区域协同救治系统对急性ST段抬高型心肌梗死患者再灌注治疗的影响

Effect of reperfusion therapy on STEMI patients transported by regional cooperative rescue system

目的：探讨基于移动互联网的区域协同救治系统对急性ST段抬高型心肌梗死（ST-segment elevation myocardial infarction, STEMI）患者再灌注时间节点及临床预后的影响。方法依据STEMI患者首次医疗接触（first medical contact, FMC）时接诊单元是否配备区域协同救治系统，将患者分为试验组与对照组。观察两组患者转运过程中的各时间节点、术后心肌肌钙蛋白I（cardiac troponin I, cTNI）达峰值时间及峰值、在院期间心衰率及病死率、超声测得术后24 h内左室射血分数（ejection fractions, EF）值及卫生经济学指标（总住院费用、天数）。结果试验组与对照组各时间节点比较，差异均有统计学意义（P〈0.05）；试验组cTNI达峰值时间较对照组提前，且cTNI峰值较对照组降低，差异均有统计学意义（t=-2.80，P〈0.01；t=-5.32， P〈0.01）；试验组入院后24 h内EF值明显优于对照组，差异有统计学意义（t=2.37，P〈0.05）；试验组院内心衰率低于对照组，差异具有统计学意义（χ2=4.46，P=0.03）；试验组心源性病死率低于对照组，差异无统计学意义（χ2=0.19，P=0.66）；试验组总住院费用、总住院时间均明显低于对照组，差异均有统计学意义（t=3.67，P〈0.01；t=2.75，P=0.01）。结论区域协同救治系统可以显著缩短STEMI患者时间延迟、改善急性期心功能，并降低患者病死率。

Objective To explore the effect of regional cooperative rescue system based on mobile internet of patients with ST-segment elevation myocardial infarction （STEMI） on the time node and prognosis.Methods According to whether the unit was equipped with a regional cooperative rescue system as the first medical contact （FMC） occurred on STEMI patients, the patients were divided into experimental group and control group. Every time node during transport process, the time to peak and peak value of cardiac troponin I （cTNI）, the rate of heart failure or cardiac death during hospitalization, the value of ejection fractions （EF） measured in 24 h, and indicators of health economics （total hospital charges, days） were observed.Results The difference of each time nodes between two groups were all statistically significant （P〈0.05）; the peak time of cTnI was earlier in experimental group than control group （t=-2.80,P〈0.01）, the peak value of cTnI was decreased in experimental group compared with the control group （t=-5.32,P〈0.01）; values of EF within 24 h after admission were significantly lower in control group than experimental group （t=2.37,P〈0.05）; heart failure rate in hospital of experimental group was less than that of the control group （χ2=4.46,P=0.03）; cardiac mortality rate of experimental group was less than that of the control group, and it was not significant between the two groups （χ2=0.19,P=0.66）; total cost in hospital, total hospital stay were significantly decreased in experimental group compared with the control group （t=3.67,P〈0.01;t=2.75,P=0.01）.Conclusions Regional cooperative rescue system could significantly shorten the time delay of patients with STEMI, improve heart function in acute stage and reduce the time and cost in hospital.