胸痛中心模式对急性ST段抬高型心肌梗死治疗方式及近期预后的影响  

The influence of chest pain center protocol on the treatment and prognosis in patients with acute ST-segment elevation myocardial infarction

作　　者：张邦滢 刘莲莲[1] 李广平[1] 车京津[1] 张晓伟[1] 袁如玉[1] ZHANG Bang-ying;LIU Lian-lian;LI Guang-ping;CHE Jing-jin;ZHANG Xiao-wei;YUAN Ru-yu(Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease,Department of Cardiology,the Second Hospital of Tianjin Medical University,Tianjin Institute of Cardiology,Tianjin 300211,China)

机构地区：[1]天津市心血管病离子与分子机能重点实验室天津医科大学第二医院心脏科天津心脏病学研究所,天津300211

出　　处：《中国介入心脏病学杂志》2018年第9期528-534,共7页Chinese Journal of Interventional Cardiology

摘　　要：目的探讨胸痛中心模式对急性ST段抬高型心肌梗死(STEMI)治疗手段及近期预后的影响。方法建立胸痛中心并运用相应的管理制度和救治流程后比较胸痛中心建立前后的救治现状。选取就诊于天津医科大学第二医院的STEMI患者800例,根据胸痛中心成立前后的不同阶段分组,胸痛中心成立前(2014年7月1日–12月31日)作为A组(162例);胸痛中心筹建期(2015年7月1日–12月31日)作为B组(173例);胸痛中心试运行期(2016年1月1日–2016年6月30日)作为C组(150例);胸痛中心成立初期(2016年7月1日–12月31日)作为D组(162例);胸痛中心持续运行期(2017年1月1日–2017年6月30日)作为E组(153例)。采用回顾性病例对照研究方法,胸痛中心成立后(C、D、E组)患者入院后进入胸痛中心救治流程,在胸痛中心成立前(A、B组)患者入院进入非胸痛中心救治流程。比较各组间STEMI患者的一般情况、院内并发症情况、直接行经皮冠状动脉介入治疗(PPCI)比例、进入医院大门到球囊扩张(门球时间,D-to-B)时间等。结果胸痛中心成立后(C、D、E组)D-to-B时间分别为(127±90)min、(73±23)min及(74±38)min,三组间比较,差异有统计学意义(P<0.001)。胸痛中心成立前(A、B组)分别为(117±53)min、(141±88)min与D组(73±23)min,三组间比较,差异有统计学意义(P<0.001)。D组院内心房颤动发生率显著低于A组[6.17%比15.43%,P=0.007]。D组PPCI比例显著高于A组(74.07%比50.62%,P<0.001)和B组(74.07%比56.07%,P=0.001)。C、D、E三组PPCI比例(62.70%比74.10%比73.90%,P=0.045)、院内死亡率(8.00%比1.85%比7.19%,P=0.035)比较,差异均有统计学意义。结论建立胸痛中心能够优化STEMI患者的诊治流程,有效缩短患者急诊滞留和D-to-B时间,使患者可以尽早接受PPCI,从而降低院内并发症和院内死亡率,明显改善患者预后。Objective To investigate the influence of chest pain center protocol（CPC） on the treatment and prognosis in patients with acute ST-segment elevation myocardial infarction（STEMI）. Methods 800 patients with STEMI were included in the study and were categorized into 5 groups according to different time point regarding the establishment of chest pain center（CPC）.Group A（n=162） included patients admitted before the establishment of CPC, group B（n=173） admitted during the preparation of CPC,group C（n=150） during the experimental CPC period,group D（n=162） during the initial period of CPC and group E（n=153） during the full-funtioning CPC period.The baseline charateristics, D-to-B time and other revascularization features, rates of in-hospital complication were all compared among the 5 groups. Results Compared with patients treated before the establishiment of chest pain center, patients treated after the chest pain center protocol setup had shorter D-to-B time [groups A ：（117±53）min, groups B：（141±88）min, groups C：（127±90） min, groups D：（73±23）min and groups E：（74 ±38） min], lower rates of in-hospital complications, including atrial fibrillation（groups A： 15.43%, groups B： 9.83%, groups C： 3.33%, groups D： 6.17% and groups E： 7.19%） and in-hospital mortality（groups A： 8.64%, groups B： 8.09%, groups C： 8.00%, groups D： 1.85% and groups E： 7.19%）. With the establishment of chest pain center protocol, the PPCI rate（groups A： 50.62%,groups B： 56.07%, groups C： 62.67%, groups D： 74.07% and groups E： 73.86%） was significantly increased in patients with STEMI. Conclusions The establishment of chest pain center could optimize the diagnosis and treatment for STEMI patients by shortening the emergency room stay and D-to-B time. The prognosis of STEMI patients was optimized by reduction of in-hospital complication and increase in PPCI rates.

关 键 词：急性心肌梗死 胸痛中心 经皮冠状动脉介入治疗 

分 类 号：R542.22[医药卫生—心血管疾病]