胸痛患者行急诊PCI绿色通道时间点的监测及策略分析  

Monitoring and countermeasure analysis of emergency pci channel time point for chest pain patients

作　　者：赵倩[1] 王燕[1] 陈铀[1] 周欣荣[1] 杨毅宁[1] 张雨晨[1] 马翔[1] 马依彤[1] ZHAO Qian;WANG Yan;CHEN You;ZHOU Xinrong;YANG Yining;MA Xiang;ZHANG Yuchen;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1469-1472,1475,共5页Journal of Xinjiang Medical University

基　　金：国家自然科学基金(81470468)

摘　　要：目的研究胸痛患者行急诊经皮冠状动脉介入治疗(PCI)绿色通道时间点的监测及分析其影响因素。方法纳入2016年1月-2017年12月于我院胸痛中心就诊并符合行急诊PCI指征的患者共440例,其中男性350例(79.5%),平均年龄(58±12)岁(21～80岁)。根据从挂号就诊到球囊扩张的时间(D2B)是否达标分为达标组185例和不达标组255例。收集患者基线资料和临床资料,分析2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、D2B时间,以及出院信息,包括院内病死率、PCI后院内心衰率、CCU时间、住院时间和总费用。采用多因素Logistic回归模型分析D2B延误的影响因素。结果 D2B达标组与不达标组患者的基线资料比较无差异(P>0.05)。2组患者总缺血时间、发病至FMC时间和FMC2B时间均无统计学差异。达标组D2B时间、通知心内科总住院时间、知情同意时间和到达导管室时间与院内不达标组比较均明显缩短,差异有统计学意义(P <0.05)。达标组患者院内病死率、PCI次日心力衰竭发生率和总费用显著低于不达标组,达标组患者的CCU时间和住院时间均短于不达标组,差异有统计学意义(P均<0.05)。多因素分析显示,通知心内科住院总时间、知情同意谈话时间以及患者到达导管室时间是影响D2B的独立危险因素。结论尽早通知心内科总住院时间,缩短知情同意时间并且及时送达患者至达导管室可以有效的缩短D2B时间。并且通过实时监测胸痛患者行急诊PCI绿色通道中各关键时间点,对缩短D2B时间、减少院内不良事件的发生有重要的临床意义。Objective To study the monitoring of the time point of primary PCI green channel for patients with chest pain and the analysis of its influencing factors.Methods From January2016to December2017,440patients were admitted to the Chest Pain Center of our hospital and met the primary PCI indications.Among them,350(79.5%)were males,with an average age of(58±12)years(21-80years).According to the time of D2B,185cases were divided into standard group and255cases into non-standard group.Baseline data and clinical data were collected.Total ischemia time,onset-first medical contact(FMC),FMC-balloon dilatation(FMC2B)time,door-to-ballon(D2B)time and discharge information were analyzed,including in-hospital mortality,in-hospital failure rate after PCI,CCU time,hospitalization time and total cost.Multivariate logistic regression model was used to analyze the influencing factors of D2B delay.Results There was no difference in baseline data between D2B and non-D2B groups(P>0.05).There was no significant difference in total ischemia time,onset time to FMC and FMC2B time between the two groups.The time of D2B,total hospitalization time,informed consent time and arrival time of catheter room in the standard group were significantly shorter than those in the non-standard group(P<0.05).The hospital mortality,incidence of heart failure and total cost of PCI in the standard group were significantly lower than those in the non-standard group.The time of CCU and hospitalization in the standard group were shorter than those in the non-standard group,and the difference was statistically significant(P<0.05).The total length of hospital stay,informed consent talk time and the time of patients arriving in catheterization room were independent risk factors affecting D2B.Conclusion Early notification of the total hospital stay in the department of cardiology,shortening the informed consent time and timely delivery to the patients to the catheter room can effectively shorten the D2B time.In addition,real-time monitoring of the key time points in

关 键 词：胸痛中心 急诊PCI 时间点 多因素Logistic回归模型 

分 类 号：R459.7[医药卫生—急诊医学]