西北地区STEMI患者溶栓后区域转运联合PCI模式的探索  

Safety and efficacy of regional transport combined with PCI model in patients with STEMI after thrombolysis in northwest China

作　　者：白明[1] 潘晨亮[1] 赵晶[1] 赵存瑞 张博[1] 慕仲元[1] 孟晓雪[1] 周兴虎 朱友琦 张钲[1] Bai Ming;Pan Chenliang;Zhao Jing;Zhao Cunrui;Zhang Bo;Mu Zhongyuan;Meng Xiaoxue;Zhou Xinghu;Zhu Youqi;Zhang Zheng(Heart Center,First Hospital of Lanzhou University,Lanzhou 730000,China)

机构地区：[1]兰州大学第一医院心脏中心,730000

出　　处：《中华心血管病杂志》2020年第8期641-647,共7页Chinese Journal of Cardiology

基　　金：甘肃自然科学基金(17JR5RA268)。

摘　　要：目的探讨西北地区急性ST段抬高型心肌梗死(STEMI)患者在非经皮冠状动脉介入治疗(PCI)医院溶栓后区域转运至PCI医院模式的安全性及有效性。方法本研究为回顾性研究,连续纳入了自2015年1月至2019年1月兰州大学第一医院胸痛中心收治的,由基层医院转诊来的、发病时间<24 h的STEMI患者1062例,根据治疗策略分为静脉溶栓联合PCI组(240例)和直接PCI组(822例)。观察终点为患者院内不良心脑血管事件及出血事件,包括全因死亡、缺血性卒中、恶性心律失常、颅内出血及血红蛋白下降程度≥50 g/L的出血。结果本研究共纳入STEMI患者1062例,年龄(61±12)岁,其中男性905例(85.2%)。直接PCI组患者的术前心肌梗死溶栓试验(TIMI)血流0级者比例明显高于静脉溶栓联合PCI组[63.0%(518/822)比36.3%(87/240),P<0.001]。与直接PCI组比较,溶栓联合PCI组患者从发病至首次医疗接触[2.11(1.00,4.00)h比3.00(1.13,7.07)h,P<0.001]及接受再灌注治疗[3.07(1.83,4.87)h比6.92(4.07,11.15)h,P<0.001]时间更短。直接PCI组的全因死亡发生率高于静脉溶栓联合PCI组[1.8%(15/822)比0,P=0.03];两组的出血事件、缺血性卒中及恶性心律失常发生率差异无统计学意义(P均>0.05)。结论就诊于非PCI医院的STEMI患者,溶栓后区域转运联合PCI的策略不显著增加出血及心脑血管事件发生风险,且可有效缩短心肌再灌注时间。溶栓后区域转运联合PCI模式可行、有效。Objective To investigate the safety and efficacy of regional transport to percutaneous coronary intervention(PCI)hospitals from non-PCI hospitals after thrombolysis in patients with acute ST-segment elevation myocardial infarction(STEMI)in northwest China.Methods In this retrospective study,1062 STEMI patients who were transferred from non-PCI hospitals within 24 hours from symptom onset,during January 2015 and January 2019 in the First Hospital of Lanzhou University,were included.According to the treatment strategy,they were divided into two groups,namely intravenous thrombolysis combined with PCI group(n=240),and primary PCI group(n=822).Observation endpoint were in-hospital adverse cardiovascular and cerebrovascular events and bleeding events,Including all-cause death,ischemic stroke,malignant arrhythmia,intracranial hemorrhage and hemorrhage with hemoglobin decrease≥50 g/L.Results A total of 1062 STEMI patients were included(age was(61±12)years old),with 905 males(85.2%).The proportion of grade 0 TIMI blood flow in the primary PCI group before operation was significantly higher than that in the thrombolysis combined with PCI group(63.0%(518/822)vs.36.3%(87/240),P<0.001).Compared with primary PCI group,the time from symptom onset to first medical contact(2.11(1.00,4.00)hours vs.3.00(1.13,7.07)hours,P<0.001)and reperfusion in thrombolysis combined with PCI group(3.07(1.83,4.87)hours vs.6.92(4.07,11.15)hours,P<0.001)were significantly shorter.The proportion of all-cause death was significantly higher in the primary PCI group than that in the thrombolysis combined with PCI group(1.8%(15/822)vs.0,P=0.03).There was no significant difference in hemorrhage,ischemic stroke and malignant arrhythmia between the two groups(all P>0.05).Conclusions For STEMI patients initially hospitalized in non-PCI hospitals,regional transport combined with PCI is feasible and effective.It does not significantly increase the risk of bleeding and cardiovascular and cerebrovascular events,with shorter time from symptom onset to myocardi

关 键 词：心肌梗死 经皮冠状动脉介入治疗 溶栓治疗 安全性 有效性 

分 类 号：R542.22[医药卫生—心血管疾病]