摘要
目的探讨首诊于基层医院的急性ST段抬高心肌梗死(STEMI)患者早期再灌注的最佳方案,如何避免再灌注延迟、缩短STEMI再灌注时间、改善患者近远期预后。方法东营市部分二甲医院、社区卫生服务站与东营市人民医院形成"三位一体"立体式急救网络,对网络内医师实施长期、持续技术业务指导,结合实际情况制定STEMI救治流程,优化早期再灌注治疗,早期启动导管室,绕行急诊,无缝隙对接及优化介入治疗围术期药物治疗。2010年3月至2012年4月东营市人民医院救治的急性STEMI患者192例,根据是否"区域化网络救治",分为非区域化救治组68例和区域化救治组124例,两组间比较发病-首次医疗接触时间(FMC)、FMC-N(溶栓时间)、FMC-B(首次球囊扩张时间)、住院时间、费用、随访1个月及6个月再发心肌梗死、心源性死亡、心功能、卒中、心肌标志物氨基末端B型脑钠肽前体(NT-proBNP)及术后患者服药依从性情况等。结果两组FMC[42(20,60)min比70(30,90)min,P=0.029]、FMC-N溶栓时间[35(12,50)min比67(39,95)min,P=0.020]、FMC-B时间[90(45,130)min比120(68,188)min,P=0.026]、知情同意沟通到导管室时间[30(15,50)min比70(30,104)min,P=0.010]及FMC后治疗药物(氯吡格雷、阿司匹林及替罗非班)应用、住院时间[(6.0±2.5)d比(10.2±3.5)d,P<0.05]及住院费用[(47 688±1542)元比(55 392±1377)元,P<0.05]比较,差异有统计学意义。1个月随访显示,两组之间差异无统计学意义;6个月随访显示,区域化救治组氯吡格雷(87.1%比51.5%,P<0.05)、他汀类药物(82.3%比44.1%,P<0.05)服用率明显高于与非区域化救治组。两组阿司匹林使用率差异无统计学意义。区域化救治组LVEF<40%发生率(7.3%比29.4%,P<0.05)、再次心肌梗死发生率(4.8%比25.0%,P<0.05)及心源性猝死发生率(2.4%比11.8%,P<0.05)明显低于非区域化救治组。结论区域化网络救治模式提高了基层医院STEMI早期就诊率,能够让大医院�
Objective To investigate the best program for early reperfusion when patients with acute ST-segment elevation myocardial infarction （STEMI） was first diagnosed in primary care and how to avoid reperfusion delay and to improve prognosis. Methods Our hospital had formed a network with other secondary hospitals and community primary care centers to provide long-term ongoing technical operational guidance for actual STEMI treatment protocal. The advantages of this regionalize network is studied by comparing the outcomes of patients outside the network in terms of first medical contact time （ FMC ）, FMC-N （Thrombolytic time）, FMC-B （first balloon time）, length of stay, costs, and the rates of recurrent myocardial infarctioncardiac death, heart function, stroke, and NT-proBNP levels during follow up 1 month and 6 months later. Results Compare the regionalization network group with the non network group, the FMC [42（20,60） minsvs. 70（30,90） mins, P=0.029], FMC-N [35（12,50） minsvs. 67（39,95） mins, P =0. 020] ,FMC-B [90（45,130） mins vs. 120（68,188） mins,P =0. 026] showed shorter time consumed. The time from informed consent to surgical treatment room [ 30 （15,50） mins vs. 70 （ 30,104 ） mins ,P = 0. 010 ] and length of stay [ （ 6. 0 ±2. 5 ） days vs. （ 10. 2 ± 3.5 ） days, P 〈 0. 05 ] were shorter with less hospitalization fee [ （47 688 ±1542） yuans vs. （55 392 ± 1377） yuans,P 〈0. 05]. In the sixth month of follow up, the Regionalization network group showed higher compliance of taking aspirin （93.5% vs. 86. 8% ,P 〉0. 05）, clopidogrel （87. 1% vs. 51.5% ,P 〈0. 05） and Statins（82. 3% vs. 44. 1% ,P 〈 0. 05）. The incidence of heart failure （7. 3% vs. 29.4% , P 〈0. 05） , recurrence of myocardial infarction （4. 8% vs. 25.0% ,P〈0. 05）and sudden cardiac death （2.4% vs. 11.8% , P〈0.05） were lower in the Regionalization Network group. Conclusions Regionalization network can help to enhance application of superior resources to pr
出处
《中国介入心脏病学杂志》
2013年第5期290-296,共7页
Chinese Journal of Interventional Cardiology
基金
中国医师协会阳光心血管研究基金(SCRFCMDA201201)
关键词
区域化网络协同救治
急性ST段抬高性心肌梗死
早期再灌注
Regionalization network collaborative treatment
Acute ST-segment elevation myocardial infarction
Early reperfusion
