摘要
目的探讨胸痛中心机制下绕行急诊科对行直接经皮冠状动脉介入治疗（PCI）的急性sT段抬高型心肌梗死（STEMI）患者的进门至球囊扩张（D—to—B）时间和短期预后的影响。方法连续入选2014年1月．2015年6月就诊于武警总医院的STEMI患者430例进行回顾性分析，按照是否借助院外传输心电图实现绕行急诊科直接到达导管室，将就诊于我院行直接PCI的STEMI患者分为绕行急诊科组和非绕行急诊科组，比较两组的D—to-B时间、住院时间、住院期间病死率、主动脉内球囊反搏（IABP）和临时起搏器的使用率以及心源性休克、脑出血等并发症的发生率。结果人选患者依据排除标准排除125例，实际入组患者为绕行组103例和非绕行组202例，绕行组平均D—to—B时间显著短于非绕行组[（57．0±28．0）min比（102．0±62．0）min，P〈0．011；D—to—B时间达标率绕行组和非绕行组分别为92．2％（95／103）和57．9％（117／202）（P〈0．01）；住院病死率绕行组和非绕行组分别为4．9％（5／103）和12-4％（25／202）（P〈0．05）；住院时间绕行组和非绕行组分别为（7．4±3．2）d和（8．4±4．2）d（P〈0．05）；使用IABP绕行组和非绕行组分别为5（4．9％）例和24例（11．9％）（P〈0．05）；心源性休克绕行组和非绕行组分别为5（4．9％）例和24例（11．9％）（P〈O．05），住院期间其他并发症（脑出血、消化道出血、急性肾功能不全、机械并发症）的发生率两组差异无统计学意义（P〉O．05）。结论STEMI患者在胸痛中心模式下绕行急诊科可以显著缩短D—to--B时间，改善患者预后。
Objective To investigate the impacts of emergency department bypass in the chest pain center （CPC） model on the door-to-balloon （D-to-B） time and short-term prognosis of patients with ST-segment elevated myocardial infarction （STEMI） after primary percutaneous coronary intervention （PPCI）. Methods Retrospective analysis was performed in 430 STEMI patients who were admitted into our hospital from January 2014 to June 2015. They were then divided into twp groups, according to whether their electrocardiograms were transmitted to catheterization room for pre-hospital diagnosis. They were compared for D-to-B time, the length of hospital stay, in-hospital mortality, the use of intra-aortic balloon pump （IABP） and temporary pacemakers, and the incidence of cardiac shock and cerebral bleeding. Results A total of 125 patients were excluded from the study; there were 103 patients in the bypass group and 202 ones in the non-bypass group. The bypass group showed obviously a shorter mean D-to-B time than the non-bypass group [（57±28） min vs （102±62） min, P〈 0.01]. In the bypass group, there were 92.2% of patients （95/103） required less than 90 min of D-to-B time, in comparison with 57.9% of patients （117/202） in the non-bypass group （P〈 0.01）. The in-hospital mortality was 4.9% （5/103） for the bypass group and 12.4% （25/202） for the non-bypass group （P 〈0.05）. The length of hospital stay was （7.4±3.2） d for the bypass group and （8.4±4.2） d for the non-bypass group （P 〈0.05）. IABP was used in 7 patients in the bypass group （6.8%） and in 30 patients in the non-bypass group （14.9%） （P〈0.05）. Cardiac shock was found in 5 patients in the bypass group （4.9%） and in 24 patients in the non-bypass group （14.9%） （P〈0.05）. No statistical difference was found in other in-hospital complications between the two group （P 〉 0.05）. Conclusion Through emergency department bypass, STEMI patients show remarkably reduced D-to-B time and i
出处
《中国急救复苏与灾害医学杂志》
2016年第4期357-360,共4页
China Journal of Emergency Resuscitation and Disaster Medicine
关键词
心肌梗死
胸痛中心
绕行急诊科
经皮冠状动脉介入治疗
Myocardial infarction
Chest pain center
Emergency department bypass
Percutaneous coronary intervention
