急性ST段抬高型心肌梗死首次医疗接触至球囊扩张再灌注时间延迟分析

Analysis of reperfusion delay in patients with acute ST elevated myocardial infarction based on first medical contact and time of presentation

目的本研究分析不同的转运方式的STEMI患者以首次医疗接触至再灌注时间(FMC-to-B)为基础的各救治时间段,探讨与指南的差距。方法选取2012年1月至2015年10月解放军第三〇六医院急诊就诊的315例STEMI患者,按不同转运方式分为急救体系(EMS)转运组及非EMS转运组,分析各急救时间,包括发病至FMC时间(SO-to-FMC)、转运时间、FMC-to-B、导管室启动延迟时间、介入操作延迟时间、急诊至球囊扩张血管再通时间(D-to-B)。结果两组患者SO-to-FMC、转运时间及FMC-to-B比较,EMS组明显低于非EMS组,差异有统计学意义(P<0.05);院前急救时间,EMS组为91 min,明显低于非EMS组的148 min,差异有统计学意义(P<0.05)。两组D-to-B时间及院内急救时间比较,差异无统计学意义(P>0.05)。结论利用EMS系统转运方式可以有效的缩短院前急救时间,从而缩短总缺血时间。我院院前急救时间与指南标准比较,还有很大差距,有必要建立有效的急救体系来缩短缺血时间并提高预后。

Objective To explore the evaluated time intervals based on FMC to balloon time in our hospital（ single center registry） ac- cording to the different route by which the patient arrived. Methods A total of 315 cases of patients with STEMI were received in the 306th Hospital of PLA from January 2012 to October 2015. Patients were divided into the EMS group and the Non-EMS group by dif- ferent arrival models. The time intervals, including SO-to-FMC time, transfer delay time, FMC-to-B time, activation delay time of cathe- terization laboratory and D-to-B time were analyzed. Results In the EMS group, the median SO-to-FMC time, transfer delay time, FMC-to-B time were significantly less than those in the Non-EMS group （P 〈 0. 05 ） ;prehospital delay time within 58 minutes was sig- nificantly less than that in the Non-EMS group （ P 〈 0.05 ）. There were statistically significant differences between the two groups. There was no difference in D-to-B time or in-hospital delay time between the both groups （ P 〉 0. 05 ）. Conclusion Prehospital delay time is effectively shortened by ESM ,which is for short total ischemia time as well. It is a long distance for our prehospital delay time comparing with the guideline. It is necessary to establish the efficient emergency system to shorten total ischemia time and improve the efficiency of treatment.