“急救车-导管室”绿色通道模式对急性心肌梗死患者急诊介入治疗的疗效观察

＂Ambulance-catheter room＂ green-channel model for acute ST-segment elevation myocardial infarction in emergency percutaneous coronary intervention

目的 观察急性ST段抬高型心肌梗死患者采用“急救车—导管室”绿色通道模式行急诊介入治疗对“入门—球囊扩张”时间及临床事件的影响.方法 选择笔者所在医院心内科自2011年1月～2013年12月行急诊介入治疗的468例STEMI患者,按照进入导管室的方式分为“急救车—导管室”模式组和“急救车—急诊科—导管室”模式组,比较两组间“入门—球囊扩张”时间的差异并记录临床事件.结果 两组间基线情况、心肌梗死部位、靶血管病变等无统计学差异;“急救车—导管室”模式组平均“入门—球囊扩张”时间为45.1 min,而“急救车—急诊科—导管室”模式组为83.3 min,两组比较有统计学意义,P＜0.05.虽然两组在全因死亡、心血管死亡、住院期间急性左心衰发生率等未达到统计学差异性,但“急救车—导管室”模式组有下降的趋势.结论 通过“急救车—导管室”模式对STEMI患者行急诊PCI术缩短了DBT时间,可能有助于改善临床预后.

Objective To observe application value of ＂Ambulance-catheter room＂,green-channel model in emergency percutaneous coronary intervention （PCI） for the patients with acute ST segment elevation myocardial infarction （STEMI） on ＂door-to-balloon＂ time and clinical events.Methods Clinical data of patients with STEMI undergone emergency PCI from 2011 January to 2013 December at the department of cardiology were recorded.A total of 468 cases were divided into two groups according to the model of emergency PCI,group A,＂ambulance-catheter room＂ model,and group B,＂ambulance-emergency department-catheter room＂ model.The ＂door-to balloon＂ time,target coronary artery,hospital mortality,etc were observed.Results Baseline of patients,target coronary artery and so on was similar between the two groups.There were significant difference in the ＂door-to balloon＂ time between group A to group B （45.1 min VS 83.3 min,P ＜0.05）.In-hospital mortality,cardiac death rate,and acute heart failure were lower in group A than those of group B,although no statistical difference was found between the two groups.Conclusion The STEMI patients who underwent emergency PCI in the ＂ambulance-catheter room＂ model may reduce the ＂door-to balloon＂ time,and improve the clinical prognosis.