胸痛中心建设中绕行急诊对急性ST段抬高型心肌梗死患者介入治疗安全性及预后的影响  

Impacts of emergency department by pass in the Chest pain center construction on the prognosis of patients with ST-segment elevated myocardial infarction after percutaneous coronary intervention

作　　者：李建民[1] 朱莉[1] 殷屹岗[1] 王如珠[1] 顾爱芹 LI Jian-min;ZHU Li;YIN Yi-gang;WANG Ru-zhu;GU Ai-qin(Internal Medicine-Cardiovascular Department,The People′s Hospital of Taizhou City,Jiangsu Province,Taizhou 225300,China)

机构地区：[1]江苏省泰州市人民医院心内科,江苏泰州225300

出　　处：《吉林医学》2018年第2期241-243,共3页Jilin Medical Journal

基　　金：江苏省科技厅支撑计划[项目编号:H201562]

摘　　要：目的:探讨在胸痛中心模式下急性ST段抬高型心肌梗死(STEMI)患者介入治疗(PCI)绕行急诊的可能性、安全性及预后。方法:选择通过胸痛中心行直接PCI的STEMI患者210例,依据是否绕行急诊科分为绕行组和非绕行组,比较绕行组和非绕行组两组患者的首次医疗接触至球囊扩张时间(First Medical Contact to balloon,FMC-to-B)、门球时间(door to balloon,D-to-B)、住院期间并发症,术后出院前左室射血分数,术后3个月MACE事件,术后6个月左室射血分数,术后6个月的6分钟步行试验(6 MWT)。结果:绕行组和非绕行组的性别、年龄、合并吸烟、高血压、糖尿病、高脂血症比例以及既往的心肌梗死比例,心肌梗死犯罪血管的分布等差异无统计学意义(P>0.05)。绕行急诊组在FMC-to-B,D-to-B时间上均明显小于非绕行组,差异有统计学意义(P<0.05)。两组患者在住院期间并发症、术后3个月MACE事件、术后出院前左室射血分数比较,差异均没有统计学意义(P>0.05),在术后6个月左室射血分数虽然绕行组要比非绕行组射血分数高,但差异无统计学意义(P>0.05)。术后6个月6 MWT绕行组要优于非绕行组,差异有统计学差异(P<0.05)。结论:绕行急诊行急诊PCI治疗有利于缩短FMC-to-B,D-to-B时间,改善预后,同时安全,风险可控。Objective To investigate the possibility,safety and prognosis of patients with acute st-segment elevation myocardial infarction after percutaneous coronary intervention in the model of chest pain center.Method Retrospective analysis was performed in210STEMI patients by chest pain direct PCI,They were divided into two groups,according to whether emergency department by pass,They were compared for FMC-to-B time and D-to-B time,Complications during hospitalization,postoperative left ventricular ejection fraction,MACE of three months after operation,left ventricular ejection fraction after six months,6minutes walk test after six months.Results Both group of gender,age,smoking,high blood pressure,diabetes and hyperlipidemia rate and old myocardial infarction,ISR weref no statistical significance(P>0.05).In the case of FMC-to-B,D-to-B,emergency department by pass group was significantly shorterer than that of the other group,the difference was statistically significant(P<0.05).There was no statistical difference between complications during hospitalization,postoperative left ventricular ejection fraction,MACE of three months after operation(P>0.05).There was no statistical difference in the left ventricular ejection fraction after six months,although the EF was higher than the non-bypass group(P>0.05).Compared with the non-bypass group,there was a statistically significant difference in the6minutes walk test after six months(P<0.05).Conclusion Emergency department by pass in the Chest pain center construction of patients with ST-segment elevated myocardial infarction after percutaneous coronary intervention is helpful to shorten the time of FMC-to-B time and D-to-B time,and improves the prognosis,while at the same time,it is safe and risk controllable.

关 键 词：急性心肌梗死 绕行急诊 经皮冠状动脉介入治疗 胸痛中心 

分 类 号：R542.22[医药卫生—心血管疾病]