胸痛中心的成立对急性ST段抬高型心肌梗死患者救治的影响

Role of the chest pain center in treatment of patients with acute ST-elevated myocardial infarction

目的探讨胸痛中心的建立对急性ST段抬高型心肌梗死(STEMI)患者救治的影响。方法参照国际胸痛中心协会的要求建立胸痛中心及相应的管理制度和救治流程。选取沈阳军区总医院2015年5月-2016年3月收治的急性ST段抬高型心肌梗死(STEMI)患者为观察组,未建立胸痛中心之前2014年1-12月收治的STEMI患者为对照组,共入选患者1088例,观察组576例,对照组512例。采用回顾性非同期队列研究方法,观察组入院后进入胸痛中心,对照组在胸痛中心成立前入院进行常规救治。观察两组STEMI患者的一般情况、入院后首份心电图完成时间以及10min内首份心电图完成份数、经皮冠状动脉介入治疗(PCI)支架置入情况、入门球囊扩张时间(D2B)、住院天数及院内死亡率等。结果与胸痛中心成立前比较,胸痛中心成立后患者的疾病种类构成以及年龄、性别等差异无统计学意义(P>0.05),与对照组相比,观察组第一份心电图平均完成时间缩短(P=0.001)。观察组PCI支架置入成功率高于对照组,但差异无统计学意义(P=0.222),入门球囊扩张时间(P<0.001)及住院时间(P=0.005)短于对照组,两组院内死亡率差异无统计学意义(P>0.05)。结论胸痛中心的建立有效缩短了STEMI患者的救治时间,提高了治疗效率,缩短了住院时间,值得在临床中进一步推广。

Objective To evaluate the role of establishment of the chest pain center in the treatment of patients with acute ST-elevated myocardial infarction（STEMI）. Methods Referring to the international association of chest pain centers, the chest pain center was established in the hospital the authors served, and the corresponding management system and treatment process were worked out. A total of 576 patients with acute STEMI, admitted after the establishment of the chest pain center（May 2015-Mar. 2016）, were recruited as the observation group, and 512 STEMI patients admitted before the establishment of the chest pain center（ Jan.- Dec. 2014） were enrolled as control group. Patients in observation group were treated in the chest pain center, and those in control group received conventional treatment. The general situation, basic diseases, the finishing time of the first ECG and the completed number of ECG within 10 minutes, the success rate of stent implantation in percutaneous coronary intervention（PCI）, the time of door-to balloon expansion（D2B）, the length of hospital stay and in-hospital mortality were compared between the two groups. Results No significant difference existed between the two groups in the species composition of diseases, age and sex. The average finishing time of the first ECG was shorter in observation group than in control group（P=0.001）, the success rate of stent implantation in PCI was higher in observation group than in control group, but without statistical significance（P=0.222）. The time of D2 B and of hospital stay was shorter in observation group than in control group（P0.001, P=0,005）, but no significant difference was found between the two groups in in-hospital mortality（P0.05）. Conclusion The establishment of the chest pain center may effectively shorten the rescue time for patients with STEMI, improve the efficiency of treatment and shorten the length of hospital stay, and is worthy of further clinical promotion.