胸痛中心建设对基层医院救治急性ST段抬高型心肌梗死的效果影响  

Effects of chest pain center construction on the treatment of acute ST-elevation myocardial infarction in basic-level hospitals

作　　者：胡彬[1] 相鹏[1] 吴新东[1] 钟泽[1] 方中华[1] 周燕 Hu Bin;Xiang Peng;Wu Xindong;Zhong Ze;Fang Zhonghua;Zhou Yan(Department of Cardiology,The First People's Hospital of Jiande,Jiande 311600,Zhejiang Province,China)

机构地区：[1]建德市第一人民医院心内科,浙江省311600

出　　处：《中国基层医药》2021年第9期1318-1322,共5页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的探讨基层胸痛中心对急性ST段抬高型心肌梗死(STEMI)患者救治时间及短期预后的影响。方法选取2014年11月至2018年11月建德市第一人民医院收治的进行经皮冠状动脉介入治疗(PCI)的STEMI患者162例为观察对象,其中基层胸痛中心成立前2014年11月至2016年10月收治的患者66例设为对照组,基层胸痛中心成立后2016年11月至2018年11月收治的患者96例设为研究组。回顾性比较两组患者的基础疾病、PCI成功率、首次医疗接触-球囊扩张(FMC-to-Balloon,FMC2B)时间、就诊-球囊扩张(Door-to-Balloon,D2B)时间以及住院病死率、PCI次日心力衰竭发生率、住院时间、住院费用。结果两组患者的基础疾病构成比和PCI成功率差异均无统计学意义(均P>0.05),但两组患者在FMC2B[(185.2±53.7)min比(108.6±46.4)min,t=6.128]、D2B时间[(121.5±23.2)min比(68.7±14.3)min,t=7.341]、住院时间[(10.3±3.5)d比(7.2±2.8)d,t=5.128]、住院费用[(43 582.0±7 186.5)元比(35 479.0±4 213.1)元,t=8.361]、院内病死率[6.1%比3.1%,χ^(2)=4.784]、次日心力衰竭发生率[13.6%比4.2%,χ^(2)=8.253]等方面差异均有统计学意义(均P<0.05)。结论建立规范的基层胸痛中心,对于县域内救治范围的患者,能够明显缩短STEMI患者FMC2B时间、D2B时间以及住院时间,改善心肌梗死患者心功能以及预后,节省医疗费用。Objective To investigate the effects of chest pain center construction in basic-level hospitals on treatment time and short-term prognosis in patients with acute ST-elevation myocardial infarction.Methods A total of 162 patients with acute ST-elevation myocardial infarction who received percutaneous coronary intervention(PCI)in The First People's Hospital of Jiande between November 2014 and November 2018 were included in this study.Among them,66 patients who received treatment in The First People's Hospital of Jiande between November 2014 and October 2016 were included in the control group.The remaining 96 patients who received treatment between November 2016 and November 2018 were included in the study group.The underlying diseases,PCI success rate,first medical contact-to-balloon time,door-to-balloon time,in-hospital mortality,incidence of heart failure on the next day of PCI,length of hospital stay,hospital medical cost were retrospectively analyzed.Results There were no significant differences in underlying disease composition ratio and PCI success rate between the two groups(both P>0.05).There were significant differences in first medical contact-to-balloon time[(185.2±53.7)minutes vs.(108.6±46.4)minutes,t=6.128],door-to-balloon time[(121.5±23.2)minutes vs.(68.7±14.3)minutes,t=7.341],length of hospital stay[(10.3±3.5)days vs.(7.2±2.8)days,t=5.128],hospital medical cost[(43582.0±7186.5)yuan vs.(35479.0±4213.1)yuan,t=8.361],in-hospital mortality[6.1%vs.3.1%,χ^(2)=4.784],the incidence of heart failure on the next day of PCI[13.6%vs.4.2%,χ^(2)=8.253]between the control and study groups(all P<0.05).Conclusion Establishment of a standardized chest pain center construction in basic-level hospital can greatly shorten the first medical contact-to-balloon time,door-to-balloon time and length of hospital stay,improve the cardiac function and prognosis of patients with myocardial infarction,and reduce medical cost.

关 键 词：心肌梗死 经皮冠状动脉介入治疗 住院时间 死亡率 基层胸痛中心 首次医疗接触 就诊-球囊扩张时间 

分 类 号：R542.22[医药卫生—心血管疾病]