县区内医联体胸痛诊疗模式对急性ST段抬高型心肌梗死患者救治的影响  

Effect of chest pain practice patterns on emergency care for patients with acute ST⁃segment elevation myo⁃cardial infarction under integrated health care system

作　　者：谭晓晖 林嘉诚 李秀媛 陈凤媚 廖淑娟 朱可云 TAN Xiaohui;LIN Jiacheng;LI Xiuyuan;CHEN Fengmei;LIAO Shujuan;ZHU Keyun(Department of Cardiovasology,Xinhui People′s Hospital of Jiangmen City,Xinhui Hospital Affiliated to Southern Medical University,Jiangmen 529100,China;不详)

机构地区：[1]江门市新会区人民医院(南方医科大学附属新会医院)心血管内科,广东江门529100 [2]江门市新会区人民医院(南方医科大学附属新会医院)古井分院,广东江门529145

出　　处：《实用医学杂志》2021年第12期1559-1562,共4页The Journal of Practical Medicine

基　　金：江门市医疗卫生领域科技计划项目;广东省医学科研基金指令性课题(编号:C2020105);广东省医学科学技术研究基金项目(编号:B2015145)。

摘　　要：目的对比江门市新会区医疗单位在不同胸痛诊疗模式对急性ST段抬高型心肌梗死(ST⁃segment elevation myocardial infarction,STEMI)患者救治时效。方法选择2017年8月至2020年7月由辖区内其他医疗卫生机构转诊至江门市新会区人民医院、诊断为STEMI并行直接经皮冠状动脉介入治疗(primary percutaneous coronary intervention,PPCI)的患者266例,分为医联体分院组(n=45)、协作医院组(n=134)、非协作医院组(n=87)三组统计对比。结果三组患者的基线人口统计学资料、Killip泵功能分级、既往基础疾病病史差异均无统计学意义(P>0.05);医联体分院组患者首次医疗接触(first medical contact,FMC)⁃心电图完成时间、心电图确诊时间、肌钙蛋白采血⁃报告时间、介入手术室激活时间、入门至导丝通过(door to wire,D to W)时间均短于另外两组(P<0.001);起病2 h内就诊比例较高(P=0.0259)、住院费用较低(P<0.001)。但三组在院死亡率和心力衰竭发生率差异无统计学意义(P>0.05)。结论以医联体为基础建设胸痛救治模式可显著缩短县区内急性胸痛患者的相关救治时间。Objective To compare the treatment effectiveness of different chest pain practice patterns for patients with ST⁃segment elevation myocardial infarction(STEMI)during emergency care at the medical agencies in Xinhui district of Jiangmen City.Methods The clinical date on 266 patients who had been transferred from other medical agencies to our hospital in which diagnosed as STEMI and received primary percutaneous coronary interven⁃tion(PCI)from August 2017 to July 2020 were collected.The patients were divided into the group of integrated health care system(n=45),the cooperative hospital group(n=134)and the non⁃cooperative hospital group(n=87).Results There were no significant differences in demographic data,Killip pump function classification and basic medical history among the three groups(P>0.05).Time to FMC⁃ECG completion,Time to diagnostic confirm on ECG,Time to troponin blood collection⁃report,Time to activation of intervention therapy room,and time to door to wire were shorter in the group of integrated health care system than in the other two groups(P<0.001),the rate of clinical visit within two hours of onset was higher(P=0.0259),and the hospitalization cost was lower(P<0.001).However,there were no significant differences in the rates of hospitalization mortality and heart failure among the three groups(P>0.05).Conclusions The construction of chest pain practice patterns based on integrated health care system can significantly shorten time to emergency care for patients with acute chest pain in counties and districts.

关 键 词：胸痛中心 诊疗模式 县医院 急性ST段抬高型心肌梗死 效率 

分 类 号：R541.4[医药卫生—心血管疾病]