6 ± 6. 2 min vs. 28. 3 ± 8. 5 min,P 0. 001）,activation time of the catheter（ 20. 6 ±5. 2 min vs. 35. 3 ± 4. 6 min,P 0. 001）,FMC-to-B time（ 119. 3 ± 34. 6 min vs. 152. 3 ± 39. 7 min,P 0. 001）,D-to-B time（ 72. 1 ± 28. 7 min vs. 108. 2 ± 28. 1 min,P 0. 001）,hospitalization stay（ 7. 2 ± 1. 4 d vs. 11. 4 ± 2. 9 d,P 0. 001） and costs（ 36 018. 8 ± 556. 5 RMB vs. 45 119. 6 ± 666. 0 RMB,P 0. 001） in observation grou

关 键 词：区域协同救治模式 心肌梗死 急救医疗服务 诊断时间 治疗 

分 类 号：R542.22[医药卫生—心血管疾病]