急诊PCI介入时间延迟对AMI患者预后的影响及延迟因素分析  

Impact of time delay of emergency percutaneous coronary intervention(PCI) on prognosis of AMI patients and analysis on influencing factors

作　　者：王春艳[1] Wang Chunyan(Clinical Medicine Science,The First Clinical Medical College of China Three Gorges University,Yichang,Hubei,443000,China)

机构地区：[1]三峡大学第一临床医学院,湖北宜昌443000

出　　处：《西南国防医药》2018年第4期310-312,共3页Medical Journal of National Defending Forces in Southwest China

摘　　要：目的分析急诊经皮冠状动脉介入(PCI)治疗时间延迟对急性心肌梗死(AMI)患者预后的影响及延迟相关因素。方法回顾性分析医院2015年9月~2017年5月收治的急诊PCI患者的临床资料,以建立CPC时间节点(2016年7月)暴露分组,将2016年7月及以前收治的89例纳入A组,将2016年8月及以后收治的144例纳入B组,对比两组近远期预后差异、急诊流程时间[包括发病-首次医疗接触时间(S0-to-FMC)、入门-导管室时间(D-to-C)、进门至球囊扩张时间(D-to-B)]。结果 B组PCI术后左室射血分值(LVEF)高于A组,左心室舒张末期内径(LVEDd)低于A组,住院时间及费用低于A组,不良心血管事件(MACE)、出血性并发症及机械性并发症等总发生率(2.78%)亦显著低于A组(12.36%)(P<0.05)。结论急诊PCI术介入时间延迟不利于AMI患者预后,通过建立胸痛中心可缩短院外急诊流程时间,减少D-to-B时间,改善患者预后,且可降低医疗费用。Objective To analyze the impacts of time delay of emergency PCI on prognosis of AMI patients and the influencing factors of time delay.Methods A retrospective analysis was conducted on clinical results of emergency PCI patients admitted into our hospital from September 2015 to May 2017.The patients were grouped according to the visiting time(July 2016):those admitted during or before July 2016 were in Group A(n=89)while those admitted during or after August 2016 were in Group B(n=144).The near-term and long-term prognoses,emergency procedure duration(including onset of disease-first medical contact(S0-to-FMC),door-to-cath lab(D-to-C)and door-to-balloon dilatation(D-to-B))were compared between the two groups.Results Group B had a higher left ventricular ejection fraction(LVEF)than Group A after PCI and lower left ventricular end-diastolic dimension(LVEDd)than Group A.The hospital stays and expenditures of Group B were also lower.The total incidences of major adverse cardiac events(MACE),hemorrhagic complications and mechanical complications(2.78%)were significantly lower than those of Group A(12.36%)(P<0.05).Conclusion Time delay of emergency PCI is unfavorable for prognosis of AMI patients.The time for outpatient emergency procedure and the D-to-B step can be shortened by setting up a chest pain center so as to improve patients'prognosis and reduce hospitalization costs.

关 键 词：急诊 经皮冠状动脉介入 时间延迟 心肌梗死 预后 影响因素 

分 类 号：R541[医药卫生—心血管疾病]