入院前电话通知对中老年ST段抬高心肌梗死患者进急诊室至球囊扩张时间的影响

The effect of prehospital 12-lead electrocardiogram and transtelephonic notifiication on door-to-balloon time in patients with ST-segment elevation myocardial infarction

目的探讨入院前心电图采集和电话通知对ST段抬高心肌梗死（STEMI）患者进入急诊室至球囊扩张时间[进门至球囊扩张（door to balloon，D2B）时间]的影响。方法对2006年1月至2007年12月就诊于北京安贞医院抢救中心并接受直接经皮冠状动脉介入治疗（PCI）的STEMI患者的临床资料进行分析。将患者分为3组：无入院前心电图（无心电图）组、有入院前心电图（有心电图）组和依据入院前心电图进行电话通知（电话通知）组。主要分析指标为D2B时间。次要分析指标为住院期间患者病死率。结果纳入研究患者402例，其中无心电图组137例（34．1％），有心电图组176例（43．8％），电话通知组89例（22．1％）。3组患者年龄、性别、既往病史及心肌梗死部位比较，差异无统计学意义（P〉0．05）。与无心电图组比较，有心电图组和电话通知组患者D2B时间缩短，3组分别为113min、96min和86min（均P〈0．01）。3组患者住院期间病死率[分别为4例（2．9％）、4例（2．3％）和3例（2．2％）]比较，差异无统计学意义（均P〉0．05）。结论入院前心电图采集和早期电话通知能缩短STEMI患者D2B时间，使更多的患者D2B时间〈90min。入院前与医院建立电话联系可缩短再灌注时间。

Objective To explore the effect of prehospital 12-lead electrocardiogram （ECG） and transtelephonie notification on door-to balloon time in patients with ST-segment elevation myocardial infarction （STEMI）. Methods Four hundred and two patients with STEMI who underwent primary PCI from January 2006 to December 2007 in Beijng Anzhen Hospital were analyzed. They were divided into 3 groups： 137 patients without prehospital ECG （group A）, 176 patients with prehospital ECG （group B） and 89 patients with prehospital ECG and early transtelephonie notification （group C）. Door-to balloon time and in-hospital mortality were compared among the groups. Results There were no significant differences in age, sex, past medical history and infarcted area among three groups. Compared with group A, patients in group B and group C had much shorter door-to-balloon time （96 minutes and 86 minutes vs. 113 minntes in group A, all P〈0.01）. No difference was found in inhospital mortality among three groups （2.9 % vs. 2.3 % vs. 2.2%, P〉 0.05）. Conclusions Prehospital ECG and early transtelephonic notification can significantly shorten door-to balloon time in patients with STEMI. Coordinated system including prehospital ECG and transtelephonic notification is proved to be feasible and effective.