胸痛救治快速反应体系对急性ST段抬高型心肌梗死患者救治预后的影响

发布时间：2018-07-23 13:05

【摘要】：目的探讨胸痛救治快速反应体系对急性ST段抬高型心肌梗死(STEMI)患者救治近期和远期预后的影响。方法参照中国胸痛中心的要求建立胸痛中心并建立胸痛救治快速反应体系和救治流程。选取广西壮族自治区人民医院2014年6月至2015年11月收治的STEMI患者为观察组,选取未建立胸痛救治快速反应体系之前2012年1-12月收治的STEMI患者为对照组,共入选患者624例,观察组374例,对照组250例。采用回顾性非同期队列研究方法,观察组入院后采取胸痛救治快速反应体系进行救治,对照组在胸痛中心成立前入院进行常规救治。观察两组患者的一般情况、入院后首份心电图完成时间、入门球囊扩张时间(D2B)、住院时间、平均住院费用、住院期间不良心脏事件(院内病死、心力衰竭)发生率;所有出院患者随访1年,分别比较左室射血分数(LVEF)、左室舒张末内径(LVEDD)、室壁瘤形成、B型钠尿肽前体(pro-BNP)、血肌酐(Scr)、C反应蛋白(CRP)及不良心脏事件(心力衰竭、死亡、再次入院)发生率等。结果与对照组相比,观察组入院后首份心电图平均完成时间缩短(P=0.001),入门球囊扩张时间、住院时间、平均住院费用少于对照组(P0.05),住院期间不良心脏事件(院内病死、心力衰竭)观察组低于对照组(P0.05)。随访6个月后,观察组LVEF显著高于对照组(P0.05),而观察组LVEDD、pro-BNP、CRP、不良心脏事件发生率均低于对照组(P0.05),室壁瘤形成率和Scr水平在观察组与对照组之间差异无统计学意义(P0.05)。随访1年后,观察组LVEF仍高于对照组(P0.05),观察组LVEDD、pro-BNP、CREA、CRP、室壁瘤形成率、不良心脏事件发生率均低于对照组(P0.05)。结论胸痛救治快速反应体系建立不仅有效缩短了STEMI患者的救治时间,提高了治疗效率,缩短住院时间,减少住院费用,还能改善生活质量和疾病预后。
[Abstract]:Objective to investigate the effect of rapid response system for chest pain treatment on the short and long term prognosis of patients with acute St segment elevation myocardial infarction (STEMI). Methods according to the requirements of China chest pain Center, the chest pain center was established and the rapid response system and treatment process were established. The STEMI patients treated in Guangxi Zhuang Autonomous region people's Hospital from June 2014 to November 2015 were selected as the observation group and the STEMI patients admitted from January to December 2012 as the control group before the establishment of a rapid response system for the treatment of chest pain. A total of 624 patients were selected as the control group. There were 374 cases in the observation group and 250 cases in the control group. The retrospective non-synchronous cohort study was used to treat chest pain in the observation group after admission, and the control group was treated with routine treatment before the establishment of the chest pain center. The general conditions of the two groups were observed, such as the completion time of the first electrocardiogram after admission, the time of initial balloon dilation (D2B), the time of hospitalization, the average cost of hospitalization, and the incidence of adverse cardiac events (hospital death, heart failure) during hospitalization. Left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), atrial natriuretic peptide precursor (pro-BNP), serum creatinine (Scr) C-reactive protein (CRP) and adverse cardiac events (heart failure, death) were compared in all discharged patients for one year. The incidence of readmission, etc. Results compared with the control group, the average completion time of the first electrocardiogram in the observation group was shorter than that in the control group (P0. 001), the time of initial balloon dilation, the average hospitalization time and the average hospitalization cost were less than those in the control group (P0.05). Heart failure) in the observation group was lower than that in the control group (P0.05). After 6 months follow-up, LVEF in the observation group was significantly higher than that in the control group (P0.05), while the incidence of adverse cardiac events in the observation group was lower than that in the control group (P0.05). There was no significant difference in the formation rate of ventricular aneurysm and the level of Scr between the observation group and the control group (P0.05). After 1 year follow-up, the LVEF of the observation group was still higher than that of the control group (P0.05). The rate of formation of ventricular aneurysm and the incidence of adverse cardiac events in the observation group were lower than those in the control group (P0.05). Conclusion the establishment of a rapid response system for the treatment of chest pain can not only effectively shorten the treatment time, improve the treatment efficiency, shorten the hospitalization time, reduce the hospitalization cost, but also improve the quality of life and the prognosis of the disease.
【作者单位】：广西壮族自治区人民医院/广西壮族自治区胸痛中心心血管内科;广西壮族自治区人民医院/广西壮族自治区胸痛中心急诊科;
【基金】：广西壮族自治区重大科技攻关科题(桂科攻14124003-9) 广西壮族自治区卫生厅自筹课题(Z2014213)
【分类号】：R542.22

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