摘要
目的研究不同来院方式急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者再灌注延迟的状况及其相关影响因素。方法回顾性收集2016年6月1日至2018年7月31日年龄大于18周岁、通过不同来院方式到达上海市嘉定区中心医院胸痛中心行急诊冠脉介入治疗(primary percutaneous coronary intervention,PPCI)的320例STEMI患者为研究对象。根据患者来院方式分为120现场接送组(n=29)、120转院组(n=111)和自行来院组(n=180)。收集患者基线资料、再灌注时间和主要不良心血管事件(急性左心衰、室颤和院内死亡),使用logistic回归分析小于90 min门球时间(door-to-balloon,D2B)影响因素。结果320例患者中,首发症状到首次医疗接触(symptom onset-to-first medical contact,S2FMC)时间为118 min(50,377)min、从首次医疗接触到球囊扩张时间为87 min(66,120.5)min、首发症状到球囊扩张时间为221 min(135,482.5)min。其中120转院组的上述时间指标均长于120现场接送组和自行来院组,各组差异均有统计学意义(P<0.05)。各组中S2FMC占总缺血时间分别为:120现场接送组51.14%,120转院组63.29%,自行来院组55.26%。从入医院大门到入导管室时间为33 min(9,53.5)min,120转院组用时最少;而D2B时间为63 min(42,85)min,自行来院组的时间指标大于另外两组,差异均有统计学意义(P<0.05)。多因素回归分析发现120转院(OR=15.251,95%CI:5.328~43.657,P<0.01)、120现场接送(OR=8.219,95%CI:1.861~36.307,P=0.005)、首次医疗接触至首份心电图(FMC2ECG)时间(OR=0.975,95%CI:0.962~0.989,P<0.01)和吸烟(OR=2.099,95%CI:1.015~4.341,P=0.045)是小于90 min门球时间的独立预测因素(P<0.05)。不良事件主要发生在首发症状后约6 h内。其中,室颤发生率为3.75%(95%CI:3.73%~3.77%)、急性左心衰发生率为10.94%(95%CI:7.52%~14.36%)、院内死亡发生率为2.5%(95%CI:0.79%~4.21%),三组不良事件发生率差异无统计学意义(P>0.05)。结论STEMI患者
Objective To assess the association between the different prehospital transfer pathways to the hospital and reperfusion delay in patients with ST segment elevation myocardial infarction(STEMI).Methods We retrospective collected 320 STEMI patients aged 18 years or older who underwent primary percutaneous coronary intervention(PPCI)from June 1,2016 to July 31,2018.They were divided into three groups according to different prehospital transfer pathways:patients directly transferred from the field by ambulance to PCI-capable center hospital(field transfer group,n=29);patients transferred by ambulance from PCI-incapable hospitals to PCI-capable center hospital(inerhospital transfer group,n=111);patients transferred by friends or relatives to PCI-capable center hospital(self-transfer group,n=180).The basic characteristic attributes,reperfusion time and fatal complications such as acute left heart failure cases(ALHF)cases,ventricular fibrillation(VF)cases,and in hospital death were collected and compared.In addition,logistic regression analysis was used to analyze uni-and multivariate of door-to-balloon(D2B)time less than 90 min.Results The S2FMC interval were 118 min(50,377)min,FMC-to-balloon interval were 87 min(66,120.5)min and the onset-to-balloon time were 221 min(135,482.5)min.The above three interval in the interhospital transfer group were longer than those in the field transfer and self-transfer groups(P<0.05).S2FMC accounted for 51.14%of onset-to-balloon time in the field transfer group,63.29%in the interhospital transfer group and 55.26%in the self transfer group.The door-to-catheter room interval were 33 min(9,53.5)min.The interval in the interhospital transfer group were shorter than those in the field transfer and self-transfer groups(P<0.05).The interval in the self-transfer group were longer than those in the interhospital transfer and field transfer groups(P<0.05).Multiple regression analysis showed that the interhospital transfer group(OR=15.251,95%CI:5.328-43.657,P<0.01),field transfer group(OR=8.219,
作者
林全洪
许向东
张云柯
王飞
顾建华
徐耀伟
朱仰阁
李君
Lin Quanhong;Xu Xiangdong;Zhang Yunke;Wang Fei;Gu Jianhua;Xu Yaowei;Zhu Yangge;Li Jun(Jiading Disrtrict Medical Emergency Center,Shanghai 201808,China;Department of Cardiology,Jiading District Central Hospital,Shanghai 201800,China)
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2020年第7期921-928,共8页
Chinese Journal of Emergency Medicine
基金
上海市嘉定区农业和社会事业科研项目(JDKW-2017-W37)
上海市医学重点专科建设项目(ZK2019c03)。
关键词
STEMI患者
不同来院方式
再灌注时间
ST segment elevation myocardial infarction
Transfer pathways
Reperfusion time
