胸痛中心持续优化改进对急性ST段抬高型心肌梗死患者急诊救治时间及诊疗效果的影响  

Effect of continuous improvement and optimization of Chest Pain Center on the diagnosis and treatment effect of patients with acute ST-elevation myocardial infarction

作　　者：陆晓晨[1] 耿海华[1] 吴晓晖[1] 盛红专[1] LU Xiaochen;GENG Haihua;WU Xiaohui;SHENG Hongzhuan(Department of Cardiology,the Affiliated Hospital of Nantong University,Nantong 226001)

机构地区：[1]南通大学附属医院心血管内科,南通226001

出　　处：《南通大学学报（医学版）》2020年第4期311-314,共4页Journal of Nantong University(Medical sciences)

基　　金：国家自然科学基金资助项目(30971224);南通市科技局资助项目(MS12018023)。

摘　　要：目的:探讨通过持续改进优化胸痛中心就诊流程建设,对急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者的急诊经皮冠脉介入治疗(percutaneous coronary intervention,PCI)救治时间及诊疗效果的影响。方法:采用回顾性研究的方法,将胸痛中心成立后标准化流程建设初期(试运行阶段)收治的STEMI患者设为对照组(n=110),标准化流程建设后期(流程完善阶段)收治的STEMI患者作为观察组(n=110),对比两组救治指标、住院期间临床事件诊疗效果的差异情况。结果:(1)救治指标:观察组急诊逗留时间、首次医疗接触-球囊扩张(first medical contact to ballon,FMC2B)时间均低于对照组,分别是[(46.45±21.17)min vs(96.00±38.18)min,P<0.001]、[(86.88±33.16)min vs(145.80±48.35)min,P<0.001];观察组院前心电图(electrocardiograph,ECG)传输率、急诊绕行率高于对照组,分别是(0.53 vs 0.24,P<0.001)、(0.09 vs 0.03,P<0.001);发病至首次医疗接触(symptom to first medical contact,S-to-FMC)时间、FMC2B时间≥120 min患者的溶栓率两组差异无统计学意义,分别是[(123.49±58.86)min vs(138.43±63.59)min,P>0.05]、(7%vs 8%,P>0.05)。(2)住院期间临床事件指标:观察组的院内心力衰竭发生率低于对照组(21%vs 36%,P<0.001),住院时间、院内死亡率与对照组差异无统计学意义,分别是[(9.82±2.32)d vs(10.25±2.39)d,P>0.05]、(0.9%vs 1.8%,P>0.05)。结论:胸痛中心标准化流程持续性改进和完善,缩短了STEMI患者的救治时间,降低了心力衰竭发生率,但在FMC2B时间>120 min患者诊疗方案选择上尚有待进一步改善。Objective:To investigate the effects of continuous improvements of patients with ST-segment elevation myocardial infarction(STEMI)undergoing primary percutaneous coronary intervention(PPCI)in Chest Pain Center of general hospital.Methods:We adapt retrospective study methods,patients with STEMI during the initial period of setting standard period in Chest Pain Center were categorized as the control group(110 cases)and patients during the later period of setting standard proses were categorized as the observation group(110 cases),the differences of treat indexes and clinical events during hospitalization were compared.Results:(1)Treat indexes:the observation group,when compared to the control group,had shorter emergency stay time(min)[(46.45±21.17)vs(96.00±38.18),P<0.001]and first medical contact to ballon(FMC2B)time(min)[(86.88±33.16)vs(145.80±48.35),P<0.001];the observation group,when compared to the control group,had higher pre-hospital electrocardiograph(ECG)transmission ratio(0.53 vs 0.24,P<0.001)and emergency bypass ratio(0.09 vs 0.03,P<0.001);there were no differences of symptom to first medical contact(S-to-FMC)(min)[(123.49±58.86)vs(138.43±63.59),P<0.001]and thrombolytic therapy ratio during FMC2B equal of above 120 min patients(7%vs 8%,P>0.05).(2)Clinical events during hospitalization:the observation group had lower heart failure ratio in hospital compared to the control group(21%vs 36%,P<0.001),and there were no differences of hospitalization time(day)[(9.82±2.32)vs(10.25±2.39),P>0.05]and in-hospital death ratio(0.9%vs 1.8%,P>0.05)of two groups.Conclusion:The continuous improvement during setting Chest Pain Center can shorten FMC2B time,lower heart failure ratio.Further improvements is needed in patients whose FMC2B is equal or above 120 min in choosing a fit therapeutic schedule.

关 键 词：ST段抬高型心肌梗死 胸痛中心 优化改进 

分 类 号：R542.22[医药卫生—心血管疾病]