胸痛中心对急性ST段抬高型心肌梗死区域协同救治效果的影响  

Impact of treatment of acute ST-segment elevation myocardial infarction patients from regional cooperative chest pain center

作　　者：陈铀[1] 艾丽菲热.买买提 赵倩[1] 周欣荣[1] 杨毅宁[1] 张雨晨[1] 马翔[1] 马依彤[1] CHEN You;Ailifeire Maimaiti;ZHAO Qian;ZHOU Xinrong;YANG Yining;ZHANG Yuchen;MA Xiang;MA Yitong(Department of Heart Center,The First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院心脏中心,乌鲁木齐830054

出　　处：《新疆医科大学学报》2018年第12期1459-1464,共6页Journal of Xinjiang Medical University

基　　金：国家自然科学基金(81470468)

摘　　要：目的探讨胸痛中心模式下的综合医院辐射基层医院对急性ST段抬高型心肌梗死区域协同救治效果的影响。方法入选新疆医科大学第一附属医院2013年10月-2017年9月在胸痛中心成立前后48个月收治的明确诊断急性STEMI并行直接经皮冠状动脉介入治疗(PPCI)患者共654例,按照来院方式的不同分为首诊PCI医院患者415例和首诊非PCI医院患者239例。按照时间先后顺序将胸痛中心成立前后首诊PCI医院患者分为常规救治组165例和胸痛中心组250例;首诊非PCI医院患者分为常规转诊组82例和胸痛中心转诊组157例。比较各组患者总缺血时间、发病-首次医疗接触(FMC)时间、FMC-球囊扩张(FMC2B)时间、院内临床事件(包括院内病死率、术后心衰发生率、靶血管重建率)的差异情况。分析各组患者总缺血时间影响因素。结果 (1)首诊PCI医院的患者中,与常规救治组比较,胸痛中心救治组总缺血时间、发病至FMC时间、FMC2B时间均显著缩短,差异有统计学意义(P <0.05)。首诊非PCI医院患者中,与常规转诊组比较,胸痛中心转诊组总缺血时间、发病至FMC时间、FMC2B时间均显著缩短,差异有统计学意义;与胸痛中心转诊组比较,首诊PCI医院胸痛中心救治组在总缺血时间、发病至FMC时间和FMC2B时间上缩短更明显,差异均有统计学意义(P <0.05)。(2)胸痛中心救治组患者院内病死率、PPCI术后心衰率显著低于常规救治组,差异有统计学意义(P <0.05)。胸痛中心转诊组患者PPCI术后心衰率显著低于常规转诊组,差异有统计学意义。(3)首诊PCI医院、受高中以上教育程度、家庭年收入>6万与总缺血时间存在线性关系。结论胸痛中心能显著提高急性STEMI患者救治效果,改善患者短期预后,但综合医院对基层医院的辐射尚需加强。Objective To explore the impact of treatment of acute ST-segment elevation myocardial infarction patients in general hospital and related grass roots cooperative hospitals from regional cooperative chest pain center.Methods From October2013to September2017,654patients with acute STEMI and direct percutaneous coronary intervention(PPCI)were admitted to our hospital48months before and after the establishment of chest pain center.They were divided into415patients in initial PCI hospital and239patients in initial non-PCI hospital.According to the time of chest pain center establishment sequence,165patients in initial PCI hospital were routine treatment subgroup and250patients were chest pain center treatment subgroup;82patients in initial non-PCI hospital were routine referral subgroup and157patients were chest pain center referral subgroup.Total ischemia time,from onset to first medical contact(FMC),from FMC-balloon dilatation(FMC2B)were compared among relevant patients,hospital clinical events(including in-hospital mortality rate,incidence of heart failure and target vessel reconstruction rate)were compared among the groups.The influencing factors of total ischemic time in each group were analyzed.Results(1)Compared with the routine treatment group,the total ischemia time,the time from onset to FMC and FMC2B in the chest pain center treatment group were significantly shortened in the patients who were first diagnosed in PCI hospital(P<0.05).Compared with the routine referral group,the total ischemia time,the time from onset to FMC and FMC2B in the referral group of chest pain center were significantly shortened,and the difference was statistically significant.Compared with the referral group of chest pain center,the total ischemia time,the time from onset to FMC and FMC2B in the treatment group of chest pain center of the first PCI hospital were significantly shorter.The upper shortening was more obvious,and the difference was statistically significant(P<0.05).(2)The hospital mortality and heart failure rate after

关 键 词：胸痛中心 区域协同救治 急性STEMI 救治效果 

分 类 号：R469.7[医药卫生—临床医学]