摘要
目的分析建设胸痛中心对急性ST段抬高型心肌梗死(STEMI)患者救治效果及1年预后的影响。方法收集某医院胸痛中心开始建设前后12个月的STEMI并行直接经皮冠脉介入治疗(PCI)的患者病历资料,共88例,分为建设前组40例,建设后组48例。比较两组患者基线资料、实验室化验指标、发病至导丝通过时间(S-to-W)、首次医疗接触至导丝通过时间(FMC-to-W)、发病至首次医疗接触时间(S-to-FMC)、进医院大门至导丝通过时间(D-to-W)、D-to-W≤90 min达标率、心力衰竭发生率、住院病死率、住院时间以及服药情况。患者出院后,随访1年,继续记录服药情况,记录两组患者出院后1年主要心血管不良事件(MACE)发生情况。结果两组患者的基线资料、血红蛋白、血脂、糖化血红蛋白、空腹血糖、血肌酐、白蛋白、尿酸、术后罪犯血管TIMI血流3级比例、服药情况比较,差异无统计学意义(P>0.05)。建设后组的S-to-W、FMC-to-W、D-to-W较建设前组明显缩短(P<0.05);建设后组的D-to-W≤90 min达标率较建设前组显著增加(P<0.05)。建设后组S-to-FMC与建设前组相比,差异无统计学意义。建设后组患者心力衰竭发生率、BNP峰值与建设前组比较明显降低(P<0.05)。建设后组患者住院时间较建设前组相比明显缩短(P<0.05)。两组患者住院期间死亡率比较,差异无统计学意义(P>0.05)。与建设前组相比,建设后组1年内MACE发生率较低,差异有统计学意义(P<0.05)。进一步通过Kaplan-Meier生存曲线分析随访期间两组患者无MACE累积生存率,显示建设后组患者无MACE累积生存率显著高于建设前组(Log Rank=5.929,P=0.015)。结论胸痛中心的建设,能够缩短STEMI患者S-to-W、FMC-to-W、D-to-W,提高D-to-W≤90 min达标率,降低STEMI患者心力衰竭的发生率,减少住院天数,同时可改善STEMI患者出院后1年预后。
Objective To analyze the influence of the construction of chest pain center on therapeutic effect and 1-year prognosis of patients with ST segment elevated myocardial infarction(STEMI). Methods Retrospective analysis method was used, medical records of 88 STEMI patients who underwent primary PCI 12 months before and after the construction of chest pain center were collected in the Second Affiliated Hospital of Guangzhou Medical University Panyu District. The patients were divided into pre-construction group(n=40) and post-construction group(n=48).The baseline data, laboratory test results, from onset to guide wire through time(S-to-W), from first medical contact to guide wire through time(FMC-to-W),from onset to the first medical contact time(S-to-FMC), from entering hospital door to guide wire through time(D-to-W), standard-reaching rate of D-to-W≤90 min, heart failure rates, hospital mortality, hospital stays and medication situation were compared between the two groups. After discharge, patients were followed up for 1 year. The medication situation and the incidence of major adverse cardiovascular events(MACE) in 1 year were recorded. Results There was no statistically significant difference in baseline data, hemoglobin, blood lipids, glycosylated hemoglobin, fasting blood glucose, blood creatinine, albumin, uric acid, postoperative criminal vascular TIMI blood flow, and medication status between the two groups of patients(P>0.05). The S-to-W, FMC-to-W and D-to-W of the post-construction group were significantly shorter than those of the pre-construction group(P<0.05);the D-to-W≤90 min compliance rate of the post-construction group was higher than that of the pre-construction group Significant increase(P<0.05). There was no statistically significant difference between S-to-FMC in the post-construction group and the pre-construction group. The incidence of heart failure and peak BNP of patients in the post-construction group were significantly lower than those in the pre-construction group(P<0.05). The hosp
作者
黎德恩
梅啸
李明琰
LI Deen;MEI Xiao;LI Mingyan(The Second Affiliated Hospital of Guangzhou Medical University,Guangzhou 511447,China)
出处
《现代医院》
2021年第12期1879-1882,1885,共5页
Modern Hospitals
基金
广东省自然科学基金资助项目(2015A030313451)。
关键词
急性ST段抬高型心肌梗死
经皮冠脉介入治疗
胸痛中心
导丝通过时间
ST-segment elevation myocardial infarction
Percutaneous coronary intervention
Chest pain center
Guide wire through time
