绿色通道急诊经皮冠状动脉介入治疗急性心肌梗死患者152例的临床分析

Clinical effect of 152 patients with acute myocardial infarction performed emergency percutaneous coronary intervention through green track

目的分析绿色通道急诊经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗在抢救急性心肌梗死患者中的有效性。方法回顾性分析2012年在成都军区昆明总医院行绿色通道急诊PCI治疗的急性心肌梗死患者152例的临床资料,观察患者是否在有效的时间窗内得到治疗,分析临床诊治及疗效,对比不同入院方式对门-球时间的影响。结果 152例患者门-球时间为(78.5±28.8)min,其中56例直接入导管室患者的门-球时间为(52.6±10.5)min,96例经过住院部后入导管室的患者的门-球时间为(89.6±29.7)min,显著高于直接入导管室组,差异有统计学意义(P<0.05)。治疗过程中植入主动脉内球囊反搏(IABP)60例,临时起搏器27例,抽吸导管使用58例。血流恢复心肌梗死溶栓试验(thrombolysis in myocardial infarction,TIMI)1级2例,TIMI 2级7例,TIMI 3级143例;TIMI 3级的发病时间显著低于TIMI 1级患者发病时间,差异有统计学意义[(10.5±3.8)h vs.(14.5±1.1)h,P<0.05]。因肾功能衰竭、感染等原因死亡3例,抢救成功率为98.02%。结论急诊PCI治疗绿色通道的建立并保持畅通提高了急性心肌梗死患者的救治率。

Objectives To investigate the effectiveness of emergency percutanecus coronary intervention （PCI） through green track in patients with acute myocardial infarction （AMI）. Methods One hundred and fifty-two consecutive patients with AMI were included in this study. Clinical data of them were collected and retrospectively analyzed. Whether the patients received treatments within effective time window was observed. Clinical effect was analyzed, and effects of different admission ways on door-to-balloon （D2B） time was compared. Results D2B time of the 152 patients was （78.5±28.8） min. Of all, the duration of 56 patients who were directly sent to the catheter room was （52.6± 10.5 ） min, 96 patients who were sent to the catheter room from the inpatient department was （89.6±29.7） rain which was significantly longer （P〈0.05）. Intra-aortic balloon pumps （IABP） were used in 60 cases, temporary pacemakers in 27 cases and suction catheter in 58 cases. Blood flow recovery：2 patients were with thrombolysis in myocardial infarction （TIMI） grade 1 flow, 7 patients with TIMI grade 2 flow, and 143 patients with TIMI grade 3 flow. The onset time of patients with TIMI grade 3 flow was significantly lower than that of patients with TIMI grade 1 flow [ （10.5±3.8）h vs. （14.5±1.1）h, P〈0.05]. Three patients died in renal failure and infections, and the rescue successful rate was 98.02%. Conclusions Establishment and maintain of green track in emergency PCI can improve the treatment of patients with acute myocardial infarction.