县域协同救治体系对ST段抬高型心肌梗死救治效果的影响  

The therapeutic effects of county collaborative network for ST segment elevation myocardial infarction

作　　者：李志明 胡厚祥[2] 杜松柏[1] 谢佑龙 岳荣川[2] 陈丽[2] LI Zhiming;HU Houxiang;DU Songbai;XIE Youlong;YUE Rongchuan;CHEN Li(Department of Cardiology,People's Hospital of Nanbu County,Nanchong 637000,China;Department of Cardiology,The Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,China)

机构地区：[1]南部县人民医院心内科,四川南充637000 [2]川北医学院附属医院心内科,四川南充637000

出　　处：《老年医学研究》2022年第2期6-9,共4页Geriatrics Research

基　　金：四川省基层卫生事业发展研究中心项目(SWFZ21-C-96,川东北“胸痛救治一体化”模式现况调查及影响因素研究)。

摘　　要：目的 探讨县域协同救治体系对ST段抬高型心肌梗死(STEMI)救治效果的影响。方法 回顾性分析南部县人民医院胸痛中心建设前后收治的165例STEMI患者的病例资料,根据有无采用县域协同救治体系,将2016年6月—2017年5月的患者作为建设前组,2017年6月—2018年5月的患者作为建设后组。比较两组直接经皮冠状动脉介入治疗(PPCI)比例、静脉溶栓比例、总缺血时间、发病至首次医疗接触(FMC)时间、FMC至球囊扩张(FMCtoB)时间、进入大门至球囊扩张(DtoB)时间、知情同意时间、导管室激活时间、开始穿刺至球囊扩张时间、FMC至开始溶栓(FMCtoN)时间、进入大门至开始溶栓(DtoN)时间、院内总心衰率及病死率等。结果 与建设前组比较,建设后组PPCI比例升高(92.22%比41.33%,P<0.001),FMCtoB时间缩短[(105.60±28.45)min比(183.40±88.96)min,P=0.001],DtoB时间缩短[(84.22±25.71)min比(157.40±74.07)min,P<0.001],知情同意时间缩短[(29.72±18.21)min比(68.35±31.48)min,P<0.001],导管室激活时间下降[(14.45±4.90)min比(27.88±9.73)min,P<0.001],开始穿刺至球囊扩张时间缩短[(29.75±7.43)min比(43.25±8.08)min,P<0.001]。与建设前组比较,建设后组静脉溶栓比例下降(7.78%比58.67%,P<0.001),DtoN时间缩短[(31.00±8.57)min比(90.60±24.39)min,P<0.001],知情同意时间缩短[(24.40±14.60)min比(58.83±26.86)min,P=0.040]。与建设前组比较,建设后组院内总心衰率下降(7.78%比21.33%,P=0.012),院内总病死率下降(3.33%比12.00%,P=0.033)。结论 采用县域协同救治体系可提高STEMI的救治效果。Objective To investigate the therapeutic effects of county collaborative network for ST segment elevation myocardial infarction(STEMI).Methods The clinical data of 165 cases of STEMI patients admitted before and after the construction of chest Pain Center in Nanbu County People’s Hospital were retrospectively analyzed.According to whether the county collaborative network was adopted or not,patients from June 2016 to May 2017 were included in the pre-construction group and patients from June 2017 to May 2018 were included in the post-construction group.The two groups’ indicatorsin terms of the ratio of primary percutaneous coronary intervention(PPCI),the ratio of intravenous thrombolysis,total isch-emia time,symptom onset to first medical contact time(FMC),FMC to balloon time(FMCto B),door to balloon time(Dto B),informed consent time,cath lab activation time,start puncture to balloon time,FMC to needle time(FMCto N),doorto needle time(Dto N),rates of total heart failure and mortality in the hospital were compared.Results Compared with thepre-construction group,the proportion of PPCI in the post-construction group increased(92.22% vs 41.33%,P<0.001),FMCto B shortened[(105.60±28.45)min vs(183.40±88.96)min,P=0.001],Dto B reduced[(84.22±25.71)min vs(157.40±74.07)min,P<0.001],informed consent time decreased[(29.72±18.21)min vs(68.35±31.48)min,P<0.001],cath lab activation time dropped[(14.45±4.90)min vs(27.88±9.73)min,P<0.001],start puncture to balloontime debased[(29.75±7.43)min vs(43.25±8.08)min,P<0.001].Compared with the pre-construction group,the choice of intravenous thrombolysis after the construction reduced(7.78% vs 58.67%,P<0.001),Dto N decreased[(31.00±8.57) min vs(90.60±24.39) min,P<0.001],informed consent time debased[(24.40±14.60) min vs(58.83±26.86)min,P=0.040].Compared with the pre-construction period,rates of total heart failure decreased(7.78% vs21.33%,P=0.012)and rates of total death drooped(3.33% vs 12.00%,P=0.033)in the hospital in the post-construction.Conclusion The results sugges

关 键 词：急性心肌梗死 胸痛中心 经皮冠状动脉介入治疗 溶栓 

分 类 号：R542.22[医药卫生—心血管疾病]