胸痛中心模式下不同到院方式对急性ST段抬高型心肌梗死患者再灌注时间的影响

发布时间：2018-05-13 16:20

本文选题：心肌梗死 + 血管成形术　；参考：《中国循环杂志》2017年09期

【摘要】：目的:探讨在区域性协同胸痛中心模式下不同到院方式对急性ST段抬高型心肌梗死(STEIM)患者的再灌注时间的影响。方法:入选我院在胸痛中心运行前后18个月收治的诊断STEIM并行直接经皮冠状动脉介入治疗(PCI)术的患者364例,根据患者到医院的方式不同,将364例患者分为首诊PCI医院患者197例和首诊非PCI医院患者167例;按照时间先后顺序将胸痛中心运行前后首诊PCI医院患者分为绿色通道组91例,胸痛中心组106例;首诊非PCI医院患者分为常规转诊组71例,胸痛中心转诊组96例。比较各组患者总缺血时间、发病-首次医疗接触(S-FMC)时间、FMC-球囊扩张(FMC2B)时间、就诊-球囊扩张(D2B)时间,并对总缺血时间的影响因素进行回归分析。结果:与常规转诊组比较,胸痛中心转诊组患者的总缺血时间[325(236,1185)min vs 367(214,1 340)min,P0.05]、FMC2B时间[115(82,227)min vs 149(94,483)min,P0.05]、D2B时间[69(35,195)min vs 105(55,260)min,P0.05]明显缩短,差异均有统计学意义。而与胸痛中心转诊组比较,首诊PCI医院患者的总缺血时间[283(168,873)min vs 325(236,1185)min,P0.05]、FMC2B时间[78(45,265)min vs 115(82,227)min,P0.05]进一步缩短,差异均有统计学意义。对影响总缺血时间的因素进行多因素线性回归分析,结果显示高中及以上学历(β=-0.117,P=0.047)、60min内可到达PCI医院(β=-0.243,P=0.000)、首诊PCI医院(β=-0.175,P=0.000)是总缺血时间的独立影响因素。结论:区域性协同胸痛中心能够缩短转诊的STEMI患者的FMC2B时间;但胸痛患者若能在60 min到达PCI医院,则尽快到PCI医院首诊是最好的就诊方式,能够最大限度地减少患者总缺血时间。
[Abstract]:Objective: to investigate the effects of different hospitalizations on reperfusion time in patients with acute ST-segment elevation myocardial infarction (STEIM) under the regional cooperative chest pain center model. Methods: 364 patients who were admitted to our hospital for 18 months before and after the operation of chest pain center were enrolled in the diagnosis of STEIM combined with direct percutaneous coronary intervention (PCI). 364 patients were divided into PCI hospital (197 cases) and non-PCI hospital (167 cases), the patients were divided into green channel group (91 cases) and chest pain center group (106 cases) before and after the operation of chest pain center. The patients were divided into routine referral group (71 cases) and chest pain center referral group (96 cases). The time of total ischemia, the time of onset and the time of FMC-balloon dilatation (FMC2B), the time of media-balloon dilatation (D2B) and the time of total ischemic time were compared in each group. The influencing factors of total ischemic time were analyzed by regression analysis. Results: compared with the conventional referral group, the total ischemic time in the chest pain center referral group was significantly shorter than that in the chest pain center referral group [325V 2361185min vs 36721414140min (P0.05)] FMC2B time [115(82227)min vs 149U 94483min] D2B time [69(35195)min vs 10555260min P 0.05], the difference was statistically significant. The total ischemic time [283(168873)min vs 325 236U 1185 min P05] FMC2B time [78(45265)min vs 115 82227 min P0.05] was further shortened in the first visit PCI hospital compared with that in the chest pain center referral group, and the difference was statistically significant. Multivariate linear regression analysis was carried out on the factors affecting the total ischemic time. The results showed that high school education (尾 -0.117) could reach the PCI hospital (尾 -0.243) within 60 minutes (尾 -0.243) and the first PCI hospital (尾 -0.175) was an independent influencing factor of the total ischemic time. Conclusion: regional cooperative chest pain center can shorten the FMC2B time of referred STEMI patients, but if chest pain patients arrive at PCI hospital at 60 min, it is the best way to first visit PCI hospital as soon as possible. Can minimize the patient's total ischemic time.
【作者单位】：广州市番禺区中心医院心内科广州市番禺区心血管病研究所;
【基金】：广东省科技厅立项(2013B021800048) 广东省医学科研基金立项(2014172)
【分类号】：R542.22

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