不同入院方式对急性ST段抬高型心肌梗死患者救治效率的影响  

Impact of different admission ways on treatment efficiency in patients with acute ST-segment elevation myocardial infarction

作　　者：崔彩艳 周名纲 陈安芳 成联超 张翠 刘汉雄 蔡琳 Cui Caiyan;Zhou Minggang;Chen Anfang;Cheng Lianchao;Zhang Cui;Liu Hanxiong;Cai Lin(Department of Cardiology,Third People′s Hospital of Chengdu Affiliated to Southwest Jiaotong University,Chengdu 610031,China;Department of Cardiology,First People′s Hospital of Shuangliu District,Chengdu,Chengdu 610200,China)

机构地区：[1]西南交通大学附属医院,成都市第三人民医院心内科,610031 [2]成都市双流区第一人民医院心内科,成都610200

出　　处：《中华心血管病杂志》2020年第4期302-307,共6页Chinese Journal of Cardiology

基　　金：四川省应用基础研究项目(2018JY0126)。

摘　　要：目的分析不同入院方式对急性ST段抬高型心肌梗死(STEMI)患者接受介入治疗时效性和院内病死率的影响。方法入选2017年1月至2019年6月于成都市9家医院接受直接经皮冠状动脉介入治疗(PPCI)的STEMI患者1044例进行回顾性分析,根据入院方式分为救护车组(100例)、自行来院组(584例)和转院组(360例)。收集3组患者的救治时效性指标,即再灌注时间(包括发病至到达医院大门时间、进入医院大门至球囊扩张时间)和心肌总缺血时间(指发病至球囊扩张时间),以及院内死亡发生情况。比较3组患者的救治时效性指标和院内全因病死率,并采用多因素logistic回归分析入院方式是否为接受PPCI的STEMI患者院内死亡的影响因素。结果救护车组患者心肌总缺血时间比自行来院组[180.0(135.0,282.0)min比278.0(177.8,478.5)min,P<0.05]和转院组[180.0(135.0,282.0)min比301.0(204.3,520.8)min,P<0.05]短。关于发病至到达医院大门时间,救护车组<自行来院组<转院组[100.0(56.3,198.0)min比149.0(72.0,313.5)min比238.0(135.0,545.0)min,P<0.05]。救护车组和转院组进入医院大门至球囊扩张时间均比自行来院组短[分别为75.0(44.3,101.8)min比97.0(71.0,140.5)min和67.0(40.0,91.8)min比97.0(71.0,140.5)min,P均<0.05]。3组患者的院内全因病死率差异无统计学意义(P>0.05)。多因素logistic回归分析结果显示,入院方式不是院内死亡的独立危险因素(P>0.05)。结论经急救系统入院的STEMI患者接受介入治疗的时效性更强,不同入院方式对患者院内病死率无明显影响。Objective To analyze the impact of different admission ways on the timeliness of percutaneous coronary intervention and in-hospital mortality in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods A total of 1044 patients with STEMI,who received primary percutaneous coronary intervention(PPCI)in 9 hospitals in Chengdu from January 2017 to June 2019,were retrospectively enrolled.According to the admission ways,patients were divided into ambulance group(n=100),self-transport group(n=584)and transferred group(n=360).Timeliness and in-hospital mortality were compared among the groups.Indicators of timeliness included the time from symptoms onset to arrive at the hospital,the time from arrive at the hospital to balloon and the total myocardial ischemia time(the time from symptoms to balloon).Multivariate logistic regression analysis was used to verify whether the admission ways was the determinant for in-hospital death in STEMI patients receiving PPCI.Results The median total myocardial ischemic time in the ambulance group was significantly shorter than that in the self-transport group(180.0(135.0,282.0)minutes vs.278.0(177.8,478.5)minutes,P<0.05)and the transferred group(180.0(135.0,282.0)minutes vs.301.0(204.3,520.8)minutes,P<0.05).The median time from symptoms to door was as follows:ambulance group<self-transport group<transferred group(100.0(56.3,198.0)minutes vs.149.0(72.0,313.5)minutes vs.238.0(135.0,545.0)minutes,all P<0.05).The median door-to-balloon time was significantly shorter in the ambulance group and transferred group than in the self-transport group(75.0(44.3,101.8)minutes vs.97.0(71.0,140.5)minutes,67.0(40.0,91.8)minutes vs.97.0(71.0,140.5)minutes,both P<0.05).There was no significant difference in all-cause mortality among the three groups(P>0.05).Multivariate logistic regression analysis showed that admission way was not significantly associated with in-hospital death(P>0.05).Conclusions STEMI patients,who are admitted through the medical emergency system,are more likely to

关 键 词：急性ST段抬高型心肌梗死 入院方式 救治效率 

分 类 号：R542[医药卫生—心血管疾病]