摘要
目的分析胸痛中心实行绕行急诊对接受直接经皮冠状动脉介入(PPCI)治疗的ST段抬高型急性心肌梗死(STEMI)患者救治时间及院内病死率的影响。方法纳入2015年8月至2017年7月就诊广州军区广州总医院并接受PPCI治疗的500例STEMI患者。根据是否绕行急诊,分为绕行组(n=378)和非绕行组(122)。比较两组患者的基线资料、发病到首次医疗接触(S-to-FMC)时间、门球时间(D-to-B)及<90 min达标率、发病到球囊扩张时间(S-to-B)、院内病死率的变化。结果两组患者在性别、年龄、高血压史、Killip分级、住院天数等方面差异无统计学意义(P> 0.05)。两组患者S-to-FMC时间差异无统计学意义[(152.7±167.0)min vs.(177.8±233.3)min,P=0.273]。绕行组患者D-to-B时间显著低于非绕行组[(48.5±19.7)min vs.(86.2±61.9)min,P <0.001],D-to-B达标率显著高于非绕行组(95%vs. 73.8%,P <0.001)。绕行组患者S-to-B时间明显低于非绕行组[(326.3±274.1)min vs.(461.5±351.2)min,P <0.001],病死率亦显著低于非绕行组(1.6%vs. 5.7%,P=0.029)。结论胸痛中心实行绕行急诊机制可以显著缩短行PPCI治疗的STEMI患者的D-to-B时间,提高D-to-B达标率,并缩短患者的S-to-B时间(总缺血时间),降低院内病死率。胸痛中心未来的建设应该加强公众教育,提高大众对急性胸痛的警觉意识、鼓励大众发病后尽早就诊,缩短S-to-FMC时间;同时对于诊断明确的STEMI患者,应当尽可能实行绕行急诊科,缩短患者救治时间,改善患者预后。
Objective To investigate the effects of the chest pain center to imply the mechanism of bypassing the emergency department on treatment time and in-hospital mortality of patients with acute ST-segment myocardial infraction(STEMI)undergoing primary percutaneous coronary intervention(PPCI).Methods From August 2015 to July 2017,500 consecutive STEMI patients undergoing PPCI in Guangzhou General Hospital were included.These patients were divided into two groups:the bypass group(n=378)who bypassed the emergency department and directly accessed to the catheterization room,and the non-bypass group(n=122)who did not bypass the emergency department.All basic clinical characteristics,symptom onset-to-first medical contact(S-to-FMC),door-to-balloon(D-to-B)time,the ratio of D-to-B time within 90 minutes,symptom onset-to-balloon(S-to-B)time and in-hospital mortality were compared between the two groups.Results There was no statistical differences in sex,age,the history of hypertension,killip class and length of hospital stay between the two groups(P>0.05).The S-to-FMC time was comparable between the two groups[(152.7±167.0)min vs.(177.8±233.3)min,P=0.273].The mean D-to-B time was significantly shorter in bypass group while compared with that of non-bypass group[(48.5±19.7)min vs.(86.2±61.9)min,P<0.001],and the frequency of D-to-B time within 90minutes was higher in bypass group than that of non-bypass group(95%vs.73.8%,P<0.001).The S-to-B time was remarkably shorter in bypass group than non-bypass group[(326.3±274.1)min vs.(461.5±351.2)min,P<0.001].Besides,the in-hospital mortality was significantly lower in bypass group than non-bypass group(1.6%vs.5.7%,P=0.029).Conclusion Bypassing the emergency department can significantly shorten D-to-B time,increase the ratio of D-to-B time within 90 minutes and shorten S-to-B time,decrease in-hospital mortality among STEMI patients.The future construction of chest pain center should strengthen public education,raise public awareness of acute chest pain,encourage public to seek med
作者
孔冉冉
向定成
易绍东
宋瑞
KONG Ranran;XIANG Dingcheng;YI Shaodong;SONG Rui(Southern Medical University,Guangzhou 510515,China)
出处
《实用医学杂志》
CAS
北大核心
2018年第17期2904-2907,2929,共5页
The Journal of Practical Medicine
基金
广州市科技计划产学研专项(201508020043)
广州市科技计划重大专项(2014Y2-00068)
广州市重点实验室建设专项(穗科信字[2013]163-15)
关键词
ST段抬高型急性心肌梗死
胸痛中心
绕行急诊科
门球时间
总缺血时间
ST-segment elevation myocardial infraction
chest pain center
bypass the emergency department
door-to-balloon time
symptom onset-to-balloon time
