河北省急性心肌梗死患者使用急诊医疗服务系统现状分析及对治疗和预后影响  

Current situation of emergency medical service system for patients with acute myocardial infarction in Hebei Province and its influence on treatment and prognosis

作　　者：李雨彤 高恒波[1] 姚冬奇[1] 肖浩[1] 董艳玲 吕宝谱 刘亮[1] 陈慧[1] 孙艺青 田英平[1] Li Yutong;Gao Hengbo;Yao Dongqi;Xiao Hao;Dong Yanling;Lyu Baopu;Liu Liang;Chen Hui;Sun Yiqing;Tian Yingping(Emergency Department,Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院急诊科,石家庄050000

出　　处：《中华急诊医学杂志》2021年第7期809-815,共7页Chinese Journal of Emergency Medicine

基　　金：河北省政府资助临床医学优秀人才培养和基础课题研究项目(2017-46)。

摘　　要：目的调查河北省急性心肌梗死(acute myocardial infarction,AMI)患者使用急诊医疗服务系统(emergency medical service,EMS)现状及其对患者急性期治疗和近、远期预后的影响。方法收集河北省主要三级及部分具有代表性的二级医院在2016年1至12月期间住院的AMI患者。根据其不同就诊方式分为EMS组和自行就诊组,对两组患者的一般情况、发病到就诊时间、治疗方法、院内病死率及3年病死率等指标进行分析总结。结果共纳入2961例患者,采用EMS方式就诊患者占33.13%,自行就诊患者占66.87%。既往有高血压病病史以及ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者更倾向于选择EMS方式就诊,差异有统计学意义。并且EMS组患者更倾向于前往三级医院就诊(88.58%vs 85.76%,P=0.033)。EMS组患者发病到就诊时间明显短于自行就诊组患者(160 min vs 185 min,P<0.01),且EMS组从症状发作到就诊时间在<3 h及3~6 h时间段患者所占比例均高于自行就诊组(55.76%vs 49.14%,21.41%vs 19.09%,P<0.01)。相比自行就诊组,EMS组患者有更高的再灌注治疗率(67.48%vs 61.67%,P=0.002)。EMS组患者的急性期院内病死率较高(7.03%vs 4.44%,P=0.003),但其3年病死率低于自行就诊组(17.31%vs 20.77%,P<0.05)。结论EMS能够缩短AMI患者发病到就诊时间,增加患者再灌注治疗率,并且能改善患者的远期预后。Objective To investigate the current situation of emergency medical service(EMS)system and its effect on treatment of the acute stage and short-and long-term prognosis in patients with acute myocardial infarction in Hebei province.Methods Totally 2961 patients with acute myocardial infarction who were admitted to major tertiary and some representative secondary hospitals in Hebei province from January 2016 to December 2016 were collected.According to the pattern of arriving hospital,all the patients were divided into the EMS group and self-transport group.The general conditions,time from onset to treatment,treatment methods,in-hospital mortality rate and 3-year mortality rate were compared between the two groups.Results Of the included 2961 patients,33.13%of them were transported through EMS and 66.87% of them by private transport.Patients with a history of hypertension and ST-segment elevation myocardial infarction were more likely to choose EMS,and the difference was statistically significant(P<0.05).Moreover,patients in the EMS group were more likely to go to tertiary hospitals for treatment(88.58%vs 85.76%,P=0.033).The time from onset to treatment of the EMS group was significantly shorter than that of the self-transport group(160 min vs 185 min,P<0.01),and the proportion of patients in the EMS group from onset-to-door time in<3 h and 3-6 h was higher than that of the self-transport group(55.76%vs 49.14%,21.41%vs 19.09%,P<0.01).Compared with the selftransport group,the EMS group has a higher rate of reperfusion therapy(67.48% vs 61.67%,P=0.002).Patients in the EMS group had a higher in-hospital mortality rate in the acute stage(7.03% vs 4.44%,P=0.003),but its 3-year mortality rate was lower than that of the self-transport group(17.31%vs 20.77%,P<0.05).Conclusions EMS can shorten symptom-onset-to-arrival time,increase the rate of reperfusion therapy and improve long-term prognosis of patients with acute myocardial infarction.

关 键 词：急性心肌梗死 急诊医疗服务系统 入院方式 再灌注治疗 病死率 

分 类 号：R542.22[医药卫生—心血管疾病]