胸痛中心建立对急性ST段抬高型心肌梗死患者救治的影响  

The influence of chest pain center establishment on treatment for patients with ST-segment elevation myocardial infarction

作　　者：王作兰 冯娜娜[1] 车京津[1] WANG Zuo-lan;FENG Na-na;CHE Jing-jin(Department of Cardiology,the Second Hospital of Tianjin Medical University,Tianjin 300211,China)

机构地区：[1]天津医科大学第二医院心脏科,300211

出　　处：《天津医药》2018年第4期400-405,共6页Tianjin Medical Journal

摘　　要：目的探讨胸痛中心(CPC)建立是否可以提高急性ST段抬高型心肌梗死(STEMI)患者的抢救效率。方法连续入选2015年11月1日—2017年1月1日就诊于天津医科大学第二医院、发病时间在12 h内的STEMI患者274例,以CPC成立时间(2016年6月1日)为节点分为成立前组(140例)和成立后组(134例)。比较2组患者就诊-双联抗血小板聚集药物(D-DAPT)时间、门-肝素(D-H)时间、门-球(D-to-B)时间、症状发作-医院大门(SO-Door)时间、总缺血时间、冠状动脉造影术(CAG)结果、主要心血管不良事件(MACE)、平均住院时间及平均住院费用等。结果与成立前组相比,成立后组的D-DAPT时间、D-H时间、D-to-B时间、SO-Door时间及总缺血时间均缩短(均P<0.01);成立后组的左室射血分数显著高于成立前组,而KillipⅢ/Ⅳ级比例和B型氨基端利钠钛原水平较低(P<0.05);成立后组冠状动脉介入术前梗死相关动脉再灌注比例增加(41.1%vs.25.8%,P=0.016),同时植入支架患者比例下降(77.5%vs.90.0%,P=0.008);住院期间急性心力衰竭和死亡发生率显著下降(均P<0.05)。且成立后组平均住院时间及平均住院费用显著降低。多因素分析显示,SO-Door时间长、有前壁心肌梗死和高血压病史是患者发生MACE的独立危险因素。结论以缩短总缺血时间为目的的CPC建立可提高对STEMI患者的救治效率,降低院内死亡和心力衰竭的发生率,节约医疗资源。Objective To investigate whether the establishment of chest pain center(CPC)can improve the rescue efficacy in the treatment of patients with ST-segment elevation myocardial infarction(STEMI).Methods A series of consecutive acute STEMI patients(n=274)within 12 hours after symptom onset were screened,who were admitted in the 2nd Hospital of Tianjin Medical University between November 1,2015 and January 1,2017.According to the time of the establishment of CPC(June 1,2016),patients were divided into the group before the establishment of CPC(early group,n=140)and the group after the establishment of CPC(late group,n=134).Data of door-to-double dual antiplatelet therapy(DDAPT)time,door-to-heparin(D-H)time,door-to-balloon(D-to-B)time,symptom onset to door(SO-Door)time,total ischemia time,the results of coronary angiography,the major adverse cardiovascular events(MACE),the average length of hospital stay and hospital expenses were compared between two groups.Results Compared with the early group,data of DDAPT time,D-H time,D-to-B time,SO-Door time and total ischemia time were significantly shorter in the late group(all P<0.01).LVEF was significantly higher,but the rate of Killip classⅢ/Ⅳand the level of NT-proBNP were lower in the late group than those of the early group(P<0.05).The ratio of infarct related artery reperfusion was increased(41.1%vs.25.8%,P=0.016),while the proportion of patients with stent implantation was decreased(77.5%vs.90.0%,P=0.008)in the late group.The incidences of acute heart failure and death were significantly decreased during hospitalization(both P<0.05).In addition,the average of hospitalization expenditure and length of hospital stay were significantly lower in the late group.Multivariable Logistic regression analysis showed that long SO-Door time,anterior myocardial infarction and hypertension were independent risk factors of in-hospital MACE in patients.Conclusion The establishment of the chest pain center,which is aimed to shorten the total ischemia time,can improve rescue efficiency

关 键 词：心肌梗死 血管成形术 经腔 经皮冠状动脉 急诊医疗服务 胸痛中心 总缺血时间 院前急救 

分 类 号：R542.22[医药卫生—心血管疾病]