摘要
目的通过启动院内ST段抬高心肌梗死(STEMI)患者救治的临床路径,探讨优化急诊经皮冠状动脉介入治疗(EPCI)流程对门-球囊(D to B)时间及STEMI患者预后的影响。方法根据美国心脏病学学会/美国心脏协会(ACC/AHA)、中国急性STEMI诊断和治疗指南制定临床路径并制作诊疗流程图,对2010年1月—2010年12月间本院心内科急性STEMI患者(A组)的诊治情况进行调查,收集数据,作为优化路径前资料;从2011年1月—2011年12月使用优化的临床路径对STEMI患者(B组)的诊治进行干预,将临床路径运用电子化病历,按临床路径的提示进行优化诊治。患者出院时将入选患者的相关数据进行收集记录,并在完成病例6个月随访后对数据进行分析,对临床路径进行质量控制及持续改进。结果 STEMI患者经临床路径优化前后D to B平均时间由99.8 min缩短至89.4 min,D to B时间达标比例由54.5%提高至71.5%(P<0.05);住院期间药物规范使用的比例β受体阻滞剂、ACEI/ARB及四联药物规范使用比例明显提高(P<0.05);住院期间死亡率由12.3%降低至6.1%,至出院后30 d累计死亡率临床路径优化组仍有明显改善(P<0.05);主要不良心脏事件(MACE)发生率在住院期间、30 d及180 d均有明显改善(P<0.05)。结论本研究通过临床路径的干预缩短了STEMI患者D to B时间,住院期间及出院后30天患者的死亡率明显下降。同时,使临床医生的医疗行为更接近指南的要求,使医疗资源的利用更加合理。
Objective To evaluate the implementation of clinical pathways in management of acute ST-elevated myocardial infarction （STEMI）with emergent percutaneous coronary intention （EPCI）. Methods The clinical pathways and diagnosis procedure were developed according to ACC/AHA and the Chinese guidelines for diagnosis and treatment of acute STEMI. One hundred and eighty-seven patients with STEMI were managed from January 2010 to December 2010 when the clinical pathways were not implemented （ group A） and another 165 patients with STEMI were managed with optimized procedures following the clinical pathways from January 2011 to December 2011 （group B ）. The procedures and outcomes of patients were documented and compared between two groups. Results Compared to group A the D to B time of STEMI patients in group B was shortened from 99.8 min to 89.4 min, and the up-to-standard rate of D to B time increased from 54.5% to 71.5% （ P 〈 0.05 ）. The rate of standardized medication in group B increased significantly （ P 〈 0.05 ）. In-hospital mortality decreased from 12.3% to 6.1% and the accumulative mortality of 30 d after discharge was also decreased （P 〈 0.05 ）. The incidence of major adverse cardiac events （MACE）in hospital, 30 d and 180 d after discharge of group B was reduced significantly （ P 〈 0.05 ）. Conclusion The implementation of clinical pathways improve the management and outcomes of patients with acute STEMI with EPCI.
出处
《同济大学学报（医学版）》
CAS
2013年第6期41-44,48,共5页
Journal of Tongji University(Medical Science)
基金
国家自然科学基金(81070107)
关键词
心肌梗死
临床路径
门-球囊时间
经皮冠状动脉介入治疗
myocardial infarction
clinical pathways
door-to-balloon time
percutaneous coronary intervention
