新型区域协同救治模式对急性ST段抬高型心肌梗死治疗的影响

Impact of new regional cooperative rescue model on first medical contact to balloon time and outcome in patients with ST-elevation myocardial infarction

目的 观察采用新型区域协同模式对急性ST段抬高型心肌梗死（STEMI）救治的首次医疗接触到球囊扩张（FMC-to-B）时间及其预后的影响.方法 入选2010年1月至2013年1月在江苏大学附属医院行急诊PCI的非本院首诊、发病时间在24 h内,行急诊经皮冠状动脉介入治疗（PCI）的患者,依据是否纳入区域协同救治模式分为研究组（230例,采用区域协同救治模式）和对照组（168例,采用常规模式）.比较两组患者首次医疗接触至球囊扩张（FMC-to-B）时间、进门至球囊扩张（D-to-B）时间、转诊时间、心功能、平均住院日及住院费用等指标有无差别,并随访患者6个月,观察主要不良心脏事件（MACE）发生率.结果 研究组FMC-to-B、D-to-B、转诊时间[分别为（98 ±23）、（25±7）和（62±12） min]均明显低于对照组[分别为（212 ±37）、（107±18）和（103±23） min,P均＜0.05].出院后6个月研究组患者左心室射血分数高于对照组（54.9％±8.6％比48.9％ ±9.1％,P=0.01）,左心室舒张末期内径小于对照组[（48.9±5.7）mm比（51.4±6.0） mm,P＜0.01],且MACE发生率明显低于对照组[7.4％（17/230）比17.9％（30/168）,P＜0.05].研究组的住院天数[7（5,13）d比10（6,20）d]及平均住院费用[42 221（23 184,77 768）元比49 654（25126,122 433）元]低于对照组（P均＜0.05）.结论 采用新型区域协同救治模式可明显缩短FMC-to-B时间,改善患者心功能及预后,减少MACE发生,减轻患者经济负担.

Objective To evaluate the effect of new regional cooperative rescue model on the first medical contact-to-balloon time and outcome in patients with ST-elevation myocardial infarction.Method Patients with acute myocardial infraction （AMI） and onset time within 24 hours transferred from other hospitals to our clinic and underwent emergent percutaneous coronary intervention （PCI） between January 2010 and January 2013 were included in this study.Patients were divided into two groups：regional cooperative treatment group （n =230） and control group （n =168） according to whether the first contact clinic belongs to the regional cooperative rescue model or not.The first medical contact to balloon （FMC-toB） time,door to balloon （D-to-B） time,referral time,cardiac function,mean cost,days of hospitalization,and major adverse cardiac event （MACE） during the 6 months follow up were compared.Results Mean FMC-to-B time,D-to-B time and referral time were significantly decreased from （212 ± 37）,（107 ± 18）,（103±23） min （control group） to （98 ±23）,（25 ±7）,（62 ± 12） min respectively in regional cooperative treatment group.Mean medical cost （42 221 （23 184,77 768）RMB vs.49 654 （25 126,122 433）RMB） and days of hospitalization （7 （5,13）days vs.10（6,20） days） were also significantly lower in regional cooperative treatment group than in control group.At 6 months follow up,LVEF was significantly higher（54.9％ ±8.6％ vs.48.9％ ±9.1％,P=0.01）,LVEDD （（48.9 ±5.7）mm 比（51.4±6.0）mm,P ＜ 0.01） as well as MACE rate （7.4％ （17/230） vs.17.9％ （30/168）,P ＜ 0.05） were significantly lower in regional cooperative treatment group than in control group.Conclusion The regional cooperative rescue model can decrease the FMC-to-B time,improve cardiac function,and reduce both patients＇ financial burden and MACE in patients with acute myocardial infarction.