宁波地区急性ST段抬高型心肌梗死救治情况及预后调查

The investigation of treatment and prognosis of acute ST segment elevation myocardial infarction in Ningbo region

目的通过回顾性分析急性ST段抬高型心肌梗死(STEMI)患者救治情况及近远期预后,为推动规范救治STEMI提供依据。方法选取宁波地区STEMI患者190例,根据是否成功行急诊血管再灌注治疗,分为急诊再灌注组(45例)与延迟再灌注组(111例),调查首诊时间、转院率、转诊时间、直接PCI比率、住院死亡率、心力衰竭发生率,梗死后1周和1年的超声心动图检查结果。结果发病至首诊中位时间为5h,转院率61.1%,1级医院转院中位时间为1 h,2级医院转诊中位时间为3 h,直接PCI比例21.6%,静脉溶栓比例5.8%,住院死亡率6.3%,住院期间心力衰竭发生率40.0%。梗死后1周内急诊血管再灌注组超声心动图左心室射血分数(LVEF)、左心室舒张末期内径(L.VEDd)、左心室收缩末期内径(LVESd)与延迟血管再灌注组比较差异均无统计学意义(均P>0.05),1年后急诊血管再灌注组LVEDd、LVESd较延迟组小,差异均有统计学意义(均P<0.05)。结论宁波地区STEMI救治状况落后,住院死亡率及心力衰竭发生率高,需大力改进。

Objective To promote standardized treatment of acute ST segment elevation myocardial infarction （STEMI） by retrospectively analyzing treatment and short- and long- term prognosis of patients with STELMI. Methods 190 patients with STEMI were enrol ed and divided into immediate reperfusion group（n=45） and delayed reperfusion group （n=111） based on whether received effective immediate reperfusion therapy. The time from symptom onset to admission, transfer rate and time, the percentage of emergency PCI, in- hospital mortality and incidence of heart failure, echocardiographic results within 1 week and 1 year later after myocardial infarction were surveyed. Results The median time from symptom onset to admission was 5 hours, the transfer rate was 61.1%, the transfer time was 1 hour to the first level hospital and 3 hours to the second level hospital, the percentage of emergency PCI was 21.6%, the ratio of intravenous thrombolysis was 5.8%, the in- hospital mortality was 6.3%, the incidence of the heart failure was 40%. Left ventricular ejection fraction, left ventricular end diastolic diameter and systolic diameter were similar between immediate and delayed reperfusion groups within 1 week, but the later two parameters were significantly less in immediate reperfusion group than in delayed reperfusion group after one year（al P＆lt;0.05）. Conclusion The treatment conditions of STEMI in Ningbo region is unsatisfactory, with higher in- hospital mortality and heart failure incidence, which should be improved strongly.